The Special Investigative Unit of RJN Investigations, Inc. was recently notified of a felony arrest based upon a documented fraud referral. In this case, the claimant was employed as a caretaker of the California Department of Social Services – I.H.S.S. At the time of the claimant’s deposition, he appeared wearing a back support and ambulating with the aid of a cane. Proactively, the Senior Claims Examiner authorized the RJN SIU Department to perform a RUSH surveillance. During the ongoing surveillance, extensive video evidence was obtained depicting the claimant ambulating freely without any noticeable signs of artificial support or noticeable restrictions. The video evidence was subsequently provided to the QME for review and comment. In his QME report, it stated in part the following:
“Overall, review of the subrosa video footage demonstrates a degree of inconsistency between what Mr. Lopez reported and exhibited at the time of the PQME examination, and what he was visualized performing during the video segments…My reporting on this case has changed as a result of this additional information and my revised reporting follows below…”
In compliance with the regulations set forth by the California Department of Insurance Fraud Division, the RJN SIU formally filed this case with their office as well as with the Los Angeles County District Attorney’s Office. Felony charges were then issued against the claimant, and a preliminary criminal hearing was set. The claimant failed to appear for the hearing and as a result, a felony bench warrant was issued for his arrest. After almost five years on the run, the claimant had a formal interaction with law enforcement and their check of NCIC revealed his felony warrant and he was promptly arrested. The claimant is now due to appear before a Superior Court Judge in Los Angeles County on November 20th, 2025.
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 4 years, we have secured $2,033,302.00 in court ordered restitution/savings on behalf of our valued clients.
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