What the panel ordered
The September 8, 2020 Findings and Award is affirmed; reconsideration is denied.
Defendant sought reconsideration of the arbitrator's Findings and Award dated September 8, 2020, which found applicant was insured for workers' compensation by defendant for the date of injury and that the policy did not exclude applicant from coverage.
What was disputed, and how it came out
Each issue the panel decided, with the reasoning it gave. An outcome is what this panel did on this record — not a rule, and not a prediction.
The policy did not contain a pre-approved limiting or restricting endorsement excluding applicant from coverage; the Certificate of Liability Insurance did not indicate applicant was excluded; credibility determinations favored applicant.
From the decision · page 7Pursuant to the arbitrator's opinion, there has been no finding of AOE/COE or any issues of permanent or temporary disability. This arbitration was solely limited to whether the applicant was covered on the alleged date of injury of August 30, 2019.
The facts that decided it
What the panel treated as outcome-determinative, and which side it favoured.
The Certificate of Liability Insurance did not indicate that applicant was excluded from coverage; the exclusion checkbox was blank.
Favours Applicant prevailed
This documentary evidence supported that applicant was covered by the policy on the date of injury.
From the decision · page 7Applicant's attorney, in his response to the Petition for Reconsideration, relies on their Exhibit A, which is a Certificate of Liability Insurance which does not indicate that the applicant is excluded from coverage. In fact, under number A on the Certificate of liability Insurance there is no indication that any proprietor, partner, or executive officer member is excluded. That checkbox is blank indicating to the arbitrator that this sole proprietor was in fact covered. This coverage would make Norguard Insurance Company responsible on the applicant's alleged date of injury.
The policy did not contain a pre-approved limiting or restricting endorsement excluding applicant from coverage.
Favours Applicant prevailed
Without such an endorsement, the policy was not limited and applicant was covered.
From the decision · page 4II. The terms of workers' compensation policies issued in California are governed by statute, and each policy is conclusively presumed to contain all the provisions required by law. (Ins. Code, § 11650.) Workers' compensation insurance policies in California are subject to regulation by the Department of Insurance. (Ins. Code, § 11651, 11657, 11658.) Beginning in 1967, endorsements that limit or restrict coverage of workers' compensation policies are subject to prior approval by the Insurance Commissioner. (Cal. Code of Regs., tit. 10, § 2261, 2262.) In addition, all workers' compensation policies must "contain a clause to the effect that the insurer will be directly and primarily liable to any proper claimant for payment of...compensation." (Ins. Code, § 11651.) The policies in question do not contain a pre-approved limiting and restricting endorsement excluding applicant from coverage. Accordingly, the policies are not limited. Furthermore, we have given the arbitrator's credibility determinations great weight because the arbitrator had the opportunity to observe the demeanor of the witnesses. (Garza v. Workmen's Comp. Appeals Bd. (1970) 3 Cal.3d 312, 318-319 [35 Cal.Comp.Cases 500, 504-505].) We conclude there is no evidence of considerable substantiality that would warrant rejecting the arbitrator's credibility determinations. (Id.)
Applicant was the sole employee and paid premiums for the policy.
Favours Applicant prevailed
It would be unjust enrichment for the insurer to collect premiums and not provide coverage.
From the decision · page 7Also, it would certainly be unjust enrichment if the applicant were excluded from a policy from which he paid premiums if the policy did not cover anyone as the defendants allege. The applicant was the only employee of the applicant OBA Countrywide Router and Plumbing.
The rules the panel named
Authorities as the decision cited them, with how this panel applied each one.
Ins. Code, §§ 11650, 11651, 11657, 11658; Cal. Code Regs., tit. 10, §§ 2261, 2262
Workers' compensation policies must contain all provisions required by law and are subject to regulation; endorsements limiting coverage require prior approval; insurer is directly and primarily liable to any proper claimant.
The policy did not contain a pre-approved limiting or restricting endorsement excluding applicant from coverage, so coverage was not limited.
From the decision · page 4II. The terms of workers' compensation policies issued in California are governed by statute, and each policy is conclusively presumed to contain all the provisions required by law. (Ins. Code, § 11650.) Workers' compensation insurance policies in California are subject to regulation by the Department of Insurance. (Ins. Code, § 11651, 11657, 11658.) Beginning in 1967, endorsements that limit or restrict coverage of workers' compensation policies are subject to prior approval by the Insurance Commissioner. (Cal. Code of Regs., tit. 10, § 2261, 2262.) In addition, all workers' compensation policies must "contain a clause to the effect that the insurer will be directly and primarily liable to any proper claimant for payment of...compensation." (Ins. Code, § 11651.) The policies in question do not contain a pre-approved limiting and restricting endorsement excluding applicant from coverage. Accordingly, the policies are not limited. Furthermore, we have given the arbitrator's credibility determinations great weight because the arbitrator had the opportunity to observe the demeanor of the witnesses. (Garza v. Workmen's Comp. Appeals Bd. (1970) 3 Cal.3d 312, 318-319 [35 Cal.Comp.Cases 500, 504-505].) We conclude there is no evidence of considerable substantiality that would warrant rejecting the arbitrator's credibility determinations. (Id.)
What proof carried it
The evidence the panel weighed, by kind.
Applicant's credibility was found persuasive, especially as to being the sole employee.
From the decision · page 7The applicant's credibility was found to be persuasive especially as to the fact that he was the sole employee of the applicant OBA Countrywide Router and Plumbing.
Certificate of Liability Insurance did not indicate applicant was excluded from coverage; checkbox for exclusion was blank.
From the decision · page 7Applicant's attorney, in his response to the Petition for Reconsideration, relies on their Exhibit A, which is a Certificate of Liability Insurance which does not indicate that the applicant is excluded from coverage. In fact, under number A on the Certificate of liability Insurance there is no indication that any proprietor, partner, or executive officer member is excluded. That checkbox is blank indicating to the arbitrator that this sole proprietor was in fact covered. This coverage would make Norguard Insurance Company responsible on the applicant's alleged date of injury.
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About this page
- A published decision of the California Workers' Compensation Appeals Board, taken apart by what it turned on. The Board publishes the decision itself; this page adds the extraction and quotes the passage behind every claim.
- The injured worker is not named here, and the case caption is not printed. Physicians appear as the decision names them, because a medical opinion is an act in a public proceeding.
- Issues, outcomes and weights were extracted by AI and released only where the source passage checked. Read the official decision before relying on anything here. Not legal advice.
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