The Special Investigative Unit of RJN Investigations, Inc. was notified that the San Diego County District Attorney’s Office had filed 15 felony insurance fraud charges based upon a documented referral submitted. In this particular case, the claimant worked as a packer and alleged to have suffered a work-related injury to her wrists, hands, right shoulder and neck. Records pertaining to the claimant’s past medical history were subsequently obtained and reviewed, which revealed that she had an extensive history of medical issues and treatment involving the same body parts as alleged in her current claim. Based on the records obtained, the claimant was untruthful and made multiple material misrepresentations to the industrial medical providers as well as to the senior claims examiner. A deposition of the claimant was then conducted, and it was during this time the claimant continued to make additional material misrepresentations. In compliance with the regulations set forth by the California Department of Insurance, the RJN SIU formally referred this case to the CDI Fraud Division as well as to the San Diego County District Attorney’s Office. Upon completion of a criminal investigation conducted by the San Diego County District Attorney’s Office, their office formally charged the claimant with 15 felony counts of insurance fraud. The claimant is scheduled for an arraignment to take place on February 5th, 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 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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