The Special Investigative Unit of RJN Investigations, Inc. was recently notified by the Orange County District Attorney’s Office of the criminal filing based upon a documented referral submitted to their department. In this case, a correctional officer with the County alleged while working in the jail, that a co-worker intentionally reclined his chair while the claimant was walking by, causing her to hit the counter and suffer injuries to her right upper extremities. The claims examiner proactively assigned the RJN SIU to conduct an investigation to determine if the claim should be accepted. In the course of that investigation, a review of the surveillance videos at the jail facility revealed no evidence of such an incident occurring on the alleged date of injury. Moreover, the co-worker in question adamantly denied that the incident described by the claimant even occurred in a recorded statement. Upon completion of the investigation and 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 Orange County District Attorney’s Office Workers’ Compensation Fraud Unit. Upon completion of the criminal investigation performed by the Orange County District Attorney’s Office, the claimant was formally charged with one count of Filing a False Claim in violation of Penal Code Section 550(a)(1) and three counts of Making a Material Misrepresentation in violation of Insurance Code Section 1871.4(a)(1). The claimant was subsequently arrested, and her bail was set at $20,000.00. The claimant’s arraignment is set for next month.
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 240 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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