The special investigative unit of RJN investigations, Inc. was formally notified by the Ventura County District Attorney’s office as to formal criminal charges being filed based upon a documented SIU referral submitted. In this particular case, the claimant alleged to have suffered extensive injuries as a result of a “trip and fall” at work . She was placed on total temporary disability and alleged to have needed a walker to ambulate. A subsequent surveillance investigation performed by the RJN SIU resulted in extensive video evidence directly contradicting the claimant’s statements to the treating doctors. At the claimant’s deposition, she made specific material misrepresentations as to the various activities captured on subrosa video evidence . At the time of our formal referral, over $452,000.00 had been spent on the workers compensation claim . In compliance with the regulations as forth by the California Department of insurance, the RJN SIU then formally referred this case with their fraud division, as well as with the Ventura County District attorney’s office. After a thorough criminal investigation was conducted, the claimant was formally charged with multiple felony fraud charges, as was her husband for conspiracy to commit insurance fraud. Their preliminary hearing is now set for next month.
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 260 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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