HomeMy WebLinkAbout1991-07-09; City Council; 11244; SETTLEMENT OF WORKERS COMPENSATION CLAIM OF DAVID KELSO. SETTLEMLXT OF WORKERS
COMPENSATION CLAIM OF DAVID KED0
Approval of Resolution No. 7 I -317 approving the Stipulations with Request for Award 1
authorizes the payment of $7,315, at the rate of $140 per week, to David Kelso as settler
of his workers compensation claim.
ITEM EXPLANATION
This matter arose on July 23, 1989 when the claimant, a firefighter, suffered a work relat
injury when he slipped off of a fire truck and struck his knee. He sustained a contusion
the medial femoral condyle (a severe bruise) of the right knee. He has been receiving
medical treatment since the date of the injury.
The claimant’s condition has stabilized and he is now permanent and stationary. He is
continuing to work in his usual and customary occupation as a firefighter. However, he 1
permanent disabilities which inhibit his ability to lift heavy objects, as before the injury, a
suffers moderate knee pain after some activities.
His medical reports were submitted to the State Division of Workers Compensation, Off
Benefit Determination, for evaluation.
The permanent disability rating which they provided, as well as the need for possible futi
medical treatment, have been incorporated into the settlement agreement which has bee:
submitted for consideration.
The claimant and HCM Claim Management Corp., the City’s Third Party Administrator,
agreed on the terms and conditions contained in that agreement.
It is Staffs recommendation that the Stipulations with Request for Award be approved.
FISCAL IMPACT
The cost of the settlement is $7,315, excluding possible future medical treatment. If sucl
treatment is required, the City will be obligated to pay those expenses. There is no met1
for predicting what those costs may be. There are sufficient funds available in the Work
Compensation Self-Insurance Fund to cover the cost of this settlement.
Resolution No.
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RESOLUTION NO. 9 1 - 2 17
A RESOLUTION OF THE CITY COUNCIL OF THE CITY OF CARLSBAD, CALIFORNIA,
AUTHORIZING THE EXPENDITURE OF FUNDS FOR SETTLEMENT OF THE WORKERS
COMPENSATION CLAIM OF DAVID KELSO
WHEREAS, HCM Claim Management Corp., the Third Party Administrator for
City of Carlsbad, has recommended a settlement in the Workers Compensation case of
David Kelso; and
WHEREAS, there are sufficient funds available in the Workers Compensation Si
Insurance Fund to pay the settlement,
NOW, THEREFORE, BE IT RESOLVED by the City Council of the City of
Carlsbad, California, as follows:
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That the above recitations are true and correct.
That the expenditure of $7,315 from the Workers Compensation Self-
Insurance Fund is authorized for the settlement of said case.
That the Council accept the Stipulations with Request for Award, attache
hereto as Exhibit 2.
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PASSED, APPROVED AND ADOPTED at a Regular Meeting of the Cii
Council of the City of Carlsbad on the gth
vote, to wit:
day of Ju1Y . 1991, by the following
AYES:
NOES: None
Council Members Lewis, Kulchin, Larson, Nygaard and
ABSENT None
ATiEST
ae;da/. p- ALETHA L. RAUTENKRANZ, City C1 rk
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0 * EX1 WORKERS’ COMXNSAT~CN APPEALS 80Am
STATE OF CALIFORNIA .
Case No. Unassigned \
A pp i iCUd
Davi2 Kelso Stipulations
with Request
VS. €or Award
City of Carlsbad.
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Dqe&nts
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The pmes hereto sepulate to the issuance oi an .*ward and/or Order, based upon the foilowing fact:
waive the requirements oC Labor Code Section 5.313:
1. 3avid Kelso , born 03-21-49 < Enpioyee I
A 7 - If empioyeli within the State oi California as c “2 Engineer on JI 23-39
\ Occupanon ! Date oi !~tury)
s.2 L
L-Lv of Carlsbad whose mmpensatlon insurance carric
sustained injury arising out of and in the course of ernpioyment t3 rFqht :
7-27-39 through 7-31-89 and
( Employer) OY
XY Claim Xcpt.
?PnS Of body IEjUI
2. The injury caused temporary disability for the period
8-28-89 for which indemnity is payable at S 224.00 hrough
week, less credit for such payments previousiy made. ( fu? ly compensated 1
3. ne i..jw caused permanent &abihty of IS I/%, for which indemnity is payable at S ’’O.’
per week be,o;inning fort;rwith , in he sum of s 7 r 315 - 00 , less credit io.
payments previousiy made.
,b lnfonnai rating has w been previously issued.
( Selccc one)
4, There- may be need for medical treatment to cue or relieve from the effects Of said 1
...-..-.. -.. - ! Select one)
Upon dewar limited to injury herein mentioned, defendan& has; L5d,&i{Gito
t authorize or show gccd cause for denial. licant tacid authority .to secu~e -&atever 9e-t is n&ssd iqGL+i
Cure or relieve the effects of injury.
Failure to.do s~,sh+ll 2iye app- ’-i .,
------...- , ::1 >,~ARTYCH OF . Hi TRIAL RE
.. DIVISIOY OC IMDUJTRIAL AC a---.. 4- _I .=.-I 1 ;..;..J
j 3 8 *j?q Jd3
?=-==a OIA WCA3 P3RX 3 (eSY. S-7S) ( Pa3e I) sza I
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WORKERS’ qMPENSATION APPEALQBOARD
STATE OF CALIFORNIA
5. ?.fedical-legzl e,Tenses are payable by deienaant as ioihws: ??one
4. .ipplicant’s attome!’ requesi a fee of S N/A
-- i. Liens against cumpsztion are payable as foilows: ~one
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.S. ether stipulanons:
Parties aqree to waive interest 3n the Award if
.- .. n ,ais :.;rtnin 20 days of sertrice.
L - 4- 97’
-3 &E * 9,avid els so
1200 Calrsbad Village Dr.
373-76-1246 Carlsbad, Ca 97008
Sociai Securiv Number of .Applicant .iddress oi Employer
1171 Phillips Dr. 3954 Nurphy Canyon Xd. $D; Vista, Ca 92083 San Diego. c1- a 9717-1
.iddress of .ipplicznt riddress of Insuran
X/A -
N/A San Diego, Ca 92123
.A.ttomev for Applicant Attorney or Authorized Rhresentative for De - 3954 lrurpny Canyon Rd. %D2C
.iddress of .xttorney or .iucnorized ReDresenta
- -..- - -__, ..._ . . x-7
.Address of .-ittome? for .iTpiicmt
.*--. .,-...;diLdGs,j
I .-. -. . . . . . DEPARTWENT OF INDUSTRS41
3iA WCi3 ioaw 3 (3Sv 5.751 (Page 2) :$ij u 8 15yj DIVISION OF IHOUSTRIAI
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