WCPanelIQ
PanelDenied

Benitez Gomez, Gustavo

GUSTAVO BENITEZ GOMEZ, Applicant vs. EXPRESSIONS GENERAL REMODEL; NORGUARD INSURANCE COMPANY, Defendants

ADJ number
ADJ11969555
Decision date
Dec 21, 2023
District office
Oakland
WCJ
Steven Siemers (Arbitrator)
Claim administrator
NorGUARD Insurance Company
Commissioners
—
LC §5270LC §5275LC §3202.5CCR §10625

Summary

Applicant Gustavo Benitez Gomez sustained an alleged injury on May 8, 2018 while employed by Expressions General Remodel. NorGUARD Insurance Company contended that its workers' compensation policy (JAWC857596) covering Expressions had been validly cancelled on or about November 12, 2017 for the employer's failure to permit a payroll audit, prior to the injury. Following arbitration under Labor Code section 5275, the arbitrator concluded that NorGUARD failed to prove by a preponderance of the evidence that the notice of cancellation was actually mailed, relying on an unclear mailing ledger (Exhibit 27) that did not even reference NorGUARD and the testimony of a witness from underwriting who lacked personal knowledge of the mailing process. The arbitrator therefore held the policy was not effectively cancelled and NorGUARD was liable for coverage. The WCAB adopted and incorporated the arbitrator's Report and denied reconsideration, additionally noting WCAB Rule 10625's definition of 'proof of service.'

Issues

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Holding

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Analysis

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Applicant takeaway

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Defense takeaway

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Provider takeaway

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