The Special Investigative Unit of RJN Investigations, Inc. was notified of the successful prosecution of a claimant who was employed as a Phlebotomist in Los Angeles County. The claimant alleged to have sustained a slip and fall injury to the knee during the course of his employment. Based on the claimant’s subjective complaints, RJN conducted a surveillance investigation in which the claimant was observed active, carrying such things as wooden pallets, furniture, and also a 3-foot-long tree log. He was also seen conducting gardening activities and running errands with no display of hesitation or discomfort. During a subsequent deposition, the claimant denied under oath the ability to do some of the things he was seen doing during the surveillance investigation. The surveillance video was then provided to the claimant’s treating doctors who noted discrepancies in the claimant’s activities when compared to what he was reporting at the time of evaluations. Based on this information and combined with the claimant’s material misrepresentations made at the time of his deposition, RJN SIU submitted a formal referral to both the Los Angeles County District Attorney’s Office as well as the California Department of Insurance Fraud Division. Our office was notified by the Los Angeles County DA that the claimant was charged with 2 felony counts and an arrest warrant was issued. On January 23, 2025, the claimant, Juan Ruiz entered a plea to Count 2, Insurance. Code section 1871.4(a)(1), as a misdemeanor. He paid restitution in full, in advance, in the amount of $36,634.86, which led to the settlement. He was placed on one year of summary probation, ordered to complete 100 hours of community service by August 21, 2025, and was ordered to pay an additional restitution fine in the amount of $200. Once he finishes his community service and successfully completes a minimum of six months of probation, he may seek to have probation terminated early. The Los Angeles County District Attorney’s Office has concluded their case as there are no pending (future) court appearances.
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 $1,989,784.86 in court ordered restitution on behalf of our valued clients.
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