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Home My WebLink About1991-11-05; City Council; Resolution 91-3581 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 0 0 RESOLUTION NO. 9 1 - 3 5 $ A RESOLUTION OF THE CITY COUNCIL OF THE CITY OF CARLSBAD, CALIFORNIA, AUTHORIZING THE EXPENDITURE OF FUNDS FOR SE'ITLEMENT OF THE WORKERS COMPENSATION CLAIMS OF RICHARD K. SMITH WHEREAS, Ms. Susan England, Defense Counsel for the City of Carlsbad in this matter, has recommended a settlement of the Workers Compensation claims of Richard K. Smith; 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: I. 2. That the above recitations are true and correct. That the expenditure of $17,000 from the Workers Compensation Self- Insurance Fund is authorized for the settlement of said claims. That the Council accept the Compromise and Release, attached hereto as Exhibit 2. 3. I If 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 0 0 PASSED, APPROVED AND ADOPTED at a Regular Meeting of the Cit Council of the City of Carlsbad on the 5th day of November1991, by the following vote, to wit: AYES: Council Members Lewis, Larson, Stanton and Nygaard NOES: None ABSENT. Council Member Kulchin A”EST: AL,ETHAL. I Y gW IU.IJLJp IYJdJV .IL ___ ..--...--..-.-- -. . DIVlS101V OF IhDUSTRIAL ACCIDENTS PLETING FORM WORKERS' COMPENSATION APPEALS BOARD 8f38 &f3m sw7m23-- :USE OF PAGE 2 OEFORE 376-26-0720 SOCIAL SECURITY NO. 995 Knowles Avenue :HARD K. SMITH Carlsbad, CA 92008 1200 Carlsbad Village Drive ewtc.wr IEU~PLOTECI Y OF CARLSBAC), Self-insured Carlsbad, CA 92008-1989 , j n i ste red blgrr~rcr N~UE OF EMPLOYER 3954 Murphy Canyon Hoad, Suite D-205 I CLAIM MANAGEMENT CORPORATION Sari Diego, CA 92123 - CORIBCT NAYF OF INI~URANCE CARRIER ADDr(L!IS Firefighter ~3/7/as, 1 I /7,/85, 1/4/87, att Car 1 sbad Cal ifomia (DATE - lN-..lm- - 7 / t 1 a6 lu-bback, heart, ski n , 157bTEI )he sustoined injury arising OUI of ond in the course of employment to - ears (hearing loss), hypertension be i 'ure employee clqi that vvhil e p o &6904 l 71 t 77t33, 7723/ggd, Or a- ImCUPATION LT TIME OF INJURV) , by the ernplo (STAR WUbT PARTS OF WDV WERE INJURED1 in oddit 17,000 .oo %e portie5 hereby ogree to settle any and 011 cloims on account of soid injury by the payment of the sum of $ - any sums heretofore paid by the employer or the insurer to the employee, less amounts set forth in Porograph NO. 6. pon opproval of this compromise agreement by the Workers' Compensation Appeals Board or a workers' compensation judge ond paymen ;cordonce wifh the provisions hereof, soid employee releases and forever discharger said employer and insurance carrier from 011 &;mr c wses of oction, wheth'er now known or ascertained, or which may hereofter arise or develop as o result of s,oid injury, including any and obility of said employer ond said insuronce carrier and; each of them to' the dependents, heirs, executors, representatives, odministratorr ssigns of soid employee. lnless otherwise expressly provided herein, opprovol of this agreement RELEASES ANY AND ALL CLAIMS OF APPLICANT'S DEPENDENTS 'EATH BENEFITS RELATING TO INJURY OR INJURIES COVERED By THIS COMPROMISE AGREEMENT. The porties hove considered :lease of these benefit!; in arriving at the sum in Porograph NO. 2. lnless otherwise expressly ordered by a workers' comptrnsation judge. approval of this agreement DOES NOT RELEASE ANY CLAIM AP .ANT MAY NOW OR HEREAFTER HAVE FOR REHABIL11'ATlON OR BENEFITS IN CONNECTION WITH REHABILITATION. he porties represent that the following fads ore true: (If facts are disputed, state what eoch porty contends under Porogroph No. 10.) -- LAST DIT OFF WORK DUE TO mls INJURV DATE OF (1IRTU ACTUAL EARNINGS AT TIME OF INJURY 10/21/29 Max i mum Not App7icable - MENTS MADE BY EMPLOYER OR INSURANCE CARRIER ~11 applicable periods compensated by full salary per L.C. Section 4850 - TEYPORbRV D15bEIlLIlV IWDEMNITY WEEKLY RbTE IPERIODS COVERED - VERYANENT WSIBIL1TY INOEYNITY TOTAL MEDICAL AND YOSF'ITAL BILLS $2,940.00 $1 2,190.10 - EFITS CLAIMED BY INJURED EMPLOYEE nlffi AND ENDlNG DbTES OF ALL PERIODS OFF WE TO TUIS INJURY MEDICAL AND HOSPITAL BILL5 PhiD BY EMPLOYEE - None Known - As above - no further claim UNPblC MEDlCbL AND MOW~TAL EXPEN5E None Known ; 1 t any , ESTIMATED FUTURE MEDICAL EXPENSE M ma I 3e Paid B~. sol E! 1 y by App 1 i cant To Be Paid B$O 1 e 1 Y by APP 1 i cant FOLLOWING AMOUNTS ARE TO BE DEDUCTED FEOM THE SETTLEMENT AMOUNT: PAYABLE TO-- 2,940.00 CREDIT ,ro Defendants for P. D. A .$ PAYABLE TG $ PAYABLE TO- PAYABLE TO 5 PAYABLE TO-- 'I 4 1 0 6 0 . 00 VING A BALANCE OF $- r than in a lump sum, or there is odditionol informationi, specify on separate poge(s).) , less approved attorney fee [See Parogrzph No 9), poyoble to opplicont. (If payment is to WCAE CORM i 5 ~PEV I 583) PAGE 1 I *3 2 SEE ATTACHED PAGE 1-A 7. Liens not mentioned in Paragraph No. 6 arc e be disposed of OS fOlIOwS: 8. For the purpose of determining the lien claim(s) filed for benefits paid pursuant to the Unemployment Insurance Code or for be by lien claimants defined in labor Code Sec. 4903.1, the parties propose reduction of the lien claim(s) in occordance with formulc . Amount of attorney fee previously paid, if any, S - 0% 9. Applicant's (employee's) attorney requests a fee of $ 204 10. Reason for Compromise, special provisions regarding rehabilitation and death benefit claims, and additional information: 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 employee, anc may in its discretion set the matter for hearing as a regular application, reserving to the parties the right to put in issue any off herein, ond that if hearing is held with this document used as an application the defendants shall have available to them all c available os of the date of filing of this document, and that the WCAB may thereafter eiiher approve said Compromise Agree or diwpprove the same and issue Findings and Award after hearing has been held and the matier regularly submitted for deci WITNFSS the signature hereof this f 7 iiayoj.&,lgU,at WnNESs - SCOT1 A. O'MARA ATTORNEY FOR APPLICANT ENGLAND, HODIK & TROVILLION 7WE -ANT'S (EYROYEE'SI SlUdATURE MUST M AlTESTED OY TWO D1SI-STTED PERSONS OR xxm- n1V-E A woranv wnuc. STATE OF CALIFORNIA rc 1 BY SUSAN L. ENGLAND ATTORNEY FOR DE DANT County of .<A 3@%& On this 17dayofLA.D.,19_, 9 f before me, AidQ- LEFrma a Notary Public in and for the said County and State, residing therein, duly commissioned and sworn, personally appea v LC4 VA < known to me to be the person- whose name nstrument ...... ----.-'-.-'r"-h .- andocks to me that Ae-executed thcsame. r .I i . ... .. !< '.'2,. .. &I..? F. 1'h'a've:~rcunifB set my hand and affixed my official seal the day and year in this Cerl ........... ..... .. written. < 1. . ... L4/??&4 .. ..- _, , .. d , .. ,-~ ...... - ........ .. . ._-. . ,- . ' .. . .,_ , -. . - ._ - ~ ._ ~ c.. --/.-.-.. fu and .Stalp of Caftjornic 0 0 COMPROMISE AND RELEASE RE: RICHARD K. SMITH v. CITY OF CARLSBAD CASE NOS. 86 SO0 105529, 105530; 86 SDO 105538-41; 87 SO0 11132 7. Liens not mentioned in ParaqraDh No. 6 . . . Defendant has paid of will pay medical-legal liens as follows: Steven Emmet, M.D., $645.00, $900.00, $280.00, $375.00, $115,00, $295,00, and $770.00; Geoffrey Smith, M.D., $770.00; Scott Adler, M.D., $910.00, $60.00, $285.00, and $740.00; S. 0. Neurodiagnostic, $910.00; James Grisolia, M.D., $880.00; Smith-Hanna Medical Group, $365.00; Richard Cundiff, M.D., $706.00. --------------------------------------------------------------- ............................................................... 10. Reason for ComDromise: There is a serious and substantial issue as to whether or not t Applicant’s hypertensive condition arose out of and occurred in t course of his employment. It is the contention of the Defenda that the Applicant is not affected with heart trouble and support of that contention relies upon the opinions Douglas Davidson, M.D., who set forth in his report that there we no objective factors for diagnosis of heart disease. As to a other allegations of injury, there is a dispute as to the natur extent and duration of permanent disability, if any. There is dispute as to the apportionment to be applied to this Applicant disability because of his preexisting condition. There is dispute as to the kind, need, frequency and quality of futL medical treatment that may be required, if any. It is the inte of the parties that this agreement absolves Defendant of a liability for claimed retroactive temporary disability through t date this agreement is approved by the Board. Pursuant to the case of Carter v. County of Los Anqeles, et I 51 C.C.C. 255, the Defendant employer herein is released from 2 liability for workers’ compensation benefits which may arise fi any subsequent injury or re-injury during any phase of I rehabilitation process. This waiver includes any additior permanent disability or further medical treatment, mileage or ott 1-A a 0 incidental benefits. It is understood that this waiver does not any way affect Applicant’s right to receive vocation rehabilitation benefits which are or may be due to the injuri alleged in Paragraph 1 of the Compromise and Release Agreement. Applicant hereby makes this waiver expressly, knowingly and wi full knowledge of the potential rights he may have, if any, in t absence of this waiver and release. Nothing contained here abrogates the right of Defendant to raise QIW as an issue in a subsequent rehabilitation proceeding. Legal counsel for the respective parties have reviewed the medic reports submitted in this case, the opinions and conclusions of t doctors as set forth in those reports and the subjective complair of the Applicant as set forth in those reports. After assessing the information, the parties feel that the figi indicated in Line 2 is a fair and equitable settlement of this cz and have decided to resolve these questions in dispute and any i a71 other questions relative to this injury which may exist now may arise in the future and avoid the hazards and delays 1 i ti gation. The parties do intend to include in this Compromise and Release E of the provisions of Paragraph 4 of this agreement. It is further agreed that if the Order Approving Compromise 4 Release is paid within twenty-five (25) days of its date issuance, interest thereon shall be waived. Law Offices of SCOTT A. O’MARA BY 1-8 my nEconoita nmuE WHEN nEconmo MAIL IO 8 9 4 nruL Bfi&7X? 5mJ-J g F'%??d. &vi 4693 .c /r 1 5'*if cPII(sq OpLI ?m?, DO*79:-043024E % FF RF : ! 3.00 I. 06 fEES: 99 22-fiUG-1991 11~17 AI%$ OFFICIAL GECDRDS ,4 Itim EUAI~S~ COUHTY wow 5 SA1 DIE60 CDUIIIY PECDBDEP'S OFFICE flF : 1.00 (SPACE &f THIS LINdE@RLCOIILlCR'S USE)