The Special Investigative Unit of RJN Investigations, Inc. was notified by the Riverside County District Attorney’s Office of the successful prosecution in the case of People of California vs. F. Cerchio. In this particular case, the claimant was employed as a Special Education Teacher who allegedly suffered an injury to her left thumb and left hand. Due to her ongoing complaints, the claimant remained off work on total temporary disability. Given the claimant’s complaints of difficulty with activities of daily living, the claims adjuster assigned surveillance on the case to the RJN SIU. During the surveillance level investigation, substantial video evidence was obtained of the claimant which depicted her clearly utilizing her left hand in a normal manner. The video evidence secured was then provided to the primary treating physician for review and comment. Upon review of the subrosa video evidence, the PTP made significant changes to his medical reporting. In compliance with the regulations set forth by the California Department of Insurance, the RJN SIU formally referred this case to both the CDI Fraud Division as well as Riverside County District Attorney’s Office. Upon completion of a criminal investigation conducted by the Riverside County District Attorney’s Office, the claimant was charged with six felony counts in violation of Insurance Code Section 1871.4(a)(1). After multiple criminal hearings, the claimant pled guilty to one count in violation of Insurance Code Section 1871.4(a)(1) and the other five counts were dismissed. As part of her sentencing, the claimant was ordered to complete 12 months summary probation. At this time, a restitution hearing is currently pending for the claimant.
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 223 convictions for workers’ compensation insurance fraud in California. In just the last 4 years, we have secured $1,402,030.00 in court ordered restitution on behalf of our valued clients.
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