HomeMy WebLinkAbout1993-05-04; City Council; Resolution 93-126c ll a 0
1 RESOLUTION NO. 93-126
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A RESOLUTION OF THE CITY COUNCIL OF THE
CITY OF CARLSBAD, CALIFORNIA,
AUTHORIZING THE EXPENDITURE OF FUNDS
FOR SEITLEMENT OF THE WORKERS
COMPENSATION CLAIM OF DAVID MITCHLEY
5 11 WHEREAS, HCM Claim Management Corp., the Third Party Administrator for the
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City of Carlsbad, has recommended a settlement in the Workers Compensation case of
David Mitchley; and
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Insurance Fund is authorized for the settlement of said case. 15
2. That the expenditure of $11,620 from the Workers Compensation Self- 14
1. That the above recitations are true and correct. 13
Carlsbad, California, as follows:
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
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3. That the Council accept the Stipulations with Request for Award, attached
hereto as Exhibit 2.
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Council of the City of Carlsbad on the 4th day of MAY 1992, by the following 2
PASSED, APPROVED AND ADOPTED at a Regular Meeting of the City
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AYES: Council Members Lewis, Stanton, Kulchin, Nygaard, Fil
NOES: None
ABSENT None
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ATIEST
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CLAUDE A. LE\jirIS,'Mayor
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.j QPP-14-1993 14:42 FROM GILLETTE-SDO TD P. a;
,?. 0 5 0 EXHIBIT 2 %
\ WQRKEkS’ COMPENSATION APPEALS BOARD
SAl€ OF CALIFORNIA
SDO’ 172389 CaseNo. SDO 172390
Stipulatlons
wlth Request
David Mitchley
vs. for kwdltd
City of Carlsbad, P.S,I.;
% HCM Claim Management Corporation
urn- }
The oarties hereto stipulate to the issuance of an Award andlor Order. based upon the fOlbW1q Pacts
waive th6 requirenwltv of Lamr Coae Sectlon %la
1. David Mitchlev ,born 9/22/51 {FIWllW> 6/30/90 6r enrployeci within the State of cailfornia ss-FireXqhter on 6/30/89 - 6/301
by City sf Carl.sbad WhbS6 compensatiull hwrance ca Permissibly Self--xed
% HCM Claim suetalnod injury arising out of and in Lhe wurve 01 employment = Management Carp, mms 01 dDeyW)umd
2. The tnjury causeu temporary $isability for the period Fully COmpenSated -
COwpscrm) -
ttlrougn , for which indemnity is Payable at SL-CS 4 8 5 0
week, 1635 Credit t0t such paymentspreviouslymaUe.
3. The injury caused permanent Ulsability Of 2 2-1 / 2 X. lor which ih-mnity is payable at SX.-!!iL”
perweekbeginning 4/13/92 ,Inthesumof$ 11.620,.00 , tess crem
PayffMtS previously made.
An informal rating MI4 has not b6sn previously issued. ~serea one)
4. There BX PE~K (‘%kt m6J
may be need for medical treatment to cure or relieve
VWL WWW FORM 3 LRW. 9401 (Page 1)
from the effects of sail
DCNATMCMOFlHbUmWAl
ONISION OF INDUmULAC
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QPR-14-1793 14:42 FROM GILLETTE-SDO TO Y.&
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k, r 1 - WORK# ;' COMPENSATION hxms BOARD
STATE OF CALIFORNIA
5. MeeicaWe $1 expenses are payable b defendant as farlow to be a83uoted or pakd Ly defendant w&hM~@~i&?t!ion reserved k M.D. (8al.anct
WCAB) 1
6 Agpncant's attorney request a fee of s / 3 Q qt 00
7. Liens against compensation are payable as fallours: None
a Otherstipuiations: A) It is further understood and agroed that the aforesaid sum shall be deemed to include such mterest as is prc by Labor Code Section 5800, if gaid within thirty (30) days
8) The parties have thoroughly investigated and reviewed the permanent disability preclusions imposed by the treating and eva ting physicians and in aqreement that this 8tipul.ation at 23-l/i is based solely upon the presuasive opinion expressed by Dr. Thc
The parties further stipulate that they have rejected the apportionment prescribed by Dr. Thompson based upon the applicar ability to return to his earlier assigned.duties and perform thc fully until his injury on 6/30/90. The parties further agree tl Mitchley is capable of performing his usual and customary dutie: stated,by fhe QUs, he is not a qualified injured worker and ma! 45?!2,/?3 rnA+ David Mitchley ".
inue 1 hls usual occupatmn.
-. Wlicsnt U
1200 Carlsbad Village brim
570-84-1873 Carlsbad, CA 92908 Social Securltyffumber of bollcant Address of Employer
4084 Thomas Street 3954 xlrlurphy Canyon Road, S-D2( Ocew-ide. CA 92056 - _Carlabad, CA 92008 Adaress of Insurance mwany
Charles J. Mof
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Attorney for Applicant Attorney or Authorized ~w~e~entative tor vetenam
2330 Third Avenue 7851 Mission Center Court, Su San Diego, CA 92101-1514 Sal1 Dieqo, CA 9 2108 Adaress of Attorney tor Applicant AdureSS of Attorney or Autnor~Zed Representative
LWCWWFoRy3tREVq9.86) (Page 21 OEPARhrrENT OF INDUPrrrUL RE
KiMSIOW OF INOUmlAL AC
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