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Home My WebLink About1992-10-20; City Council; 11927; Authorizing Funds for Settlement of Workers Compensation Richard Szabad0 0 ex: < 9 & .. z 2 a b $ z 3 0 0 Cl.0 OF CARLSBAD - AGENW BILL -y$-,. DEPT. TITLE: SETILEMENT OF WORKERS’ AB# I1 qd? MTG..~WWZ COMPENSATION CLAIMS OF RICHARD CITY A CITY k DEPT. RM RECOMMENDED ACTION: Adopt Resolution No. 9 k*3i2approving the Compromise and Release which authorizes the payment of $18,000 to Richard Szabad. SZABAD ITEM EXPLANATION The claimant is a former Police Officer in the Carlsbad Police Department. He was employed by the City for a period of 14 years prior to his resignation in 1991. The terms and conditions of the proposed settlement are set forth in the Compromise and Release (Exhibit 2). The terms and conditions were agreed upon by the attorney representin, the claimant and the attorney representing the City, and have been approved by HCM Claim Management, the City’s Third Party Administrator. The settlement is intended to include all claims that the claimant may have as a result of his employment with the City, pertaining to the injuries set forth in the Compromise and Release. FECAL IMPACT The cost of the settlement is $18,000. There are sufficient funds available in the Workers’ Compeiisation Self-Insurance Fund to cover the cost of this settlement. EXHTBITS 1. Resolution No. (j a-316 2. Cornpromise & Release $ 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 0 0 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 WHEREAS, Mr. Charles Loof, Defense Counsel for the City of Carlsbad in this matter, has recommended a settlement of the Workers Compensation claims of Richard Szabad; and WHEREAS, there are sufficient funds available in the Workers Compensation Sell 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 $18,000 from the Workers Compensation Self- Insurance Fund is authorized for the settlement of said claims. That the Council accept the Compromise and Release, attached hereto as Exhibit 2. 3. I 1 2 3 4 5 6 7 8 9 10 11 12 13, 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 0 e PASSED, APPROVED AND ADOPTED at a Regular Meeting of the City >unci1 of the City of Carlsbad on the Yiote, to wit: 20th day of OCTOBER 1992, by the following AYES: NOFS: None ABSENT: None Council Members Lewis, Kulchin, Larson, Stanton, Nyga< ATTEST ALETHA a L. RAUTENKRANZ, 5c? Rh* City C1 rk I 1. 91 2. 91 3. 91 CASEN0.4* 91 e- 'JJL Exhibit 2 STATE OF CALIFORNIA DEPAATMNT OF INOUSTRIAL RELATIONS W RKERS' COMPENSATION APPEALS BOARD 0 COMPROMISE AND RELEASE - PLEASE SEE INSTRUCTIONS ON REVERSE OF PACE 2 BEFORE COMPLETING FORM u & H ~D'OIVISION OF WORKERS' COMPENSATION SEP 14 1949 SOCIAL SECURITY NO. 554-' 41 Oak Ridge Drive Maumelle, AR 72113 Richard Szabad CHARLes ' "OF 1200 Elm Avenue city of Carlsbad, P.S.I. Carlsbad, CA 92008 3954 Murphy Canyonv62d, Sui im Manaaement CorDoration San Dieqo, CX 92123 HCM Cla ADORES *Pww tEUPLOYEE1 CORRECT WE OF EYPLOYER CORRECT NU€ OF INSUWCEURRIER MOUES pi0 edasa Police Officer ' T~'i~Yk"P%~~Y~"I~~a"-'43'~~~ 9 r; (OCCUPATION ATTIME OF INJURY) 10/9/90-8/20/91; 12/9Qt Carlsbad CA LSfAEl on (slhe sustained injury arising out of and in the course of employment to Back I Right Knee I Left Eye rn tioa 1 State, Both Wrists, Gastro-Intestinal, '~$!f%~?ff~~f#~ Ex%emiLs. 2. The parties hereby agree to settle any ana all claims on account of said injury by the payment of the sum oft 18 t 0' in addition to any sums heretofore paid by the employer or the insurer to the employee. leSS amounts Set forth in Parag 3 Upon approval of this compromise agreement by the Workers' Compensation Appeals Board or a workers' compensation in accordance with the provisions hereof, said employee releases and forever discharges said employer and insurai claims and causes of action. whether now known or ascertained. or which may hereafter arise or develop as a re! including any and all liability of said employer and Said insurance carrier and each of them to the dependents. representatives. administrators or assigns of said employee. 4 Unless otherwise expressly provided herein. approval Of this agreement RELEASES ANY AH0 ALL CLAMS OF APPLICAH DEATH BENEFITS RELATING TO INJURY OR INJURIES COVEREO BY THIS COMPROMISE AGREEMNT. The parties hat release of these benefits in arriving at the sum in Paragraph No 2 5 Unless othervise expressly ordered by a workers' compensation judge, approval of this agreement DOES NOT RELEA' CANT MAY NOW OR HEREACTER HAVE FOR REHABILITATION OR BENEFITS IN CONNECTION WITH REHABILITATION. 6 The parties represent that the followng facts are true. (If facts are disputed. state what each party contends ur (DATE OF INJURY) (ClW ACTUAL EbRNlNCSATTIUE OF INJURY UST MY OFF WK DUE 1 DATE Of 81RW 3/2/53 urn DisDuted PAYMENTS MADE BY EMPLOYER OR INSURANCE CARRIER EUWRIRY OlYBlLlTV INDEYNITY MEKLY RAE PERIODS COWERED Fully Compensated in this Settlement per Labor Code PERUANENT DlSABlLlTT INOEUNlTT TOTU YEOlCU liN0 HOSPITAL BILLS Zero $7 $522.73 BENEFITS CLAIMED BY INJURED EMPLOYEE EEClNNlNC AN0 ENOiNG MES Of *u PERlOOS OFF DUE 10 THri INJURY Fully Comtsensated in this Settlement Per Labor Code TOTALUNPIJDYEOIC*LANOHOSP(TILOBE~ None, to be Paid all b y thaniurrEo FUTURE UED~CU D(PENS€ 10 RE pAl~ BY. Applicant Except as Per Paragraph 7 THE FOLLOWING AMOUNTS ARE TO BE DEDUCTED FROM THE SElTLEMENT AMOUNT: MEOIW AND HOSPITAL eus wo w EYPLC' None TOBE PAIOBV: Applicant PAYABLE TO S PAYABLE TO 6 s PAYABLE TO b PAYABLE TO PAYABLE TO S PAYABLE TO s LEAVING A BALANCE OF $ 1 8 I 0 0 0 0 0 , less approved attorney fee (See Paragraph NO 9). payable to applic be other than in a lump sum. or there is additional information, spacity on separate page@). 1 LESS ANY PERMANENT DISABILITY ADVANCES MADE THROUGH THE DAw%sl?&! $E? 11 THE ORDER APPROVING COMPROMISE & RELEASE. e *. wi,, adiUs+ a 7 Liens not mentioned in Paragraph NO t J to be disposed of as followDefendan Dr, we1 Sandweis4 t tAe lien of WxMa~(Knoxs jg tf !mdatedTl0/92. ser ' PW rp 8 For the purpose of determining the lien claim(s) filed for benefits paid Pursuant to the Unemployment Insurance Code furnished by lien claimants defined in Labor Code SeC 4903.1, the parties Propose reductron of the lien claim(s) in a formulae attached. Not Applicable 9 Applicants (employee's) attorney requests a fee oft -6 0. 00 Amount of attorney fee previously paid. if any, 10 Reason for Compromise. special provisions regarding rehabilitation and death benefit claims, and additional informatior 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 ernp WCAB may in its discretion set the matter for hearing as a regular application. reserving to the parties the right to the facts admitted herein. and that if hearing is held with thrs document Used as an application the defendants sh; them all defenses that were available as of the date of filing of this document. and that the WCA8 may thereafter Compromise Agreement and Release or disapprove the same and issue Findings and Award after hearing has been regularly submitted for decision. Witness the sfgnaNre hered thrs day Or WITNESS WllNESS THE APPLICANTS [EYPLOYEE'S) SIGNATURE WIJS BEATTESTED BY Two DISlMERESlED Oersons OR ACICNOWXDGEO BEFORE A NOTARY PUBLIC. Charles J. Loof, Esq. for L;cc&*lcc' L*.& fdf5 ' ,k' ).,J jfi - **.w 5 STATE OF GAWOWA couniyol e .3 :LL& onthrs v a dayd AD., 19 3.2 , beforeme, LWhGCd &Jhzk 7 a Notary Public in and for the said Couniy and State. residing therein, ~commtss~oned and smm, personalW aPPeareC *! known to me to be the person - subscribed lo the wntlun lnstnmrent. and ac&nubhW b ire ttWt-he- executed the Same. lN WTmESS MR€OF, I haw hereunto set my hand &74 aft& my nffcial seal lhe day and year in ttus cerbf written. wse name - 7w-f ZtnCwL $€ u 1 I h- ' tl"P 141 11 n mf -) (pm 0 && ut--- ,& amSc.teoiC.r(om. 0 0 APPL1CANT:RICHARD SZABAD COMPROMISE AND RE~EZ CASE NO. :91 SDO 157907: 91 SDO: 91 SDO: 91 SDO This settlement includes any and all claims for medic temporarydisability, vocational rehabilitation tempor: disability and reimbursements through the te of I Order Approving Compromise and Release. It is further understood and agreed that the aforesi sum includes interest as provided by law for a period twenty-five (25) days from the date of service by . Workers' Compensation Appeals Approving Compromise and Release. DEATH BENEFIT CLAIM WAIVER: The applicant has been advised and fully understands tl this Compromise and Release Agreement releases any i all claims of any dependents to potential death benef relating to the injury or injurie@Fr;,t by tl Compromise and Release Agreement. A reasonable and substantial dispute exists between parties as to: Nature and extent of the applican disability, both temporary and permanent; need for pa present, and future medical treatment; reimbursement self-procured expenses; etc. Rather than risk uncertainties of litigation, the parties wish to set this claim, and all its esent yd potential issues, a lump sum certain. - XX E) RODGERS SETTLEMENT: [Roduers vs. WCAB (19851, 49 Cal. Cornp. Cases 5611 As part of the consideration for this Compromise Release, applicant forever releases the defendant f any liability arising out of future injuries that mi occur during vocational rehabilitation and compensable consequence of the original injury. Init: - XX F) A serious and reasonable issue exists as to in] - XX A) m"Lk Initia - XX B) "Owe Or' Initial - xx C) In i t ia 1 s, - XX D) 4,- Initia 22 to the applicant's psyche and internal systems. A! arising out of the employment and/or occurring in course of the employment as to the allegations of Initj PAGE 2-A RFWI'C" j SEp 17 I! e 0 COMPROMISE AND RELEASE RE: Richard Szabad Page Two 7 XX G) THOMAS VS. SPORTS CHALET FINDING REQUESTED (REGARD PSYCHE AND INTERNAL SYSTEM INJURIES ONLY): Please see attached Addendum regarding reque t for Tho Finding that applicant has settled all PO ial rig to vocational rehabilitation benefits. An authorized representative of the City of Carlsbad k issue and forward to the Public Employees Retiren System a Decision certifying that applicant substantially incapacitated from performingthe dutie his position of police officer due to the aggravatio~ his left eye condition and that the left eye aggraval causing such incapacity arose out of and in the coursi his employment with the City of Carlsbad as set fort1 the ophthalmology rep ofpnce K. Wozniak, M.D. d, February 20, 1992. &- - xx H) * Initik s DATE: 9-f- 92- APPLICANT : "-g2 4- DATE: <-; /{2 io 2 APP'S ATTY: PAGE 2-A(i) Rfr.F \\I S€? : 2 .a. 0 e 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/C01 applicant's psyche and internal systems which, if decided aga: the applicant, could defeat all of the applicant's rights benefits under the Labor Code, including those of Labor 1 Section 139.5 for vocational rehabilitation. The parties there request that the trier of fact carefully review the evidence make a finding in accordance with Thomas vs. Sports Chalet, 42 625. The parties acknowledge that applicant will be barred receiving any benefits if the AOE/COE issue is resolvec defendant's favor. In support of defendant's request for a Thomas vs. SDorts CP rehabilitation waiver, defendant would offer the testimony of C Bob Vales, Captain Gene Kellogg, Lieutenant Don Lewis, Serf Matt Matney, and Sergeant Jim Byler. The testimony of 1 witnesses would concern the allegations of emotional stress 01 job resulting in injury to the applicant's psyche and intc systems. Defendants would also rely upon and offer the medical repor Mark A. Kalish M.D. (psychiatrist) dated January 15, 1992, enclosures, and also the internal medicine report of D Michaels, M.D. dated December 12, 1991. The parties recognize that a request for a Thomas Findi- appropriate when there are legitimate doubts concernin! employer's liability and the worker might receive nothing i case is pursued through trial. It is also realized that it j the intention of the Board to prohibit settlements by requir: PAGE 2-B RFW $E? + 4. * 0 4 Statement of Parties Relating to Settlement of Rehabilitation Benefits Re: Richard Szabad Page Two determination in every case of entitlement to benefits. The Bo; is asked only to determine, through a review of the recon whether a serious and good faith issue exists such as would just the release requested. Applicant, in this matter, is represented by competent experienced counsel who does support the request for a Tha Finding. It is therefore respectfully requested by the defend that the Compromise and Release, as submitted, be apprc including the requested Thomas Finding. DATE 0-F- ch APPLICANT L’d&X- I ____- - -- c-f /’ ,cr ‘L, --l ---RPFLI&~NT*S A~~TORNEY .-- -___ DATE PAGE 2-B( i) RF!F SEI