On November 28th, 2023, the Special Investigative Unit of RJN Investigations, Inc. was notified of the successful prosecution of a claimant who was employed as a Janitor in Fresno County. In this case, the claimant alleges to have sustained injuries to his back and right shoulder while waxing floors. During medical evaluations, the claimant was observed utilizing a cane, wearing a back brace, and walking with a limp, however, no restrictions or supports were observed afterwards and during times he was seen running errands. During multiple follow up surveillance attempts, the claimant displayed a similar pattern and at one point was observed playing soccer. During the claimant’s deposition, the claimant denied being able to play soccer, also denied prior felony convictions and indicated that he needed to use motorized carts when shopping which all appeared to be misrepresentations based on surveillance video. The video was subsequently provided to his treating doctor who then called into question the claimant’s credibility and returned the claimant back to work with no restrictions. Based on the RJN SIU findings and to stay in compliance with regulations, the case was formally filed with the Fresno County District Attorney as well as the California Department of Insurance Fraud Division. An Investigation was initiated, and Fresno DA determined that criminal charges were warranted. After attending multiple criminal hearings, RJN SIU was advised that the claimant had accepted a plea deal and pled no contest to one count of Workers Compensation Fraud. A restitution and sentencing hearing have been scheduled for October 24th, 2024; at which time a restitution amount will be handed down.
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 on behalf of our valued clients.
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