On October 23rd, 2023, the Special Investigative Unit of RJN Investigations, Inc. was notified of the successful prosecution of a claimant who was employed as a Field Worker in Kern County. In this case, the claimant alleges to have injured his right wrist/hand while trimming grape vines on a trellis. He reported that he felt a “pop” in his right hand/wrist that day. The claimant reported the injury and was referred for treatment. The claimant continued to complain of constant pain. The claimant was on TTD status while EDD was also paying him. The claimant had been referred for several QME appointments which he failed to attend. RJN Surveillance documented that the claimant was fully capable of working using his alleged right hand and wrist without any indication of impairment or disability. He was apparently able to work at multiple jobs after his original date of injury. RJN Secured statements from one of the employers who confirmed that the claimant did in fact work for the location in contrast to what he was reporting to his medical physicians.
Based on the RJN SIU findings and in order to stay in compliance with regulations, the case was formally filed with the Kern County District Attorney who subsequently determined that criminal charges were justified and filed two felony counts against the claimant. After attending multiple criminal hearings, on October 10th, 2023, RJN SIU was advised that the claimant had accepted a plea deal in which he would plead Nolo Contendere to count one and count two would be dismissed. With this plea, the claimant has been ordered to repay restitution in the amount of $34,201.40 and will be formally sentenced on November 3rd, 2023.
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 235 convictions for workers’ compensation insurance fraud in California. In just the last 4 years, we have secured $1,685,398.40 in court ordered restitution on behalf of our valued clients.
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