HomeMy WebLinkAbout1994-01-04; City Council; Resolution 94-4. I)
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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
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WHEREAS, HCM Claim Management Gorp., the Third Party Administrator
for the City of Carlsbad, has recommended a settlement in the Workers Compensation case
of Samuel Granillo; and
9 (1 WHEREAS, there are sufficient funds available in the Workers
10 IICompensation Self-Insurance Fund to pay the settlement,
11 11 NOW, THEREFORE, BE IT RESOLVED by the City Council of the City
l2 I1 of Carlsbad, California, as follows:
13 1. That the above recitations are true and correct.
14 2. That the expenditure of $10,220 from the Workers Compensation
15 Self-Insurance Fund is authorized for the settlement of said case.
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3. That the Council accept the Stipulations with Request for Award,
attached hereto as Exhibit 2.
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PASSED7 APPROVED AND ADOPTED at a Regular Meeting of the City
2 ouncil of the city of Carlsbad on the 4th day of January 1994, by the following LI 3 ote, to wit: 4
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AYES: Council Members Lewis, Stanton, Kulchin, Nygaard and Fin1
NOES: None
ABSENT None
XI. .ArnST
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ALETHA - L. RAUTENKRANZ, d.* City Clerk
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t , ' /. e. 0. Exhibit 2.- *.
WORKERS' COMPENSATION APPEALS BOARD
STATE OF CALlFORNlA
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Appkmt 1 Case No. Unassigned
Samuel Granillo Stipulations
SSN: 553-94-8345 with Request
VS.
City of Carlsbad, P.S.I.
Defendants I for Award
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The parties hereto stipulate to the issuance of an Award and/or Order, based upon the following fact
waive the requirements of Labor Code Won 5313:
1. Samuel Granillo bo,,, April 18, 1952 ,
(")
employed within the State of California as Part Mainto Worker Lbn -
by City of Carlsbad whose compensation administrat
HCM Claim Mgt- sustained injury arising out of and in the course of employment Right Knec
(&cup.Lim) (Datedlpiyf
(Empbyct)
(Puu d body imjt
2 The injury caused temporary disability for the period March 27, 1991
through July 16, 1991 for which indemnity is payable at $ 3 12 15
week, less credit for such payments previousIy made.
3. The injury caused permanent disability of ST, for which indemnity is paf@f$~~
perweekbeginning July 17, 1991 ,inthentmof$3,360*Oo~u~~
k
payments previously made. (?'if0 14 @-KEG'\T tqtrrx:~4toC( /I4433
h informal rating has not been previously issued.
(Select-)
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4. Upon %mad: l!%Ft% to injury herein mentioned as rfer Dr. Mag report of 9/16/93, defendant has five days to authorize or good cause for denial. Failure to do so shall give applicant t authority to secure whatever treatment is necessary to cure or re1
the effect of injury. DUARTYLUT OF INDUSTRIAL R
\NL r i%R '6A*fW ~EDICAC, C&R\_r
OIVISION OF IMOUSTRIAL A
,
c. " .
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m e
WORKERS' COMPENSATION APPEALS BOARD
STATE OF CALIFORNIA
5. Medid-legd expenses are payable by defendant as fohws:
Defendant has paid all medica -legal expenses.
(Uh" Pq*Tw4@-\/5.9 47s -00)
6. Applicant's attorney request a fee Of $ YO3 s O0
7. Liens against compensation are payable a~ fobws:
None
8. Other stipuhtion~: &)D**'Z QF \dJav ,% 3-zb -.qf, dQT r3-7-7-4 t & QC\L \dh%Ly he i w~~n T V-n Tux -2.
Y //- 23 . 93
Dated
553-94-8345 social Security Number of Applicant
2855 Cottingham Street Oceanside, CA 92054
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pwfli%L
Att0rneyforAppfi-t Stewart Atcheson r 2330 Thiid Avenue
San Dieao, CA 92,LQl 2019
Address of Attorney for Applicant
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RECFlvFn 1 Hf
QEC 0 2 a93
1200 Carlsbad Village Drive
Carlsbad, CA 92008
Address of Employer
3954 Murphy Canyon Road, D-205
San Dieao, CA 92123 Address of Insurance Company
Karen Church
Attorney or Authorized Representative for Defenda
3954 Murphy Canyon Rd, D-205 San Dieao, CA 92123 Address of Attorney or Authorized Representative