HomeMy WebLinkAbout1995-03-21; City Council; Resolution 95-61II 0 * t
1
2
3
4
RESOLUTION NO. 9 5 - 6 1
A RESOLUTION OF THE CITY COUNCIL OF THE
CITY OF CARLSBAD, CALIFORNIA,
AUTHORIZING TEE EXPENDITURE OF FUNDS
FOR SETTLE"T OF THE WORKERS
COMPENSATION CJ" OF JILL PRICHARD
5
6
7
8
9
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 Se
10 Insurance Fund to pay the settlement,
11 NOW, THEREFORE, BE IT RESOLVED by the City Council of the City of
12
15
2. That the expenditure of $5,075 from the Workers Compensation Self- 14
1. That the above recitations are true and correct. 13
Carlsbad, California, as follows:
Insurance Fund is authorized for the settlement of said case.
16
17
18
3. That the Council accepts the Stipulations with Request for Award, attache
hereto as Exhibit 2.
19
20
21
22
23
24
25
26
27
28
II 0 0
1 PASSED, APPROVED AND ADOPTED at a Regular Meeting of the C
2 /I Council of the City of Carlsbad on the 21st day of MARCH 1995, by the following
3 /I vote, to wit:
4
5
6
7
a
9
la
AYES: Council Members Lewis , Nygaard, Kulchin, Finnila, E
NOES: None
ABSENT: None
1 'I 1 ATLEST I.2 1 13
l4
15
16
17
18
19
20
21
22
23
24
25
26 I1
27 I/ 28
..
.t
, ' . . ':*..' . . ..:
.. .. .. I. a',,
.. .. ,
.. .. . . .. , .
1 -. ' . ......-. i -~ ..
EXHIBIT 2
WORKERS' COMPENSATfON APPEALS BOARD
STATE OF CALIFORNIA
\
Jill Prichard Apphnt Case No. Unassigned
Stipulations
with Request
vs. for Award
Hertz Claim Management,
City of Carlsbad Defendantt
-~
The parties hereto stipulate to the issuance of an Award and/or Order, based upon the folIowing f;
waive the requirements of Labor Code Sech'on 5313:
1. Jill Prichard , bm 11-13-62
( Emph )
employed wi&h &e State of California af Recreation Specialis%n 3-2-93
(Occup.*) (Date of Injuty)
by City of Carlsbad
(bpbycr)
whose compensation insurance ca
Hertz Claim Manasement sustained injwy arising out of and in the course of employment right W
(Pam d Wy
2. The injq caused temporaiy disability for the period - 12-18-94
through 1-8-95 for which indemnity is payable at $ 336 (
week, less credit for such payments previously made.
3. fie injury caused'pennanent disability of Us, for which indemnity is payable at $14'
per week beginning f Or thw i th , in the sum of S 5 t 075 - 00 , less credi
payments previously made. R FllFI WFD
An informal rating has W%bX been previously issued.
(Sekc ODC)
SEB 08 IS
4. fiere is &~mm& need for medical treatment to rue or relieve from the effects of sa
Except in.the case of an emergency, you must contact your em or insurance carrier prior to receiving medical treatment to
authorization. DC?ARTYLHT OF INDUS7RI
( Selert one 1
OIVl~lON Or INDU.TRI
" ~
I.. .
’. ’ .. 0, .. .. i , . : ” ::. ‘ ,
..
.. .- I ,. . .. .x
t . .. , .. ..: > . ’ , vv uf\i\Lt\G LVJIIJ &I .w, .. . - - . . ..
STATE OF CALIFORNIA
3. \fedicaI.fegal expenses are payable by defendant as follows: None
6. .+pplicant’s attorney request a fee of S None
7. Liens against compensation are payable as folIoas: None
9. Other stipuIations: None
3-9”-
Dat3! ’ -
Applicant Ji 11 Prichard
1200 Carlsbad Village Drj
558- 47- 39 IC Carlsbad, CA 92008
Social Security Number of Applicant .4ddress of Employer
3936 Jefferson Street P.O. Box 710400
Carlsbad, CA 92008 San Diego, CA 92171
Address of Applicant Address of Insurance Company
N/A - Attorney for Applicant. XSMWy or Authorized Representative for 1 Barbara Stokes
N/A P.O. Box 710400, San Diego,
Address of .4ttorney for Applicant Address of &WW+ or Authorized Represel
Dl& WCAB Fonu 3 ,REV ¶.:5: I Paee 2 1 DLtAlTYCMT OI IMDUSTI
DIYI~IQN OF IMOUSTI
'.
\ a' .
,:it+:: irt,tft*>~i?, *.>t lt-+u:j~<k~i,3I l't~Ii3t1t~n< S'T;+ I'E KIF: \;Ai-.[[:l)I?[ql&
'!~i'~j,~,j.<!~~ c)i' L.({]F;~..E.~<E~' CarlpL:W.:;kTIcjp: Pete i.1 i 1 jon J Gover.no1.
:ij.i;Al:~~iL.i7 'I LVALClri'T1C)N UNIT
',<,Pi I'liEi.)liJ 'LA 7::j.<l.- 2133
; , 1 - <1 -47:~ 1 , i ,,; ,. y- 'I L r
j: r [{;L !jF- ~>~~~j~fr.~ 7 ilETEF:iIINATIOI{ ,-<..
1 .; :j i;l 1: 1 ;I 1-1 14 ,- 1: 'r CI E E 'r
u *'Z i
S111.tHAR'r' RAT1 tJG DETERMI NATION -.-..""""."""""""""".
Pi3:3e 2
DEU 0: 637518
:i,f-j.L, S}-ftip;f"', IIJI, LIfiTCD :7./.15,,'*93
f?K,5i f.::I.LTIOI.IC.; RATE:
7 7 - l4:,:;-4OH- 13.- I .I I1 :2
FLI'IIJRE rtTD1CkL TEEATPENT REXIIREi'l """"""""""""""".-""_.- $
-~tt~ i't>~ii~~t~er~i, 111~3t.11 I its R~1,iras if; 11..5I; of tutal dis~,t:~i I itu wfj-itti is
u;f!pL:.I>I t+svrt IrlBE. a{: ~~~~;1.23 the ueek.lr rate ;FF,;J~; 49.~1, 111 ttle ,j$El . 1 . ' q:
.j!~til Ok iy5j8~','';i,iiJU. ::'GYIW?~~B i:i3KtF(rt?IICe Ul khidLLii &jY4'~~ ;it?,b?f' hp' di3br 0.i'
I K r;Z. t! s:~n~rtnt tlf LERIF>ZJI..~VY rJ i e;sb I 1 i tu i ridem i tu, kl ' , Pb I ..:
: LiJ 1 ';:; 1 t*f) i, t;,.j .'z(>. 2:; W%t+b:.S 06 4.1 I .;c;i.:l j 1 i t,y f"~yRl4:f'] t, ii:-i-'.j (3fi - 3!,'(+!+;-:4t? ,y, [V
stl - x.j
i. /.
-.,* .. . :.,,.e' ., . . . . , .._ ,'.;>j ; ___ ..___,,____-. .___.__-_. ---- ----~----------~----.-----------------~-------
i.l.l!; liiL(>Ci 7 1.1 I ~;st~ i t I~Y Lvs I L!st(Ji
!:jL:IJ I-ijl<!l 1~42 (N1:1.1 t-!;lj - :'gj.gn:1;;;
..
.. '. .. .. .'. @ . , ..
.. .-
. .. ' .. 1. . ._ .. - " - - " .." - - - " - - - -. . . - __ - -. -. - . - . - . - . . - .- - - " -. - _. - - " - - - - - - - ...
..
.:~f?t,~~:+,riler\t, ~f ifi~.j{J3t,1'1di RetI&~i>n:i
;! i l.j:[.:;J.(j>; i]F M~)b:t..~.l;:; ' CCIPlF'E:I-If'i~,TIi)r: i''e<.e Li 1 i5oci j GOVE.!I IIC~I, ;,:i."[cE i)i: &EldE;'I'( l1&l'rE{<M:LtJ{; f:i~..i).l
i!l.5i,i;lL.li''1' ~~~ALUAl'lON UFlll
L . .., ,,, p- lidtl r ;-.r ..T _--
:,r,pi iliLi,(jJ tr, .;2j.jJ,-.y,*:vr>- L L) .' 'J
.> f 4 [E ;2:- CAl..lFiX!4:it4 . . .-
, -_. .
LJ >- > ; kit f
,;p>,'52,?.-.g?,t .
? 3 %
Su~.iIltiR'( RI+'T~NG DEJEf;;"INA'TIr312 ""_."_".".".".""" _."" -"".
#:ll:i-l j-ILi' 14u: ,>?7<,118 TIATE: 01 -12-35
Llllf~ I D?4irt!; Car 7 i el. :
jI1-L- F4iiILlit'l?l't srl-i)G~li12
1 cg l:j t I t-. r\ L ir L t.. j t. I. I.ICEI CLAIM EIANAtGEPiEH'i
!;l;l<L>~{&~~t i;;i *:z<bijg ~~34 MU~F'HY wt: mtd m. I #rei:IS
:;Ap: DIEGO, CA 92123
E.B~F; i ~)~ee f?er~r.eC,err.taL ive : ;--or uld I fled i ca i Eva I u5.k ion of :
.JACOB SHARP t N. it. dated GY-15-5';
II.415 C:'EF:f.liiNENT 1l;ISAbILIT'r HATING DETERMZNAT:ION IS EASED ON TtE Fi)l.LOW:[NI
i ACTC1kS ;
{r;+f,a of In,rt~py tii<j1.1: ljz-'.? U.2" $93 AS+ ijn DrjX: ,39
~2, cup st i or\ : KEL. SPEC /CLERICAL/DATA ENTI?.< P
i-.ItI;['rATIG>! iji' F',$L..Mr;rfZ FLE;I:IDI.: UF THE Alrjlif KAi.JUR t. ACCORDXNi; 'TO f.2. H.E.
, m\J[. '7' liF l.:Ll:{ii.:.l Ilk Fli.;ijf, -[k15 F:!K;!I-f 7'0 i't;: THE ti~~-iCli.' tiAPli'l Abj!; liif". L€F-l
;O at: iliE MINOR HriNDj URIST Tli 75,'76i CONTINLJOUS IIJNIMAL PAIN OVE&' THE bllZ1S-I G1Tt.i ACTI'JITIECi THAT f<EliC!IKE LiURSAL FLE;.;IClbl STi<AIl'i~ S!IF'INATIilPi
j'iriA(I1J Giy k i-iijii5 t4ATIJRE.t THE F'A.[N :IS OCCASIONfiLLY SLJtji.lT 'i'ii MOIiERt4TE
Hi\EI.( k'~f::~[)f~t:~~~G THt.'i;c . I.iil'-)ElPlENjEj IF' THE'i f?EG!JJ.fiE. i+ HEh?l'r' F'[lZLE, SUUll:rEi'l :,-l,p:!;~f:i~~ .rtj.rn--. , .LJ 1 .[]J(j (317 JtjE j.([<fS.r iS1JPI){&TIIjNj OH UiJR5iA;- FLEX:i:l)i\: A[jA:[N:5T
i:E:as].E;-iA)!~.E:. LlIL C;+iJSE Pl[llj~Kt4TFi V&lbi; lZ:[i.itj81!-.3.?'1' f*f::ELLL.i1~lINCi THK. blC!i;'T \
,Ic-IIl.,.' ,' i-.ij- ;li;ij ,,id:, .jW:i.;yIEJij ,;,: ~:~:,I:i~~-'-"~ : ik-;;, j:-c;; G[j&;.-ii:iElf ttCilii;Gi ii;,in;i.?,/JEb;
15 A 3'.: L.9iiS I1F ~'F,:~~--~~~-!~-~~~~~ C&F'Ai5 T'i FiKi LIFTII.IGt. CAK~;'~'IH{.;I f~'llSiii?!Ci~ F dk !
i;:i,lt;[Ii.I:itJLp 5L2LIKL~ tll)LitItJijr GF<ASFXNGj 'fWZ57Il.Iii t+tJD .iIJI.71dIN(i; CtF'.tr:'. ill: IiriNL i'{ i: 1 b 1 i, 7 c c C', 85;. J,
*
.. .