HomeMy WebLinkAbout1995-04-18; City Council; 13112; SETTLEMENT OF WORKERS' COMPENSATION CLAIM OF LARRY WHATLEY*I
SETTLEMENT OF WORKERS
MTG. ION CLAIM OF LARRY 4/18/95
Approval of Resolution No. 95 -101 approving the Stipulations with Request for Award
which authorizes the payment of $15,503, at the rate of $148 per week, to Larry Whatley as
settlement of his workers compensation claim.
ITEM EXPLANATION
This matter arose on December 2, 1992 when the claimant, a Park Maintenance Worker I1
injured his back while loading branches into a flatbed truck.
The claimant's condition has stabilized and he is now permanent and stationary. He is
continuing to work in his usual and customary occupation as a Park Maintenance Worker 1
However, he has permanent disabilities which restrict his participation in certain work
His medical reports were submitted to the State Division of Workers Compensation, Officc
of Benefit Determination, for evaluation.
The permanent disability rating which they provided, as well as the need for possible futun
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 $15,503, excluding possible future medical treatment. If such
treatment is required, the City will be obligated to pay those expenses. There is no metho
for predicting what those costs may be. There are sufficient funds available in the Workei
Compensation Self-Insurance Fund to cover the cost of this settlement.
1. Resolution No. 9 5- 16 l
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RESOLUTION NO. 9 5 - 1 O 1
A RESOLUTION OF THE CITY COUNCIL OF THE
CITY OF CARLSBAD, CALIFORNIA,
AUTHORIZING THE EXPENDITURE OF FUNDS
FOR SE'ITLEMENT OF THE WORKERS
COMPENSATION CLAIM OF LARRY WHATLEY
WHEREAS, HCM Claim Management Corp., the Third Party Administrator €0
the City of Carlsbad, has recommended a settlement in the Workers Compensation cas1
Larry Whatley; and
WHEREAS, there are sufficient funds available in the Workers Compensation !
Insurance Fund to pay the settlement,
NOW, THEREFORE, BE IT RESOLVED by the City Council of the City of
Carlsbad, California, as €ollows:
1.
2.
That the above recitations are true and correct.
That the expenditure of $15,503 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, attac
hereto as Exhibit 2.
3.
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PASSED, APPROVED AND ADOPTED at a Regular Meeting of the (
APRIL 1995, by the following Council of the City of Carlsbad on the
vote, to wit:
18th day of
AYES: Council Members Lewis, Nygaard, Kulchin, Finnila,
NOES: None
ABSENT: None
ATTEST:
dect;ak -A. L2Lzbd-
ALETHA L. RAUTENKRANZ, City Cprk
I I
Larry Whatley
Stipulations
WORK=' COMPENSATION APPLS BOARD
STATE OF CALIFORNIA
5. hledical-legal expenses are payable by defendant as follows: None
6. Apphnt's attorney request a fee of $ None
7. Liens against compensation are payable as follows: None
8. Other stipulations: None
4 -3% -%-
1200 Carlsbad Village
Carlsbad, CA 92008
Social Security Number of Applicant Address of Employer
1637 Lopez Street P.O. Box 710400 Oceanside, CA 92054 San Dieso, CA 92171
Address of Applicant Address of Insurance Company
N/A
Attorney for Applicant &kmzeyrn Authorized Representative
N/A P.O. Box 710400, San Die
Address of AazK#eqr or Authorized Rep
Barbara Stokes
Address of Attorney for Applicant
=EP.D-"r,- := y
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'-2~- +rf":e- - qt' x2$3!~,~f,r : 2 i F:F 1 :+, j 12~s ;T&TE Jf- CAL?Fi-jKN?A
'. l ti I S 1 <]N .,,/=' Wf:]FiKEKS ' CClMPENSA T 1 UN Pete L( I i son j Go.vernor
,'; k ICE ';F BENEFIT DETERMINATION
::~SA~ILITY EV4LUATIUN UNIT : j51j r p:'_"; r ';TFiifET
.-;AN ~IF-!;:: ZA 92101-3490
. . ;> ,:f 5 -! -7 - - 7 p 1
- ._ .-
.- -
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SL!MMt;RY RATING DETERMTNATION -------___------------------
F3ge 2
DElJ P: 70?07q5
18.1 - ?C'/- Ai). * 2F- 75- a., 2L:2
FUT!JRE MEDICAL TREATMENT REQUIRED .................................
The Permanent Disability Rating is 26.5X of totst disability which 15
-asuivalent to 104.75 weeks of disahi I itu payment. Based on average
..*e&.!r earnings of 6651.59 the weekly rete is $148.00 in the total
-a.,im ot $15~503.00. Psrments COmntence within 14 days after the date of
tast payment sf terpporarr disetli I itr indemnity.
:cy: _______ _________--__-_-----_____^______________--------
-a FORM 102 v (NEW 1-91)
MHL KNCl rSENt Ii i s3tt I I I tu Eva I ustor
293166
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::partnient of Industrial Relation5 STATE OF CAuwwA i'JISION OF WORKERS' COMPENSATION Pete il i I son F Governor
TSAFILITY EVALUATION UNIT
j50 FRONT STREET
-Y r!iEGoz CA 92i01-3690
:3FFICE OF BENEFXT DETERMINATION
7 Q /"?e, J-J 4791
.. ... .
SUHMARY RA J ING DETERHINAT ION ............................
'I!? FILE NO: 7QY67t DATE: 02-1C-?S
.:TIP 1 wee: Oarrizr:
..$%[. f WfiATLEY B2 s 11 - 00009 0
-,37 LOPEZ STREET HCH CLAIM MANAGEMENT !: ili+NSfIIE J CA 72054 3954 MURF'HY CANYON ??I3. '#3-205
SkN DIEGO) CA 92123
GIP I oyee He~rosentat I ve: Formal Hedical Evs;uat.rctn of:
KENNETH C, LAY! M.D. dated 12-30-93
'CilS PERMANENT DlSAEILXTY RATING DETERfllNATf ON IS BASED ON WE F0LLOW:INC
FtCTORS:
.:.re of Injury (DOI): 12-02-72 Ade on 1101: 44
-.TIJF~L ion : PARK MAINTENANCE IX
.*>AFItITY PER QME
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