Workers’ Compensation Insurance Fraud Case: Oxnard Man Charged in 2025
September 18, 2025 | JacobiJournal.com – A Ventura County man is facing felony charges after authorities alleged he falsified an on-the-job injury to collect workers’ compensation benefits. The case underscores California’s ongoing battle against workers’ compensation insurance fraud, which state regulators estimate costs billions annually. Oxnard Resident Charged with Fraud and Perjury Prosecutors say Gonzalo Robles Zurita, 36, of Oxnard falsely claimed that an arm injury he sustained in 2022 occurred at his workplace. Based on that report, a State of California workers’ compensation claim was opened, providing him with access to benefits including medical care and wage replacement. The State Compensation Insurance Fund (SCIF) paid over $20,000 before the claim came under scrutiny. Zurita now faces felony counts of workers’ compensation insurance fraud and attempted perjury for allegedly making false statements during a sworn deposition. He entered a not-guilty plea during his first court appearance on September 11, 2025. Investigation Uncovers Fraudulent Representations SCIF’s Special Investigation Unit conducted a criminal review into the circumstances of the reported injury. Investigators concluded that Zurita had misrepresented the time, place, and manner of his injury to unlawfully obtain compensation. Zurita has been released on his own recognizance. He is scheduled for an early disposition conference on September 22, followed by a preliminary hearing on September 24, 2025. If convicted, he could face up to three years and six months in county jail. Economic Toll of Workers’ Compensation Fraud The California Department of Insurance (CDI) estimates that fraudulent claims cost the state between $1 billion and $3 billion annually. These costs drive up premiums for legitimate businesses and result in higher consumer prices statewide. Officials stress that enforcement is necessary to protect both the integrity of the workers’ compensation system and honest policyholders. Why This Case Matters Cases like Zurita’s highlight the ongoing challenge of identifying fraudulent claims before they drain public resources. Law enforcement officials and investigators continue to prioritize insurance fraud cases to maintain fairness for both injured workers and law-abiding employers. For the official press release, visit the California Statewide Law Enforcement Association (CSLEA). FAQs: Workers’ Compensation Insurance Fraud What is workers’ compensation insurance fraud? Workers’ compensation insurance fraud occurs when someone lies or misrepresents information to receive benefits they are not entitled to, such as wage replacement or medical coverage. How much does workers’ compensation fraud cost California each year? According to CDI, fraudulent claims cost the state between $1 billion and $3 billion annually, raising insurance premiums and affecting consumer prices. What penalties can result from workers’ compensation insurance fraud? Convictions can lead to felony charges, prison time, restitution, and fines, depending on the scope of the fraud. How are fraudulent workers’ compensation claims investigated? Special Investigation Units (SIUs) within insurance organizations, along with state prosecutors and CDI, review suspicious claims, conduct surveillance, and examine sworn testimony for inconsistencies. Subscribe to JacobiJournal.com for weekly updates on fraud enforcement, regulatory actions, and high-impact court cases. 🔎 Read More from JacobiJournal.com:
San Jose Security Company Owner Faces Sentence for $3.4M Insurance Fraud
May 21, 2025 | JacobiJournal.com — San Jose insurance fraud investigations have led to the sentencing of a local security company owner after a multi-year premium evasion scheme. The California Department of Insurance (CDI) announced on May 19, 2025, that investigators uncovered a large-scale insurance fraud operation involving Raul Chavez, 40, the owner of Tactical Operations Protective Services. Chavez was found guilty of felony premium fraud for underreporting more than $3.4 million in payroll, a tactic used to avoid paying workers’ compensation insurance premiums legally owed to the State Compensation Insurance Fund. Six-Year Scheme to Evade Insurance Payments From 2017 to 2023, Chavez systematically underreported his company’s payroll. He falsely claimed to the State Compensation Insurance Fund (State Fund) that he had no employees for five consecutive years. In the 2022–2023 policy year, he reported only $40,000 in payroll related to one injured employee, even though his business continued to operate in Santa Clara County. However, a detailed audit by the Department of Insurance revealed that Chavez had concealed $3,431,903 in payroll, resulting in $205,565 in unpaid workers’ compensation premiums. “Hiding true payroll amounts to reduce workers’ comp premiums puts workers at risk and gives offending companies an unfair advantage over law-abiding companies in that they can bid lower for jobs.”— Alan Barcelona, President, California Statewide Law Enforcement Association (CSLEA) Legal Consequences and Restitution Chavez accepted responsibility and pleaded guilty to felony insurance fraud. The court sentenced him to: These penalties reflect the severity of his actions and the financial damage caused to the insurance system. How San Jose Insurance Fraud Was Uncovered Through Payroll Audit The investigation began in September 2023, when State Fund filed a fraud referral. They reported that Chavez failed to disclose a workplace injury from June 2022. Although he transported the injured employee to an emergency room, he did not report the incident to State Fund, as required by law. The referral also alleged long-term payroll underreporting. CDI investigators confirmed that Chavez failed to report accurate payroll for multiple employees over six years, intentionally violating workers’ compensation requirements. Prosecutors Pursue Justice The Santa Clara County District Attorney’s Office prosecuted the case. Their efforts, in coordination with CDI’s audit and investigation, led to Chavez being held accountable for his fraudulent conduct. His actions not only violated insurance fraud laws but also jeopardized worker safety and disrupted fair business competition in the security services industry. The National Insurance Crime Bureau (NICB) also reported on the case, highlighting its significance in combating worker compensation insurance fraud statewide. FAQs: About San Jose Insurance Fraud What was the San Jose insurance fraud scheme involving Raul Chavez? The San Jose insurance fraud case involved Raul Chavez, who underreported more than $3.4 million in payroll between 2017 and 2023. This allowed him to avoid paying over $200,000 in workers’ compensation premiums, violating California insurance laws. How was the San Jose insurance fraud discovered? The fraud was discovered when the State Compensation Insurance Fund filed a referral in 2023 after Chavez failed to report a workplace injury. A follow-up audit by the California Department of Insurance confirmed years of underreported payroll. What are the consequences of committing San Jose insurance fraud? Raul Chavez pleaded guilty to felony insurance fraud. He was sentenced to 180 days in jail (via electronic monitoring), two years of probation, and ordered to pay over $225,000 in restitution—highlighting the severe legal and financial penalties for insurance fraud in California. Stay informed on major insurance fraud cases like the San Jose scheme. Subscribe to JacobiJournal.com for reliable coverage on employer fraud, workers’ compensation violations, and California enforcement updates. 🔎 Read More from JacobiJournal.com: