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Home My WebLink About1992-11-10; City Council; 11955; SETTLEMENT OF WORKERS' COMPENSATION CLAIM OF MARK CHRISTENSENI .. 2 0 F: 0 4 i 0 z 3 0 0 Cl;y( OF CARLSBAD - AGENB BILL , DEPT. CITY A AB# I\ ’ ’ 5 TITLE. SETTLEMENT OF WORKERS’ MTG. /I -@ -4 @ COMPENSATION CLAIM OF MARK DEPT. RM CHRISTENSEN CITY M RECOMMEN DE0 ACTION: Adopt Resolution No. 92-3?5 approving the Compromise and Release which authorizes the payment of $22,000 to Mark Christensen. ITEM EXPLANATION The claimant is a former Police Officer in the Carlsbad Police Department. He was employe? by the City for a period of 8 years prior to his retirement in 1992. Mr. Christensen was injured on September 28, 1991 while riding a police motorcycle and training another officer. Travelling at approximately 5 miles per hour, his motorcycle stalled and began to fall to the side. He extended his foot to prevent it from falling over and then pulled on the handle bars and yanked the bike back up into an upright position. As a result, he suffered injuries to his neck and back. 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. LlSCAL IMPACT The total cost of the settlement is $22,000. There are sufficient funds available in the Workers’ Compensation Self-Insurance Fund to cover the cost of this settlement. EXHIBITS 1. Resolution No. qdl-33g 2. Compromise & Release L 34 I 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 / e 0 RESOLUTION NO. 9 2 - 3 3 2 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 MARK CHRISTENSEN WHEREAS, Mr. Charles Loof, Defense Counsel for the City of Carlsbad in this :natter, has recommended a settlement of the Workers’ Compensation claim of Mark Christensen; and WHEREAS, there are sufficient funds available in the Workers’ Compensation Self- ::nsurance 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 $22,000 from the Workers’ Compensation Self- Insurance Fund is authorized for the settlement of said claim. That the Council accept the Compromise and Release, attached hereto as Exhibit 2. 3. I I I 1 I 1 I a ! f I 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 Council of the City of Carlsbad on the 10th day of NOVEMBER1992, by the following ote, to wit: AYES: Council Members Lewis, Kulchin, Larson, Stanton, Nygaa NOES: None ABSENT: None ATTEST: J 1 -*-\ J:S!Lu. ,,, ,,r ZLzL- ALLETHA L. RAUTENKRANZ, City Clerk I txniDi1 L @r4 A 4 0 STATE OF CALIFORNIA DEPARTMENT OF INOUSTRIAL RELATIONS DIVISION OF WORKERS' COMPENSATION WORKERS' COMPENSATION APPEALS 8OARD r- -*+ 0 , COMPROMlSE AND RELEASE CASE NO.= 537-7t 9L-E SEE INSTRUCTIONS ON REVERSE OF PAGE 2 BEFORE COMPLETING FORM SOCW SECURITY NO. P.0. BOX 1423 Mark Christensen Enumclaw, WA 98022 City of Carlsbad, P.S.I. Carlsbad. CA 92008 HCM Claim Manaaement San Dieqo, CA 92123 1. The injured employee claims that while employed as a tctm on 9/28/91 at Carlsbad &)he sustained injury arising out of and in the course of employment to Neck & Rack CODRESS 1200 Carlsbad Village Drive 3954 Murphy Canyon%%d, Suit APPLII~NT (EYPLOYEEI CORRECT WE OF EUPLOYER CORRECT WE OF INSURANCE CIRRIER mESS Police Officer (OCCUPATION ATTIYE OF INJURY) Calif ow .t [ME OF INJURY) (SrATE WWT PMlS N BODY WIRE INJURED) 2 The parties hereby agree to settle any and all claims on account of sard injury by the payment of the sum of S 2 2 f Oo0 in addition to any sums heretofore paid by the employer or the insurer to the employee, less amounts set forth in ParagraF 3. Upon approval of this compromise agreement by the Workers' Compensation Appeals Board or a workers' compensation jud in accordance with the provisions hereof, said employee releases and forever discharges said employer and insurance claims and causes of action. whether now known or ascertained. or which may hereafter arise or develop as a resull including any and all liability of said employer and said insurance carrier and each of them to the dependents, hc representatives, administrators or assigns of said employee. 4. Unless otherwise expressly provided herein. approval of this agreement RELEASES ANY AND ALL ClAIMS OF APPLICANTS 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 P CANT MAY NOW OR HEREAFTER HAVE FOR REHABILITATION OR BENEFITS IN CONNECTION WITH REHABILITATION. DEATH BENEFITS RELATING TO INJURY OR INJURIES COVERED BY THIS COMPROMISE AGREEMNT. The parties have i 6. The parties represent that the following facts are true: (If facts are disputed, state what each party contends under WST MY OFF WK DUE TO THI MTE OF BIRTH ACTUALURNINCSATTIYE OF INJURY 4120162 $801.64/weeblv 9/30/91 and conth PAYMENTS MADE BY EMPLOYER OR INSURANCE CARRIER TEMPORPAY DlSBlLlTY INOEUNlTY k€E)(LY MTE PERIODS CObERED Fully compensated under Labor Code Section 4850 PERMANENT DISBILITY INOEYNllV TOTAL YFDIcbl. AND HOSPITAL BII 1.S None $10,800.02 BENEFITS CLAIMED BY INJURED EMPLOYEE BEGINNING MD ENDING DATES OF UL PERIOOS OFF DUE TO THS INJURY Ful ly UEDICALAND HOSPITAL BILLS PAID BY EYPLOYEE compensated under Labor Code Section 4850 None TO BE PA loeypreviously authorized by defendant ME FOLLOWING AMOUNTS ARE TO BE DEDUCTED FROM THE SETTLEMENT AMOUM: TOTALUNPIlDYEOI~ANDHOSPTT~OE#~ Applicant, except as ESTIMATED FUNRE YEDlCK MPENSE TO BE PAID BY: Applicant $Zero PAYABLE TO s PAYABLE TO $ PAYABLE TO S. PAYABLE TO $ PAYABLE TO s PAYABLE TO LEAVlNG A BALANCE OF $ 22 t 000 00 , less approved attorney fee (See Paragraph No. 9). payable to applicant. be other than in a lump sum. or there is.additional~nformation, Specify on separate page(S). Less any permanent disability advances paid to app icant from the date of preparation of this Compromise and Release to the date Of payment of the Order Approving Compromise and Release. 1 DIAWCAB FORM 15 (REV us01 [PAGE 11 c 0 0 , 7. Llens not mentioned in Paragraph No. 6 , to be dlSpoSed of as follow: None 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 reduction of the lien claim(s) in acc formulae attached. Not applicable 9 Applicant‘s (employee’s) attorney requests a fee of s Jb yd. c G’ 10 Reason for Compromise, special provisions regarding rehabilitation and death benefit claims. and additional information. Amount of attorney fee previously paid, if any, S See attached page 2-A 11. It is agreed by all parties hereto that the filing of this document is the filing of an application on behalf of the employ€ WCAB may in its discretion set the matter for hearing as a regular application. reserving to the parties the right to put the facts admitted herein, and that if hearing is held with this dOCUment used as an application the defendants Shall h8 them all defenses that were available as of the date of filing of this document, and that the WCAB may thereafter eith Compromise Agreement and Release or disapprove the same and issue Findings and Award after hearing has been held regularly submitted for decision. Witness the signature hefeof this day af , 19 0” WITNESS ~PPLIIX~EMP~OYEEI Mark Christensen WITNESS THE iPPLlCANlT [EMPLOYEES) SIGNANRE MUST BE AllESlEO BY Two OlSlNERfSTEO persons OR ACKNOWLEDGED BEFORE A NOTARY PUBLIC Charles J. Loof,Esq. for Defe I countyof- K t v\q d t Lev; ’Fi*b\n8*4 STATE OF eftttfeftfytR MASH i&To rd AD., 19 47 , beforeme, H%Aq &w-p&x- -th ont+vs 13 - &yd n&lr W a Notary public in and for the said county and Sate, residing therein, WY commissioned and m, personally appeared- mac K ~\StWY5Cn know to me to be the person- subscnbed to the Win instrumen t-b- --sa/M. IN W7NESS WEREOF, /haw? wntten. official seal the day and year in this Cerbficate first abne c? m* m tor sard Countyam state of cabtorma DiA WCAB FORM 15 (REV 2BJl (PAGE 21 (1 0 e 1 APPL1CANT:Mark Christensen COMPROMISE AND RELEASE CASE NO. : - XX A) This settlement includes any and all claims for medic temporarydisability, vocationalrehabilitationtempora disability and reimbursements through the order Approving Compromise and Release. f&ygF Initia s - XX B) 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 t Bowe Initia Orc Workers' Compensation Appeals Approving Compromise and Release. - xx C) DEATH BENEFIT CLAIM WAIVER: The applicant has been advised and fully understands tk this Compromise and Release Agreement releases any i all claims of any dependents to potential death benefj relating to the injury or injurie cov red by t€ Compromise and Release Agreement. A reasonable and substantial dispute exists between t parties as to: Nature and extent of the applicant disability, both temporary and permanent; need for par present, and future medical treatment; reimbursement i self-procured expenses; etc. Rather than risk 1 uncertainties of litigation, the s wish to set1 this claim, and all its re d potential issues, 7 a lump sum certain. - XX E) RODGERS SETTLEMENT: Tk&j2-- - XX D) Initi [Rodaers vs. WCAB (19851, 49 Cal. Comp. Cases 5611 As part of the consideration for this Compromise i Release, applicant forever releases the defendant fl any liability arising out of future injuries that mic occur during vocational rehabilitation and compensable consequence of the original injury. E 'Initials DATE:iO-? -92 APPLICANT : DATE : APP'S ATLA7 2-A