Thursday, September 21, 2017


 

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Press Release

San Diego District Attorney’s Office Secures Conviction Based on Subrosa Video Evidence

8/16/2017

On August 8th, 2017, the Special Investigative Unit of RJN Investigations, Inc. was formally notified by the San Diego County District Attorney’s Office regarding the successful prosecution in the case of People of California vs. J. Marquez.  In this case, the claimant alleged to have suffered a work related injury on a Friday, but did not report the injury and seek medical treatment until the following Monday.  Based in large part by his subjective complaints, the claimant was provided with work restrictions of no kneeling, squatting, no climbing, bending, twisting and no lifting over 25 lbs., stretch breaks for 5 minutes per hour, no forceful pushing or pulling more than 35 lbs.  As the employer was unable to accommodate, the claimant began to receive TTD benefits.  Based upon the initial red flag indicators, surveillance was performed by the RJN SIU Department.  In the course of the surveillance level investigation, the claimant was found to participate in an organized soccer club team over several dates, showing no sign 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 made similar statements to his primary treating physician.  The video evidence was presented 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 examiner, asking for a quick settlement and he would stop pursuing the claim.  The case was then formally referred by the RJN SIU to the California Department of Insurance Fraud Division as well as to the San Diego County District Attorney’s Office.  Upon completion of their criminal investigation, the claimant was formally charged with 8 counts of insurance fraud in violation of Insurance Code Section 1871.4.  Given the impact of the subrosa video evidence, the claimant entered into a plea bargaining agreement in which he pled guilty to one count and agreed to pay restitution.  At the time of sentencing, the claimant provided his first installment for the restitution in the form of a cashier’s check made payable to the employer in the amount of $3,814.40.

 

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 165 convictions for workers’ compensation insurance fraud in California.  

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