Sunday, May 27, 2018


 

Celebrating Over 30 Years (1987 - 2018)

of Superior Service to our Valued Clients

 
   
Press Release

Supermarket Employee Charged With Felony Insurance Fraud

5/24/2018

On May 24th, 2018, the Special Investigative Unit of RJN Investigations, Inc. established that felony insurance fraud charges were filed based upon the submission of a documented referral.  In this case, the claimant worked as a cake decorator for a major California supermarket.  As a result of a slip and fall, the claimant alleged to have suffered numerous injuries and retained the legal services of the Law Office of Dennis Fusi, who has since been charged by the Orange County District Attorney’s Office with felony insurance fraud charges.  Video evidence secured by the RJN SIU Department found the claimant to be engaged in significant outside physical activities, showing no restrictions or utilization of artificial support.  The claimant’s deposition was then secured in Los Angeles County and the claimant made several material misrepresentations in her testimony provided under the penalty of perjury.  As such and in compliance with the regulations set forth by the California Department of Insurance, the RJN SIU formally filed the case with their 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)(1) and two felony counts in violation of Penal Code Section 664-118(a).  A felony bench warrant has since been issued for the claimant’s arrest. 

 

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 175 convictions for workers’ compensation insurance fraud in California.  

School District Custodian Charged with Insurance Fraud

5/14/2018

On May 14th, 2018 the Special Investigative Unit of RJN Investigations was formally notified of charges being filed as a result of a documented referral.  In this case, the claimant’s deposition was taken in Bellflower, Ca. The claimant made several material misrepresentation in his testimony regarding his true prior medical and claim history.  Then while out on TDD the claimant was videotaped working on car, bending, squatting, reaching, etc. showing no restrictions. The video was then shown to the AME and he was subsequently deposed.  In his testimony, he confirms the claimant was not truthful to him as to his true medical/claim history.  He also questioned the claimant’s credibility and stated that although he limped in his office during his examination, he noticed no such limp in the video evidence.  After the cross-examination, the AME lowered the WPI from 7% to 5%. In compliance with the regulations set forth by the California Department of Insurance, the RJN SIU formally referred the case to their Fraud Division and to the Los Angeles County District Attorney’s Office.  Upon completion of their criminal investigation, the claimant was formally charged with violation of Penal Code Section 664-118 (a).  A bench warrant for the claimant’s arrest has now been issued.

 

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 175 convictions for workers’ compensation insurance fraud in California.

Felony Arrest Warrant Issued for Service Worker

4/30/2018

 On April 9th, 2018 the Special Investigative Unit of RJN Investigations, Inc. was formally notified by the Sacramento County District Attorney’s Office as to issuance of an arrest warrant for the claimant based upon the submission of a documented referral. In this particular case, the claimant was employed as a Service Worker for the Permanente Medical Group and alleged to have sustained an injury to her arm/forearm, neck and upper extremities due to repetitive movements. Based on the subjective complaints the claimant alleged during medical examinations which included the inability to dress herself, or lift her arms, she was prescribed with wrist braces and advised to wear daily. Subsequently, a surveillance investigation was authorized and the claimant was observed utilizing her wrist braces inconsistently as well as being able to complete daily activities with no signs of hesitation or discomfort. Surveillance was provided to the QME. Based on his review of surveillance, he indicated that he had significant   concerns about the patients veracity based on the subrosa being in such contrast to her presentation. In compliance with the regulations set forth by the California Department of Insurance, the case was then referred by the RJN SIU to the Sacramento County District Attorney’s Office as well as the California Department of Insurance Fraud Division. Upon completion of a detailed criminal investigation by the District Attorney, an arrest warrant was formally issued along with a letter of advisement for the claimant to appear. Once the claimant is formally arrested, she will be notified of her charges and scheduled to re appear for an Arraignment. 

 

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 175 convictions for workers’ compensation insurance fraud in California.  

Riverside County District Attorney Makes Felony Arrest

4/16/2018

 On April 5th, 2018 the Special Investigative Unit of RJN Investigations, Inc. was formally notified by Senior Investigator Kurt Lackman of the Riverside County District Attorney’s Office as to the arrest of the claimant while at his place of employment. The claimant was employed by Robertson’s Ready Mix as a truck driver. The claimant allegedly sustained a left ankle sprain when he was climbing down a ladder and stepped on a large rock. Due to the fact that the claimant’s complaints remained subjective and he complained of no improvement in his symptoms, a surveillance investigation was initiated. During surveillance, the claimant was observed traveling to Knott’s Berry Farm where he was seen standing, walking without the assistance of any ambulatory devises as well as riding on various rides. A deposition was completed where the claimant was noted to making multiple misrepresentations under the penalty of perjury. The claimant stated he had gone to Knott’s Berry Farm (the day before the deposition) but had to use a wheelchair the entire day. The claimant also testified that he did not go on any rides that day which was also a misrepresentation. In compliance with the regulations set forth by the California Department of Insurance, the case was then referred by the RJN SIU to the Riverside County District Attorney’s Office as well as the California Department of Insurance Fraud Division. Upon completion of a detailed criminal investigation by the District Attorney, an arrest warrant was formally issued for the claimant. On April 5th, the RJN SIU was notified that the claimant was arrested while at work in front of other coworkers and taken away in hand cuffs. He was booked into County Jail and formally notified of the 3 Felony Charges against him. The claimant is scheduled for an Arraignment on June 7th, 2018.    

 

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 175 convictions for workers’ compensation insurance fraud in California.

Felony Arrest Warrant Issued for Drywall taper Charged with Insurance Fraud

3/26/2018

 On March 20th, 2018 the Special Investigative Unit of RJN Investigations, Inc. was formally notified by the Los Angeles County District Attorney’s Office as to issuance of a felony arrest warrant for the claimant based upon the submission of a documented referral. In this particular case, the claimant was a Drywall taper who allegedly sustained an injury to his ankles, neck and lower back on November 30, 2015. The claimant was placed on modified duties with the restrictions that he must wear a walking boot on his right ankle and sit down work only. Red flag indicators were subsequently detected by the claim examiner who in turn proactively authorized the SIU to initiate surveillance measures.  The surveillance level investigation found the claimant to be working in the same capacity for another employer. Discreet investigative measures were implemented and it was indicated that the claimant was earning $22.00 an hour in cash. When questioned during his deposition, the claimant stated that he had been unable to drive or work for his employer or any other company since the date of injury. When questioned by the PQME, the claimant continued to deny secondary employment which was a misrepresentation based on surveillance video. In compliance with the regulations set forth by the California Department of Insurance, the case was then referred by the RJN SIU to the Los Angeles County District Attorney’s Office as well as the California Department of Insurance Fraud Division. Upon completion of a detailed criminal investigation by the LADA, the claimant was formally charged with 3 counts in violation of Insurance Code Section 1871.4 and Penal Code 664-118(a)  The claimant’s  arraignment was to take place on March 20th, 2018  but he failed to show. As such the Superior Court Judge issued a Felony warrant for his arrest.

 

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 175 convictions for workers’ compensation insurance fraud in California. 

Physician Arrested By DEA Agents on Federal Charges of Illegally Selling Narcotic Prescriptions

3/9/2018

 On March 7th, 2018, the Special Investigative Unit of RJN Investigations, Inc. was formally notified by the United States Attorney General’s Office regarding the arrest of Dr. Wendell Street.  This particular case started with suspected insurance fraud on a School District employee claim.  One of the central red flags in that case was the pharmacy billing for narcotic pain medication.  On multiple occasions, the physician issued medical reports stating, “No new significant physical findings per exam,” yet the surveillance level investigation performed by the RJN SIU Department found that the claimant never attended any such appointment on the dates they were billed.  Further analysis of the billing reflected that the physician prescribed over a period of 2 ½ years to the claimant the primary case, 41 prescriptions for OxyContin, 75 prescriptions for Actiq, 19 prescriptions for Hydrocodone and 40 prescriptions for Diazepam.  Given the evidence compiled in the SIU level investigation, the case was formally referred to the California Department of Insurance Fraud Division and the San Bernardino County District Attorney’s Office.  The investigation was subsequently transferred to the Drug Enforcement Administration.  In the course of their undercover investigation, the doctor wrote prescriptions without performing any physical examination in exchange for cash.  In the five counts related to illegal distribution of OxyContin, each carry a statutory maximum penalty of 20 years in Federal Prison.  The five counts related to alprazolam each carry a sentence of up to 5 years in prison.  This case is being prosecuted by Assistant United States Attorney Victoria Degtyareva of the Organized Crime Drug Enforcement Task Force. 

 

 

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 175 convictions for workers’ compensation insurance fraud in California.  

Convicted Of Insurance Fraud and Ordered To Pay $34,623.00 in Restitution

2/19/2018

 

On February 12th, 2018, 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. J. Garcia.  In this particular case, the claimant worked as a line cook and was subsequently terminated for being a no show at work.  He retained an attorney who filed an application alleging an injury to his back, legs, neck and shoulders from unloading boxes of food.  A surveillance level investigation performed in advance of the claimant’s deposition found him going to Knotts Berry Farm, where he was videotaped going on several rides throughout the park.  In his deposition that was taken just one month afterwards, the claimant admitted going to Knotts Berry Farm, but stated that he did not go on any of the rides and utilized his scooter the entire time.  In the surveillance video, the claimant was never seen on a scooter.  The video evidence was provided to the Panel QME for review and comment in a supplemental report.  In his report, the QME altered his original medical opinion and rated the claimant to have zero whole person impairment.  Upon receipt of that report and 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.  Upon completion of their criminal investigation, the claimant was subsequently charged with one felony count in violation of Insurance Code Section 1871.4(a)(2), one felony count in violation Penal Code Section 550(b)(1) and one misdemeanor count in violation of Penal Code Section 664-118(a).  After attending several preliminary hearings, the claimant entered into a plea bargaining agreement at which time he was sentenced to three years’ probation, 300 hours of community service and ordered to pay back the employer $34,623.00 in restitution. 

 

 

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 170 convictions for workers’ compensation insurance fraud in California.

Los Angeles Superior Court Judge Orders Claimant to Pay $ 36,366.00 in Restitution to His Employer

1/29/2018

 On January 29th, 2018, 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. M. De Castro.  This case involved a full time pest control exterminator who reportedly sustained a sprain/strain to his neck in February, 2014.  Medical treatment benefits were initially provided. Subsequent evidence secured during an AOE/COE level investigation discovered the incident never occurred.  A surveillance level investigation had established that the claimant had opened his own pest control business and was working without any restrictions.  In June, 2015, the claimant provided testimony at the WCAB trial revealing that he had not been truthful during his former deposition testimony.  On June 13th, 2016, the WCAB judge subsequently issued a “Take Nothing” based upon the evidence reviewed.  The case was then formally referred by the RJN SIU to the California Department of Insurance Fraud Division and to 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)(1) and one felony count in violation of Penal Code Section 664-118(a).  After attending several hearings, the claimant agreed subsequently pled guilty to Penal Code Section 664-118 as a felony.  He was then sentenced to 3 years formal probation and 100 hours of community service.  In addition, the Superior Court Judge ordered the claimant to pay $ 36,366.92 in restitution back to his 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 170 convictions for workers’ compensation insurance fraud in California.  

In Home Care Provider Convicted of Insurance Fraud

1/8/2018

 On January 8th, 2018, 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. E. Pace.  In this particular case, the examiner noted that on the invoices submitted by the in home care provider, that she billed exactly 4 hours every day from 8:00 a.m. – 12:00 p.m., seven days a week.  She was never late and never missed a day of work according to the billing.  An initial surveillance investigation performed by the RJN SIU found no evidence of the in home care provider providing care to the claimant during the timeframe billed.  An 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 of her during the timeframe 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.  In accordance with the regulations set forth by the California Department of Insurance, the case was then filed by the RJN SIU to their Fraud Division as well as to the Los Angeles County District Attorney’s Office.  Upon completion of a detailed criminal investigation by the Los Angeles County District Attorney’s Office, the in home care provider was formally charged with 2 felony counts in violation of Insurance Code Section 1871.4 and Penal Code Section 118(a).  After attending several hearings, the in home care provider subsequently pled nolo contendere to Count One and Count Two was dismissed.  She was then sentenced to 5 years formal probation, 180 hours of community service and ordered to pay restitution back to the employer in the amount of $ 17,400.00.

 

 

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 170 convictions for workers’ compensation insurance fraud in California.

Security Officer Pleads Guilty

12/28/2017

 On December 28th, 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. M. Otuzbiryan.  In this case, the claimant alleged that he injured his back while standing at his post during his employment. He went for medical evaluation the following day diagnosed with lumbar and thoracic sprains. He subsequently filed a CT type injury claim. After review of personnel documents, it appeared the claimant filed this claim in retaliation of losing a golf cart he occupied while at work. The claimant was placed on restriction by his doctors and the employer could not accommodate him. During a case review, it was determined the claimant was involved in an auto accident, where he injured his neck and back and received medical treatment for months. When questioned during medical examinations, the claimant failed to disclose this accident or his back and neck injuries. Additionally, he made material misrepresentations when he denied any such accident or injuries in his deposition. The claimant was also found to be employed as an Uber driver during his TTD period in this case.

 

In accordance with the regulations set forth by the California Department of Insurance, the RJN SIU referred the case to their Fraud Division as well as to the Los Angeles County District Attorney’s Office.  Upon completion of their criminal investigation, the claimant was formally charged with two felony counts insurance fraud and attempted perjury.  After attending several criminal hearings, the claimant pled to one count of insurance fraud (IC 1871.4) and agreed to pay the restitution in the amount of $9,272.60. Moreover, he was placed on 3 years’ probation and ordered to perform 200 hours of community service.

 

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 170 convictions for workers’ compensation insurance fraud in California.

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