HomeMy WebLinkAbout1990-10-16; City Council; Resolution 90-3770 a
L II RESOLUTION NO. 90-377
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A RESOLUTION OF THE CITY COUNCIL OF
THE CITY OF CARLSBAD, CALIFORNIA,
AUTHORIZING THE EXPENDITURE OF
FUNDS FOR THE SE'ITLEMENT OF THE
WORKER'S COMPENSATION CLAIMS OF
JULLAN ETHERIDGE
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WHEREAS, Mr. Hernan 0. Cetina, Defense Counsel for the City of Carlsbz 11 in this matter, has recommended a settlement in the Worker's Compensation case ( 8
9 Julian Etheridge; and
lo: WHEREAS, there are sufficient funds available in the Worker's Compensatic
11 Self-Insurance Fund to pay the settlement,
12 NOW THEREFORE, BE IT RESOLVED by the City Council of the City (
l3 /I Carlsbad, California, as follows:
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15 1. That the above recitations are true and correct.
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17 Insurance Fund is authorized for the settlement of said case.
2. That the expenditure of $12,000 from the Worker's Compensation Sel
I.8 I 3. That the City Council accepts the proposed terms and conditions of th
l9 1 Compromise and Release, attached hereto. I
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PASSED, APPROVED AND ADOPTED at a Regular Meeting of th
City Council of the City of Carlsbad.on the 16th day of October . 1990, by th
following vote, to wit:
AYES: Council Members Lewis, Kulchin, Larson, Mamaux, anc
NOES: None
ABSENT: None
ATTEST:
L!.&tiL R P- ALEm L. RAUTENKANZ, Ci Clerk
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COFPROMISE AND RELEASE e STATE OF CALIFORNIA 0 -, "J LLL
DEPARTMENT OF INDUSTRIAL RELATIONS 2) 89 SDC
CASE NO. 3 1 Unassi , PLEASE SEE .NSTRUCTIONS ON
4 REVERSE OF PAGE 2 BEFORE DIVISION OF INDUSTRIAL ACCIDENTS . COMPLETING FORM WORKERS COMPENSATION APPEALS BOARD
SOCIAL SECURITY NO. 461-17-
2813 Franklin Drive, #2109
1200 Eln Ave. AODRESS
JULIAN ETHERIDGE Mesquite, TX 75150
CITY OF CARLSBAD Carlsbad, CA 92008
BIERLY & ASSOCIATES San Diego, CA 92111
APPUCANT (EMPLOYED
CORRECT NAME OF EMPLOYER 7753 Dagget St. ADDRESS
CORRECT NAME OF INSURANCE CARRIER ADDRESS
1. The in'ure emp o ee cla'ms that while m toyed as a 1\ $/9)$8 2; 9/21/58
EEy% CarlsLaihe
custodian
(OCCUPATION AT TlME OF INJURY)
on 3) All periods of ot Carlsbad California me) fo (CITY) (STATEI
, bj
neck; back; hearing loss: both 1 @he sustained Injury arising out of and in the course of employment to extremities: left buttocks: and both hips. (STATE WHAT PARTS OF SODY 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 $ l2 1 o o o - o o
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 bard or a workers' compensation judge (
accordance with the provisions hereof, said employee releases and forever discharges said employer and insurance carrier from
causes of action, whether now known or ascertained, or which may hereafter arise or develop as a result of said injury, includi
liability of said employer and said insurance carrier and each of them to the dependents, heirs, executors, representatives, a(
assigns of said employee.
4. Unless otherwise expressly provided herein, approval of this agreement RELEASES ANY AND ALL CLAIMS OF APPLICANT'S DE
DEATH BENEFITS RELATING TO INJURY OR INJURIES COVERED BY THIS COMPROMISE AGREEMENT. The parties have
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 ANY
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 NO
DATE OF SIRTH ACTUAL EARNINGS AT TIME OF INJURY LAST DAY OFF WORK WE TO THIS INJ
11/21/56 Maximum In dispute.
PAYMENTS MADE BY EMPLOYER OR INSURANCE CARRIER
TEMPORARY DISABILITY INDEMNITY WEEKLY RATE PERODS COVERED
$9,952.00 $224.00 9/22/89 to 7/26/89 plus VRTD frcm 7/27/8
PERMANENT DISASIUTY INDEMNITY TOTAL MEDICAL AND nosPrAL BILLS
$483.84* $18,447.71
BENEFITS CLAIMED BY INJURED EMPLOYEE
BEGINNING AND ENDING DATES OF ALL PERIODS OFF DUE TO Tnls INJURY MEDICAL AND HOSPITAL SILLS PAID BY EMPLOYEE
Same as above, all.compensated by the C&R. None
TOTAL UNPAID MEDICAL AND nosPlTAL EXPENSE P.Tone ESTIMATED FUNRE MEDICAL EXPENSE ~n a; S~U
TO Be Paid By: Applicant To Be Paid By: APPlicant
THE FOUOWING AMOUNTS ARE TO BE DEDUCTED FROM THE SETTLEMENT AMOUNT: Defendant as credit for the $483.84 lien of O'Leno
advanced- [SEE 11 91 $
$ PAYABLE TO $ PAYABLE TO
*483 84 PAYABLE TO VRTD attorney's. fee $ PAYABLE TO
$ PAYABLE TO $ PAYABLE TO *
LEAVING A BALANCE OF $ I' f SI6 "16, less approved attorney fee (See Paragraph No. 9), payable to applicant. (If
other than in a lump sum, or there is additional information, specify on separate page(s).)
DIA WCAB FORM 15 (REV. 1983) (PAGE 1) a,
7. Liens nc? mentioned in Paragraph No. 9 > be disposed of as follows: The 11e.- w Anthony Markari
has been paid in full by the Defendant.
8. For the purpose of determining the lien claim(s) filed for benefits paid pursuant to the Unemployment insurance Code or for b
by lien claimants defined in Labor Code Sec. 4903.1, the parties propose reduction of the lien claim(s) in accordance with formu
**Requested in addition to amount of attorney fee previously received
9. Ap licant’s (employee’s) attorney requests a fee of $ 1 1 4 4 o o o * * . Amount of attorney fee previpusly paid, if an $ - 48
***%eceived as attorney fee for legal servlces rendered In the Regab.
10. Reuson for Compromise, special provisions regarding rehabilitation and death benefit claims, and additional information:
SEE ATTACHED ADDENDUM
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, an’
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 i
herein, and that if hearing is held with this document used as an application the defendants shall have available to them all d
available as of the date of filing of this document, and that the WCAB may thereafter either approve said Compromise Agree
or disapprove the same and issue Findings and Award after hearing has been held and the matter regularly submitted for deci
WITNESS the signature hereof this q+ day of
k --5j&U[G 1 /’ mw
OR ACKNOWLEDGED BEFORE A NOTARY PUBUC. STEPHEN W. WEBSTER, ESQ.
STATE OF =-X TEXAS LAW OFFICES OF JOEN W. MULLE 1 BY:
County of HERNAN 0. CETINA, ESQ.
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 appear
known to me to be the person- whose name
subscribed to the within Instrument, and acknowledged to me that _he-executed the same.
IN WlTNESS WHEREOF, 1 have hereunto set my hand and affixed my official seal the day and year in this Certi written.
Notary Public in and for said County and State of California
DIA WCAB FORM 15 (REV. 1983) (PAGE 2)
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ADDENDUM TO COMPROMISE & RELEASE (JOINT)
Re: Julian Etheridge v. City of Carlsbad
WCAB Case No. 89 SDO 134404;
89 SDO 134405; Unassigned
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10. Continued...
A serious dispute exists as to the nature and extent of tl applicant's disability, periods of temporary disability, if an1 parts of the body injured, and need for future medical care. TI defendants wish to buy their peace, the applicant desires a lur sum, and both parties desire to avoid the hazards and perils (
litigation and resolve all issues involved in this case by way ( this Compromise and Release.
The parties have considered the release of applicant, dependent's death benefits in arriving at this agreement, ai call that to the attention of the Judge.
In the event the applicant wants to participate
vocational rehabilitation at some future date and is found to 1
a qualified injured worker, applicant expressly waives a:
potential claim for ordinary compensation benefits and medic
treatment for any injury that may be sustained whi participating in vocational rehabilitation in compliance wi CARTER, et al., v. COUNTY OF LOS ANGELES, et al., 51 CCC 2
(WCAB en Banc 1986).
This settlement is a complete settlement of all vocation rehabilitation temporary disability and total tempora disability which may be due to date.
In further consideration of payment of aforesaid su
applicant agrees that there will be no claim of penalty
interest on the sums provided herein, so long as payment is ma
thirty (30) days from receipt of the Order Approving Compromi and Release by defense counsel.
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DATED:
DATED: @ 7 40
DATED: HERNAN 0. CETINA, ESQ.