RJN SIU was notified that the Riverside County District Attorney’s Office filed two felony counts against the claimant. In this case, the claimant was employed as a full-time County Maintenance Construction Worker. He alleged that while changing road signs, he tripped and landed on his right shoulder. During his 3-point contact, evaluations with the PTP, and PQME, the claimant denied prior injury to the right shoulder in contrast to what the claimant’s medical history indicated. The medical records from the claimant’s prior injury was secured and provided to the PQME for review and recognized that the claimant had prior treatment right up until his current claim made against the insured. The claimant’s denial of prior injuries affected the apportionment of his current claim. Based on this information and due to the prior records being deemed material to the claim, RJN SIU filed this case with both the Riverside County District Attorney as well as the Inland Empire Regional Department of Insurance Fraud Division. After an investigation conducted by the Riverside DA office, their office elected to file criminal charges and charged the claimant with one count of (1871.4(a)(1) IC and one count of 550(b)(1) PC. At this time, the claimant awaits an arraignment which was scheduled for January 12, 2024.
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 the last 4 years, we have secured $ 1,729,120.00 in court-ordered restitution on behalf of our valued clients.
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