On August 29th, 2025, the Special Investigative Unit of RJN Investigations, Inc. was notified that the Santa Clara County District Attorney’s Office completed a successful prosecution based upon a documented referral submitted by RJN SIU. In this case, the claimant worked for an Auto Dealership in Santa Clara County. On the date of injury, the claimant reports that he slipped and fell in a wet spot leading to a broken ankle. Rather than just processing this claim, the proactive examiner did further research and assigned an Aoe/Coe level investigation. During that investigation by RJN, witnesses report that the claimant was doing “Bike Tricks” prior to clocking in and fell from the bike, breaking his ankle. The claimant would receive medical treatment and surgical procedures and during a subsequent deposition, the claimant reports that he fabricated his story as he did not have health insurance. He also reports that the injury occurred after starting work which is also in contrast to employer witnesses. Upon completion of the RJN SIU level Investigation and in compliance with the California Department of Insurance Fraud Division, the case was then formally referred to both the California CDI Office as well as to the Santa Clara County District Attorney’s Office. Upon completion of the criminal investigation performed by the District Attorney’s Office, the claimant was formally arrested and advised as to the charges against him at which time he entered a plea of Not Guilty. After attending multiple criminal hearings, the claimant accepted a plea deal in August of 2025 in which he received formal probation and was ordered to repay restitution in the amount of $3,519.00.
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 3,500 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 4 years, we have secured $2,033,302.00 in court ordered restitution on behalf of our valued clients.
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