The Special Investigative Unit of RJN Investigations, Inc., was recently notified by the Ventura County District Attorney’s Office regarding the successful prosecution in the case of People of California vs. B. Luna.
In this particular case, the claimant was employed as a full-time packer who alleged to have suffered a work-related injury at her work site. The claims examiner proactively authorized a timely AOE/COE level investigation to be performed. During the recorded statement, the claimant denied having filed any prior workers’ compensation claim. When presented a medical authorization release to sign by the investigator, the claimant refused to do so. However, she did sign the California Insurance Code 1871.4 Fraud Acknowledgement. The claimant subsequently secured legal representation and her deposition was secured. A review of the deposition transcript by the RJN SIU revealed that the claimant made additional material misrepresentations regarding her true prior medical and claim history. Once the prior medical records had been secured via subpoena and in compliance with the regulations set forth by the California Department of Insurance, RJN Investigations formally filed this case with their Fraud Division as well as with the Ventura County District Attorney’s Office. Upon completion of the criminal investigation, the claimant was formally charged in violation of Insurance Code Section 1871.4(a)(1), Penal Code Section 550(b)(3) as well as Penal Code Section 487(a). After attending several criminal hearings, the claimant entered into a plea-bargaining agreement in which she pled guilty to counts #1 and #2. She was sentenced to 12 months probation and ordered to pay restitution to the insurance carrier in the amount of $26,441.16.
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 $1,953,150.00 in court ordered restitution/savings on behalf of our valued clients.
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