The Special Investigative Unit of RJN Investigations, Inc. was recently notified by the Santa Clara County District Attorney’s Office regarding the successful prosecution in the case of People of California vs. G. Delgadillo.
In this case, the claimant had filed a workers’ compensation claim alleging to have suffered a right ankle injury while working for his employer. In the course of adjusting the claim, over 1,000 pages of subpoenaed records were secured by the examiner pertaining to the claimant’s prior medical history. These records reflected that the claimant had been involved in a bicycle accident in which he injured his right ankle approximately one month prior. The claimant never informed any of the treating physicians nor the claims examiner about this prior injury in which he did receive medical treatment. The RJN SIU then secured the claimant’s recorded statement and once again, made several material misrepresentations during that interview. In compliance with the regulations set forth by the California Department of Insurance, the RJN SIU then formally filed this case with their Fraud Division as well as with the Santa Clara County District Attorney’s Office. Upon completion of their criminal investigation, the claimant was formally charged in violation of Insurance Code Section 1871.4(a) as well as Penal Code Section 550(b)(3). After attending several criminal hearings, the claimant entered into a plea-bargaining agreement. As part of this agreement, he was sentenced to 30 days in County Jail, 12 months of formal court probation and ordered to pay back restitution in the amount of $7569.39.
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 245 convictions for workers’ compensation insurance fraud in California. In just the last 4 years, we have secured $1,850,240.00 in court ordered restitution/savings on behalf of our valued clients.
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