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Home My WebLink About1990-08-28; City Council; 10793; Workers comp claim settlement - J.H. Kordisy3 4B# /4 7 DEPT. RM \IITGm 8/28/90 RECOMMENDED ACTION: TITLE: SETTLEMENT OF WORKERS COMPENSATION CLAIM OF JO Approval of Resolution No. % -31 f approving the proposed Compromise and Release which authorizes the payment of $32,500 to Joel H. Kordis as settlement in full of his various workers compensation claims. ITEM EXPLANATION Mr. Kordis is a former Carlsbad Police Officer who sustained numerous injuries during the course of his employment with the City. Those injuries involved his back, neck, shoulders, wrists and hands. The Compromise and Release was negotiated by Attorneys representing the City of Carlsbad and Mr. Kordis. The agreement releases the City from all liability for injuries already sustained and for benefits which may arise as the result of any subsequent injury or reinjury, including those sustained in any rehabilitation program. The right to future medical treatment is also waived by Mr. Kordis. However, the right to request and receive future rehabilitation benefits is specifically reserved to Mr. Kordis. If he chooses to request such benefits in the future, the City will be obligated to provide them. It is Staff’s recommendation that the Compromise and Release be approved. FISCAL IMPACT The total cost of the settlement, excluding possible future rehabilitation benefits, is $32,500. If Mr. Kordis decides to enter a rehabilitation program, the City will be obligated to pay for the cost of that program as well. There is no method for determining what those costs may be. Rehabilitation programs normally include the costs of training the claimant for a new occupation and the payment of temporary disability benefits during the course of the training period. Sufficient funds are available in the City’s Workers Compensation Self-Insurance Fund to cover the cost of this settlement and any future costs which may be incurred as the result of a rehabilitation program. EXH IBlTS 1. Resolution No. % -378 2. Compromise and Release 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 RESOLUTION NO. 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 ie City of Carlsbad in this matter, has recommended a settlement in the Vorker’s Compensation case of Joel H. Kordis; and WHEREAS, there are sufficient funds available in the Worker’s :ompensation Self-Insurance Fund to pay the settlement, NOW, THEREFORE, BE IT RESOLVED by the City Council of the City of :arkbad, California, as follows: 1. 2. That the above recitations are true and correct. That the expenditure of $32,500 from the Worker’s Compensation ielf-Insurance Fund is authorized for the settlement of said case. 3. That the Council accept the Compromise and Release, attached iereto as Exhibit A. 1 2 2 4 5 6 7 E 9 1c 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 PASSED, APPROVED AND @OPTED at a Regular Meeting of the City €ouncil of the City of Carlsbad on the 28th day of August . 1990, by the following vote, to wit: AYES: NOES: ABSENT: ATTEST: Council Members Lewis, Larson and Pettine None Council Members Mamaux and Kulchin BTATL OF CALlFOANlA DEPARTMENT OF INDU8TRIAL RELATlONf WORKERS COMPENSATION APPEALS WAR0 COMPROMISE AND RELEASE PLIE'u~ it ~NSTRUCTIONS ON c DlVlSlON OF INDUSTRIAL ACCIDENTS CASE NO. SEE ATTACHED PAOE 1-4 &EVLRSC OF ChGE 2 OtFORI COMPLETINO *WORM SOCIAL SECURITY NO. 550-90-3592 P.O. Box 2102. JOEL H. KORDIS San Marcos, CA 92069 ACCUCIII -IN 1200 Carlsbad Village Drive. CITY OF CARLSBAD Carlsbad, CA 92008-i989 BIERLY AND ASSOCIATES San Diego, CA 92111 7750 Daggett Street, Suite 112, connsc? NAY Q swnovmn connccr NAY. oc tNstmmus cmnun AWIgSS '. The injured employee claims that while employed as a Off cer IOCCWATION AT ny. o. INJW~ on SEE ATTACHED PAGE 1-A Carlsbad (5) San Diego California , by the employer (s)he sustained injury arising out of and in the course of employment to SEE (DATR OT mmmn ICIW (*?Am PAGE '-A (WAIL WIT CARTS oc BODY wens INJWIDI 2. The parties hereby agree to settle any and 011 claims on account of said injury by the payment of the sum of t 32 V 500 a O0 in oddition to any sums heretofore paid by the employer or the insurer to the employee, ku amounts set forth in Paragraph No. 6. 3. Upon approval of this compromise agreement by the Workers' Compenlation Appeals Board or a workers' compensation judge and poyrnent in accordance with the provisions hereof, said employee releases and forever discharges said employer and insurance carrier from all claims ond causes of don, whether now known or ascertained, or which may hereafter arise or develop as a result of said injury, including any and 011 liability of said employer and said insurance carrier and each of them to the dependents, heirs, executors, representatives, administrotors or assigns of said employee. 4. Unless otherwise expressly provided herein, approval of this agreement RELEASES ANY AND ALL CLAIMS OF APPLICANT'S DEPENDENTS TO DEATH BENEFITS RELATING TO INJURY OR INJURIES COVERED BY THIS COMPROMISE AGREEMENT. The parties have considered the release of these benefitr in arriving at the sum in Paragraph No. 2. 5. Unless otherwise expressly ordered by a workers' compensation judge, approwl of this agreement DOES NOT RELEASE ANY CLAIM APPLI- 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. 10.) 4/27/54 Maxi mum Not Applicable PAYMENTS MADE BY EMPLOYER OR INSURANCE CARRIER $0.00 $196.00 $1,986.00 $25,597.60 -ny1*.w USAWLITV INM- roIu UUNCAL AND HOSPITAL ILU BENEFITS CLAIMED BY INJURED EMPLOYEE meam"a AND wlm mms oc ALL - ow oum m IS war YDlCu M HOWIU .Lu CIL) Dr -*.I Same As Above None Known TOTu -u CJo ppp(Y None Kn own ullllirm - -AL UICU.. None Solely by Applicant ToBePaidBv: Solely by Applicant THE FOLLOWING AMOUNTS ARE TO BE DEDUCTED FROM THE SETTLEMENT AMOUNT: Carrier Permanent t PAYABLE TO t t PAYABLE TO i PAYABLE TO t PAYAW TO t PAYABLE TO 1 ,986.00 CREDIT Disability Advancas 8 . *. .I 6 , ks approved attomay fee (% Paragraph No. 9, payable to OpplKOnt. (If payment is to be 30,514.00 LEAVING A BALANCE OF $ ofher than in a lump sum, or there is additional informotion, specify on separate pa&).) DIA WCAB FORM IS (REV. low (PA- 1) . 67 97793 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 SD 103150 (4) 87 SDO 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) 4/5/87 (5) 5/2/87 (6) 9/14/81 to 4/5/87 (7) 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 . 1 -A COMPROMISE AND RELEASE AGREEMENT RE: JOEL H. KORDIS CASE NOS. 83 SD 80572, 85 SD 95342, 86 SO 103150, 87 SDO 113344, 87 SDO 113865, 87 SO0 114321, 87 SDO 119087, 87 SDO 119086 10. Reason for Compromise: There are serious and reasonable issues as to the nature, extent, and duration of permanent disability, if any; the kind, need, frequency, and quality of future medical treatment that may be required, if any. Pursuant to the case of Carter v County of Los Anqeles. et al, 51 C.C.C. 255, the defendant employer and the carrier herein are released from any liability for workers’ compensation benefits that may arise from any subsequent injury or re-injury during any phase of the rehabilitation process which is the direct consequence of the injuries alleged in Paragraph #1 of this agreement. It is understood that this waiver does not, in any way affect Applicant’s right to receive vocational rehabilitation benefits which are, or may be, due to the injuries alleged in Paragraph 81 of this Compromise and Release. Nothing contained herein abrogates Defendant’s right to raise QIW as an issue in any subsequent rehabilitation proceeding. Legal counsel for the respective parties have reviewed the medical reports submitted in this case, the opinions and conclusions of the doctors as set forth in those reports and the subjective complaints of the Applicant as set forth in those reports. After assessing the information, the parties feel that the figure indicated in Paragraph #2 is a fair and equitable settlement of this case and have decided to resolve these questions in dispute and any and all other questions relative to this injury which may exist now or may arise in the future and avoid the hazards and del ays of 1 i ti gati on. The parties do intend to include in this Compromise and Release all of the provisions of Paragraph #4 of this agreement. It is further agreed that if the Order Approving Compromise and Release is paid within twenty-five (25) days of its date of issuance, interest thereon shall be waived. LAW OFFICES OF SCOTT A. O’MARA Attorney for Applicant KORDIS, Applicant 1 -B . 7. ths'hot nwntiomd in Parogro h No. 6 3 b. dis Md of os followst D.fond8nt h8n p8ld or Wpl1 p8y the lion orJohn 8. Kltchln, M.D. in the mount Of $920.00 and tho lion of Hortn 6 Wo8torn 1.110 ~nnurmnco ~ompany/~l~nica~ Phy81C81 Thorapy in ttm amount of $2,193.32. -w & - HuWI~~'S ~L~AS hCL*OC tKLn p<u.c4 dLkl7drY 8. For thhid punuont to the Unemployment Insurance Code or for hn%s furnikd by lien claimants &fined in Lobor Code S.C. 4903.1, the pa&s propose reduction of the lien claim(&) in occordance with formulae moched. r 9.. Applicant's (employee's) Onormy requests a fee of S , Amount of attorney fee previously paid; if any, $ b' 10. Reason for Compromise, rpociol provisions regarding rehabilitation and de& benefii claims, and additional information: 5It App\;-nkcwwrUy sec5 tc ha d+vEVI'CXP[j Q&fr,I/CkjL: r.5cci-i A. O'Mwcc $31GO.'-0 a,?cLv;& -rh,stk 44 8 03 11. H is agreed by all parties hereto that the filing of this document is the filing of an application on behalf of the employee, and that the WCAB 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 he facts admitted herein, and that if hearing is held with this document used as an application the defendants shall. have available to them all defenses that were available as of the date of filing of this document, and that the WCAB may thereafter either approve said Compromise Agreement and Release or disapprove the same and issue Findings and Award after hearing has been held and the matter regularly submitted for decision. SIGNAWL YUST U All'ESTSD W TWO DI-ISRD CU- A WOTUV -. BY crm STATE OF CALIFORNIA JEROME H. KATSELL 1 ATTORNEY FOR DEFENDANT County of On thb hY of AD., 19 -, before me, a Notary Public in and for the sard County and State, residing therefn, duly commCrJioned and sworn, persmNy appeared known to me to be the person-whose name subscribed to the within Instrument, and llcknMuledged to me that -he- executed the same. IN WITNESS WHEREOF, I haw hereunto set my hand and affixed my official seal the day and year in this Certificate first ah written. Notory Pd4c In ond fa rordCounty ond Sta:e of cOhforn4a C-QMPROMISE AND RELEASE PLE wt.;H~ 'INSTRUCTIONS ON .AEVERSE OF phot 2 BEFORE COMPLETING PORM 8TATC OF CALIFORNIA DEPARTMENT OF INDUSTRIAL RELATION3 ' DIVISION OF INDUSTRIAL ACCIDENTS - CASE NO,SEE ATTACHED PAOE 1-A WORKERS COMPENSATION APPEAL3 BOARD SOCIAL SECURITY NO. O- O- P.O. Box 2102, JOEL H. KORDIS San Mar-cos, CA 92069 ACMANT mYPLOVIIl 1200 Carlsbad Village Drive. CITY OF CARLSBAD Carlsbad, CA 92008-igag 7750 Daggett Street, Suite 112, connacT NAU oc wwoyin BIERLY AND ASSOCIATES San Diego, CA 92111 COIILCY NAY1 OP INSUIIAIICI CAllIlCI ADDICBS IOCCWAT~ AT nut or wun 1. fie injured employee claims thot while employed os o Off cer on SEE ATTACHED PAGE 1-A at Carlsbad (5) San Diego , California , by the employer IDAYE OC INJtJIYI IClPr) ISTAW (@he sustoined injury arising out of ond in the course of employment to SEE ATTACHED '-A (ETAYE WHAT PARTE DF 6ooV WERE INWILD) 2. The porties hereby agree to settle any and all claims on account of soid injury by the poyment of the sum of $ 32 t 500 ' O0 in oddifion to any sums heretofore paid by the employer or the insurer to the employee, less amounts set forth in Poragroph No, 6. 3. Upon opprovol of this compromise agreement by the Workers' Cornpenration Appeals Board or o workers' compensation judge ond poyment in occordonce with the provisions hereof, said employee releoses and forever discharges said employer ond inruronce corrier from oll claims ond causes of action, whether now known or oscertoined, or which moy hereofter orise or develop os o resuh of soid injury, including ony and all liability of said employer and said inruronce carrier and each of them to the dependents, heirs, executors, representatives, odministrotors or assigns of wid employee. . 4. Unless otherwise expressly provided herein, opprovol of this agreement RELEASES ANY AND ALL CLAIMS OF APPLICANT'S DEPENDENTS TO DEATH BENEFITS RELATING TO INJURY OR INJURIES COVERED BY THIS COMPROMISE AGREEMENT. The parties have considered the releose of these benefits in arriving at the sum in Paragraph No. 2. 5. Unless otherwise expressly ordered by o workers' compenscrtion judge, approval of this ogreemcnt DOES NOT RELEASE ANY CLAIM APPLI- CANT MAY NOW OR HEREAFTER HAVE FOR REHABILITATION OR BENEFITS IN CONNECTION WITH REHABILITATION. 6. The parties represent thot the following facts ore true: (If facts ore disputed, state whot each party contends under Porograph No. 10.) DATE OC URYH ACTUAL EARNINGS AT TIYE OF INJURY IAST DAY ocr WORN we TO THIB IWUY 4/27/54 Maxi mum Not Applicable PAYMENTS MADE BY EMPLOYER OR INSURANCE CARRIER TCYCOIAIV DISADIUlT INDEYNm WEULY RAY€ PERIODS COVERED $0.00 $196.00 $1.986.00 $25.597.60 PEIYANENT USAEILITI INDEYNITI TOTAL MEDICAL AND HOSPITAL DIU BENEFITS CLAIMED BY INJURED EMPLOYEE DEOINNINO AND KNDINO DArCS OC AU r(ll00S OCT DUK TO ?MIS IWUY UCDCU AND HOUlTAL DILU CAI0 BV LYROYKK ToBePaidBy: Solely by Applicant ToBePaidBy: Solely by Applicant THE FOLLOWING AMOUNTS ARE TO BE DEDUCTED FROM THE SETTLEMENT AMOUNT: Carrier Permanent t PAYABLE TO t s PAYABLE TO i PAYABLE TO t PAYABLE TO t PAYABLE TO 1 \ 986.00 CREDIT Disability Advances z ,. ,,- - , less approved attorney fee (See Paragraph No. 9). payable to applicant. (If poyment is to be 30,514.00 LEAVING A BALANCE OF $ other than in o lump sum, or there is odditianal information, specify on seporate poge(s).) DIA WCAB FORM 18 (REV. 1083) (PAGE 1) E1 91193 I COMPROMISE AND RELEASE AGREEMENT CASE NOS. 83 SD 80572, 85 SD 95342, 86 SD 103150, RE: JOEL H. KORDIS 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 SD 103150 (4) 87 SDO 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) 4/5/87 (5) 5/2/87 (6) 9/14/81 to 4/5/87 (7) 5/1/87 (8) 4/19/87 PARTS OF BODY INJURED: Right Upper Extremity Left Upper Extremity Right Wrist Back, Neck, Right Shoulder Back, Neck, Right Shoulder Upper Extremities, Back, Neck, Right Shoulder Right Wrist, Shoulder, Neck and Back Right Wrist, Shoulder, Neck and Back . 1 -A COMPROMISE AND RELEASE AGREEMENT RE: JOEL H. KORDIS CASE NOS. 83 SD 80572, 85 SD 95342, 86 SD 103150, 87 SO0 113344, 87 SDO 113865, 87 SO0 114321, 87 SDO 119087, 97 SDO 119086 10. Reason for Compromise: There are serious and reasonable issues as to the nature, extent, and duration of permanent disability, if any; the kind, need, frequency, and quality of future medical tr,eatment that may be required, if any. Pursuant to the case of Carter v County of Los Anqeles, et al, 51 C.C.C. 255, the defendant employer and the carrier herein are released from any liability for workers’ compensation benefits that may arise from any subsequent injury or re-injury during any phase of the rehabilitation process which is the direct consequence of the injuries alleged in Paragraph #1 of this agreement. It is understood that this waiver does not. in any way affect Applicant’s right to receive vocational rehabilitation benefits which are, or may be, due to the injuries alleged in Paragraph #1 of this Compromise and Release. Nothing contained herein abrogates Defendant’s right to raise QIW as an issue in any subsequent rehabilitation proceeding. Legal counsel for the respective parties have reviewed the medical reports submitted in this case, the opinions and conclusions of the doctors as set forth in those reports and the subjective complaints of the Applicant as set forth in those reports. After assessing the information, the parties feel that the figure indicated in Paragraph #2 is a fair and equitable settlement of this case and have decided to resolve these questions in dispute and any and all other questions relative to this injury which may exist now or may arise in the future and avoid the hazards and delays of litigation. The parties do intend to include in this Compromise and Release all of the provisions of Paragraph #4 of this agreement. It is further agreed that if the Order Approving Compromise and Release is paid within twenty-five (25) days of its date of issuance, interest thereon shall be waived. LAW OFFICES OF SCOTT A. O’MARA SCOTT . O’MARA Attorney for Applicant KORDIS, Applicant 1-B I_ ,7, beniwi mentioned in Paragra h No. 6 a be dit oted of as followcI Defendant ham pmid or n P 11 pay th. lion or John 8, Kitchin, M.0. In tho , Jnt Of $820.00 and tho lion of Horth Western Life In~uranco Company/Clinlcal Phy#ical Therapy in the mount of $2,183.32. ' -- L @' 1 lh. b-tcuk~cu~'s hen5 hcuT bun ycud a( .1.- r)(b 8. For thmaim(s) filed for benefita paid pursuant to the Unemployment Insurance Code or for*ben?ts furnihd by lien claimants defined in labor Code Sec. 4903.1, the parties propose reduction of the lien claim(s) In accordance with formulae attached. A' ' 00 * 9. Applicant's (employee's) attorney requests a fee of $3- . Amount of attorney fee previously paid; if any, $ r I 10. Reason for Compromise, special provisions regarding rehabilitation and death benefit claims, and additional information: E ATTACHED PAGE 1-B b. 11. h is agreed by all parties hereto that the filing of this document is the filing of an application on behalf of the employee, and that the WCAB 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 the facts admiiied herein, and that if hearing is held with this document used as an application the defendants shall have available to them all defenses that were available as of the date of filing of this document, and that the WCAB moy thereafter either approve said Compromise Agreement and Release or disapprove the same and issue Findings and Award after hearing has been held and the matter regularly submitted for decision. WE A?CUCAM'S (L E'S1 SIGNANIS WST BE ATTESTED BY TWO MSINTUESTLD -SON* BY JEROME H. KATSELL DATU STATE OF CALIFORNIA 1 ATTORNEY FOR DEFENDANT Cwnty of On thts day of A.D., 19 -,before me, a Notary Public tn and for the said County and State, restdtng therefn, duly commisdoned and sworn, personally appeared known to me to be the person- whose name- subsertbed to the within Instrument, and acknowledged to me that &-executed the same. IN WTNESS WHEREOF, 1 haw hereunto set my hand and afjtxed my oj&iaI seal the day and year in thts Ceritficaie firsi ohme wrtlten. Noiary PuMic tn and for raidCouniyand %re of Cblifornia DIA WCAB FORM 1S (RN. 1983) (PAQIE