HomeMy WebLinkAbout1995-03-28; City Council; Resolution 95-720 0
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RESOLUTION NO. 95-72
A RESOLUTION OF THE CITY COUNCIL OF THE
CITY OF CARLSBAD, CAL,IFORNIA,
AUTHORIZING THE EXPENDITURE OF FUNDS
FOR SETILEMENT OF THE WORKERS
COMPENSATION CLAIM OF MARC RENO
WHEREAS, HCM Claim Management Cop, the third party administrator for th(
City of Carlsbad, has recommended a settlement in the Workers Compensation case of
Marc Reno; and
WHEREAS, there are sufficient funds available in the Workers Compensation Sei
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 $9,275 from the Workers Compensation Self-
Insurance Fund is authorized for the settlement of said case.
3. That the Council accepts the Stipulations with Request for Award, attache
hereto as Exhibit 2.
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1 PASSED, APPROVED AND ADOPTED at a Regular Meeting of the Ci!
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Council of the City of Carlsbad on the 28th day of MARCH 1995, by the following
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14 k-! RAUTENKRANZ, City Clerk
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vote, to wit:
AYES: Council Members Lewis, Nygaard, Finnila, Hall
NOS: None
ABSENT: Council Member Kulchin
ATTEST:
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0' 0
EXH I B I'
WORKERS' COMPENSATION APPEALS BOARD
STATE OF CALIFORNIA
-~
Marc Reno Ad-
554-45-0173
Case No. Unassigned
Stipulations
with Request
vs. for Award
Hertz Claim Management,
City of Carlsbad
fie parties hereto stipulate to the issuance of an Award and/or Order, based upon the following facts,
waive the requirements of Labor code Sextion 5313:
. &l-I0-(~3
1. Marc Reno t born (Lgbrr) 7'
employed within the State of Cdifornin of Police Officer on 10-22-93 ((krumabr) (Dau d Injuty )
bv City of Carlsbad whose compensation inruranoe carrie~
(L..Pbra)
Hertz Claim -9mnt sustained injwy arising out of and in the course of employment right knc
(Pamdbcdri.run
2 The injury caused temporaiy .disability for the period 2-4-94
through 2-6-94 for which indemnity is payable at $ 336 00
week, less credit for such payments previously made.
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3. ne injury -used permanent disability of 19%. for which indemnity is payable at t 140 - (
per week beginning forthwith , in the sum of $ 9275 00 , less credit for
payments previously made.
An informal rating has &UW€ been previously issued.
(Sckd w)
~~!s~Fn '
F~~ 13 11
4. There SXlWiW may be need for medical treatment to we or relieve from the effects of said u
Except in the case of an emergency, you must contact your emp'
insurance carrier prior to receiving medical treatment to obt
authorization.
(StlCc( one )
~AR?YLWT OF INDU*mIAL mIL
DIVI.IO* O? I*o".mI.L uc
__... -.". - *.. .
0 .. .,- ...”.” .. STATE OF CALIFORNIA
5. \ledical-legal expenses are payable by defendant 1~ fo1lo-s: None
8. .%ppIicant’s attorney request a fee of S Nom
7. Liens against compensation are payable as foI1ow.s: None
8. Other stipulations: None
22~ -E”/- /-) . -d=/
Marc Reno
1200 Carlsbad Villaqe Dr - 554-45-0173 Carlsbad, CA 92008
Social Security Xumber of .ipplicant Address of Employer 7
1892 Centennial Way P-0. BOX 710400 &T($‘ Escondido, CA 92026 San Dieqo, CA 92 4
Address of Applicant Address of Insurance Cornpan‘y %@ ’
N/A .
c_ Attorney for .4pplicant .- or .-\uthorized Representative fl
N/A P.O. Box 710400, San Die
Address of .ittorney for Applicant Address of ktttxxewr Authorized Reprc
Barbara Stokes
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