On November 7th, 2023, the Special Investigative Unit of RJN Investigations, Inc. was formally notified by the Riverside County District Attorney’s Office of the recent outcome of a criminal hearing pertaining to restitution. This hearing was in reference to the case of People of California vs. F. Cerchio. In this case, the claimant was employed as a teacher with the Alhambra Unified School District, who alleged to have suffered an injury to her left thumb and left hand. Due to ongoing complaints, the claimant remained off work on Total Temporary Disability. Given the claimant’s complaints of difficulty with activities of daily living, the claims adjuster proactively assigned surveillance on the case to the RJN SIU. During the surveillance level investigation, substantial video evidence was obtained of the claimant which depicted her clearly utilizing her left hand in a normal manner. The video evidence secured was then provided to the primary treating physician for review and comment. Upon review of the subrosa video evidence, the PTP made significant changes in his medical reporting. In compliance with the regulations set forth by the California Department of Insurance, the RJN SIU formally referred this case to their Fraud Division as well as to the Riverside County District Attorney’s Office. Upon completion of the criminal investigation conducted by the Riverside County District Attorney’s Office, the claimant was charged with six felony counts in violation of Insurance Code Section 1871.4(a)(1). After multiple criminal hearings, the claimant pled guilty to one count in violation of Insurance Code Section 1871.4(a)(1) and the other five counts were dismissed. As part of her sentencing, the claimant was ordered to complete 12 months of summary probation. At her most recent criminal hearing held at Riverside County Superior Court in October 2023, the judge ordered the claimant to pay the Alhambra Unified School District $43,722.33 in 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 235 convictions for workers’ compensation insurance fraud in California. In just the last 4 years, we have secured $1,729,120.00 in court ordered restitution/savings on behalf of our valued clients.
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