Restaurant Worker Convicted of Workers’ Compensation Insurance Fraud and Must Pay Back Restitution in The Amount Of $20,000.00

The Special Investigative Unit of RJN Investigations, Inc. was formally notified by the Los Angeles County District Attorney’s Office regarding the successful prosecution in the case of People of California vs. A. Smith. In this particular case, the claimant alleged to have suffered a work-related injury to his back while lifting a box. Over the course of the claims handling, records pertaining to the claimant’s prior medical history were obtained which revealed a history of injury and complaints involving the same body part. The claimant made material misrepresentations during his AOE/COE statement when he denied any prior back injuries. Moreover, the claimant denied any previous injuries or complaints regarding his back to the treating doctor. In compliance with the regulations set forth by the California Department of Insurance, the RJN SIU formally referred this case to their Fraud Division as well as to the Los Angeles County District Attorney’s Office. Upon completion of a criminal investigation conducted by the Fraud Division, the claimant was formally charged with three felony counts in violation of Insurance Code Section 1871.4(a)(1). The claimant was subsequently arrested and arraigned, during which time he entered a Not Guilty plea. After several court hearings, the claimant changed his plea at his most recent criminal hearing in September. The claimant pled Nolo Contendere to one count in violation of Insurance Code Section 1871.4(a)(1) and the other two counts were dismissed. As part of the terms of the plea, the claimant must complete 15 days of community service and also must pay back restitution in the amount of $20,000.00.


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 3,500 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 three ½ years, we have secured $1,260,090.00 in court ordered restitution on behalf of our valued clients.

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