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CA Department of Insurance

Insurance Commissioner Jones Announces Arrest Of North Coast Man For Insurance Fraud

News: 2011 Press Release

For Release: June 23, 2011
Media Calls Only: 916-492-3566
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Insurance Commissioner Jones Announces Arrest Of North Coast Man For Insurance Fraud
Man Significantly Over Reported Symptoms and Limitations

Insurance Commissioner Dave Jones today announced that Oscar Fuentes III, 48, of Willits was arrested in Mendocino County on two felony counts of insurance fraud, including a violation of Insurance Code Section 1871.4(a)(1) and a violation of Penal Code Section 550(a)(6). Fuentes was booked into the Ukiah branch of the Mendocino County Jail. His bail has been set at $60,000.00. The case is being prosecuted by the Sonoma County District Attorney's Office.

An investigation conducted by the California Department of Corrections, Office of Internal Affairs (CDC-OIA) in June of 2008 led investigators to contact the California Department of Insurance Fraud Division, resulting in a joint investigation and his arrest. According to investigators, on August 14, 2003 Fuentes allegedly suffered a work related injury to his neck, back and upper extremities while moving bunk beds onto a flatbed truck while he was employed as a Warehouse Manager II with the California Department of Corrections and Rehabilitation (CDCR), San Quentin State Prison.

The investigation revealed that on June 12, 2006, Fuentes subsequently received a Workers' Compensation Appeals Board (WCAB) award of $42,735.00, based on his permanent disability injury rating of 45 percent. The State Compensation Insurance Fund (SCIF) also paid approximately $27,562.63 in medical benefits, $9,421.00 in loss expenses and $1,922.00 in Vocational Rehabilitation. Fuentes, with the assistance of his attorney, submitted a petition to reopen his claim to the WCAB for 100 percent disability. However, Fuentes was found not to be 100 percent disabled by the Agreed Medical Examiner (AME). The AME stated Fuentes significantly over reported his symptoms and limitations.

Investigators later used video surveillance of Fuentes over several days revealing that he was actively coaching baseball and taking part in coaching activities; carrying baseball equipment, raking the infield, chalking lines, and hitting baseballs to players. Fuentes was also seen mowing a lawn and assisted boys as they rode all-terrain vehicles. Fuentes was also filmed doing other various physical activities. Fuentes did all these activities without any signs of pain or discomfort.

According to SCIF, if Fuentes would have been found to be 100 percent disabled he would have received approximately $2,051,819.12.

The California Department of Insurance, established in 1868, is the largest consumer protection agency in California. Insurers collect $310 billion in premiums annually in California. Since 2011 the California Department of Insurance received more than 1,000,000 calls from consumers and helped recover over $469 million in claims and premiums. Please visit the Department of Insurance website at Non-media inquiries should be directed to the Consumer Hotline at 800.927.4357. Telecommunications Devices for the Deaf (TDD), please dial 800.482.4833.

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