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Home My WebLink About1990-08-28; City Council; Resolution 90-318w 0 1 I1 RESOLUTION NO. 90-318 2 3 4 5 6 ~ ~ A RESOLUTION OF THE CITY COUNCIL OF THE CITY OF CARLSBAD, CALIFORNIA, AUTHORIZING THE EXPENDITURE OF FUNDS FOR SETTLEMENT OF THE WORKER’S COMPENSATION CLAIMS OF JOEL H. KORDIS. ~ WHEREAS, Mr. Jerome Katsell, of England & Hodik, Defense Counsel for I 7 orker’s Compensation case of Joel H. Kordis; and 8 he City of Carlsbad in this matter, has recommended a settlement in the gl WHEREAS, there are sufficient funds available in the Worker’s 10 11 Compensation Self-Insurance Fund to pay the settlement, NOW, THEREFORE, BE IT RESOLVED by the City Council of the City of 12 13 Carlsbad, California, as follows: 14 2. That the expenditure of $32,500 from the Worker’s Compensation 15 1. That the above recitations are true and correct. 16 17 18 19 20 21 22 23 24 25 26 I 1 Self-Insurance Fund is authorized for the settlement of said case. 3. That the Council accept the Compromise and Release, attached hereto as Exhibit A. 27 11 28 - 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 I 20 21 22 23 24 25 26 27 28 PASSED, APPROVED AND ADOPTED at a Regular Meeting of the City Council of the City of Carlsbad on the 28th day of August . 1990, k the following vote, to wit: AYES: Council Members Lewis, Larson and Pettine NOES: None ABSENT: Council Members Mamaux and Kulchin ATTEST: AJP- ALETIIA L. RAUTENKANZ, City C$rk PCK'SE kr 'INSTRUCTIONS ON COMPLETING FORM REVERSE OF PAGE 2 BEFORE DEPARTMENT OF INDUSTRIAL RELATIONS w DIVISION OF INDUSTRIAL ACCIDENTS 0 CASE NO. SEE ATTACH' - -. WORKERS COMPENSATION APPEALS BOARD SOCIAL SECURITY NO. 5 !j O- 9 O- P.O. Box 2102, JOEL H. KORDIS San Marcos, CA 92069 CITY OF CARLSBAD Carlsbad, CA 92008-1989 BIERLY AND ASSOCIATES San Diego, CA 92111 ACCUCANT IIYPLOYILI 1200 Carlsbad Village Drive, CORRECT NAYE OP IYPLOYmR 7750 Daggett Street, Suite 11 CORRECT NAY€ OF 1N.URANCE CARRIER ADDRE8E :. The injured employee claims that while employed as a Pol ice Officer mccupATm AT nur of #wan on SEE ATTACHED PAGE ?-a ot Carlsbad (5) San Diego California (DATE OF INJURI) fCITII WTAm (s)he sustained injury arising out of and in the course of employment to SEE ATTACHED PAGE "A (STfiTE -AT PART8 OF DODY WERE INJURED) 2. The parties hereby agree to settle any and all claims on account of said injury by the payment of the sum of $ 32,500. OC to any sums heretofore paid by the employer or the insurer to the employee, less amounts set forth in Paragraph No. 6. 3. Upon approval of this compromise agreement by the Workers' Compensation Appeals Board or a workers' compensation iudg accordance with the provisions hereof, said employee releases and forever discharges said employer and insurance carrier frc causes of action, whether now known or ascertained, or which may hereafter arise or develop as a result of said injury, inch liability of said employer and said insurance carrier and each of them to the dependents, heirs, executors, representatives, assigns of said employee. . 4. Unless otherwise expressly provided herein, approval of this agreement RELEASES ANY AND ALL CLAIMS OF APPLICANT'S DEATH BENEFITS RELATING TO INJURY OR INJURIES COVERED BY THIS COMPROMISE AGREEMENT. The parties ha1 release of these benefits in arriving at the sum in Paragraph No. 2. 5. Unless otherwise expressly ordered by a workers' compensation judge, approval of this agreement DOES NOT RELEASE At CANT MAY NOW OR HEREAFTER HAVE FOR REHABILITATION OR BENEFITS IN CONNECTION WITH REHABILITATION. 6. The parties represent that the following facts are true: (If facts are disputed, state what each party contends under Paragraph h DATE OF BIRTH ACTUAL EARNINGS AT nuE OF INJURY UST DAY OFF WORK WE TO THIS I 4/27/54 Maxi mum Not Appl i cab1 e PAYMENTS MADE BY EMPLOYER OR INSURANCE CARRIER TEYPORARY MSAOIUTI INDEYNm WEEKLY RATE PERIODS COVERED $0.00 $196.00 $1,986.00 $25,597.60 KRYANENT DISAIIILITY INDEMNm TOTAL YEDlCAL AND HOSPITAL BILLS - BENEFITS CLAIMED BY INJURED EMPLOYEE BEGINNING AND ENDING DATES OF AU PER1ooS OFF WE TO THIS IWWUY YEOlCAL AND HOSPITAL ILLS PAID OY EUPLOYEE Same As Above None Known TOTAL MAW Y~olcu AND HOwKAL -None Known ESnuArED FUNRE YEOKAL EXPENSE None TohPaidBy: Solely by Applicant ToBePaid By: Solely by APP' THE FOLLOWING AMOUNTS ARE TO BE DEDUCTED FROM THE SETTLEMENT AMOUNT: Carrier Permanent s 1 ,986.00 .CREDIT Disability Advances s 8 .. ', PAYABLE TO s PAYABLE TO i PAYABLE TO s *I ' PAYABLE TO . s PAYABLE TO LEAVING A BALANCE OF $ other than in a lump sum, or there is additional information, specify on separate page(s).) 30,514.00 , less approved attorney fee (See Paragraph No. 9), payable to applicant. (If f 7 DIA WCAB FORM 15 (REV. 1983) (PAGE 1) a w 0 COMPROMISE AND RELEASE AGREEMENT RE: JOEL H. KORDIS CASE NOS. 83 SD 80572, 85 SD 95342, 86 SD 103150, 87 SDO 113344, 87 SDO 113865, 87 SDO 114321, 87 SDO 119087, 87 SDO 119086 CASE NOS.: (1) 83 SD 80572 (2) 85 SD 95342 (3) 86 SO 103150 (4) 87 SO0 113344 (5) 87 SDO 113865 (6) 87 SDO 114321 (7) 87 SDO 119087 (8) 87 SDO 119086 DATES OF INJURY: (1 ) 8/21/83 (2) 10/16/82 (3) 4/12/86 (4 1 4/5/87 (5) 5/2/87 (6) 9/14/81 to 4/5/87 (7 1 5/1/87 (8) 4/19/87 PARTS OF BODY INJURED: (1) Right Upper Extremity (2) Left Upper Extremity (3) Right Wrist (4) Back, Neck, Right Shoulder (5) Back, Neck, Right Shoulder (6) Upper Extremities, Back, Neck, Right Shoulder (7) Right Wrist, Shoulder, Neck and Back (8) Right Wrist, Shoulder, Neck and Back P 1 -A .. - e COMPROMISE AND RELEASE AGREEMENT RE: JOEL H. KORDIS CASE NOS. 83 SD 80572, 85 SD 95342, 86 SD 103150, 87 SDO 113344, 87 SDO 113865, 87 SDO 114321, 87 SDO 119087, 87 SDO 119086 10. Reason for Compromise: There are serious and reasonable issues as to the nature, exter and duration of permanent disability, if any; the kind, nee frequency, and quality of future medical treatment that may required, if any. Pursuant to the case of Carter v County of Los Anqeles, et E 51 C.C.C. 255, the defendant employer and the carrier herein E released from any 1 iabil ity for workers’ compensation benefits tk may arise from any subsequent injury or re-injury during any phz of the rehabilitation process which is the direct consequence the injuries alleged in Paragraph #1 of this agreement. It understood that this waiver does not.in any way affect Applicant right to receive vocational rehabilitation benefits which are, may be, due to the injuries alleged in Paragraph #1 of tk Compromise and Release. Nothing contained herein abrogat Defendant’s right to raise QIW as an issue in any subsequc rehabilitation proceeding. Legal counsel for the respective parties have reviewed the medic reports submitted in this case, the opinions and conclusions of t doctors as set forth in those reports and the subjective complair of the Applicant as set forth in those reports. After assessing the information, the parties feel that the fig1 indicated in Paragraph #2 is a fair and equitable settlement this case and have decided to resolve these questions in displ and any and all other questions relative to this injury which n exist now or may arise in the future and avoid the hazards z delays of litigation. The parties do intend to include in this Compromise and Release E of the provisions of Paragraph #4 of this agreement. It is further agreed that if the Order Approving Compromise E Release is paid within twenty-five (25) days of its date issuance, interest thereon shall be waived. ,<.& KORDIS, d Applicant SCOTT X. O’MARA - LAW OFFICES OF SCOTT A. O’MI Attorney for Applicant 1 -B . 7. liens'hot mentioned in Paragra h No. 6 atllJbe dis sed of as followrl , Dofendant ha8 paid or wpl1 pay the lion orJohn 9. Kitchtn, H.D. In tho amt Of $920.00 and the 111 I west.& Lifm Insurance Company/Clinical Physical Therapy in tho amount of $2,193.32. -+&&+,+A 8. For the purpose of detoid pursuant to the Unemployment Insurance Code or for b by lien claimants defined in lobor Code Sec. 4903.1, the parties propose reduction of the lien claim(s) in accordance with formu 9. Applicant's (employee's) attorney requests a fee of S 3% . Amount of attorney fee previously paid; if any, $ L Llr lh * HUluvicu-Ii \La")% h-.c burr pc.id I Od 4% 10. Reason for Compromise, rpeciol provisions regarding rehabilitation ond death benefit claims, and additional information: L* Apph-flt;&oYuy 4r:S 5c Lx Cl&&(-j p&-fr..l/~*]~= \.Scott A. O'Mcc/a $3100.% a,-?Cih;& "h;stCL. 64 8 ocl .6-e '-SCLbs+it-uzt~bm GP A tt-cr JCLY s WCI s -& ~d - I 13, I gL SEE ATTACHED PAGE 1-B 11. It is agreed by all parties hereto that the filing of this document is the filing of an application on behalf of the employee, anc may in its discretion set the matter for hearing as a regular application, reserving to the parties the right to put in issue any of tl herein, and that if hearing is held with this document used as an application the defendants shall have available to them all dc available as of the date of filing of this document, and that the WCAB may thereafter either approve said Compromise Agreer or disapprove the same and issue Findings and Award after hearing has been held and the matter regularly submitted for decis day of- 19 .@E, at BY : *rpucANTiuIpLo*p) JOEL H. KORDIS LAW OFF1 S OF SCOTT A. O'MAR, " TI(€ A-IM'S iE!k&$ES) SICNANRE MUST BE ATIESTED BY TWO DISINTERESTED PERSONS -*' ' MA'A ' ATTY ' FoR AP OR ACKNOWLEDGE0 Oi2FORE A NOTARY WELIC. ND & HODIK BY STATE OF CALIFORNIA JEROME H. KATSELL 1 ATTORNEY FOR DEFENDANT County of On this day of A.D., 19 -, before me, a Notary Public in and for the said County and State, residing therein, duly commissioned and sworn, personally appeare known to me to be the person- whose nume subscribed to the within Instrument, and acknowledged to me that &-executed the same. IN WITNESS WHEREOF, I haw hereunto set my hand and affixed my official seal the day and year fn this Certij written. Notary PUMic in and jorsaidCountyand State ojCalijmfa DIA WCAB FORM 15 (REV. 1983) (PAGE 2)