Wednesday, May 22, 2019


 

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Press Release

Monterey County District Attorney’s Office Secures Conviction of Claimant For both Workers Compensation Insurance and Welfare Fraud

4/16/2019

 The RJN Investigation’s Special Investigative Unit was recently informed by the Monterey County District Attorney’s Office as to the successful prosecution in the case of the People of California v. E. Hernandez. In this particular case, the claimant alleged to have injured her back while performing in-home care duties for the insured.  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 and receiving any additional income.  As a result, the examiner proactively assigned the case to the RJN SIU to conduct a surveillance level investigation.  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 treating doctor.  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 Workers’ Compensation Fraud Unit.  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.  During the criminal investigation, it was also determined that the claimant failed to report her second job to the Department of Social Services. By failing to disclose the second job to both the insurer and the Department of Social Services, she obtained income and benefits that she was not entitled to.  As such, she was also charged with a felony violation of the Welfare Institution Code Section 10980(c)(2). On March 27th, 2019 Judge Panetta sentenced the claimant to 180 days in county jail will then be placed on 3 years formal probation.  She was also ordered to pay back the employer for the workers compensation insurance fraud $ 18,369.00 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 187 convictions for workers’ compensation insurance fraud in California.

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