The Special Investigative Unit of RJN Investigations, Inc. was recently notified by the San Bernardino County District Attorney’s Office that they filed four felony counts against the claimant. In this case, the claimant was employed as an assistant general manager, who was alleged to have suffered a work-related injury to his right ankle. The claimant initially reported that he slipped on some snow and twisted his ankle while discarding trash into the dumpster. However, when confronted with some inconsistencies, the claimant changed his story, stating that he injured his foot while organizing the dry storage area. A timely AOE/COE level investigation was then authorized by the proactive claims examiner. Upon completing the AOE/COE level investigation, significant red flags were discovered. Remarkably, the insured’s surveillance system had captured video footage from the alleged date of injury. The video footage did not depict the claimant sustaining any injury as alleged. It was also learned through the video footage that the claimant had committed multiple company policy violations as well as state compliance violations, which ultimately resulted in the claimant being terminated effective immediately. In compliance with the regulations set forth by the California Department of Insurance, the RJN SIU formally referred this case to both the San Bernadino County District Attorney’s Office as well as to the California Department of Insurance Fraud Division. Upon completion of the criminal investigation by the San Bernadino County District Attorney’s Office, the claimant was formally charged with four felony counts in violation of Insurance Code 1871.4(a)(1), Insurance Code 1871.4(a)(2), Penal Code 550(b)(3) and Penal Code 666(b). The claimant was recently arraigned, and it was at this time he entered a plea of Not Guilty. His next criminal hearing is scheduled to take place next month on 3/17/25.
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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