Workers' Compensation Settlement - Jerome Ben Copyright 2014
City of Dubuque Consent Items # 8.
ITEM TITLE: Workers' Compensation Settlement - Jerome Ben
SUMMARY: City Attorney recommending approval of an Agreement of Settlement
regarding a workers' compensation claim that was filed against the City of
Dubuque by Jerome Ben
SUGGESTED DISPOSITION: Suggested Disposition: Receive and File; Approve
ATTACHMENTS:
Description Type
❑ Staff Memo Staff Memo
❑ Reddick Letter Supporting Documentation
❑ Agreement For Settlement Supporting Documentation
Masterpiece on the Mississippi
TRACEY STECKLEIN
PARALEGAL
MEMO
To:
Kevin Firnstahl
City Clerk
MEMORANDUM
DATE: May 12, 2015
RE: Jerome Ben vs. City of Dubuque — Workers' Compensation Claim
Kevin:
Attached for the May 18, 2015 City Council agenda is the original Agreement for
Settlement, executed by claimant, regarding the Jerome Ben Workers' Compensation
claim: Once approved at the City Council meeting, I would appreciate it if you would
obtain the City Manager's signature, and then send the Agreement back to me for
processing.
Thank you.
Attachment
OFFICE OF THE CITY ATTORNEY DUBUQUE, IOWA
SUITE 330, HARBOR VIEW PLACE, 300 MAIN STREET DUBUQUE, IA 52001-6944
TELEPHONE (563) 583-4113 / FAX (563) 583-1040 / EMAIL tsteckle@cityofdubuque.org
HE CITY OF
DUB
E MEMORANDUM
Masterpiece on the Mississippi
BARRY LINDAHL
CITY ATTORNEY
To: Mayor Roy D. Buol and
Members of the City Council
DATE: May 11, 2015
RE: Jerome Ben vs. City of Dubuque —Workers' Compensation Claim
Attorney Les Reddick, representing the City of Dubuque, is recommending approval of
an Agreement for Settlement regarding a Workers' Compensation claim that was filed
against the City of Dubuque by Jerome Ben. Mr. Ben is an employee of the City of
Dubuque Public Works Department and sustained a work-related back injury in 2011
while working as an Equipment Operator.
As a result of Mr. Ben's injury, he incurred a 13% functional impairment and a 40 pound
lifting restriction. All medical bills and past benefits have been voluntarily paid and the
attached Agreement has been negotiated over the past year.
The settlement is for an additional 7% impairment and totals $22,340.50 and represents
what would be a fair result if this matter were tried before the Workers' Compensation
Commissioner. The City is not paying anything that Mr. Ben is not otherwise owed
under the Workers' Compensation Statute.
I recommend approval of this Agreement for Settlement.
BAL:tls
cc: Michael C. Van Milligen, City Manager
Cindy Steinhauser, Assistant City Manager
Randy Peck, Personnel Manager
Don Vogt, Public Works Director
Les Reddick, Esq.
F:\USERS\tsteckle\Workers Comp-Reddick Cases\Ben Jerome\MayorCouncil_BenWkrsCompClaim_051115.doc
OFFICE OF THE CITY ATTORNEY DUBUQUE, IOWA
SUITE 330, HARBOR VIEW PLACE, 300 MAIN STREET DUBUQUE, IA 52001-6944
TELEPHONE (563)583-4113/FAX (563)583-1040/EMAIL balesq@cityofdubuque.org
i
KANE,NORBY& REDDICK, P.C.
ATTORNEYS
Brian J.Kane 2100 ASBURY ROAD,SUITE 2
Les V.Reddick* DUBUQUE,IOWA 52001-3091
Brad J.Heying
Todd L.Stevenson* Retired:
Kevin T.Deeny** Gary K.Norby
Bradley B.Kane
Joseph P.Kane
Nicholas J.Kane
All admitted in Iowa Phone: (563)582-7980
*Also admitted in Illinois Facsimile: (563)582-5312
**Also admitted in Wisconsin E-mail:Ireddick@kanenorbylaw.com
May 7, 2015
Mr. Barry A. Lindahl
City Attorney
Harbor View Place, Suite 330
300 Main Street
Dubuque, Iowa 52001-6944
RE: JEROME BEN V. CITY OF DUBUQUE
AGREEMENT FOR SETTLEMENT
Dear Barry:
Attached is an Agreement for Settlement for City Council approval and signature by Mike
Van Milligen where indicated. Would you please process this, accordingly.
Mr.Ben sustained a work related injury while in the course of his employment with the City
of Dubuque.As a result of the injury he incurred a 13%functional impairment and a 40 pound lifting
restriction.All medical bills and past benefits have been voluntarily paid and the attached Agreement
is the product of negotiation over the past year.
The settlement is for an additional 7%impairment and totals$22,340.50 and represents what
would be a fair result if this matter were tried before the Workers Compensation Commissioner.We
are not paying anything that Mr. Ben is not otherwise owed under the Workers Compensation
Statute.
Should you have any questions please contact us.
Very truly yours,
KANE,NORBY&REDDICK, P.C.
By 4
Les V. Reddick
LVR/bmo
Enc.
BEFORE THE IOWA WORKERS' COMPENSATION COMMISSIONER
TEROME BEN
Claimant, : Contested Case File No.5047836
vs. : Compliance File No. 1534670
CITY OF DUBUQUE. Injury Date: 08/05/11
Employer,
and AGREEMENT FOR SETTLEMENT
Iowa Code Section 85.35(2)
SELF-INSURED
Insurance Carrier,
Defendants.
The undersigned parties submit this Agreement for Settlement to the Workers'
Compensation Commissioner for approval. The parties agree:
1 . Claimant sustained an injury arising out of and in the course of employment
with Employer on 08/05/11 (date).
2. Jurisdiction exists because the injury occurred in Iowa OR Iowa Code section
85.71(_) applies. (Circle one.)
3. Claimant is married/single (circle one), entitled to 3 exemption(s) and gross
weekly earnings are $971.87 using Iowa Code section 85.360.
The rate of weekly compensation is $638.30 (If the rate for PPD
differs it is $ per week.)
4. The injury caused Claimant to sustain the following disability and resulting
entitlement to compensation:
a. Temporary total disability/temporary partial disability/healing period
compensation for weeks from (date) thru
(date). Iowa Code sections 85.33, 85.34(1). (A detailed
description maybe attached.) See attached.
b. Permanent partial disability for 20 % loss of whole body
(member or earning capacity) resulting in 100 weeks of compensation
under Iowa Code Section 85.34(2)( u ) payable commencing
10/10/12 (date).
c. Other compensation or benefits consisting of
5. Benefits that accrued and were paid are shown in the attached
payment activity report (PAR), dated
Benefits that remain to be paid are 35 weeks which equals $22,340,50.
6. The employer/insurance carrier shall file a final electronic Subsequent
Report of Injury [SROI (FN)] and mail Claimant a PAR that contains the
information in the final SROI, including the date that weekly
compensation was last paid. Rules 876 IAC 2.6, 3.1(2), and 11.7.
7. This settlement waives a hearing, decision, and resulting statutory benefits. It
is subject to review -reopening for three years following the last date that
weekly compensation is paid. Iowa Code sections 8526(2) and 86.14.
8. Claimant is entitled to medical care for the injury, including care in the future,
Iowa Code sections 85.26(2) and 85.27. (A detailed description may be attached.)
9. Evidence that corroborates this settlement i ttached. A Claimant's
Statement is attached if claimant is not represented by an attoji.
WHEREFORE, the parties request thathis tlement`I approved.
CI .l ant- fate
Employer/Insurer
Michael Van Milligen
1)
ate Employer/Insurer's Attorney Date
Claiman-t's Attr
Date
ORDER
I find that substantial evidence supports the terms of the foregoing settlement,
the employee knowingly waives hearing, decision, and resulting statutory
benefits and the settlement is a reasonable and informed compromise of the
competing interests of the parties. The foregoing settlement is therefore
approved this day of , 20
lowa Workers' Compensation Commissioner
The information provided will be open for public inspection under Iowa Code §§
22.11 and 86.45(1).
14-0021 (02/15)
OWA
C E
DEVELOPMENT