Thursday, April 19, 2018


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Press Release

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


 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.






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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