The Special Investigative Unit of RJN Investigations, Inc. was notified of the successful prosecution of a claimant who was employed as a Hospital Employee in Sacramento, California. The claimant alleged to have sustained a slip and fall injury to the head, shoulder, upper and lower back. The claimant would seek treatment essentially being placed on modified duties and restrictions by the claimant’s physicians. Due to the fact that the claimant’s complaints were not improving with treatment, RJN Investigations surveillance team was authorized to conduct a surveillance investigation. During the course of a surveillance investigation which secured over two ½ hours of surveillance footage, the claimant was observed on multiple days running errands and at one point lifting water jugs, a propane tank and shopping with no limitations. However, the claimant was also seen arriving at a medical facility utilizing a walker while only at the medical location. During another approved set of surveillance, RJN Investigations secured video of the claimant inconsistently using a cane. Based on the video secured, surveillance was provided to the claimant’s treating doctors who reviewed and changed their medical opinion. Additionally, the doctor stated the following, “I do not see that is my role to say that this is a fraud case, but I can understand a prosecutor considering that possibility.” Based on this information, RJN SIU submitted a formal referral to both the Sacramento County District Attorney’s Office as well as the California Department of Insurance Fraud Division. Our office was notified by the Sacramento County DA that the claimant was charged with two felony counts and an arrest warrant was issued on February 17th, 2023. Since that time, the claimant attended multiple hearings and on June 13th, 2025, RJN SIU was notified that the claimant accepted a plea deal and the claimant paid restitution in the amount of $30,000.00. The claimant received one year of probation and 120 days in jail which was stayed. The Sacramento 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 255 convictions for workers’ compensation insurance fraud in California. In just the last four years, we have secured $2,019,784.86 in court ordered restitution on behalf of our valued clients.
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