On October 17th, 2022, the Special Investigative Unit of RJN Investigations, Inc. was notified of the successful prosecution in the case of People of California vs. C. Alfaro. In this particular case, the claimant was a manager for a nationwide coffee store chain. He had filed a workers’ compensation claim alleging a back injury as a result of moving a cash register. Despite receiving consistent medical treatment, the claimant’s subjective complaints did not appear to be improving. As such, the claims examiner authorized surveillance to be performed. In the course of the surveillance investigation, the claimant was observed to be operating a minimart in Downtown Los Angeles, California. The SIU investigation revealed that the claimant had filed for a fictitious business statement for this minimart in advance of his alleged injury date, thus suggesting that it was a pre-planned staged injury. The RJN SIU was successful in securing detailed bank records and Cal Fresh payments documenting significant income collected by the claimant while at the same time obtaining TTD benefits. In compliance with the regulations set forth by the California Department of Insurance, the RJN SIU formally filed the case with their Fraud Division as well as with the Los Angeles County District Attorney’s Office. Upon completion of a detailed criminal investigation by the Los Angeles County District Attorney’s Office, the claimant was formally charged with one felony count of Insurance Code Section 1871.4(a)(1) and one misdemeanor count in violation of Penal Code Section 118. After several criminal hearings, the claimant entered into a plea-bargaining agreement in which he pleaded no contest to the criminal charges and was subsequently sentenced to perform 200 hours of community service and pay restitution in the amount of $27,555.26. As part of the sentencing, the claimant presented a $10,000.00 advance payment towards the restitution at the time of his sentencing.
ABOUT R.J.N. SIU:
Formed in 1996, the RJN SIU Division was created to assist California employers, governmental agencies, insurance carriers and TPA firms in securing professional assistance so as to detect, investigate, and prosecute insurance fraud. To date, the unit has trained well over 4,000 examiners and the documented referrals by this unit have resulted in over 215 convictions for workers’ compensation insurance fraud in California. In just the last 4 years, we have secured $1,315,200.00 in court ordered restitution on behalf of our valued clients.