The Special Investigative Unit of RJN Investigations, Inc. was notified of the successful prosecution of a claimant who was employed as a County Employee in Riverside, CA. The claimant is alleged to have sustained continuous trauma injuries during the course of her employment. Based on the claimant’s deposition testimony, it was noted that the claimant denied prior similar symptoms, however records show that the claimant did in fact have prior complaints with treatment which was in contrast to what she testified to. When provided the prior records for review, the claimant’s treating doctor indicated that the claimant had exhibited “poor credibility.” The case went before the WCAB and based on the judge’s review of records and comments made by the claimant, he ruled and issued a “Take Nothing” decision. Due to this decision, combined with the claimant’s material misrepresentations made at the time of her deposition, RJN SIU submitted a formal referral to both the Riverside County District Attorney’s Office as well as the California Department of Insurance Fraud Division. Our office was notified by the Riverside County District Attorney’s office that an arrest warrant was issued, and criminal charges were filed against the claimant. Five felony counts in total were filed, two Counts of Section 550, subdivision (a)(1), two Counts of Penal Code section 118 and one count of Insurance Code section 1871.4, subdivision (a)(1). The claimant turned herself in and was arraigned. Since that time, the claimant attended multiple hearings and in her most recent criminal hearing that occurred on November 6th, 2024, the claimant plead Guilty to PC M550(B)(1) “Filing fraudulent Insurance claims.” All other charges were dismissed, and the claimant has now been ordered to repay restitution in the amount of $42,767.96.
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 four years, we have secured $1,926,708.96 in court ordered restitution on behalf of our valued clients.
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