The Special Investigative Unit of RJN Investigations, Inc. was recently notified by the San Diego County District Attorney’s Office regarding the successful prosecution in the case of People of California vs. C. Orduno.
In this case, the claimant filed a workers’ compensation claim alleging injuries to her hands, wrist, right shoulder and neck. The claimant subsequently secured legal representation for her claim. With discovery through WCAB subpoenas, the claims examiner was able to secure medical records reflecting an extensive history of medical issues and treatment for the same body parts. Based on these records, the claimant was untruthful and made multiple material misrepresentations with the industrial treating physician, chiropractor and Senior Claims Examiner. Just prior to the claimant’s scheduled deposition, the proactive claims examiner authorized RJN SIU to conduct surveillance, which found the claimant to be active and showing no sign of hesitation or restrictions. In the claimant’s deposition that was taken in San Diego County, she continued to make several material misrepresentations under penalty of perjury. In accordance with the regulations set forth by the California Department of Insurance, the RJN SIU then formally referred this case to their Fraud Division as well as to the San Diego County District Attorney’s Office Workers’ Compensation Fraud Unit. Upon completion of a thorough criminal investigation, the San Diego County District Attorney’s Office filed 15 felony counts of insurance fraud, failure to disclose an event material to a claim and attempted perjury. After several hearings, the claimant subsequently entered into a plea-bargaining agreement in which she was sentenced to community service, probation and ordered to pay back $33,710.37 in restitution.
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 250 convictions for workers’ compensation insurance fraud in California. In just the last 4 years, we have secured $1,883,941.00 in court ordered restitution/savings on behalf of our valued clients.
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