HomeMy WebLinkAbout1993-05-04; City Council; 12205; SETTLEMENT OF WORKERS COMPENSATION CLAIM OF DAVID MITCHLEYAB# la; '' ' TITLEm SETTZEMENT OF WORKERS
MTG. COMPENSATION CLAIM OF DAVID
DEPT. RM MITCHLEY
DEPT. ~
CITY A
CITY M
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RESOLUTION NO. 93 - 126
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 MITCHLEY
WHEREAS, HCM Claim Management Corp., the Third Party Administrator for the
City of Carlsbad, has recommended a settlement in the Workers Compensation case of
David Mitchley; 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:
2.
2.
That the above recitations are true and correct.
That the expenditure of $11,620 from the Workers Compensation Self-
Insurance Fund is authorized for the settlement of said case.
That the Council accept the Stipulations with Request €or Award, attached
hereto as Exhibit 2.
3.
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PASSED, APPROVED AND ADOPTED at a Regular Meeting of the City
Council of the City of Carlsbad on the 4th
vote, to wit:
day of MAY 1992, by the following
AYES: Council Members Lewis, Stanton, Kulchin, Nygaard, Fir
NOES: None
ABSENT: None
ATTEST:
bh g ea+ ALElX4.L. RBUTENKRANZ, City Clerk
I
- __ 0 w EXHIBIT 2 v4 r. II 5
I WORKEkS’ COMPENSATION APPEALS BOARD
STATE OF WFORNU
SDO’ 172389
/@Pi;G?nt CaNo- SDO 172390 David Mitchley
Stipulatlons
wlth Request
vs. for Award
City of Carlsbad, P.s.1.;
% HCM Claim Management Corporation
uefendards
The ~arties her- stlpuiate to the ~ssuance of an AwaM and/or Oreer. based upon the fOllaWng fact!
waive tho requlrenlaiitv of Laow uoae sectton S19:
,born 9/22/51
6130190 &
employed within the State of Callfornta as F ire-FJuhter 6/ 3 0 / 8w30 I
by Citv sf Carlobad Whose compensalh?ii tiwurance CI
sultaln~d whjury erlsing out at and in lhe WUI st# ol t3mpbflWlt - (SlWllar”M, 1. David Mitchlev
on
COIWpo=N
Permissibly Self- xed
Management Carp. [Pam ol I)DC(YM)Urn
3 HCM Claim
2. The injury caused temporary dbabilrty for the period FUllY comrmwated
for which indemnity IS payable at EI&!S 4 85 0 througn.
weak. loss creait tor sucn payments previously made
a The rnjuFycaumd gemanent Ulsability of 22-11 2 X, ?or which indemnity is payable otSxd?$-
per week bcpning 4 / 13 19 2 ,Int~s~at$ 11,620.00 , kvs craait
peyments previously Alada
An mformal rating op# ha8 not blm previously ~ssuea. uaot one)
4. There #x EQ)IwK nay be need far medical tfeatment to cure or relieve Wont the effects of 8 We mol
DC?.#iThICMOIC 1NC)mw
DMSlON of INOUSRUL
Urn WGW FORU 3 [REV. %oo) (Page 1)
w (+~-14-1yy2 ~w-wc I I\WI ----- - - 1
I hlP J - WORK@ Y COMPENSATION A. .JmLs BOARD
< SME OF CAUFORNlA
5 Meaicawe 1 awenses are payable b defendant as folfoWEl: M rkariq. M.D. (Ba7ance to be a&s+od or paLd (;r defeixknt wpzh furisdic ion reserved b] WCAB) *
e. ADpiicant's attorney request a fee of s / 3 9 +( 00
7. Liens against compensation atu payam as foibm Nons
8 Otherstiwiations A) Xt fs further understood and ayroed that the aforesaid sum shall be deemed to include such interest as is prc by Labor Code Section 5800, if paid within thirty (39) day8
B) permanent disability preclusions imposed by the treating and ev ting physicians and fn aqreament that this Stipulation at 22-l/ is based solely upon the gresuasive opinion expressed by Dr. Th The parties further stipulate that they have rojecbd the apportionment prescribed by Dr. Thompson based upon the applica ability to return to his earlier asstgnsd duties and psrfoa th fully until his injury on 6/30/90. The parties further agree t Mitchley is sagabls of performing his usual and crustornary dutir stated,by fhe QKEs, he is not a qualified injured worker and m
The parties have thoroughly investigated and revaewod the
inur z his usual occupatLon. 4Ar&
- Amlieant W
570-84-1873 Carlsbad, CA 92008
Saclal Secwlty NwtDa of Apglicant
4084 Thomas Street 3954 Murphy Canyon Road, S-D QceaIljtide. CA 92056 Carlabad, CA 92008
1200 Caxlsbad Village Drive Addroo. of Jimpkyct
AdanEs ot Insurance &*any
Charles J. Loof
Attorney for Apphcant
2330 Third Avenue 7851 Mission Center Court, E San Diego, CA 93.101-1514 Sari Dieuo, CA 92108
AUafesS of Attarnoy for hpplicant
owc wca WRY a mm. pea)
Attorney et Authorize0 RIIyrssccntafrve tor Wfma
Muress of Attorney or AutnorizQd Representative
OEHllTMEWI OF INDUSTRLII
DN1SI0(1 OF IN0VZII)U
(mge 21
TC'