The Special Investigative Unit of RJN Investigations, Inc. was recently notified of the successful prosecution in the case of People of California vs. I. Rivera. In this particular case, the claimant was employed as a full-time Riverside County employee who filed a workers’ compensation claim for lower extremity injuries. Despite being provided with extensive medical treatment, the claimant alleged that he was not getting better and as such, could not return to work full duty. The proactive examiner on the claim assigned RJN SIU to conduct surveillance to determine the claimant’s true outside physical activity level. In the course of that investigation, substantial video evidence was obtained directly contradicting the claimant’s statements to the treating doctors in regard to his physical capabilities. In compliance with the regulations set forth by the California Department of Insurance, the RJN SIU formally filed this case with their Fraud Division as well as with the Riverside County District Attorney’s Office. Upon a detailed criminal investigation, the claimant was formally charged with eight counts in violation of Insurance Code Section 1871.4(a)(1) as well as Penal Code Section 550(b). The claimant rejected a plea-bargaining agreement and as such, the case went to a jury at the Riverside County Superior Court. Upon conclusion of the trial, the claimant was convicted on all eight counts. The sentencing date is now set for January 23rd, 2026, and the District Attorney’s office is seeking $230,000.00 in restitution on behalf of the victim employer.
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 $2,172,027.00 in court ordered restitution/savings on behalf of our valued clients.
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