HomeMy WebLinkAbout1992-10-20; City Council; Resolution 92-312/I e w
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RESOLUTION NO. 9 2 - 3 12
A RESOLUTION OF THE CITY COUNCIL OF THE
CITY OF CARLSBAD, CALIFORNIA,
AUTHORIZING THE EXPENDITURE OF FUNDS
FOR SETTLEMENT OF THE WORKERS
COMPENSATION CLAIMS OF RICHARD SZABAD
5 WHEREAS, Mr. Charles Loof, Defense Counsel for the City of Carlsbad in this
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matter, has recommended a settlement of the Workers Compensation claims of Richard
Szabad; and
8 WHEREAS, there are sufficient funds available in the Workers Compensation Self-
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Insurance Fund to pay the settlement,
NOW, THEREFORE, BE IT RESOLVED by the City Council of the City of
Carlsbad, California, as follows:
1. That the above recitations are true and correct.
2. That the expenditure of $18,000 from the Workers Compensation Self-
Insurance Fund is authorized for the settlement of said claims.
3. That the Council accept the Compromise and Release, attached hereto as'
Exhibit 2.
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-* .I PASSED, APPROVED AND ADOPTED at a Regular Meeting of the City
unci1 of the City of Carlsbad on the 20th day of OCTOBER 1992, by the following 2
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4 // AYES: Council Members Lewis, Kulchin, Larson, Stanton, Nygaard
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NOES: None
ABSENT. None
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ALETHA L. RAUTENKRANZ, City C1 rk
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W STATE OF CALIFORNIA
-1 m & H S*D.DIVISION OF WORKERS COMPENSATION CASEN0.4* 91 SD
Exh-t 2 L. YL 3u 3. 91 SD COMPROMISE AND RELEASE DEPARTMENT OF INDUSTRIAL RELATIONS * PLEASE :€E INSTRUCTIONS ON
REVERSE OF PAGE 2 BEFORE
COMPLRING FORM SEP 14 199f W RKERS’ COMPENSATION APPEALS BOARD SOCIAL SECURITY NO. 554-86-
Richard Szabad c#ARLcc ’ ‘’ ‘OF 41 Oak Ridge Drive
Maumelle, AR 72113
1200 Elm Avenue APPLICANT [EMPLOYEE) ADORES
City of Carlsbad, P.S.I. Carlsbad. CA 92008
HCM Claim Manaaement CorDoration San Diego, CX 92123
CORRECT WE OF EMPLOYER 3954 Murphy Canyonvhsd, Suite
CORRECT NAME OF INSURANCECARRIER ADDRESS
’. ’r’i y’L”r9 %ap;oyy/y~ygyy: g3’yfl g r; pi0 ed asa Police Officer
(OCCUPATION AT TIME OF INJURY)
on 10/9/90-8/20/91; 12/9gt Carlsbad , CA (clnl [DATE OF INJURY) [STATE1 ,by(
(s)he sustained injury arising out of and in the course Of employment to Back r Right Knee I Left Eye I Pr
2. The parties hereby agree to settle any and all claims on account of said injury by the payment of the sum of $ 18 I 000 (
in addition to any sums heretofore paid by the employer or the insurer to the employee, less amounts set forth in Paragraph h
3. Upon approval of this compromise agreement by the Workers’ Compensation Appeals 6oard or a workers‘ compensation judge
in accordance with the provisions hereof, said employee releases and forever discharges said employer and insurance ci
claims and causes of action, whether now known or ascertained, or which may hereafter arise or develop as a result 01
including any and all liability of said employer and said insurance carrier and each of them to the dependents. heirs
representatives, administrators or assigns of said employee.
’ Exfremlhes. m tiop I State, Both Wrists l Gastro-Intestinal, ‘~4f%~!%f~~R%8%D)Ur
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 cor
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 P:
DATE OF BIRTH ACTUAL EARNINGSATTIME OF INJURY LPST DAY OFF WORK DUE TO THIS IN,
3/2/53 Maximum Disputed
PAYMENTS MADE BY EMPLOYER OR INSURANCE CARRIER
TEMPOWRY DISABILITY INOEMNIM WEEKLY RATE PERIOOS COMRED
Fully Compensated in this Settlement per Labor Code
PERMANENT OISABILtlY INDEMNITY TOTAL MEDICAL AND HOSPITAL BILLS Zero $7,522.73
BENEFITS CLAIMED BY INJURED EMPLOYEE
BEGINNING AND ENDING OAKS OF ALL PERIODS OFF DUE TO THIS INJURY MEDICAL AND HOSPITAL BILLS PAID BY EMPLOYEE
Fully Compensated in this Settlement Per Labor Code None
TOTAL UNPAIO MEDICAL AND HOSPITAL EXPENSE None , to be Paid a 11 by theSTIMATE0 FUTURE MEDICAL EXPENSE
TO RE pp,l~~y:Applicant Except as Per Paragraph 7 TO BE PAID BY Applicant
THE FOLLOWING AMOUNTS ARE TO BE DEDUCTED FROM THE SETTLEMENT AMOUNT
$ PAYABLE TO $ PAYABLE TO
$ PAYABLE TO $ PAYABLE TO
$ PAYABLE TO $ PAYABLE TO
LEAVING A BAUNCE OF $ 18 I 000 0 0 , less approved attorney fee (See Paragraph NO. 9). payable to applicant. (If F
be other than in a lump sum, or there is additional information, specify on separate page(s) . 1
LESS ANY PERMANENT DISABILITY ADVANCES MADE THROUGH THE DAWBWEP %E: THE ORDER APPROVING COMPROMISE & RELEASE. SP 17 DU WW FORM 15 (REV. UlJO) (PME 11
7. Liens not mentioned in Paragraph N m . r: to be disposed of as follows: Dpf L adwt u
tde lien of ScotXMara (Kno-
8. For the purpose of determining the lien claim(s1 filed for benefits paid pursuant to the Unemployment Insurance Code or
furnished by lien claimants defineg in Labor Code Sec. 4903.1. the parties propose reduction of the lien claim(s) in acco
formulae attached. Not Applicable
~ mxt of Dr, Samuel~andwelss serwes r
.!' %%?%%%% j~~f2~~dated~lO/9~
9. Applicant's (employee's) attorney requests a fee of $ & 160 . 00 . Amount of attorney fee previously paid, if any, $1
10. Reason for Compromise, special provisions regarding rehabilitation and death benefit claims, and additional information:
Please See Attachments
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,
WCAB may in its discretion set the matter for hearing as a regular application. reserving to the parties the right to put in
the facts admitted herein, and that if hearing is held wi.th this document used as an application the defendants shall have
them all defenses that were available as of the date of filing of this document, and that the WCAB may thereafter either i
Compromise Agreement and Release or disapprove the same and issue Findings and Award after hearing has been held ar
regularly submitted for decision.
Witness the signaiure hereof Mis day of
WITNESS
WITNESS
THE APPLICANT3 [EMPLOYEE'S) SIGNATURE MUST BE ATtESTED BY TWO DISINTERESTED persons OR ACKNOWLEDGED BEFORE A NOTARY PUBLIC. Charles J. Loof, Esq. for Defer
c;Gc&"d
STATE OF 6AEQMlA
County of @ (
on this II a day of . !/L+/c AD., 19 72 , &fore me, /dL .' L? ?&fL ',&k ,
a Notary Public in and for the said County and state, residing therein, commissioned and sworn, personally appeared
LdG& ,.&.&k 'I
known to me to be the person - whose name "
subscribed to the within Instrument, and acknculsswd to re fnar-he- executed the same.
IN WmJESS WHEREOF, I have hereunto set my hand am affM my official seal the day and year in this Certifica '
written. RrnRn,
&J ~CkQ , Azc" t3rP 1% E
DIA WCM FORM 1 S [REV. 2/so) [PAUE 21 ait;T in am tor sas C4WtYamState ~l ca~~rrni.
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APPL1CANT:RICHARD SZABAD COMPROMISE AND RELEASE
CASE NO. :91 SDO 157907; 91 SDO;
91 SDO; 91 SDO
=A) This settlement includes any and all claims for medical temporarydisability, vocational rehabilitationtemporary disability and reimbursements through the te o the Order Approving Compromise and Release. w Inltia
- XX B) It is further understood and agreed that the aforesaid sum includes interest as provided by law for a period of
twenty-five (25) days from the date of service by the Workers' Compensation Appeals Bo# ,o>pthe Order Approving Compromise and Release.
DEATH BENEFIT CLAIM WAIVER: The applicant has been advised and fully understands that this Compromise and Release Agreement releases any and all claims of any dependents to potential death benefits relating to the injury or injurie overed by this Compromise and Release Agreement.
Initial
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ZD) A reasonable and substantial dispute exists between the parties as to: Nature and extent of the applicant's
disability, both temporary and permanent; need for past, present, and future medical treatment; reimbursement for self-procured expenses; etc. Rather than risk the uncertainties of litigation, the parties wish to settle this claim, and all its potential issues, via a lump sum certain. gz-y
XX E) - RODGERS SETTLEMENT: [Rodqers vs. WCAB (19851, 49 Cal. Comp. Cases 5611
As part of the consideration for this Compromise and Release, applicant forever releases the defendant from any liability arising out of future injuries that might occur during vocational rehabilitation and compensable consequence of the original injury. m
Initial's
EF) A serious and reasonable issue exists as to injury
arising out of the employment and/or occurring in the course of the employment as to the allegations of to the applicant's psyche and internal systems. mi
Initial$
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COMPROMISE AND RELEASE RE: Richard Szabad Page Two
- XX G) THOMAS VS. SPORTS CHALET FINDING REOUESTED (REGARDINC PSYCHE AND INTERNAL SYSTEM INJURIES ONLY): Please see attached Addendum regarding request for Thomas Finding that applicant has settled all PO IE;; right$ to vocational rehabilitation benefits. I ” /--
- XX H) An authorized representative of the City of Carlsbad wil:
issue and forward to the Public Employees Retiremenl System a Decision certifying that applicant is substantially incapacitated from performingthe duties oi his position of police officer due to the aggravation oi
his left eye condition and that the left eye aggravatior causing such incapacity arose out of and in the course 01 his employment with the City of Carlsbad as set forth ir the ophthalmology rep of,Wnce K. Wozniak, M.D. datec February 20, 1992. e Initi& s
DATE : 9-f- qL/
DATE : q //.-! iu 7
APPLICANT : ~A+2 A?
APP’S ATTY: -
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Continuation of Paragraph 10 RE: Richard Szabad
REGARDING PSYCHIATRIC AND INTERNAL SYSTEM INJURIES ONLY
STATEMENT OF PARTIES RELATING TO SETTLEMENT OF REHABILITATION BENEFITS
UNDER
LABOR CODE SECTION 139.5 (THOMAS VS. SPORTS CHALET, 42 CCC 625)
A serious and good faith issue exists regarding injury AOE/COE tc
applicant's psyche and internal systems which, if decided against the applicant, could defeat all of the applicant's rights tc benefits under the Labor Code, including those of Labor Cod€ Section 139.5 for vocational rehabilitation. The parties therefore request that the trier of fact carefully review the evidence anc make a finding in accordance with Thomas vs. Sports Chalet, 42 CCC
625.
The parties acknowledge that applicant will be barred fron receiving any benefits if the AOE/COE issue is resolved ir defendant's favor.
In support of defendant's request for a Thomas vs. SDorts Chalet rehabilitation waiver, defendant would offer the testimony of Chief
Bob Vales, Captain Gene Kellogg, Lieutenant Don Lewis, Sergeant
Matt Matney, and Sergeant Jim Byler. The testimony of these witnesses would concern the allegations of emotional stress on the job resulting in injury to the applicant's psyche and internal systems.
Defendants would also rely upon and offer the medical reports of Mark A. Kalish M.D. (psychiatrist) dated January 15, 1992, witk
enclosures, and also the internal medicine report of Daniel Michaels, M.D. dated December 12, 1991.
The parties recognize that a request for a Thomas Finding is appropriate when there are legitimate doubts concerning thc employer's liability and the worker might receive nothing if thc case is pursued through trial. It is also realized that it is not the intention of the Board to prohibit settlements by requiring a
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Statement of Parties Relating to Settlement of Rehabilitation Benefits Re: Richard Szabad Page Two
determination in every case of entitlement to benefits. The Board is asked only to determine, through a review of the records, whether a serious and good faith issue exists such as would justify the release requested.
Applicant, in this matter, is represented by competent and experienced counsel who does support the request for a Thomas
Finding. It is therefore respectfully requested by the defendant that the Compromise and Release, as submitted, be approved including the requested Thomas Finding.
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DATE APPLICANT Ad?&*?-.
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DATE __"" "" "" < "- """" APPLICANT'S APTORNEY
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