The Special Investigative Unit of RJN Investigations, Inc. was recently notified by the Orange County District Attorney’s Office regarding the successful prosecution in the case of People of California vs. G. Delgado. In this case, the claimant was employed as a Deputy Juvenile Correction Officer, who alleged that because of restraining a youth, he fell to the ground injuring both his right and left knee. The employer questioned the status of the claim as the injured worker was placed off work collecting TTD benefits, which extends his pre-planned vacation time by one week. Given this red flag indicator, the RJN SIU was requested to initiate investigative measures to include a social network investigation and surveillance. The social network level investigation revealed evidence indicating that the claimant was advertising his services as a personal trainer. The surveillance investigation successfully secured several hours of video evidence depicting the claimant working out inside of a gym as well as providing personal training services. The claimant’s recorded statement was then obtained where he made several material misrepresentations. The video evidence was then shown to the primary treating physician, who upon review, made a significant change in his medical opinion. In accordance with the regulations set forth by the California Department of Insurance, the case was then formally filed with their Fraud Division as well as with the Orange County District Attorney’s Office. The Orange County District Attorney’s Office then conducted an extensive criminal investigation that included issuing search warrants on the claimant’s bank accounts. The claimant was subsequently charged with one count in violation of Penal Code Section 550(b)(3) as well as one count of Insurance Code Section 1871.4(a)(1). After attending several preliminary hearings in Superior Court, the claimant entered into a plea-bargaining agreement in which he pled guilty to both counts. As part of the plea, the claimant was ordered to pay back the employer $41,893.49 in restitution. He was also sentenced to 90 days in jail, but the jail time was stayed pending no probation violations and making monthly payments on the restitution.
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 225 convictions for workers’ compensation insurance fraud in California. In just the last 4 years, we have secured $1, 569,059.00 in court ordered restitution on behalf of our valued clients.
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