HomeMy WebLinkAbout1992-12-01; City Council; 11978; SETTLEMENT OF WORKERS' COMPENSATION CLAIMS OF CHRISTINE CHRISTENSEN1
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DEP SETTLEMENT OF WORKERS' COMPENSATION CLAIMS OF CHRISTINE CITY
-I"" - ClWOF CARLSBAD - AGENlyBlLL + -8
'AB# ''j "* TITLE:
MTG. /%-I- 4 &
DEPT. f2@ CHRISTENSEN CITY
RECOMMENDED ACTION:
Adopt Resolution No. 92- 3ygapproving the Compromise and Release which authorizes the
payment of $16,500 to Christine Christensen.
ITEM EXPLANATION
The claimant is a former Police Officer in the Carlsbad Police Department. She was
employed by the City for a period of 4 years prior to her retirement in 1992.
Mrs. Christensen was injured on October 15, 1991 while attempting to assist her partner in
the apprehension of a suspect. The suspect ended up falling and taking her down, with his
full weight landing on top of her. She suffered injuries to her right knee, right hip, right
shoulder, right wrist, right elbow, 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.
FISCAL IMPACT
The total cost of the settlement is $16,500. There are sufficient funds available in the
Workers' Compensation Self-Insurance Fund to cover the cost of this settlement.
EXHIBITS
1. Resolution No. 9&-3q8
2. Compromise & Release
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RESOLUTION NO. 9 2 - 3 4 8
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 CHRISTINE
CHRISTENSEN
WHEREAS, Mr. John W. Mullen, Defense Counsel for the City of Carlsbad in this
matter, has recommended a settlement of the Workers Compensation claims of Christine
Christensen; 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 City of
Carlsbad, California, as follows:
1.
2.
That the above recitations are true and correct.
That the expenditure of $16,500 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.
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PASSED, APPROVED AND ADOPTED at a Regular Meeting of the Cii
Council of the City of Carlsbad on the 1st
vote, to wit:
day of DECEMBER 1992, by the following
AYES: Council Members Lewis, Kulchin, Larson, Stanton
NOES None
ABSENT: Council Member Nygaard
A'ITEST:
/1
ALETHA L. RAUTENKRANZ, d4 --rci/.,ni City Clerk -- a / CI
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*, "l.4- DEPARTMENT OF INDUSTRIAL RELATIONS
DIVISION OF INDUSTRIAL ACCIDENTS 0 CASE NO.- WORKERS' COMPENSATION APPEALS BOARD 0 b" 1.11 ..V 1.1. ab -.x- ..bCb-u-
P-EASE SEE INSTRUCTIONS ON REVERSE OF PAGE 2 8EFORE COMPLETING FORM A
SOCIAL SECURITY NO. 558-59-
CHRIS TINE CHRISTENSEN P.O. BOX 1423, ENUMCLAW, WA 98022
1200 ELii AVENUE, CARLSBAD, CA 92C CITY OF CARLSBAD
3954 MURPHY CANYON RD., #D205, SAB PCM CLAIMS MANAGEMENT CORPORATION
1. The injured emplo ee claims that while employed as a
APPLICANT (EMPLOYEE) ADDRESS
ADDRESS CORRECT NAME OF EMPLOVER
ADDRESS CORRECT NAME OF INSURANCE CARRIER
POLICE OFFICER 1) 10-1f-91 (OCCUPATION AT TIME OF INJURY)
on 2) 10-15-90 TO 10-15-91at CARLSBAD ,CALIFORNIA
(s)he sustained injury arising out of and in the course of employment to WRTa + 1
'CITY'RIGHT KNEE, RIGHT HIP, mCm SHOULI (DATE OF INJURY)
(STATE WHAT PARTS OF BODY WERE INJURED)
2. The parties hereby agree to settle any and all claims on account of said injury by the payment of the sum of $ 16 500 00
to any sums heretofore paid by the employer or the insurer to the employee, less amounts set forth in Paragraph No. 6.
3. Upon approval of this compromise agreement by the Workers' Compensation Appeals Board or a workers' compensation jud
accordance with the provisions hereof, said employee releases and forever discharges said employer and insurance carrier 1
causes of action, whether now known or ascertained, or which may hereafter arise or develop as a result of said injury, int
liability of said employer and said insurance carrier and each of them to the dependents, heirs, executors, representative$
assigns of said employee.
4. Unless otherwise expressly provided herein, approval of this agreement RELEASES ANY AND ALL CLAIMS OF APPLICANT'!
DEATH BENEFITS RELATING TO INJURY OR INJURIES COVERED BY THIS COMPROMISE AGREEMENT. The parties hi
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 I
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 party contends under Paragraph
-- 10- 15-91
DATE OF BIRTH ACTUAL EARNINGS AT TIME OF INJURV UST DAY OFF WORK DUE TO THIS
PAYMENTS MADE BY EMPLOYER OR INSURANCE CARRIER
TEMPORARY D1SAL)IUTV INDEMNITY WEEKLY RATE PERIODS COVERED
FTJ1.T. W,ARY l,.C. 4850
$1,.260.00 & continuinq $12,384.47
PERMANENT DISABILITY INDEMNITY TOTAL MEDICAL AND HOSPITAL BILLS
BENEFITS CLAIMED BY INJURED EMPLOYEE
EEG *.?.:X= e.?:5 cL'ZL:3 DATES Q.; LLL PEW@CS ?F' PJC -0 TWS IN IURV YEOICAL AND nosp1TAL BILLS PAID BV EMPLOYEE
NONE
ESTIMATED FUNRE MEDICAL EXPENSE
10-15-91 TO PRESENT, APPLICANT RETIRED
TOTAL UNPAID MEDICAL AND HOSPITAL EXPENSE
To Be Paid By: APPLICANT - NONE KNOWN To Be Paid By: APPLICANT
THE FOLLOWING AMOUNTS ARE TO BE DEDUCTED FROM THE SETTLEMENT AMOUNT:
PAYABLE TO see Be1aw f PAYABLE TO ** f
f PAYABLE TO f PAYABLE TO
s PAYABLE TO s PAYABLE TO
LEAVING A BALANCE OF $ 16.500.0 0
other than in a lump sum, or there is additional information, specify on separate page(s).)
, less approved attorney fee (See Paragraph No. 9), payable to applicant. 1
Less permanent disability advances paid to applicant to the date of #pyKfPfi a thkf
Order Approving Compromise and Release. \Jc- :: 0 *\%e
9130 -_ -- z 1 DIA WCAB FORM IS (REV 1983) (PAGE 1) .. . ..,
2
. 7. Liens not mentioned in Paragraph NO. !m e to be disposed of as follows: NO T.TEN
k
8. For the purpose of determining the lien claim(s) filed for benefits paid pursuant to the Unemployment Insurance Code or for t
by lien claimants defined in labor Code Sec. 4903.1, the parties propose reduction of the lien claim($) in accordance with formc
9. Applicant's (employee's) attorney requests a fee of f 1 * 980. O0 . Amount of attorney fee previously paid, if any, $ -
IO. Reason for Compromise, special provisions regarding rehabilitation and death benefit claims, and additional information:
THERE EXISTS A DISPUTE REGARDING THE NATURE AND EXTENT OF DISABILITY AS WELL AS F
CARE.
APPLICANT DESIRES TO CONTROL HER OWN MEDICAL CARE.
PARTIES WISH TO AVOID THE HAZARDS OF LITIGATION AND SETTLE FOR A LUMP SUM APPLICANT WAIVES INTEREST IF
IS PAID WITHIN THIRTY (30) DAYS OF JUDGE'S APPROVAL.
AS PART OF THE CONSIDERATION FOR THIS COMPROMISE AND RELEASE, APPLICANT FOREVER E
THE DEFENDANT FROM ANY LIABILITY ARISING OUT OF FUTURE INJURIES THAT MIGHT KCUR
VCCATIONAL REHABILITATION AND ARE A COMPENSABLE CONSEQm OF THE ORIGINAL INJUE
(RODGERS VS. WCAB (1985), 49 CAL. COMP. CASES 561)
11. It is agreed by all parties hereto that the filing of his document is the filing of an application on behalf of the employee, c
may in its discretion set the matter for hearing as a regular application, reserving to the parties the right to put in issue any o
herein, and that if hearing is held with this document used as an application the defendants shall have available to them all
available as of the date of filing of this document, and that the WCAB may thereafter either approve said Compromise Agr
or disapprove the same and issue Findings and Award after hearing has been held and the matter regularly submitted for dc
WITNFS the signature hereof this day of
WITNESS
WITNESS
THE APWCAWS (EMPLOYEES) SIGNATURE MUST BE ATTESTED OY 'TWO DISINTERESTED PERSONS OR ACKNOMDGED BEFORE A NOTARY pun&.
k?,bih)
s&AQa LAR Sod A. D., 19 a, before me,
1 STATE OF
County of
On this at*d day o&-
a iotary Public in a@ fo>@id Coun-d Stab residing therein, duly commissioned and sworn, personally app
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IN WTNESS WHER~#$?$~{&~my 4!- hand and affixed my officiul seal the day and year in this Cc
written.
ARS ON THE COMPROMISE AND RELEASE known to me to be t 5' ~~i,n-!?J~ame -G 1 f J
subscribed to the wit 9 *q&qpr&&+&ed to me that ae-executed thesame.
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DIA WCAB FORM 1S (REV 19831 (PAGE 2)