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HomeMy WebLinkAbout1990-10-16; City Council; 10870; Workers comp claim settlement - J. Etheridge.. z 0 F 0 a A 0 z 3 0 0 RECOMMENDED ACTION: Approval of Resolution No.p3f7 approving the terms and conditions of the proposed Compromise and Release which authorizes the payment of $12,000 to Julian Etheridge as settlement in full of his various worker’s compensation claims. ITEM EXPLANATION This case arose as the result of injuries which were sustained by the Applicant, Julian Etheridge. Mr. Etheridge was a Custodian in the Building Maintenance Department. He sustained injuries to his neck, back, lower extremities, buttocks and hips and suffered hearing loss. The terms and conditions of the proposed Compromise and Release were negotiated by the attorneys representing the Applicant and the City of Carlsbad. The Applicant is specifically waiving any rights that he may have to future medical treatment for his injuries. However, the Applicant is not waiving his right to rehabilitation benefits and is specifically entitled to request the same in the future. It should be noted that the Applicant has already successfully completed one rehabilitation program and that he is currently employed in his new occupation. It is staffs recommendation that the proposed Compromise and Release be approved. FISCAL IMPACT The cost of the Compromise and Release will be $12,000, excluding any future rehabilitation benefits which may be required. There is no method for accurately calculating or predicting what the cost of any future rehabilitation benefits may be. Sufficient funds are available in the Worker’s Compensation Self-Insurance Fund to cover the cost of this settlement. EXHIBITS 1. Resolution No. $8-3r?: 2. Proposed 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. 0-3 A RESOLUTION OF THE CITY COUNCIL OF THE CITY OF CARLSBAD, CALIFORNIA, AUTHORIZING THE EXPENDITURE OF FUNDS FOR THE SETIZEMENT OF THE WORKER’S COMPENSATION CLAIMS OF JULIAN ETHERIDGE WHEREAS, Mr. Hernan 0. Cetina, Defense Counsel for the City of Carlsbad in this matter, has recommended a settlement in the Worker’s Compensation case of Julian Etheridge; and WHEREAS, there are sufficient funds available in the Worker’s Compensation Self-Insurance Fund to pay the settlement, NOW THEREFORE, BE IT RESOLVED by the City Council of the City of Carlsbad, California, as follows: 1. 2. That the above recitations are true and correct. That the expenditure of $12,000 from the Worker’s Compensation Self- Insurance Fund is authorized for the settlement of said case. 3. That the City Council accepts the proposed terms and conditions of the Compromise and Release, attached hereto. 1 2 3 4 5 6 7 a 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 PASSED, APPROVED AND ADOPTED at a Regular Meeting of the . 1990, by the City Council of the City of Carlsbad on the 16th following vote, to wit: day of October AYES: Council Members Lewis, Kulchin, Larson, Mamaux, and Pettine NOES: None ABSENT: None ATTEST: ALETHA L. JOINT 2) 89 SDG 134405 STATE OF CALIFORNIA DEPARTMENT OF INDUSTRIAL RELATIONS DIVISION OF INDUSlRIAL ACCIDENTS COFPROMISE AND RELEASE CASE NO. 3) Unassiqned , PLEASE SEE .NSTRUCTIONS ON REVERSE OF PAGE 2 BEFORE COMPLETING FORM WORKERS' COMPENSATlON APPEALS BOARD SOCIAL SECURITY NO. 461-17-1166 2813 Franklin Drive, #2109 1200 Elm Ave. JULIAN ETHERIDGE Mesquite, TX 75150 ADDaSS ACCUCINT immmovm ,CITY OF CARtSBAD Carlsbad, CA 92008 COIIECT NAYS OF LUPLOYRR 7753 Dagqet St. BIERLY & ASSOCIATES San Dieqo, CA 92111 CORRECT NAME OF INSURANCE CARRIER ADDREIS custodian IOCCUPATION AT TIME O? INJURY) 1. The 'n'ure emp o cla'ms that bile loyed as a i\ s(/9)ifr il 9/21/8v , by the employer 3j Ail'periohs bf ' at Carlsbad California on EIWI ISTATI @he sustained, erl\ew%rf2Ea$he c= Y injury arising out of and in the course of employment to neck; back; hearing loss; both lower (STAR WUAT CART5 OF BODY WERE WJURED) extremities; left buttocks; and both hips. 2. The parties hereby agree to seiile any and all claims on account of said injury by the payment of the sum of $ l2 ' 000 to any sums heretofore paid by the employer or the insurer to the employee, less amounts set forth in Paragraph No. 6. in addition 3. Upon appioval of this compromise agreement by the Workers' Compensation Appeals Board or a workers' compcnsotion judge and payment in accordance with the provisions hereof, said employee releases and forever discharges said employer and insurance carrier from all claims and causes of action, whether now known or ascertained, or which may hereafter arise or develop as a result of said injury, including any and all liability of said employer and said insurance carrier and each of them to the dependents, heirs, executors, representatives, administrators 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 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 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 pa? contends under Paragraph No. 10.) ACTUAL EARNINGS AT TIME OF INJURY LAST oAr occ wom Due TO Tnis INJURY DATE or mimn 11/21/56 Maximum In dispute. PAYMENTS MADE BY EMPLOYER OR INSURANCE CARRIER Tmmnini LnaA~iuTI INDEMN~ WCI)(LY RATS C-S covcnco $9,952.00 $224.00 9/22/89 to 7/26/89 plus VXTD from 7/27/89 to 11/30 8 PERMANENT DISABIUW INDEYNIW TOTAL MWCU AND HOSPITAL BIW $483.84* $18,447.71 BENEFITS CLAIMED BY INJURED EMPLOYEE BEGINNING AND ENDING DATES oc ALL -S OCT we TO mia IWT MEDICAL AND HOSPITAL BILLS PAID BY EMPLOY- Same as above, all compensated by the C&R. None TOTAL UNPAID MEDICAL AND nosmTAL w.w.. None ESTIMATED Cwnc MEDICAL EXPEN- 1 A ai S -9 U E e TO Be Paid By: Applicant THE FOLLOWING AMOUNTS ARE TO BE DEDUCTED FROM THE SETTLEMENT AMOUNT: To Be Paid By: APDlicant Defendant as credit for the $483.84 lien of O'Leno & Fiebster advanced- [SEE 11 91 s *483.84 PAYABLE TO VRTD attorney's fee PAYABLE TO s PAYABLE TO s PAYABLE TO s PAYABLE TO s PAYABLE TO * LEAVING A BALANCE OF $ other than in a lump sum, or there is additional information, specify on separate pagds).) ' 516 *'I6, less approved attorney fee (See Paragraph No. 9), payable to applicant. (If payment is to be DIA WCAB FORM 1 S (REV. 1983) (PAGE 1) I I I 7. Liens w* mentioned in Paragraph No. 6 a > be disposed of as folkm: The 'Ien Antnony 'Iarkarian' M*D 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 benefits furnished by lien claimants defined in labor Code Sec. 4903.1, the parties propose reduction of the lien claim(s) in accordance with formulae attached. . **Requested in addition to amount of attorney fee previouslv received. - - - - 9 Ap licant's (employee's) morney requests a fee of $ 44 O0** . Amount of attorney fee previously paid, if an S 83 84*** ***%eceived as attorney fee for legal services rendered in the Retab. Proceedin( 10. Reason for Compromise, special provisions regarding rehabilitation and death btnefii 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, 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 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 hereafter 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. (DATE1 STEPHEN W. WEBSTER, ESQ. (DATE1 'EBSTER, ESQ. (DATEI STATE OF EX&"I)s TEXAS LAW OFFICES OF JOHEJ W. IlULLEM 1 BY: County of ~ HERNAN 0. CETINA, ESQ. (DA': On this day of A.D., 19 -, bef0l.e me, a Notary Public iq and for the said County and State, residirig therein, duly commissioned and sworn, personally appeared known to me to be the person- whose name subscribed to the within Instrument, and acknowledged to me that -he- executed the same. IN WITNESS WHEREOF. 1 have hereunto set my hand and affixed my official seal the day and year in this Certificate first aboct written. DIA WCAB FORM 1s (RN. lS831 (PAQC ?) Notary Public in and for sard County and State of Califom& t $ ADDENDUM TO COMPROMISE & RELEASE (JOINT) Re: Julian Etheridge v. City of Carlsbad WCAB Case No. 89 SDO 134404; 89 SDO 134405; Unassigned 10. Continued... A serious dispute exists as to the nature and extent of the applicant's disability, periods of temporary disability, if any, parts of the body injured, and need for future medical care. The defendants wish to buy their peace, the applicant desires a lump sum, and both parties desire to avoid the hazards and perils of litigation and resolve all issues involved in this case by way of this Compromise and Release. The parties have considered the release of applicant's dependent's death benefits in arriving at this agreement, and call that to the attention of the Judge. In the event the applicant wants to participate in vocational rehabilitation at some future date and is found to be a qualified injured worker, applicant expressly waives any potential claim for ordinary compensation benefits and medical treatment for any injury that may be sustained while participating in vocational rehabilitation in compliance with CARTER, et al., v. COUNTY OF LOS ANGELES, et al., 51 CCC 255 (WCAB en Banc 1986). This settlement is a complete settlement of all vocational rehabilitation temporary disability and total temporary disability which may be due to date. In further consideration of payment of aforesaid sum, applicant agrees that there will be no claim of penalty or interest on the sums provided herein, so long as payment is made thirty (30) days from receipt of the Order Approving Compromise and Release by defense counsel. DATED: DATED: v2 48 DATED: HERNAN 0. CETINA, ESQ.