HomeMy WebLinkAbout1995-03-21; City Council; 13061; SETTLEMENT OF WORKERS' COMPENSATION CLAIM OF JILL PRICHARD*
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ClYOF CARLSBAD - AGEN-BILL '/ 7
AB# 13,016 I DEPT
DEPT. RM CITY
TITLE: SETTLEMENT OF WORKERS
COMPENSATION CLAIM OF JILL PRICHARD CITY MTG. 3/21/95
RECOMMENDED ACTION:
Approval of Resolution No. 9 5-6' approving the Stipulations with Request for Award
which authorizes the payment of $5,075, at the rate of $140 per week, to Jill Prichard as
settlement of her workers compensation claim.
ITEM EXPLANATION
This matter arose on March 23, 1993 when the claimant, a recreation specialist, suffered a
work related injury when she was moving office furniture and strained her wrist.
The claimant's condition has stabilized and she is now permanent and stationary. She is
continuing to work in her usual and customary occupation as a recreation specialist.
However, she has a permanent disability which precludes very heavy upper extremity activi
Her medical reports were submitted to the State Division of Workers Compensation, Offic
of Benefit Determination, for evaluation.
The permanent disability rating which they provided, as well as the need for possible futur
medical treatment, have been incorporated into the settlement agreement which has been
submitted for consideration.
The claimant and HCM Claim Management Corp., the City's Third Party Administrator,
have agreed on the terms and conditions contained in that agreement.
It is Staffs recommendation that the Stipulations with Request for Award be approved.
FISCAL IMPACT
The cost of the settlement is $5,075, excluding possible future medical treatment. If such
treatment is required, the City will be obligated to pay those expenses. There is no methc
for predicting what those costs may be. There are sufficient funds available in the Worke
Compensation Self-Insurance Fund to cover the cost of this settlement.
EXHIBITS
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Resolution No. 9 5- cb 1
Stipulations with Request for Award
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RESOLUTION NO. 9 5 - 6 1
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 JILL PRICHARD
WHEREAS, HCM Claim Management Corp., the Third Party Administrator for
the City of Carlsbad, has recommended a settlement in the Workers Compensation case
Jill Prichard; and
WHEREAS, there are sufficient funds available in the Workers Compensation St
Insurance Fund to pay the settlement,
NOW, THEREFORE, BE IT RESOLVED by the City Council of the City of
Carlsbad, California, as follows:
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That the above recitations are true and correct.
That the expenditure of $5,075 from the Workers Compensation Self-
Insurance Fund is authorized for the settlement of said case.
That the Council accepts the Stipulations with Request for Award, attacl
hereto as Exhibit 2.
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PASSED, APPROVED AND ADOPTED at a Regular Meeting of the C
Council of the City of Carlsbad on the 21st
vote, to wit:
day of M.ARCH 1995, by the following
AYES: Council Members Lewis, Nygaard, Kulchin, Finnila, I
NOES: None
ABSENT: None
ATTEST:
I
Am9dU
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tKHll5l ? WORK a! S’ COMPENSATION AP EALS BOARD
STATE OF CALIFORNIA
Jill Prichard Case No. Unassigned
Stipdat ions
with Request
vs. for Award
Hertz Claim Management, City of Carlsbad Defendants /
The parties hereto stipulate to the issuance of an Award and/or Order, based upon the followir
waive the requirements of Labor Code Sedan 5313:
Jill Prichard ,bm 11-13-62 1. ( Empb)
3-2-93
(Date of lniui employed within &e State of Cdifornia a~ Recreation Specialiskn
by City of Carlsbad whose compensation insuranc
riqht
(P.rtrd
(~p.~)
(-Pbucr)
Hertz Claim Manaqemnt sustained injq arising out of and in the course of employment
2 The injury caused temporary disability for the period 12-18-94
through 1-8-95 for which indemnity is pahable at $3
week, less credit for such payments previously made.
3. The injury caused permanent disability of a%, for which indemnity is payable at $-
, less CI per week beginning
payments previously made.
An informal rating has
f Orthwi th , in the sum of $ 5 I 0 75 a 00 R FCFi WF
GB Of kWW8 been previously issued.
( Sekd OIK )
4. There is slppaxmbe need for medical treatment to cure or relleve from the effects o
(Scled one)
Except in the case of an emergency, you must contact your
or insurance carrier prior to receiving medical treatment
authorization. ~ARTYLNT OI IHOU
OlVISIO~ Ot rwou
...
.. VI\I\L.I\V bV,.,, b, .-. .. . -. . a STATE OF CALIFORNIA 0
5. Medical-legal expenses are payable by defendant as follows: None
8. .\pplicant's attorney request a fee of $ None
7. Liens against compensation are payable as f01Iou.s: None
8. Other stipulations: None
3-9-4<
DatY!
Applicant Ji 11 Pr ichard 1200 Carlsbad Village
558-47- 341'3 Carlsbad, CA 92008
3936 Jefferson Street P.O. Box 710400
Carlsbad, CA 92008 San Diego, CA 92171
Social Security Number of Applicant .4ddress of Emplo) er
Address of Applicant Address of Insurance Company
N/A
Attorney for Applicant - SZiStt%F or Authorized Representative
N/A P.O. Box 710400, San Die
Address of m or Authorized Rep
Barbara Stokes
Address of .4ttorney for Applicant
DLPARTYKXT OF IN
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