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HomeMy WebLinkAbout1992-09-01; City Council; Resolution 92-2691 2 3 4 5 6 7 e 0 RESOLUTION NO. 9 2 - 2 6 9 A RESOLUTION OF THE CITY COUNCIL OF THE CITY OF CARLSBAD, CALIFORNIA, AUTHORIZING THE EXPENDITURE OF FUNDS FOR SETILEMENT OF THE WORKERS COMPENSATION CLAIMS OF MICHAEL S. VAN HOOSER WHEREAS, Mr. John W. Mullen, Defense Counsel for the City of Carlsbad in this matter, has recommended a settlement of the Workers Compensation claims of Michael S. Van Hooser; and 8 9 110 11 WHEREAS, there are sufficient funds available in the Workers Compensation Self- Insurance Fund to pay the settlement, NOW, THEREFORE, BE IT RESOLVED by the City Council of the City of 32 Carlsbad, California, as follows: :13 2. That the expenditure of $28,000 from the Workers Compensation Self- :14 1. That the above recitations are true and correct. Insurance Fund is authorized for the settlement of said claims. :15 16 :17 11 8 :19 I 2o I 3. That the Council accept the Compromise and Release, attached hereto as Exhibit 2. 21 22 23 24 25 26 ll 27 28 11 /I 0 0 1 2 3 4 5 6 7 8 9 :lo: 11 PASSED, APPROVED AND ADOPTED at a Regular Meeting of the City Council of the City of Carlsbad on the 1st day of SEPTEMBER1992, by the following vote, to wit: AYES: Council Members Lewis, Larson, Stanton, Nygaard NOES: None ABSENT Council Member Kulchin ATTEST :12 :13 :14 d&da &Em L.. 11 5 X6 :17 :18 :19 1 20 21 22 23 82 4 2 5 26 27 2 8 II 1 1 1 0- W". n - 88 SDO 730249 130250, 13025 133866, 13386 OMPROMISE AND RELEASE ..EASE ser INSTRUCTONS 3~ SATE CJP CAUCORNIA 3EPARrMENT 3s INOVSfRIAL ReUllONS OIVISION OC !NOUSTRIAL AC=:OaTs CASE NO. 89 SDO 133865 %VERSE OF P4GE 2 JEFORE 3MMN6 FORM WORKERS C3M4NSAnON APPCALJ 80~~0 SOCIAL SECURITY NO. 552-98-91 61 ZCHAEL VAN HOOSER P-0- Eax 900602, San Diego, c4 921 90 lcrcIocR 1-rLP 4001UI !ITY OF' CARLSBAD, permissibly self-li.lsured 1200 Gr-d Village Dr., Qrl-, CX 92C CoI.WX - W 1-TU rooILu :ERTZ CLAIMS MANAGEMENT [ HCYI 3954 Murphy Qnym Rd., Ste, D-205, San Dit -tZ - OC -.?GI cu1(Q 4mS.s amLJ ne iniurd empl~ycs cioimr that while empl~y+d 05 a Polrce 0ffLce.r IOCEWATWJN 4? - W 'Iucm on".I?UD SJ-SF: ADUUV.JH at Car-d q: California " 1-n Q - ICrn +, ,T& , by the empl~ our0 (r*e sustained injury arising out of and in the cours4 of m\p+tenr to F C PLEASE SEE ADDENDUM]. Thepa~h~agrntoKltleanyonaafldaim~~c#+w~of~dinjuy~~epPymcnrof~e~umoff~~~~O~-~~ in add: to any sums heredore poid by theemployer or the insurer )o th empioyeu, less amounts set forth in Porngraph No. 6. Y tmATR -A? *- OC .QoI - -1 _. -. -. ..- . .. -. Upon approval of this compromise agrnmant by the wofktsn' brnpsntorion Appeoir Bo~rd or a worken' compmsotion idge and p~l~me accordance with the provisions hereof, said employee mieases and forever dizdraqes soid employer and Mum~s carrier from all &im causes of adon, whether now known or asctrtained, or *idr may he arise or deveiop as a result of said injury, incfuding oy anc Iiibiri of said empfoyer and said imumncs carrier and euch of rh~m to rha dependents. hein, CXUU~OK, repmmtorives, admin-r . .,A:: . . ,#' Unless ohrwise cxpmdy provided herein, approval of this agmmmt RELEASES ANY AND AU CLAIMS OF APPLICANT'S DEPENDEMS DEATH BENEFiTS RELATING TO INJURY OR INJURIES COWED BY THIS COMPROMISE AGREEMENT. The p& hove considerrd reb of .Ihesa bench in orriving at the sum in Pomgroph No. 2. Unks otherwise expressly ordered by a worken' comperndon iudge. approval of rhb agrement DOES NOT RELEASE ANY UAlM AP =ANT MAY NOW OR HEREAFTER HAVE FOR REHABILIfAflON OR BENfffTs 1N CONNECTION WITH RWAEJUTATION. %e pam'a represent hat rhe following facts are true: (If fads are disputed. stota whut each paw contends under Paragraph h. 10.) . ., -. . . . . . - . . . . . . . '. - . ..- , ". . . _. :.:- I . . ~~ ... . . _c ~ . ". assigns of soid rmployaa. .. - ."" .- .. . - . " ,_ .. -. oA7x w Irn rcluILLlllrro.ATraYOprJurr USTMT~~DurOTN8yuull 09/04/54 maximum in dispute 'MMS MADE BY EMR- OR INSURANCE CARRIER " DI- I* lrsuant to trfirevious Fmdings anrrward issued in this case, payment has ka~~ove ze- -t DUrSYant to Findinus and Award. -LI *A- - spn ma e U wlth the excer>tion of a remainins dispute on amlicant's "r 04- 1- mu - uo ".I1 .w eligibility for "4850 Time". IEFITS CLAIMED BY INJURED EMPLOYE -YO-OA~WAU-OC.OUTQ+*rS-T rcDc*c AN0 *OSnTA.L .4u CUO ST CMDLOm litional TTD/4850 Time claimed. No additional claims are beinq mal L -- "- - ""Ia& - none presented "-"- in dispute % Paid BY: Please see #I 0. To Be Paid By: Please see #lo. MUOWING AMOUNTS ARE TO BE DEDUCT= FROM THE SETTLEMENT AMOUNT: * PAYABLE TO f PAYABLE TO PAYABLE TO . - -I J PAYABLE TO __ -z "A f r- !3: .. - PAYABLE TO 5 PAYABLE TO ,. . - .._ - -. 4ING A BALANCE OF 5 2 8 r Oo0 a o o , less approved morney fee (See Paragraph No. 9). payable to applicon?. (If payment is to ! * than in a lump sum, or there is additional information. speciiy on separme page(s).) .e . . 0 7. tiam cmt mantionad in Paragmph NO. 6 are to be dirwsad of as follow- PIXASE SEE ADDENDUM - ~~ 8. For the purpose of determining rho lien claim(s) filed for benefits paid pursuant to the Unemployment Insurance Code or for bcneij h by lier, claimants deiined in Labor Code Sac. 4903.1, *e parries propp red 'on of he lien cfaim(s) in accordance with formulae QnaC E 23a 4&J LPG& ,-B I Amount of ~arnay fee prcvioudy paid, if any, S ?bf, A 9. Appkant's (employee's) a"omey requets a fee of S bo. R-1 for Compmmi*, special provisions regarding rahabiiitation and death benefit daims, and odditionai informotion: PLEASE SEE ADDENDUM 1. It is agreed by all POI+= hereto that *e filing of this document is the filii of 4 application on behalf of the employee, and thd the "ry m itr discretion set the mer for heariq QI a WIar applicotion, rtKning to the parties the right to pd in iswe any of the foas ac herein. and that if hearing is heId with *is dacumerrt d as an appkdan the defendane hull have uvailable to hem all defenses thc uvailobie as of the date of filing of this document. and that the WCAB may her& either approve said Compromise Agrment and F or diipprove the we and issa~e findings and Award after hearing. hus been held ond the m&r rcgularfy submitted for decision. day of - &. (2 ,199-qat -_PCP A g2-L ,3BAU &4- U 7F-QsL c.% 4!,t -- Mxchael Van Hooser Scott A. O'Mara, Applxant's Atty. L "r a -s 1-n -~Jw= uuzl u A- .rn*a asmnmsmu msows )R y;ua.laryDarcn~rprrrrrvu~ John W, Mullen, Derendants'. Atty,. STATE OF CALIFORNIA bunty of 1 -In :his --day of -4. D., 19 -. before me, Notary Public in and for the said County and Stare. reslding therein, duly commissioned and sworn. personally appeared . .. A --- "" _c ~ L - mown to me to be the person- chose name ~*l- lbscribed to the within instrument. and acknowledged to me thnt Ae, executed the same. V W7TN&SS WHEREOF. I hace hereunto set my hand and aj'fized my ojficia! seaf the day and year in this Czrrrficate firs: s 'rif fen. - "f .. c - " ..-\ - .- Ct .-. - ., w a ADDENDUM TO COMPROMISE h RELEASE Re: Michael Van Hooser v. City of Carlsbad WCAB No.: 88 SDO 130249, 130250, 130251; 89 SDO 133865, 133866, 133867 """"""""""""----"""""~"""""~""""~""~ 1. Dates and Parts of Body. In jured: CASE NO. DATE OF INJURY PARTS OF BODY a) 88 SDO 130249 09/19/77 back b) 88 SDO 130250 10/08/78 back c) 88 SDO 130251 07/11/87-07/11/88 hearing, internal [gastritis; colitis] d) 89 SDO 133865 08/17/83 right wrist e) 89 SDO 133866 07/07/87 ribs, back, neck f) 89 SDO 133867 09/23/81 right knee 7. Liens: The employer has made an effort to pay/adjust all medical bills pursuant to the previously issued Findings and Award. The Appeals Board will retain jurisdiction of those liens that have been incorporated within the Findings and Award and the employer ,will be solely responsible for those liens referenced in the Findings and Award. with the Appeals Board to retain jurisdiction on the same: applicant to be held.harmless. 10. Reason for Compromise: It is noted that the underlying "normal issues" have been :resolved pursuant to the Findings and Award that previously issued in the above-cited matter. The Findings and Award has. been paid, however, there remains additional disputes with respect to the applicant's eligibility for payment of additional disability benefits pursuant to Labor Code Section 4850. Additionally, there are disputes with respect to some of the collateral expenses that the applicant may have sustained during the course of his vocational rehabilitation effort. Additionally, this settlement is intended to include essentially and all claim that the applicant may have as a result of his employment with the City of Carlsbad, pertaining to the injury or injuries set forth in the Findings and Award or pleadings er Le 8%""" -tz&2"L *, with the exception of the --. rovfsions for future medical care that have been provided to the - More specifically, all claims for injury to all body parts-., . ;$ applicant within the Findings and Award that previously issued. ... - .. 1- -7 - " - J. " .. - _. 0 Addendum Continued ... m Re: Michael Van Hooser v. City Of Carlsbad WCAB No.: 88 SDO 130249, 130250, 130251; 89 SDO 133865, 133866, 133867 Page 2 """"""""~""""-----""-"""""~""""""------- mentioned in the pleadings or medical record are to be resolved within the terms of this settlement, however, the applicant is retaining his eligibility for future medical care as otherwise provided in the Findings and Award issued by Judge Dietterle. AS it pertains to Labor Code Section 139.5, the parties agree and stipulate that the applicant has been successfully retrained and that the employer's obligation for retraining has essentially been satisfied. The parties anticipate a rehabilitation "plan" to be submitted to the Rehabilitation Bureau and in anticipation of that effort the partics concurrently agree that with the payment of the monies as otherwise set forth within this settlement agreement, the applicant will have been compensated in full for all benefits available to him under Labor Section 139.5 as a result of .the injury or injuries suffered herein. This settlement is intended to include any claim for interest or penalties on otherwise accrued benefits up through and including thirty (30) days after the order issues approving this settlement agreement. This settlement is intended to include any claim applicant's dependents may have for potential death benefits stemming from the injury or injuries mentioned herein which the applicant has sustained as a consequence of the entire tenure of his employment with the City of Carlsbad. Approval of this settlement agreement, therefore, resolves any claim applicant's dependents may have for potential death benefits. With respect to the liens of record, as otherwise addressed in the Findings and Award, the employer has "adjusted" the bulk of these bills but should there be'any outstanding liens or bills for which the employer has been obligated to make payment or adjustment, as provided in the Findings and Award only, the Appeals Board shall retain jurisdiction an these bills and liens, accordingly. DATED : -- 1 // // ;r &,/*I LA ,&&h Michael Van Hooser, Applicant DATED : /"- 1 f "tt A. O'Mara Attorney for Applicant DATED : John W. Mullen T Attorney for Defendant _. " i. ..