On August 15th, 2023, the Special Investigative Unit of RJN Investigations, Inc. was notified that the Santa Clara County District Attorney’s Office has arrested and filed one count of felony insurance fraud based upon a documented referral submitted. In this case, the claimant worked for an Auto Dealership in Santa Clara County. On the date of injury, the claimant reports that he slipped and fell in a wet spot leading to a broken ankle. However, witnesses report that the claimant was doing “Bike Tricks” prior to clocking in and fell from bike breaking his ankle. The claimant would receive medical treatment and during a subsequent deposition, the claimant reports that he fabricated his story as he did not have health insurance. He also reports that the injury occurred after starting work which is also in contrast to employer witnesses. Upon completion of the RJN SIU level Investigation and in compliance with the California Department of Insurance Fraud Division, the case was then formally referred to both the California CDI Office as well as to the Santa Clara County District Attorney’s Office. Upon completion of the criminal investigation performed by the District Attorney’s Office, the claimant was formally arrested, and advised as to the charges against him at which time he entered a plea of Not Guilty. His next scheduled criminal hearing is currently pending.
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 3,500 examiners and the documented referrals by this unit have resulted in over 230 convictions for workers’ compensation insurance fraud in California. In just the last 4 years, we have secured $1,651,197.00 in court ordered restitution on behalf of our valued clients.
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