Tuesday, June 27, 2017


 

Celebrating 30 Years (1987 - 2017)

of Superior Service to our Valued Clients

 
   
Press Release

Claimant Ordered To Pay Back School District $18,720.00 in Restitution

6/22/2017

 On June 20th, 2017, the Special Investigative Unit of RJN Investigations, Inc. was formally notified by the Los Angeles County District Attorney’s Office regarding the successful prosecution in the case of People of California vs. S. Ashley.  In this particular case, the claimant was a Teacher Assistant who alleged that a student had bit her right index finger, resulting in an injury.  When the claimant showed her finger to her supervisor, the supervisor noted there was no blood, no broken skin and no discoloration of her finger.  Moreover, the claimant denied first aid treatment.  Four months later, she filed a workers’ compensation claim and during the course of the AOE/COE investigation, the claimant adamantly denied ever seeking any treatment in reference to her right index finger prior to the date of injury.  A subsequent medical canvass investigation revealed that just one week prior to the alleged date of injury, the claimant was treated at Centinella Hospital Medical Center Emergency Room for “right index finger pain/injury.”  During that examination, the claimant received three x-rays of the right hand and fingers and was prescribed 500 mg. of Vicodin.  Upon securing certified copies of the medical records along with the claimant’s recorded statement, the case was formally prepared and referred by the RJN SIU to that of the California Department of Insurance Fraud Division and to the Los Angeles County District Attorney’s Office.  The claimant was subsequently charged with one felony count in violation of Insurance Code Section 1871.4(a)(2) and one felony count in violation of Penal Code Section 550(b)(1).  After several hearings, the claimant entered into a plea bargaining agreement in which she agreed to plead no contest to Count #1 of Insurance Code Section 1871.(a)(2), as a felony.  She was placed on 3 years felony probation and required to complete 200 hours of community service.    In addition, she was ordered to pay restitution back to the School District in the amount of $18,720.00.

 

ABOUT R.J.N. SIU:

 

Formed in 1996, the SIU Division was created to assist California employers, small size 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 2,750 examiners and the documented referrals by this unit have resulted in over 160 convictions for workers’ compensation insurance fraud in California.  

Fraud Division’s Criminal Investigation Leads to Felony Charges Being Filed

6/7/2017

 On June 7th, 2017, the Special Investigative Unit of RJN Investigations, Inc. was formally notified by the Los Angeles County District Attorney’s Office regarding the outcome of the preliminary hearing based upon a documented referral. 

 

In this particular case, the claimant was alleging to have sustained a continuous trauma claim from August 15th, 2009 thru June 6th, 2016, as a result of daily activities and conditions at work.  The claimant alleged to be suffering from pain and multiple body parts which included his back, neck, wrists, hands and arms.  A subsequent surveillance level investigation performed over multiple days found the claimant to be engaged in significant outside activity which included building a brick wall around the front of his house, showing no signs of hesitation or restrictions.  At the claimant’s deposition taken after the subrosa video evidence was obtained, the claimant denied performing any of the types of activities that were captured on subrosa videotape.  As such, in compliance with the regulations set forth by the California Department of Insurance, the case was formally filed by the RJN SIU to their Fraud Division as well as to the Los Angeles County District Attorney’s Office.  A detailed criminal investigation conducted by the Fraud Division resulted in the filing of one felony count in violation of Insurance Code Section 1871.4(a)(2) and one felony count in violation of Penal Code Section 664-118.  At the preliminary hearing on this date the claimant entered a not guilty plea.  He is now free on bail with a hearing set for next month.

 

ABOUT R.J.N. SIU:

 

Formed in 1996, the SIU Division was created to assist California employers, small size 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 2,750 examiners and the documented referrals by this unit have resulted in over 160 convictions for workers’ compensation insurance fraud in California. 

Subrosa Video Of Claimant Not Using Wheelchair Leads To Criminal Charges

5/22/2017

On May 22nd, 2017, the Special Investigative Unit of RJN Investigations, Inc. was formally notified by the Los Angeles County District Attorney’s Office regarding the filing of criminal charges based upon a submitted documented referral.  In this case, the claimant alleged to have suffered an injury as a result of moving a patient from a bed to a gurney and felt pain and popping in her low back.  The claimant then began to receive Total Temporary Disability benefits as well as an in home care provider.  Despite the medical treatment provided, the claimant alleged that she was getting worse and as such, required a wheelchair.  A surveillance level investigation performed by the RJN SIU found that the claimant only utilized a wheelchair at medical related appointments.  On non-medical appointment dates, the claimant was videotaped shopping at various stores without utilizing any medical equipment to assist her.  She carried out her day without any guarded movements and appeared to function physically without any pain, discomfort or altered gait.  Upon showing the video evidence to the AME, a change of medical opinion was rendered.  As a result, the case was formally filed by the RJN SIU with the California Department of Insurance Fraud Division as well as with the Los Angeles County District Attorney’s Office.  Upon completion of their criminal investigation, the claimant was formally charged with one felony count in violation of Insurance Code Section 1871.4(a)(2) and one felony count in violation of Penal Code Section 550(b)(1).  The claimant’s arraignment is scheduled for next month.

ABOUT R.J.N. SIU:

Formed in 1996, the SIU Division was created to assist California employers, small size 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 2,750 examiners and the documented referrals by this unit have resulted in over 160 convictions for workers’ compensation insurance fraud in California. 

Ventura County District Attorney’s Office Charges Claimant with Insurance Fraud

5/15/2017

 On May 10th, 2017 the Special Investigative Unit of RJN Investigations, Inc. was formally notified by the Ventura County District Attorney’s Office regarding the filing of criminal charges based upon submission of a documented referral.  In this particular case, the claimant alleged that while working for a landscaping company, he had injured his back. Based in large part by subjective complaints, the claimant was issued work restrictions of no twisting, bending or stooping, no heavy lifting, overhead lifting, and pushing or pulling greater than 10 lbs.  The employer could not accommodate these restrictions and as such, the claimant began to receive TTD benefits.  As the claimant’s subjective complaints were not changing despite receiving medical treatment, a surveillance level investigation was authorized.  In the course of the surveillance level investigation, evidence was obtained indicating that the claimant was working at a lemon orchard in Ventura, California.  The SIU level investigation revealed that the claimant had not informed the examiner nor the treating doctors regarding the secondary employment and income.  The case was subsequently referred to the California Department of Insurance Fraud Division as well as to the Ventura County District Attorney’s Office Workers’ Compensation Fraud Unit.  Upon completion of a criminal investigation performed by the Ventura County DA office the claimant was formally charged with violation of Insurance Code section 1874.1(a)(1) and Penal Code Section 550 (b) (3) .  At his preliminary hearing held on May 10th, 2017 the claimant entered a not guilty plea and remains free on $20,000.00 bail.

 

 

 

ABOUT R.J.N. SIU:

 

Formed in 1996, the SIU Division was created to assist California employers, small size 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 2,750 examiners and the documented referrals by this unit have resulted in over 160 convictions for workers’ compensation insurance fraud in California. 

Staging a Fake Injury Results in Criminal Charges

5/1/2017

 On April 28th, 2017, the Special Investigative Unit of RJN Investigations, Inc. was formally notified by the Los Angeles County District Attorney’s Office regarding criminal charges being filed based upon a documented referral submitted.  In this case, the claimant alleged that as a result of being hit by a forklift, he suffered multiple injuries.  The claimant stated he could not remember anything after the impact until he woke up in the hospital 1 ½ hours later.  An analysis of the employer’s security video noted that the claimant clearly and intentionally moved into a position in front of the slowly moving forklift.  The forklift operator’s view forward was obstructed by large stacks of pallets being moved and he could not have seen the claimant.  The claimant had an unobstructed view of the oncoming forklift.  Once the claimant got into position in front of the slowly moving forklift, he turned his back and at the last minute, jumped out of the way, rolling onto the ground as if injured.  During the course of the investigation, a surveillance level investigation was performed.  In that investigation, the claimant was noted to utilize a cane only upon arriving and departing from his medical appointment.  In compliance with regulations set forth by the California Department of Insurance, the case was formally referred to the Los Angeles County District Attorney’s Office and to the California Department of Insurance Fraud Division.  Upon completion of their criminal investigation, the claimant was formally charged with 1 felony count in violation of Insurance Code Section 1871.4 and one count in violation of Penal Code Section 664-118, Attempted Perjury.  A felony arrest warrant has now been issued on this case.

 

R.J.N. SIU:

 

Formed in 1996, the SIU Division was created to assist California employers, small size 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 2,750 examiners and the documented referrals by this unit have resulted in over 160 convictions for workers’ compensation insurance fraud in California. 

In Home Care Provider Charged With Submitting False Invoices

4/17/2017

 On April 12, 2017 the Special Investigative Unit of RJN Investigations, Inc.  was notified by the Los Angeles County District Attorney's Office as to the filing of felony charges on an in-home care provider based upon a documented referral submitted.  In this case, the examiner noted that on the invoices submitted by the in-home care provider that she billed exactly 4 hours every single day, from   8 AM to 12 PM, seven days a week.  An initial surveillance performed by the RJN SIU found no evidence of the in-home care provider providing care to the Claimant during the time frames billed. A unmanned surveillance  van was then utilized on a 24/7 basis and substantial additional video evidence was secured reflecting the in-home care provider was not with the claimant taking care of her during the time frames she was billing the claim file.   Further investigation discovered that the in-home care provider was actually a relative of the claimant with a different last name.  A documented referral was then submitted to the California Department of Insurance Fraud Division as well as to the Los Angeles County District Attorney's Office.  Upon completion of their criminal investigation ,  the in-home care provider was formally charged with two felony counts in violation of Insurance Code Section 1871.4 and Penal Code section 118 (a)  The arraignment is scheduled for next month .   

 

ABOUT R.J.N. SIU:

 

Formed in 1996, the SIU Division was created to assist California employers, small size 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 2,750 examiners and the documented referrals by this unit have resulted in over 160 convictions for workers’ compensation insurance fraud in California. 

San Bernardino County District Attorney Files Felony Charges Against School Maintenance Worker

4/4/2017

 On April 3rd, 2017, the Special Investigative Unit of RJN Investigations, Inc. was formally notified by the San Bernardino County District Attorney’s Office regarding the arrest of a school maintenance worker based upon a documented referral submitted.  In this case, the claimant filed a continuous trauma claim involving multiple body parts covering a timeframe of 2011 thru 2014.  As the claim progressed, red flag indicators were detected by the examiner.  As such, a surveillance level investigation was requested and video evidence was obtained of the claimant working out on several occasions at a gym.  While at the gym, he was videotaped bench pressing with dumbbells, lateral pull downs, bicep and tricep machines, without any discomfort or apparent restrictions.  The claimant’s deposition was subsequently taken in San Bernardino County and in the course of this testimony, the claimant made specific material misrepresentations regarding his physical abilities under the penalty of perjury.  In accordance with the regulations set forth by the California Department of Insurance, the case was then referred to the San Bernardino County District Attorney’s Office Workers’ Compensation Fraud Unit as well as to the California Department of Insurance Fraud Division.  Upon completion of their criminal investigation, the claimant was formally charged with four felony counts of insurance fraud and attempted perjury.  The claimant’s preliminary hearing is currently scheduled for April 7th, 2017.

 

ABOUT R.J.N. SIU:

 

Formed in 1996, the SIU Division was created to assist California employers, small size 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 2,750 examiners and the documented referrals by this unit have resulted in over 160 convictions for workers’ compensation insurance fraud in California. 

Superior Court Judge Orders Claimant To Pay $146,518.00 In Restitution Back To The Employer

3/31/2017

 On March 31st, 2017, the Special Investigative Unit of RJN Investigations, Inc. was formally notified regarding the outcome of a restitution hearing in the case of People of California v. S. Carver.

 

In this particular case, the claimant alleged to have suffered a low back injury.  Despite substantial medical treatment provided, the claimant’s medical condition was not improving and she began to utilize a cane.  Surveillance by the RJN SIU Department documented the claimant utilizing a cane only at her medical appointments and while testifying at the WCAB.  Surveillance performed on non-medical/legal appointment dates, found the claimant ambulating freely without the utilization of a cane or other artificial support.  In her deposition, the claimant testified that she could only walk a few feet without the use of a cane.  The video evidence along with a copy of the deposition transcript was then provided to the treating doctor for review and comment.  In his supplemental report, the treating doctor changed his medical opinion and returned the claimant back to work full duty.  In accordance with regulations set forth by the California Department of Insurance, the case was then submitted by the RJN SIU Department to the Sacramento County District Attorney’s Office as well as to the California Department of Insurance Fraud Division.  Upon completion of their criminal investigation, the claimant was formally charged with three felony counts of workers’ compensation insurance fraud.  After attending several hearings, the claimant subsequently entered into a plea bargain agreement.  In the subsequent restitution hearing, the Sacramento County Superior Court Judge ordered the claimant to pay $146,518.00 in restitution to her employer.   

 

ABOUT R.J.N. SIU:

 

Formed in 1996, the SIU Division was created to assist California employers, small size 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 2,750 examiners and the documented referrals by this unit have resulted in over 160 convictions for workers’ compensation insurance fraud in California. 

Former Sheriff Deputy Convicted For Committing Insurance Fraud

3/13/2017

 On March 1st, 2017, the Special Investigative Unit of RJN Investigations, Inc. was formally notified by the Orange County District Attorney’s Office regarding the successful prosecution in the case of People of California vs. N. Zappas. 

 

In this particular case, while working as a Sheriff Deputy in the Harbor Patrol Division, the claimant tripped over a firehose and fell on his back, injuring his left shoulder, left side of his neck and lower back.  He was placed on work restrictions of no heavy lifting, pushing or pulling greater than 10 lbs. by the treating physician. The Orange County Risk Management Department subsequently received an anonymous tip indicating that the claimant was engaged in cross-fit type activity involving heavy lifting.  A surveillance level investigation performed by the RJN SIU secured several hours of video evidence of the claimant engaged in consistent cross-fit activities which included lifting over 200 lbs.  In December, 2015, while under oath during his deposition, the claimant denied lifting anything over 20 lbs. since the date of injury and claimed he could not lift anything heavy, could not do squats and could not run.  The video was then shown to the doctor who changed his medical opinion.  In compliance with regulations set forth by the California Department of Insurance, a documented referral was then submitted to the Orange County District Attorney’s Office and to the California Department of Insurance Fraud Division.  Upon completion of an extensive criminal investigation, the claimant was formally charged with 11 counts of insurance fraud and 7 felony counts of perjury under oath.  Given the extent of the evidence, the claimant subsequently entered into a plea bargain agreement.  After pleading guilty to committing insurance fraud, the claimant was subsequently sentenced to 3 years formal probation, 180 days in jail and ordered to pay $34,838.00 in restitution to that of the County of Orange.  In addition, he was also required to dismiss his 2011 and 2015 workers’ compensation claims with prejudice as a condition of his probation.

 

ABOUT R.J.N. SIU:

 

Formed in 1996, the SIU Division was created to assist California employers, small size 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 2,750 examiners and the documented referrals by this unit have resulted in over 160 convictions for workers’ compensation insurance fraud in California. 

Former Costa Mesa Police Department Officer Convicted Of Committing Insurance Fraud Against City Of Costa Mesa

2/27/2017

 On February 17th, 2017, the Special Investigative Unit of RJN Investigations, Inc. was formally notified by the Orange County District Attorney’s Office regarding the successful prosecution in the case of People of California vs. R. Natividad.   

 

In this particular case, the claims examiner detected contradictory information regarding the AOE/COE aspects of the claim.  The examiner proactively assigned RJN SIU to conduct investigative measures.  In the course of that investigation, which entailed interviews and analyzing CCTV video footage, evidence was obtained that directly contradicted the claimant’s allegations of a work related injury.  In accordance with regulations set forth by the California Department of Insurance Fraud Division and upon the completion of the SIU level investigation, the case was formally referred to that agency as well as the Orange County District Attorney’s Office.  Upon completion of a joint criminal investigation, the claimant was formally charged with one felony count in violation of Penal Code Section 550(a)(1) as well as one felony count of insurance fraud in violation of Insurance Code Section 1871.4(a)(1).  After attending several preliminary hearings, this case moved forward to a jury trial.  In the trial, testimony was provided by the doctor, the claims examiner, SIU Investigator and other police officers, as well as viewing the CCTV video evidence. After the week long trail, the jury came back with a guilty verdict as to all felony counts.   Natividad faces a maximum sentence of 6 years in County Jail at his sentencing scheduled for  April 7th, 2017.    

 

ABOUT R.J.N. SIU:

 

Formed in 1996, the SIU Division was created to assist California employers, small size 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 2,750 examiners and the documented referrals by this unit have resulted in over 160 convictions for workers’ compensation insurance fraud in California. 

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