Friday, December 15, 2017


 

Celebrating 30 Years (1987 - 2017)

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Press Release

Subrosa Video Of Claimant Not Using Wheelchair Leads To Criminal Charges

5/22/2017

On May 22nd, 2017, the Special Investigative Unit of RJN Investigations, Inc. was formally notified by the Los Angeles County District Attorney’s Office regarding the filing of criminal charges based upon a submitted documented referral.  In this case, the claimant alleged to have suffered an injury as a result of moving a patient from a bed to a gurney and felt pain and popping in her low back.  The claimant then began to receive Total Temporary Disability benefits as well as an in home care provider.  Despite the medical treatment provided, the claimant alleged that she was getting worse and as such, required a wheelchair.  A surveillance level investigation performed by the RJN SIU found that the claimant only utilized a wheelchair at medical related appointments.  On non-medical appointment dates, the claimant was videotaped shopping at various stores without utilizing any medical equipment to assist her.  She carried out her day without any guarded movements and appeared to function physically without any pain, discomfort or altered gait.  Upon showing the video evidence to the AME, a change of medical opinion was rendered.  As a result, the case was formally filed by the RJN SIU with the California Department of Insurance 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)(2) and one felony count in violation of Penal Code Section 550(b)(1).  The claimant’s arraignment is scheduled for next month.

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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