On June 20th, 2023, the Special Investigative Unit of RJN Investigations, Inc. was recently notified by the Fresno County District Attorney’s Office regarding the filing of felony charges based upon submission of a documented referral. In this particular case, the claimant worked as an in-home care provider with the California Department of Social Services. She alleged to have suffered a work-related injury, injuring her neck, back, shoulders and lower extremities. In advance of the claimant’s deposition, the claims examiner proactively procured the claimant’s prior medical records. The claimant subsequently made material misrepresentations in her deposition as well as to the treating physicians in regard to her true prior medical history. In accordance with the regulations set forth by the California Department of Insurance, the RJN SIU then formally filed this case with their Fraud Division as well as with the Fresno County District Attorney’s Office. Upon completion of the criminal investigation performed by the District Attorney’s Office, the claimant was formally charged with two felony counts in violation of Insurance Code Section 1871.4 as well as one count in violation of Penal Code Section 664-118, Attempted Perjury. The claimant’s is now scheduled for a criminal hearing on July 18th, 2023, in Fresno Superior Court.
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.
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