Sunday, May 27, 2018


 

Celebrating Over 30 Years (1987 - 2018)

of Superior Service to our Valued Clients

 
   
Press Release

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.

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