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Home My WebLink About1995-02-14; City Council; Resolution 95-38-7 II 0 0 1 2 3 4 5 6 7 8 9 LO I1 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 I RESOLUTION NO. 9 5 - 38 A RESOLUTION OF THE CITY COUNCIL OF THE CITY OF CARLSBAD, CALIFORNIA, AUTHORIZING THE EXPENDITURE OF FUNDS FOR SETTIEh4ENT OF THE WORKERS COMPENSATION CLAIMS OF SANDRA MULHALL WHEREAS, Mr. Daniel P. Trovillion, Defense Counsel for the City of Carlsbad i~ this matter, has recommended a settlement of the Workers Compensation claims of Sand: Mulhall; and WHEREAS, there are sufficient funds available in the Workers Compensation Sel Insurance Fund to pay the settlement, NOW, THEREFORE, BE IT RESOLVED by the City Council of the City of Carlsbad, California, as follows: 1. That the above recitations are true and correct. 2. That the expenditure of $26,000.00 from the Workers Compensation Self- Insurance Fund is authorized for the settlement of said claims. 3. That the Council accept the Compromise and Release, attached hereto as Exhibit 2. I I I I. I I I I I i 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 I 20 21 22. 23 24 25 26 27 28 I 0 0 PASSED, APPROVED AND ADOPTED at a Regular Meeting of the C Council of the City of Carlsbad on the 14th day of FEBRUARY l995, by the following vote, to wit: AYES: Council Members Lewis, Nygaard, Kulchin, Finnila, E NOES: None ABSENT: None ATTEST: ALETHA L. RAU COMPROMISE AND RELEASE PLEASE SEE INSTRUCTIONS ON REVERSE OF PAGE 2 BEFORE COMPLETING FORM 0 0 EXHIBIT 2 STATE OF CALIFORNIA DEPARTMENT OF INDUSTRIAL RELATIONS DiVlSION OF WORKERS COMPENSATION WORKERS' COMPENSATION APPEALS BOARD CASE NO. SDo 1! SOCIAL SECURITY NO. 562-9: 7728 Calle Caracas Sandra Mulhall Carlsbad, CA 92009 Cit of Carlsbad, sel -insured Carlsbad. CA 92008-1989 Hertz Claim Management, administrator San Dieqo, CA 92171 r AP LlCANT (EMPLOYEE1 1200 Carlsbad Village Drive P 0 Box 710400 ADDRESS CORRECT NAME OF EMPLOYER ADDRESS CORRECT NAME OF INSURANCE CARRIER ADDRESS 1. The injured employee claims that while employed as a clerk twist I I (OCCUPATION ATTIME OF INJURY) on 09/20/92 - 09/20/93 at Carlsbad , CA (s1he sustained injury arising out of and in the course of employment to upper extremities : hands (DATE OF INJURY) [GIN) z bj CSTATEI (STATE WHAT PARTS OF BODY WERE IN JURED1 2. The parties hereby agree to settle any and all claims on account of said injury by the payment of the sum of $ ,-. in addition to any Sums heretofore paid by the employer or the insurer to the employee, less amounts set forth in Paragraph 3. Upon approval of this compromise agreement by the Workers' Compensation Appeals Board or a workers' compensation judgl in accordance with the provisions hereof, said employee releases and forever discharges said employer and insurance ( claims and causes of action, whether now known or ascertained, or which may hereafter arise or develop as a result including any and all liability of said employer and said insurance carrier and each of them to the dependents, hei representatives, administrators or assigns of said employee. 4. Unless otherwise expressly provided herein, approval of this agreement RELEASES ANY AND ALL CLAIMS OF APPLICANT'S C DEATH BENEFITS RELATING TO INJURY OR INJURIES COVERED BY THIS COMPROMISE AGREEMENT. The parties have c( 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 Ah 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 under DATE OF BIRTH ACTUALEARNINGSATTIMEOF INJURY LAST DAY OFF WORK DUE TO THIS 01 /3.3./53 442.31 AWE not atmllcable PAYMENTS MADE BY EMPLOYER OR INSURANCE CARRIER TEMPORARY DISABILITY INDEMNITY WEEKLY RATE PERIODS COVERED 9,436.50 294.89 09/20/93 - 04/11/94 PERMANENT DISABILIV INDEMNITY TOTAL MEDICAL AN0 HOSPITAL BILLS *2,960.00 6,119.69 BENEFITS CLAIMED BY INJURED EMPLOYEE BEGINNING AN0 ENDING DATES OF ALL PERIODS OFF DUE TO THIS INJURY MEDICAL AND HOSPITAL BILLS PAID BY EMPLOYEE same as above none known ToBepaidBv: all authorized care has been paid TO Be Paid BY: applicant THE FOLLOWING AMOUNTS ARE TO BE DEDUCTED FROM THE SEllLEMENT AMOUNT: TOTAL UNPAID MEDICAL AND HOSPITAL EXPENSE ESTIMATED FUTURE MEDICAL WENSE minim * credit $2,960.00 , defendant, PDAs $ PAYABLE TO PAYABLE TO $- PAYABLE TO $ $- PAYABLE TO $ PAYABLE TO LEAVING A BALANCE OF $ 2 3 I 04 0 . 0 0 , less approved attorney fee (See Paragraph No. 91, payable to applicant. ( be other than in a lump sum, or there is additional information, specify on Separate pagds). ) * $1,000 lump sum PDA. Advances at $140 per week, effective 09/05/94. Defendant has credit right for all advances. DWC WCAB FORM 15 (REV. 1992) (PAGE 1) 0 e Compromi se and Release Re; Sandra E, Mulhall v. City of Carlsbad SDO 190929 10. Reason for Compromise: 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 beca of her pre-existing condition. There is a dispute as to the ki need, frequency and qual ity of future medical treatment that ma) required, if any. It is the intent of the parties that t agreement absolves Defendant of any liability for clai retroactive temporary disabi 1 ity through the date this agreement approved by the Board. It is the intent of the parties hereto to hereby release Defendant herein from any liability for temporary disabili additional permanent disability or further medical treatme mi leage 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 forth Paragraph #I of this agreement. Pursuant to the case of Carter v County of Los Anseles. et a 51 CCC 255, the Defendant employer and carrier herein are relea from any liability for workers' compensation benefits which l arise from any subsequent injury or re-injury during any phase the rehabilitation process necessitated by this injury. It understood that this waiver does not in any way affect Applican right to receive vocational rehabilitation benefits which are may be due to the injuries alleged in Paragraph #1 of ' Compromise and Release Agreement. Applicant hereby makes this waiver expressly, knowingly, and w full knowledge of the potential rights she may have, if any, in ' absence of this waiver and release. Nothing contained her< abrogates the right of Defendant to raise QIW as an issue in c subsequent rehabilitation proceedings. 1 -A 0 Legal counsel for the respective parties have reviewed the medi 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 disp[ and any and all other questions relative to this injury which I exist now or may arise in the future and avoid the hazards i delays of litigation. The parties do intend to include in this Compromise and Release i of the provisions of Paragraph #4 of this agreement. It is further agreed that if the Order Approving Compromise i Release is paid within twenty-f ive (25) days of its date issuance, interest thereon shall be waived. { 64 IiANDRA MULHALL { Appl i cant CHARLES P. BROWN, Attorney for Applicant 1 -B 7. Liens not mentioned in Paragraph No. 6 e - s to be disposed of as follows: 9 ~. Iln 11egS. 4 8. For the purpose of determining the lien claim(s1 filed for benefits paid pursuant to the Unemployment Insurance Cod furnished by lien claimants defined in Labor Code Sec. 4903.1, the parties propose reduction of the lien claim@) in 2 formulae attached. 9. Applicant's (employee's) attorney requests a fee of $ 3 .\ a 0 0 . Amount of attorney fee previously paid, if any 10. Reason for Compromise, special provisions regarding rehabilitation and death benefit claims, and additional informatior A 06 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 employ WCAB may in its discretion set the matter for hearing as a regular application, reserving to the parties the right to put the facts admitted herein, and that if hearing is held with this document used as an application the defendants shall hi them all defenses that were available as of the date of filing of this document, and that the WCAB may thereafter eithl Compromise Agreement and Release or disapprove the same and issue Findings and Award after hearing has been held regularly submitted for decision. Witness me signature hereof this 7 \b day of &!=" " I~S , at \ -\,Y\\ C WITNESS WITNESS Charles P. Brown, atty/applic THE APPLICANT'S (EMPLOYEE9 SIGNATURE MUST BE AllESTED BY TWO DISINTERESED PERSONS OR ACKNOWLEDGED BEFORE A NOTARY PUBLIC. England, Hodik & Trovillion County of STATE OF CALIFORNIA 3. Dieao $ by Daniel P. Trovillion, atty for defendants h on mis o\%ay o<\\" AD., 76 5 , before me, c 1 ,b&&,\kk$,q - u a Notary Pubific in and for me said County and State, residing therein, duly commissioned and swrn. personally appeared- SQ22!=-- L&\L known io me ,tu be me person - whose name subscribed t~o me within Instrument, and acknowledged tu me ma& he- executed the same. IN WmVESS WHEREOF, /have here the day and year in this Certific written. ARY PUBLIC - CALIFORNIA SAN DIEGO COUNTY DWC WCAB FORM 15 (RN. 19921 (PAGE 2)