HomeMy WebLinkAbout1992-10-20; City Council; 11929; WORKERS COMPENSATION CLAIM SETTLEMENT PROPOSAL FOR ROY PEIRSONSETTLEMENT PROPOSAL FOR ROY
RECOMMENDED ACTION:
Approval of Resolution No. ?z- 3’ approving the proposed Stipulations with Request for
Award which authorized the payment of $5,215 at the rate of $140.00 per week to Roy
Peirson as settlement of his workers compensation claim.
ITEM EXPLANATION
Roy Peirson is a Police Officer currently employed by the City. He was injured on 12/18/90
when he slipped on an unstable ground surface and sustained a tear of the left lateral media
meniscus (knee), requiring orthoscopic surgery.
Mr. Peirson’s condition has stabilized and he has been declared permanent and stationary. I
must avoid frequent or repetitive kneeling, squatting and negotiation of rough or uneven
The proposed settlement was negotiated by Mr. Peirson’s attorney and HCM Claim
Risk Management is recommending approval of the proposed settlement.
FISCAL, IMPACT
The cost of the settlement is $5,215 excluding possible future medical treatment. If such
treatment is required, the City will be obligated to pay those expenses. There is no method
for predicting what those costs may be. There are sufficient funds available in the Workers
Compensation Self-Insurance Fund to cover the cost of this settlement.
1. Resolution No. qd-3j.3
2. Stipulations with Request for Award P
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RESOLUTION NO. 92 - 3 13
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 ROY PEIRSON
WHEREAS, HCM Claim Management Corp., the Third Party Administra
for the City of Carlsbad, has recommended a settlement in the Workers Compensation ci
of Roy Peirson; and
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 Ci
of Carlsbad, California, as follows:
1.
2.
That the above recitations are true and correct.
That the expenditure of $5,215 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,
attached hereto as Exhibit 2.
3.
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PASSED, APPROVED AND ADOPTED at a Regular Meeting of the Cil
Council of the City of Carlsbad on the 20th day of OCTOBER 1992, by the following
vote, to wit:
AYES: Council Members Lewis, Kulchin, Larson, Stanton, Ny;
NOES: None
ABSENT None
ATX'EST
ALETHA L. RAUTE
I
l ) EXHIB~ t ’- * [(.e \!./I ’ WORKERS’ COMPENSATION APPEALS-~h
STATE OF CALIFORNIA
\ @//cant CaseNo. SDO 157386
Roy S. Peirson
Stipulations
with Request
vs. for Award
City of Carlsbad, P.S.I.
The parties hereto stipulate to the issuance of an Award andfor Order, based upon the fOllOWing fl
waive the requirements of Labor Code Section 5315
1. ROY S. Peirson ,born 9/26/53
(EmpJoyss)
employed within the state of California as Pol ice Officer on 12/18/90 (Date 01 InJury)
by City of Carlsbad whose compensation insuranc
Management Corp . sustained injury arising out of and in the course of employment J,ef t knee
F (occupattonl
Employer) P.S.I. % HCM ClaiZn
(Pam of body in
2 The inflry caused temporary disabtlity for the period Fully compensated
Labor Cc
for whtch indemnrty IS payable at S 4 8 5 0 through
week. less credit for such payments previously made.
3. The injury caused permanent dtsabtlity of 11-3 / 4 %, for which indemnity is payable at $ 140 (3
per week beginning JUlY 18 1991 ,inthesumof$ 5,215.00 . less CI
payments previously made.
An informal rating &# has not been previously issued.
(Select pel Is&
be need for medical treatment to cure or relieve from the effects c F 4. There EX Wmot tseiea one)
ENTOF INDUS RECFIWD /UT MSiON OF INDUS
DWC WCAB FORM 3 (REV 9-90] (Page 1) s~p 17 @
* *
WORKERL COMPENSATtON WEALS BOAR
STATE OF CUlPORNU
5 Medical-lrgal expenses are payable by defendant as follow.
Mission Hills Medical Group has baen paid by Defendant.
6 ~itcant’9 attorney request a fee of S 6s
7. Liens against compensation am payaare ds fo11ow:
None
a Otner stlpulation3:
A) It is further understood and agreed that the aforesaid I shall be deemed to include such interest as is provided Labor Code Section 5800.
Based upon the total medical record and the testimony g’ by Roy S. Peirson, the parties have agreed that the lev4 disability (11.75%) is based, in full, upon the worker’i subjective complaints, as opposed to any physical raetr
or work preclusions.
B) c % qlw477
Dated z* Appltcant
1200 Carlsbad Village Dri Carlsbad, CA 92008
3954 Murphy Canyon Road, San Diego, CA 92123 Address of Insurance company
Charles J. Loof, Esq. Attorney or AUtnorizee Reglestntatrve for 0
7851 Mission Center Cour
dress of Attorney or Autr\arireuRcpreSefi
555-72-4142 ~ddress~or~~mgloyer Social Security Number ot Applicant
1157 La Tortuga
Vista, CA 92083
Attorney for Applicant
2330 Third Avenue San Diego, CA 92101-1534 !pa Dfego, CA 93108
Address of Attorney tor ApQliC8nt
-c wcA9 mau 3 (QEV 9-40) OLFrrnULNTW INE
OMUOR OF 1110 (Page 2)