Sunday, October 22, 2017


 

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Press Release

Monterey County District Attorney’s Office Files Felony Fraud Charges

9/18/2017

 On September 13th, 2017, the Special Investigative Unit of RJN Investigations, Inc. was formally notified by the Monterey County District Attorney’s Office regarding the filing of a felony fraud charge based upon a documented referral. 

 

In this particular case, the claimant alleged to have injured her back while performing in home care duties for the assured.  Based in large part on subjective complaints, the claimant then began to receive temporary total disability payments.  During a telephone conversation with the examiner, the claimant hesitated when asked if she was working or receiving any additional income.  As such, a surveillance level investigation was authorized, and in the course of the surveillance, evidence was obtained indicating that the claimant was indeed working and not reporting that status to the examiner and/or the treating doctor.  Upon completion of the SIU level investigation, the case was then referred by the RJN SIU to the California Department of Insurance Fraud Division as well as to the Monterey County District Attorney’s Office.  Upon completion of a detailed criminal investigation performed by the Monterey County District Attorney’s Office, the claimant was formally charged with violation of Penal Code Section 550(b)(3) which is a felony.  At the criminal hearing held on this date, the claimant entered a not guilty plea.

 

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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