The URL can be used to link to this page

Home My WebLink About1995-02-14; City Council; 13022; SETTLEMENT OF WORKERS' COMPENSATION CLAIMS OF SANDRA MULHALL-' AB# /3,oa2- TITLE MTG. 2/14/95 SETILEMENT OF WORKERS' DEPT. RM COMPENSATION CLAIMS OF SANDRA MULHALL DEPT. CITY 1 CIW n n % 3 2 3 4 5 6 7 8 9 10 I1 l2 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 0 0 RESOLUTION NO. 95-38 A RESOLUTION OF THE CITY COUNCIL OF THE CITY OF CARLSBAD, CALIFORNIA, AUTHORIZING THE EXPENDITURE OF FUNDS FOR SElTLEMENT OF THE WORKERS COMPENSATION CLAIMS OF SANDRA MULHALL WHEREAS, Mr. Daniel P. Trovillion, Defense Counsel for the City of Carlsbad this matter, has recommended a settlement of the Workers Compensation claims of Sal Mulhall; and WHEREAS, there are sufficient funds available in the Workers Compensation I 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 $26,000.00 from the Workers Compensation Se Insurance Fund is authorized for the settlement of said claims. That the Council accept the Compromise and Release, attached hereto Exhibit 2. 3. i I/ 1 I I 1 I I / I 1 1 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 0 0 PASSED, APPROVED AND ADOPTED at a Regular Meeting of the Ci Council of the City of Carlsbad on the 14th day of FEBRUARY 1995, by the following vote, to wit: AYES: Council Members Lewis, Nygaard, Kulchin, Finnila, H NOES: None ABSENT: None ATTEST: ALETHAL.RAU I EXHIBIT 0 STATE OF CALIFORNIA DEPARTMENT OF INDUSTRIAL RELATIONS COMPPOMISE AND RELEASE PLEASE SEE INSTRUCTIONS ON CASENO. SDo REVERSE OF PAGE 2 BEFORE DIVISION OF WORKERS' COMPENSATION WORKERS' COMPENSATION APPEALS BOARD COMPLETING FORM 0 SOCIAL SECURIN NO. 5 6 2 - 7728 Calle Caracas 1200 Carlsbad Village Drive P 0 Box 710400 San Dieqo, CA 92171 Sandra Mulhall Carlsbad, CA 92009 Citg of Carlsbad, sel -insured Carlsbad. CA 92008-1989 Hertz Claim Management, administrator 1. The injured employee claims that while employed as a on 09/20/92 - 09/20/93 at Carlsbad , CA [DATE OF INJURY) (CITY) (slhe Sustained injury arising out of and in the course of employment to upper extremities ; hands AODRESS AP LlcANT [EMPLOYEE] ADDRESS CORRECT NAME OF EMPLOYER AODRESS CORRECT NAME OF INSURANCE CARRIER clerk typist 1 I [OCCUPATION ATTIME OF INJURY1 (STATE) (STATE WHAT PARTS OF BODY WERE INJURE 2. The parties hereby agree to settle any and all claims on account of said injury by the payment of the sum of $ .mQ in addition to any Sums heretofore paid by the employer or the insurer to the employee, less amounts Set forth in ParagrZ 3. Upon approval of this compromise agreement by the Workers' Compensation Appeals Board or a workers' compensation ju in accordance with the provisions hereof, said employee reteases and forever discharges said employer and insuranc claims and causes of action, whether now known or ascertained, or which may hereafter arise or develop as a reSL including any and all liability of said employer and said insurance carrier and each of them to the dependents, 1 representatives, administrators or 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 have 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 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 undi DATE OF BIRTH ACTUAL EARNINGSATTIME OF INJURY LPSTDAY OFFWORKDUETO' 01/22 /53 442.31 AWE PAYMENTS MADE BY EMPLOYER OR INSURANCE CARRIER not am1 icable TEMPORARY DlSABlLlM INDEMNW WEEKLY RATE PERIODS COMRED 9 f 436.50 294.89 09/20/93 - 04/11/94 PERMANENT DISABILITY INDEMNrrY TOTAL MEDICAL AN0 HOSPITAL BILLS "2,960.00 6,119.69 BENEFITS CLAIMED BY INJURED EMPLOYEE BEGINNING AND ENDING DAES OF ALL PERIODS OFF DUE TO THIS INJURY MEDICAL AN0 HOSPITAL BILLS PAID BY EMPLOYE1 same as above none known TOTAL UNPAID MEDICAL AND HOSPITALEXPENSE TO Be Paid Bv: all authorized care has been paid THE FOLLOWING AMOUNTS ARE TO BE DEDUCTED FROM THE SETTLEMENT AMOUM: ESTIMATED FUTURE MEDICAL WENS min TO Be Paid BY: applicant credit $2,960.00 defendant f PDAs $ PAYABLE TO PAYABLE TO $ PAYABLE TO $ PAYABLE TO * $ PAYABLE TO $ LEAVING A BALANCE OF $ 23 , 04 0 . 0 0 , less approved attorney fee (See Paragraph No. 91, payable to applican be other than in a lump sum, or there is additional information, specify on separate pageb). ) * $1,000 lump sum PDA. Advances at $140 per week, effective 09/05/9 Defendant has credit right for all advances. OWC WCAB FORM 15 (REV. 19W (PAGE 1) 0 0 Compromise and Release Re: Sandra E. Mulhall v. City of Carlsbad SDO 190929 10. Reason for ComDromise: There is a dispute as to the nature, extent, and duration permanent disability, if any. There is a dispute as to apportionment to be applied to this Applicant’s disability bec of her pre-existing condition. There is a dispute as to the k need, frequency and quality of future medical treatment that ma required, if any. It is the intent of the parties that agreement absolves Defendant of any liability for cla retroactive temporary disability through the date this agreemen approved by the Board. It is the intent of the parties hereto to hereby release Defendant herein from any liability for temporary disabil additional permanent disability or further medical treatm mileage expense or other incidental benefits which may, in absence of this agreement, be recoverable by the Applicant for injuries occurring during the rehabilitation process which is compensable consequence of the primary injuries as set fort1 Paragraph #1 of this agreement. Pursuant to the case of Carter v County of Los Anseles, et 51 CCC 255, the Defendant employer and carrier herein are rele from any liability for workers’ compensation benefits which arise from any subsequent injury or re-injury during any phaE the rehabi 1 i tation process necessitated by this injury. I understood that this waiver does not in any way affect Applice right to receive vocational rehabilitation benefits which ar may be due to the injuries alleged in Paragraph #1 of Compromise and Release Agreement. Applicant hereby makes this waiver expressly, knowingly, and full knowledge of the potential rights she may have, if any, i absence of this waiver and release. Nothing contained hc abrogates the right of Defendant to raise QIW as an issue it subsequent rehabilitation proceedings. 1 -A 0 0 Legal counsel for the respective parties have reviewed the medic reports submitted in this case, the opinions, and conclusions the doctors as set forth in those reports and the subject- complaints of the Applicant as set forth in those reports. After assessing the information, the parties feel that the fig1 indicated in Paragraph #2 is a fair and equitable settlement this case and have decided to resolve these questions in dispi and any and all other questions relative to this injury which I exist now or may arise in the future and avoid the hazards delays of litigation. The parties do intend to include in this Compromise and Release of the provisions of Paragraph #4 of this agreement. It is further agreed that if the Order Approving Compromise Release is paid within twenty-five (25) days of its date issuance, interest thereon shall be waived. WALWICK & BRO L4 BY v? S’ANDRA MULHALL i Appl i cant CHARLES P. BROWN, Attorney for Applicant 1-6 y 7. Liens not mentioned in Paragraph NO.@ to be disposed of as follows: 1 m 1 -Lals- 8. For the purpose of determining the lien claim(s1 filed for benefits paid pursuant to the Unemployment insurance cod1 furnished by lien claimants defined in Labor Code Sec. 4903.1, the parties propose reduction of the lien claim(s) in a formulae attached. 9. Applicant's (employee's) attorney requests a fee of $ 3 \ a 0 . . Amount of attorney fee previously paid, if any 10. Reason for Compromise, Special provisions regarding rehabilitation and death benefit claims, and additional informatior 00 =bt see attached page 1-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 emplc WCAB may in its discretion set the matter for hearing as a regular application, reserving to the parties the right to p the facts admitted herein, and that if hearing is held with this document used as an application the defendants shal them all defenses that were available as of the date of filing of this document, and that the WCAB may thereafter e Compromise Agreement and Release or disapprove the same and issue Findings and Award after hearing has been h regularly submitted for decision. witness me signature hereof this o\. \h dayof 5-m- , iPi5, at \.\L\% WITNESS WITNESS Charles P. Brown, atty/appl PERSONS OR ACKNOWLEDGED BEFORE A NOTARY PUBLIC. England, Hodik & Trovillion THE APPLICANTS (EMPLOYEE31 SIGNATURE MUST BE ATTESTED BY 7wO DISINTEREZI'ED by Daniel P. Trovillion, atty for defendants AD., ies , beforeme, C .b +s&& 1 t STATE OF CALIFORNIA COUntYOf Sari Die(yo on mis q%ay o\\%a+ a Notary Public in and for me said County and State, residing therein, duly commissioned and SLYnrn, personally appeared - cc. W%\\ \c).---! mown to me to be me person - whose name subscribed to me within Instrument. and acknowledged to me mafg_he- executed the same. IN mES WHERfOF, I haw he written. Comm. #983732 me day and year In this Certificate first abc ARY PUBLIC - CALIFOANI SAN OlEGO coUNp( Cornm. Explres Jan. 3 DWC WCAE FORM 15 (REV. 1-21 (PAGE 2)