Sunday, October 22, 2017


 

Celebrating 30 Years (1987 - 2017)

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Press Release

Soccer Surveillance Video Results In Felony Charges

2/6/2017

 On February 6th, 2017, the Special Investigative Unit of RJN Investigations, Inc. was formally notified by the San Diego County District Attorney’s Office regarding the filing of formal criminal charges based upon a documented referral.  In this case, the claimant alleges to have suffered a work related injury on a Friday, but did not actually report the injury and seek medical treatment until the following Monday.  Based in large part by subjective complaints, the claimant was provided with work restrictions of no kneeling/squatting, no climbing/bending/twisting, no lifting over 25 lbs., stretch breaks for 5 minutes per hour, no forceful pushing/pulling more than 35 lbs.  Based upon the initial red flag indicators, surveillance was performed by the RJN SIU.  In the course of this surveillance level investigation, the claimant was found to participate in an organized soccer club team over several dates while showing no signs of hesitation or restrictions.  The claimant’s statement was promptly secured and he specifically denied being able to play soccer since his date of injury.  The claimant then made similar statements to the primary treating physician.  The SIU presented the video evidence to the primary treating physician and in his supplemental report, he changed his medical opinion releasing the claimant to work without restrictions and called into question the actual AOE/COE aspects of the injury.  The claimant also sent several e-mails to the examiners asking for a quick settlement and he would stop pursuing the claim. The case was then formally referred to the California Department of Insurance Fraud Division as well as to the San Diego County District Attorney’s Office Workers’ Compensation Fraud Unit.  Upon completion of a detailed criminal investigation by the San Diego County District Attorney’s Office, the claimant was formally charged with 8 felony counts of violation of Insurance Code Section 1871.4.  The claimant’s preliminary hearing is scheduled for February 21st, 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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