HomeMy WebLinkAbout1995-04-18; City Council; Resolution 95-101i ll e e
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RESOLUTION NO. 9 5 - 10 1
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 LARRY WHATLEY
WHEREAS, HCM Claim Management Corp., the Third Party Administrator for
the City of Carlsbad, has recommended a settlement in the Workers Compensation case
Larry Whatley; and
WHEREAS, there are sufficient funds available in the Workers Compensation St
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 $15,503 from the Workers Compensation Self-
Insurance Fund is authorized for the settlement of said case.
I 3. That the Council accepts the Stipulations with Request for Award, attache.
I hereto as Exhibit 2.
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1 PASSED, APPROVED AND ADOPTED at a Regular Meeting of the C
2 Council of the City of Carlsbad on the 18th day of APRIL 1995, by the following
3 vote, to wit:
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AYES: Council Members Lewis, Nygaard, Kulchin, Finnila, 1
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NOES: None
ABSENT None
ATTEST:
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l4 ALETHA ami& L. p4. RAUkkPrk
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EXHIBIT 2
WORKERS' COMPENSATION APPEALS BOARD
STATE OF CALIFORNIA
Larry. Whatley Appliwnt i Case No. Unassigned
Stipulations
with Request
VS. for Award
The parties hereto stipulate to the issuance of an Award and/or Order. based upon the fo]lowb
waive the requirements of Labor G~C Section 5313:
1. Larry Whatley * turn . 5-1-d
(E=&#)
-a-
employed within the State of California ~f park Maintenance Worker on 'I1 12-2-92 (0crup.Iial ( DIlr d Injur,
City of Carlsbad whose compensation insurance by (EmPhrI
IJerti Claim Manaqemnt sustaiDed injury arising out of and in the course of emplo>ment back
(PIN of h
2. The injury caused temporary disability for the period - 1-22-93
through 3-2 9-9 3 for which indemnity is payable at $336.(
week, less credit for such payments previously made. 0,
p, 3. The injury caused permanent disability of 26.59, for which indemnity is payable at $2
per week beginning 3-30-93 , in the sum of $ 15 r 503 - 00, less crd
payments previously made.
An informal rating has ki~w been previously issued.
( Seled ODC 1
4, There *&rrot may be need for medical treatment to cure or relieve from the effects of
(Selcrl ow)
OLrARTY@HT Or IHDUST
DlVlllON Or IKDUST
e 0'
WORKERS' COMPENSATION APPEAlS BOARD
STATE OF CALIFORNIA
. 5. !ledical-legal expenses are payable by defendant as follows: None
6. App!icant's attorney request a fee Of 5 None
..
7. Liens against compensation are payable as follows: None
8. Other stipulations: None
Q,
4 *?5 -3- 4
./
1200 Carlsbad Villaqe Dr
" Social Sccurity Number of Applicant
1637 Lopez Street
Oceansihe, CA 92054 "- Address of Applicant
1 N!!! . ..."."..""""
Atlorncy for Appllcant
N/A
Address of Attorney for Applicant
- Carlsbad, CA 92008
P.O. Box 710400
Address of Insurance Company
Address of Employer
San Dieso, CA 92171
rkbcnw)cNr Auhrizeti neprercntalivc for """_
Barbara Stokes
PPQ
Address of Attomy or Authorized Represe
~c..*-"C\- :* .LIZ.-,-
.. 0'
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.?I- -jr t t1.e.- - yJ+' Ind!Jstr I ;3 1 F:!. I :+, j l;nS STATE Jf- CAL:,FtjPNIA I'!lSl[)fd .jF ;Jt:jRKEgS' CCIHF'ENSATION F'€?k@ W I i son P Governor :..'.F-iCE 1;; EEIIEFIT DETERMINATION
IIC~A~EI-ITY EU4LUATION UNIT
.;Arl DI'E-II,- r CA 92101-3690
i:j~,) ?t-.:~:'~ r tj;f(i:E:T
.) ,, c 7:; - - 7:: L 4 .- ._
SUMMARY FATING DETERMINATION
""""e~l~~""l=l"~*~-~-
Fase 2 IjEU *: 7090785
18.1 - 25:<- 2F- 25- 26 :2
FuSug~_HEq~C~L_I~SAI~~~~-~~~~~~~~
The Permanent Disability Rating is 26,5% of total disability which 16
yqu iva 1 en?, to 104.75 weeks of dis~bi I itr Payment. Based on average
12eCrlr ezrningls of $651.159 the ueeklr rate is $148.00 in the total
.o.;rn ot $13/503.00. F'arments commence within 14 days after the d2te ot'
13st payment of ternporarr disatli I its indemnity. k! ;::y: """_ ~"""""""""""""""""""""~""
KA#L KNU ISEN! D'i sat1 I I I tu Eva i uator
'ITU FORM 102 (NEW 1-91i 293166
0 0'
z~artn~ent of Industrial Relations ;')ISION QF WORKERS' COMPENSATION
ISAEILITY EVALUATION lJNlT
35~17 FRONT STREET
.:FFICE OF BENEFIT DETERMINATION
.'.:I DIEGOp Ck 92101-3690 , 'I ,'67C- -I-J 475'1
%
STATE OF CALIFORNIA Pete W i I son t Governor
SUHMARY RATING DETERHlNATION
""""""""""""""
:!.! FILE NO: 709676 DATE: 02-10-'?5
T~P I oyee:
-PI ji tiHkTLEY $3
'-, 3 ,> 1-CIF'EZ STREET
~-.-~,NsILIE! CA Y2054
- -.
Carr ior I
HCfl CI-AIH MANAGEMENT
3954 MURF'HY CANYON FD. '#D-ZQ5
SAN DIEGO! CA 92123
srl-oo00w
I;IP I oyee Representat I ve: Formal rledicel Evaiuat Ion of:
KENNETH C. LAY! M. 0, dated i2-30-93
LI:IS PERMANENT DISABILITY RATIHG UETERfllNATION IS BASEB ON THE FOLLOW:[N(;
kCTQRS:
:re of Injury (KtOI) : 12-02-92 Age on 1101: 44
:. ~JF 2 !, t on : PARK MAINTENANCE I1
r -hE!LIT'I' PER QME