Sunday, May 27, 2018


 

Celebrating Over 30 Years (1987 - 2018)

of Superior Service to our Valued Clients

 
   
Press Release

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.

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