The Special Investigative Unit of RJN Investigations, Inc. was notified that the Orange County District Attorney’s Office filed felony insurance fraud charges based upon a documented referral submitted. In this case, both husband and wife claimants worked as police officers for the City of Tustin. They both alleged that they suffered work-related injuries while working their usual and customary job duties. The claimants underwent medical treatment and were placed on temporary total disability. They continued to receive their full salaries under Labor Code Section 4850 until those benefits were exhausted, then they began collecting workers’ compensation TTD benefits. As the claimants continued reporting complaints of ongoing persistent pain despite undergoing the treatment recommendations, the proactive claims examiner authorized surveillance. As a result of the surveillance investigation, extensive video evidence was secured of the claimants engaged in physical activities that were contradictory to their reports of pain and limitations to the treating physician. Depositions for the claimants were subsequently conducted and they both made multiple material misrepresentations regarding their medical conditions and physical abilities. In compliance with the regulations set forth by the California Department of Insurance, the case was then formally referred by the RJN SIU to their Fraud Division as well as to the Orange County District Attorney’s Office. Upon completion of the criminal investigation performed by the Orange County District Attorney’s Office, 27 total felony counts of insurance fraud were formally filed between the two claimants. Their arraignment hearings are scheduled to take place on February 15th, 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 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.
Leave a comment!