Calif. Man Arrested on Felony Counts of Insurance Fraud

Oscar Fuentes III was arrested on two Felony counts of insurance fraud, according to the California Insurance Commissioner’s office.

Fuentes was booked into the Mendocino County Jail and bail has been set at $60,000.00.

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 during his employment as a Warehouse Manager II at San Quentin State Prison.

The investigation revealed that 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 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 investigation was conducted jointly by the California Department of Corrections, Office of Internal Affairs (CDC-OIA) and the California Department of Insurance Fraud Division. The case is being prosecuted by the Sonoma County District Attorney’s Office.

Source: California Department of Insurance