The Special Investigative Unit of RJN Investigations, Inc. was notified by the Sonoma County District Attorney’s Office regarding the successful prosecution in the case of People of California vs. M. Godinez. In this particular case, the claimant attended her QME appointment at which time she complained of pain and swelling in her left ankle, constant pain in both knees and constant pain to the left lower extremities. She reported that she limps all of the time and utilizes a cane in order to ambulate. The RJN SIU secured extensive video evidence of the claimant attending this appointment and utilizing the cane. Upon exiting the QME examination, the claimant was followed to her residence where she was observed performing manual labor, yardwork while showing no restrictions, hesitation or utilization of the cane. While performing the yardwork, the claimant was repeatedly bending at the waist, lifting and carrying wood boards, hacking weeds with an ax, carrying a pallet and walking freely. The video evidence secured was then provided to the QME for review and comment. Upon review of the subrosa video evidence, the QME made significant changes in his medical reporting. In compliance with the regulations set forth by the California Department of Insurance, the case was then formally referred by the RJN SIU to their Fraud Division as well as to the Sonoma County District Attorney’s Office. Upon completion of a criminal investigation performed by the Sonoma County District Attorney’s Office, the claimant was formally charged with one felony count of Insurance Code Section 1871.4(a)(1) and one felony count of Penal Code Section 550(a)(1). After attending multiple criminal court hearings, the claimant entered into a plea bargain agreement. The claimant pled guilty to one count in violation of Penal Code Section 484(a) as a misdemeanor and the other two counts were dismissed. As part of her plea, the claimant was ordered to complete one year court probation and 40 hours of community service work, as well as agreeing to deduct $48,442.18 from her C&R settlement before the WCAB for a portion of benefits previously paid.
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 $ 1,642, 559.18 in court ordered restitution/savings on behalf of our valued clients.