Saturday, August 18, 2018


 

Celebrating Over 30 Years (1987 - 2018)

of Superior Service to our Valued Clients

 
   
Press Release

Landscaper Convicted by Ventura County District Attorney’s Office

8/14/2018

 On August 13th, 2018, the Special Investigative Unit of RJN Investigations, Inc. was formally notified by the Ventura County District Attorney’s Office regarding the successful prosecution in the case of People of California vs. Alvizo, J. In this particular case, the claimant alleged that while working for a landscaping company, he 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 investigation was authorized.  In the course of the surveillance investigation, evidence was obtained indicating that the claimant was working at a lemon orchard in Ventura, California.  The SIU 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 by the RJN SIU 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). On August 13th, 2018, the claimant was sentenced to 180 days in county jail, followed by 60 months of probation, and ordered to pay back the insurance carrier $27,095.87 in restitution.

 

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.

Soccer Playing Claimant Charged

7/30/2018

 On July 25th, 2018 the Special Investigative Unit of RJN Investigations was notified of charges being filed as a result of a documented referral. In this case, the claimant filed a post termination claim alleging a Cumulative Trauma Injury from April 2nd, 2002 thru February 4th, 2016. The claimant was alleging to have suffered from injuries to multiple body parts throughout the course of his employment.  A subsequent surveillance investigation found the claimant to be very active, even competing in soccer leagues showing no signs of hesitation or discomfort. When he was questioned during his deposition, the claimant was specifically asked if he still played soccer to which the claimant stated that he had not played soccer for over a year. Furthermore, he indicated that he stopped playing soccer while he was still employed. The RJN SIU formally referred the case to the Ventura County District Attorney’s Office as well as the California Department of Insurance Fraud Division. Upon completion of their criminal investigation, the claimant was formally charged and entered a not guilty Plea during his arraignment. The claimant is scheduled to re appear on August 15th, 2018 in the event he does not accept a proposed plea agreement provided by the District Attorney.

 

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.

Substitute School Teacher Arrested

7/11/2018

 On July 9th, 2018, the Special Investigative Unit of RJN Investigations, Inc. was formally notified by the Los Angeles County District Attorney’s Office of the arrest of a claimant based upon the submission of a documented referral. In this particular case, the claimant was employed as a substitute teacher for a public school district and alleged to have sustained an injury to her left shoulder. The claimant alleged she was walking to her classroom, when two students were walking in the opposite direction. One of the students pushed the other student which caused his backpack to push her into the locker, causing injury to her left shoulder.  Subsequently, and again during her deposition, she claimed that these two students assaulted her and she filed a police report with the Alhambra Police Department reporting that the two students intentionally pushed her into a wall. Initially, the claimant also reported the incident occurred between 1st period and 2nd period. She later changed her story to say it took place between 3rd and 4th period.  However, video shows no incident occurring. Additionally, the claimant told the principal’s secretary on the date of injury that she had hurt the same arm/shoulder earlier in the week when she fell from her horse, and the incident at school aggravated that preexisting injury.  That history was not provided to any of the initial or subsequent medical providers. Subpoenaed Medical Records later confirmed the claimant injured her left shoulder at home when she fell off a horse.  In compliance with the regulations set forth by the California Department of Insurance, the case was then referred by the RJN SIU to the Los Angeles County District Attorney’s Office as well as the California Department of Insurance Fraud Division. Upon completion of a detailed criminal investigation by the District Attorney, the claimant was subsequently charged with one felony count in violation of Insurance Code Section 1871.4(a)(1), and one misdemeanor count in violation of Penal Code Section 664-118(a). On July 2nd, 2018, the claimant was arrested and formally notified of her charges. She pled not guilty to both counts and is scheduled to appear for her Preliminary Setting in August 2018.

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.

Staging a Fake Injury Results in Criminal Conviction

6/11/2018

 On June 11th, 2018, the Special Investigative Unit of RJN Investigations, Inc. learned of the successful conviction in the case of People of California vs. H. Golian.  In this particular case, the claimant alleged that as a result of being hit by a forklift, he suffered multiple injuries.  The claimant stated that he could not remember anything after the impact until he woke up in the hospital approximately 1 ½ hours later.  An analysis of the employer’s security video noted that the claimant clearly and intentionally moved into a position in front of the slowly moving forklift.  The forklift operators view forward was obstructed by a large stack of pallets being moved and he could not have seen the claimant.  The claimant had an unobstructed view of the oncoming forklift.  Once the claimant got into position in front of the slowly moving forklift, he turned his back and at the last minute, jumped out of the way, rolling onto the ground as if injured.  During the course of the investigation, the RJN SIU also performed surveillance.  In the course of that investigation, the claimant was noted to utilize a cane only upon arriving and departing from his medical appointment.  In compliance with the regulations set forth by the California Department of Insurance, the case was formally referred to their Fraud Division as well as to 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 and one count in violation of Penal Code Section 664-118, Attempted Perjury.  After attending several preliminary hearings, the claimant entered into a plea bargaining agreement in which he agreed to plea nolo contendere.  As a result of the plea, the claimant was then sentenced to one year probation and pay various court fines. 


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.
 

Supermarket Employee Charged With Felony Insurance Fraud

5/24/2018

On May 24th, 2018, the Special Investigative Unit of RJN Investigations, Inc. established that felony insurance fraud charges were filed based upon the submission of a documented referral.  In this case, the claimant worked as a cake decorator for a major California supermarket.  As a result of a slip and fall, the claimant alleged to have suffered numerous injuries and retained the legal services of the Law Office of Dennis Fusi, who has since been charged by the Orange County District Attorney’s Office with felony insurance fraud charges.  Video evidence secured by the RJN SIU Department found the claimant to be engaged in significant outside physical activities, showing no restrictions or utilization of artificial support.  The claimant’s deposition was then secured in Los Angeles County and the claimant made several material misrepresentations in her testimony provided under the penalty of perjury.  As such and in compliance with the regulations set forth by the California Department of Insurance, the RJN SIU formally filed the case with their 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)(1) and two felony counts in violation of Penal Code Section 664-118(a).  A felony bench warrant has since been issued for the claimant’s arrest. 

 

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.  

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.

Felony Arrest Warrant Issued for Service Worker

4/30/2018

 On April 9th, 2018 the Special Investigative Unit of RJN Investigations, Inc. was formally notified by the Sacramento County District Attorney’s Office as to issuance of an arrest warrant for the claimant based upon the submission of a documented referral. In this particular case, the claimant was employed as a Service Worker for the Permanente Medical Group and alleged to have sustained an injury to her arm/forearm, neck and upper extremities due to repetitive movements. Based on the subjective complaints the claimant alleged during medical examinations which included the inability to dress herself, or lift her arms, she was prescribed with wrist braces and advised to wear daily. Subsequently, a surveillance investigation was authorized and the claimant was observed utilizing her wrist braces inconsistently as well as being able to complete daily activities with no signs of hesitation or discomfort. Surveillance was provided to the QME. Based on his review of surveillance, he indicated that he had significant   concerns about the patients veracity based on the subrosa being in such contrast to her presentation. In compliance with the regulations set forth by the California Department of Insurance, the case was then referred by the RJN SIU to the Sacramento County District Attorney’s Office as well as the California Department of Insurance Fraud Division. Upon completion of a detailed criminal investigation by the District Attorney, an arrest warrant was formally issued along with a letter of advisement for the claimant to appear. Once the claimant is formally arrested, she will be notified of her charges and scheduled to re appear for an Arraignment. 

 

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.  

Riverside County District Attorney Makes Felony Arrest

4/16/2018

 On April 5th, 2018 the Special Investigative Unit of RJN Investigations, Inc. was formally notified by Senior Investigator Kurt Lackman of the Riverside County District Attorney’s Office as to the arrest of the claimant while at his place of employment. The claimant was employed by Robertson’s Ready Mix as a truck driver. The claimant allegedly sustained a left ankle sprain when he was climbing down a ladder and stepped on a large rock. Due to the fact that the claimant’s complaints remained subjective and he complained of no improvement in his symptoms, a surveillance investigation was initiated. During surveillance, the claimant was observed traveling to Knott’s Berry Farm where he was seen standing, walking without the assistance of any ambulatory devises as well as riding on various rides. A deposition was completed where the claimant was noted to making multiple misrepresentations under the penalty of perjury. The claimant stated he had gone to Knott’s Berry Farm (the day before the deposition) but had to use a wheelchair the entire day. The claimant also testified that he did not go on any rides that day which was also a misrepresentation. In compliance with the regulations set forth by the California Department of Insurance, the case was then referred by the RJN SIU to the Riverside County District Attorney’s Office as well as the California Department of Insurance Fraud Division. Upon completion of a detailed criminal investigation by the District Attorney, an arrest warrant was formally issued for the claimant. On April 5th, the RJN SIU was notified that the claimant was arrested while at work in front of other coworkers and taken away in hand cuffs. He was booked into County Jail and formally notified of the 3 Felony Charges against him. The claimant is scheduled for an Arraignment on June 7th, 2018.    

 

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.

Felony Arrest Warrant Issued for Drywall taper Charged with Insurance Fraud

3/26/2018

 On March 20th, 2018 the Special Investigative Unit of RJN Investigations, Inc. was formally notified by the Los Angeles County District Attorney’s Office as to issuance of a felony arrest warrant for the claimant based upon the submission of a documented referral. In this particular case, the claimant was a Drywall taper who allegedly sustained an injury to his ankles, neck and lower back on November 30, 2015. The claimant was placed on modified duties with the restrictions that he must wear a walking boot on his right ankle and sit down work only. Red flag indicators were subsequently detected by the claim examiner who in turn proactively authorized the SIU to initiate surveillance measures.  The surveillance level investigation found the claimant to be working in the same capacity for another employer. Discreet investigative measures were implemented and it was indicated that the claimant was earning $22.00 an hour in cash. When questioned during his deposition, the claimant stated that he had been unable to drive or work for his employer or any other company since the date of injury. When questioned by the PQME, the claimant continued to deny secondary employment which was a misrepresentation based on surveillance video. In compliance with the regulations set forth by the California Department of Insurance, the case was then referred by the RJN SIU to the Los Angeles County District Attorney’s Office as well as the California Department of Insurance Fraud Division. Upon completion of a detailed criminal investigation by the LADA, the claimant was formally charged with 3 counts in violation of Insurance Code Section 1871.4 and Penal Code 664-118(a)  The claimant’s  arraignment was to take place on March 20th, 2018  but he failed to show. As such the Superior Court Judge issued a Felony warrant for his arrest.

 

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. 

Physician Arrested By DEA Agents on Federal Charges of Illegally Selling Narcotic Prescriptions

3/9/2018

 On March 7th, 2018, the Special Investigative Unit of RJN Investigations, Inc. was formally notified by the United States Attorney General’s Office regarding the arrest of Dr. Wendell Street.  This particular case started with suspected insurance fraud on a School District employee claim.  One of the central red flags in that case was the pharmacy billing for narcotic pain medication.  On multiple occasions, the physician issued medical reports stating, “No new significant physical findings per exam,” yet the surveillance level investigation performed by the RJN SIU Department found that the claimant never attended any such appointment on the dates they were billed.  Further analysis of the billing reflected that the physician prescribed over a period of 2 ½ years to the claimant the primary case, 41 prescriptions for OxyContin, 75 prescriptions for Actiq, 19 prescriptions for Hydrocodone and 40 prescriptions for Diazepam.  Given the evidence compiled in the SIU level investigation, the case was formally referred to the California Department of Insurance Fraud Division and the San Bernardino County District Attorney’s Office.  The investigation was subsequently transferred to the Drug Enforcement Administration.  In the course of their undercover investigation, the doctor wrote prescriptions without performing any physical examination in exchange for cash.  In the five counts related to illegal distribution of OxyContin, each carry a statutory maximum penalty of 20 years in Federal Prison.  The five counts related to alprazolam each carry a sentence of up to 5 years in prison.  This case is being prosecuted by Assistant United States Attorney Victoria Degtyareva of the Organized Crime Drug Enforcement Task Force. 

 

 

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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