HomeMy WebLinkAbout1994-01-04; City Council; 12523; Workers Comp Claim Settlement ProposalI
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SETTLEMENT PROPOSAL FOR SAMUEL
ENDED ACTION:
Approval of Resolution No. q9-y approving the proposed Stipulations with Request for
Award which authorizes the payment of $10,220 at the rate of $140.00 per week to Samuel
Granillo as settlement of his workers compensation claim.
ITEM EXPLANATION
Samuel Granillo is a Park Maintenance Worker I1 currently employed by the City. He injure
his back on 6/26/92 when he fell while trying to move a cement trash container. This injury
required surgery in March of 1993.
Mr. Granillo’s condition has stabilized and he has been declared permanent and stationary,
He continues to have frequent, mild pain in his lower back and is restricted from veryjeavy
The proposed settlement was negotiated by Mr. Granillo’s attorney and HCM Claim
Risk Management is recommending approval of the proposed settlement.
FISCAL IMPACT
The cost of the settlement is $10,220 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.
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RESOLUTION NO. 9 4 - 4
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 SAMUEL GRANILLO
WHEREAS, HCM Claim Management Corp., the Third Party Administrato
for the City of Carlsbad, has recommended a settlement in the Workers Compensation case
of Samuel Granillo; and
WHEREAS, there are sufficient funds available in the Workers
Compensation SelE-Insurance Fund to pay the settlement,
NOW, THEREFORE, BE IT RESOLVED by the City Council of the Cit]
of Carlsbad, California, as follows:
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2.
That the above recitations are true and correct.
That the expenditure of $10,220 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 City
2ouncil of the City of Carlsbad on the
,,rote, to wit:
4th day of January 1994, by the following
AYES:
NOES: None
ABSENT None
Council Members Lewis, Stanton, Kulchin, Nygaard and 1
ATEST: - 2.--, tlLLETHA L. RAUTENKRANZ, City Clerk
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, Ex
WORKERS COMPENSATION APPEAtS BOARD
STATE OF CAUFORNIA
Applicant Case No. Unassigned
Samuel Granillo Stipulations
with Reques
vs. for Award
SSN: 553-94-8345
City of Carlsbad, P.S.I.
Defendants
The parties hereto stipulate to the issuance of an Award and/or Order, based upon the foll
waive the requirements of Labor Code Seaion 5313:
1. Samuel Granillo ,bm April 18, 1952
(-)
employed within the State of Caifornia as Part mint. Worker L bn-kmxLaL
whose compensation admj
sustained injury arising out of and in the course of employment Risl
(DcrUPaca) (Date a
by City of Carlsbad
HCM Claim Mqt*
(EmP)orc?)
( PU
2 The injury caused temporary disability for the period Harch 27, 1991
kugh July 16, 1991 for which indemnity is payable at $3
week, less credit for such payments previausly made.
3. The injury caused permanent disability of 8%. for which indemnity is paRml;dl
, in the sum of $3 t 360 oo&o$g per~&&ginning July 17, 1991
payments previously made. ( qb2, 14 cKEV\t TqrnrtobbCC 114 433
hn informal rating has not been previously issued.
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(scleaoor)
rc. WR. Fwwae hEDw& Camcr 4. Upbunt%%an6? Ir;’myt%to inlury herein mentioned as rfer D1 report of 9/16/93, defendant has five days to authorize
good cause for denial. Failure to do so shall give applic authority to secure whatever treatment is necessary to cure (
the effect of injury. DUARTYCWT OC 11
OIVI#ION OF It
fr <
WORKERS' COMPENSATION APPEALS BOARD
STATE OF CALIFORNIA
5. Medical-legal expenses are payable by defendant as follows:
Defendant has paid all medica -legal expenses. (-0C-L- TyP.%*PaL\fLd 47s . "")
.oo 6. Applicant's attorney request a fee of $ yQ3
7. Liens against compensation are payable as follows:
None
8. Other stipulations:
d)D&tf ox= \dyWy \5 3-Zb-4\, de7 '3-x7-4(
fib OCLL \dAu-y LL*\wv:n 7 cn. ct-)dc: -1.
RECFIUFn x //- 23 - 4??
Dated DEC 0 2
KJ-a
Applicant Samuel Granillo
Social Security Number of Appliat
1200 Carlsbad Village Drive 553-94-8345 Carlsbad, CA 92008
Address of Employer 2855 Cottingham Street 3954 Murphy Canyon Road, D-:
Oceanside, CA 92054 San Dieao, CA 92173
Adaress of ~m~ran~e Company
Karen Church
Attorney or Authorized Representative for Dc 2330 Third Avenue 3954 Murphy Canyon Rd, D-20
San Dieso, CA 92123 San Dieso, CA 97101 2019 Address of Attorney or Authorized Represent
Attorney for Applicant Stewart Atcheson
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Address of Attorney for Applicant