Workers' Compenstation ClaimsMasterpiece on the Mississippi
TO: The Honorable Mayor and City Council Members
FROM: Michael C. Van Milligen, City Manager
SUBJECT: Workers' Compensation Claims
Michael Clancy: 5004896, 5013605
Kevin Sweeney: 5025261, 5027995
DATE: February 1, 2011
Dubuque
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Al- Ameticatfty
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Assistant City Attorney Crenna Brumwell recommends City Council approval of the
following workers' compensation claim settlements:
1. Michael Clancy, Files 5004896 and 5013605, for $22,899.60; and
2. Kevin Sweeney, Files 5025261 and 5027995, for $60,148.20.
I concur with the recommendation and respectfully request Mayor and City Council
approval.
MCVM:jh
Attachment
cc: Barry Lindahl, City Attorney
Cindy Steinhauser, Assistant City Manager
Crenna Brumwell, Assistant City Attorney
Mic ael C. Van Milligen
DUB 7E MEMORANDUM
Masterpiece on the Mississippi
CRENNA M. BRUMWELL, Es
ASSISTANT CITY ATTORNEY
To: Michael C. Van Milligen
City Manager
DATE: January 20, 2011
RE: Workers' Compensation Claims
Michael Clancy: 5004896, 5013605
Kevin Sweeney: 5025261, 5027995
In a review of how the workers' compensation claims are processed and medical
information shared with the City Council, it was discovered that two settlements, while
pending litigation, were approved by the City Council in closed session but never
formally brought before the City Council in open session for approval upon final
resolution. I ask that the following settlements be retroactively approved by the City
Council on an upcoming Consent Agenda.
1. Michael Clancy, Files 5004896 and 5013605, $22,899.60
2. Kevin Sweeney, Files 5025261 and 5027995, $60,148.20
Please let me know if there are any questions on this matter. Thank you.
cc: Randy Peck, Personnel Manager
tiED
BEFORE THE IOWA WORKERS' COMPENSATION COMMISSIONER
NOV 0 32
KEVIN SWEENEY, ) Contested Case File Nos.:502 f(ER$' C'i`jMpCNS1411014
) 5027995
Claimant, )
) Compliance File Nos.: 1432170
vs. ) 1490045
CITY OF DUBUQUE, ) Injury Date: 01/19/06
) 12/19/06
Employer, )
AGREEMENT FOR SETTLEMENT
) Iowa Code Section 85.35(2)
SELF - INSURED, )
Defendant, )
The undersigned parties submit this Agreement for Settlement to the Workers'
Compensation Commissioner for approval. The parties agree:
1. Claimant sustained injuries arising out of and in the course of employment with
Employer on January 19, 2006 and December 19, 2006.
2. Jurisdiction exists because the injury occurred in Iowa.
3. Claimant is married, entitled to two (2) exemption(s) and gross weekly
earnings are $ 904.30 using Iowa Code Section 85.36(2). The rate of
weekly compensation for Case No. 5025261 is $ 571.34 . The rate of weekly
compensation for Case No. 5027995 is $ 572.84 .
The City stipulates to settlement at the higher rate of $572.84.
4. The injury caused Claimant to sustain the following disability and resulting
entitlement to compensation:
a. Temporary total disability /healing period compensation for 24 weeks
and 3 days from May 11, 2006 to August 14, 2006 and
February 28, 2007 to May 16, 2007 and temporary partial disability
benefits for 11 days from August 10, 2006 thru
August 21, 2006 , Iowa Code sections 85.33, 85.34(1).
b. Permanent partial disability for 4% loss of MAN AS A WHOLE
(MAAW) resulting in 20 weeks of compensation under Iowa
Code Section 85.34(2) (u1 payable commencing November 14, 2006 .
c. Other compensation or benefits consisting of twenty -five percent (25 %)
industrial disability settlement with credit for the four percent (4 %)
5. Benefits that accrued and were paid are shown in the attached payment activity
report (PAR), dated . Benefits that remain to be paid are
the 21% Industrial Disability Settlement
6. The employer /insurance carrier shall file a final electronic Subsequent Report of
Injury (SROI) 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 85.26(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.
9. Evidence that corroborates this settlement:
The Claimant currently works full -time (40 hours /week average) as a
maintenance worker for the City of Dubuque. The Claimant is paid at a
rate of $21.40 per hour.
WHEREFORE, the parties request that this Settlement be approved.
Claimant
Attached you will find the following:
• Job Description for the position of Maintenance Worker
• Medical reports outlining the Claimant's recovery from his work -
related injuries and restrictions resulting from those injuries.
7/07
ate C a
imant's Att
Date
Subscribed and sworn to by claimant before me on this day of
;;;u.,7 r JAM ES C KLOSTER(vMANN
COMMISSION NUMBER 221 059
1Y QOM 11SSION EXPIRES
City of Dubuque, Iowa, Employer
By: Crenna Brumwell
Assistant City Attorney
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 sett) ment is a re sonable and informed compromise of the competing interests of
the pa i- s. The regoing settlement is therefore approved this
, 2009.
day of
Iowa Workers' CompensatiorCommissioner
FILE
mnq
WORKERS' Ca PENSATION J
Revised 2/06
MAINTENANCEWORKER
GENERAL STATEMENT OF DUTIES: Performs and supervises a variety of skilled and
semi - skilled tasks in the maintenance and repair of buildings, grounds, streets, sewers and
equipment; performs related work as required.
DISTINGUISHING FEATURES OF THE CLASS: The work in this class involves
responsibility for performing a variety of skilled and semi- skilled tasks in the maintenance and
repair of buildings, facilities, equipment, streets, sewers and grounds. Assignments are
received in the form of oral or written work orders. The work is performed according to
general or specific instructions of a lead worker or supervisor who inspects work while in
progress and upon completion.
EXAMPLES OF WORK (ILLUSTRATIVE ONLY):
ESSENTIAL: Supervises, as a lead person, and performs a variety of skilled and semi - skilled
work in the repair and maintenance of buildings, equipment, facilities, streets, sewers and
grounds; instructs and inspects the work of other employees to ensure proper performance of
maintenance work and repairs; maintains time and other records; uses a variety of hand and
power tools; operates light and medium equipment and a variety of small and larger mowers,
operates a snow plow, shovels snow and removes ice from streets and walks.
KNOWLEDGE, SKILLS AND ABILITIES:
ESSENTIAL: Knowledge of the methods, practices, tools and materials used in a variety of
building, equipment, street, sewer and grounds maintenance and repair activities; knowledge
of the occupational hazards and necessary safety precautions applicable to buildings,
equipment, street; sewer and grounds maintenance; ability to safely perform a variety of
semi - skilled and skilled tasks in the repair and maintenance of various types of equipment
and facilities; ability to handle a variety of tasks without close supervision; ability to
understand and follow oral and written instructions and directions; ability to plan, organize
and supervise the activities of employees; ability to maintain effective working relationships
with employees and the general public; ability to work outside. during inclement weather;
physical ability to handle medium to heavy work with some heavy lifting; skill in the building or
mechanical trade; skill in the use and care of tools and equipment necessary to perform
various repair tasks; demonstrated ability to follow a management philosophy that is input
oriented and values problem solving and development of partnerships; demonstrated ability
to work effectively as a member of the team; a desire to be part of an organization that values
service, people, integrity, responsibility, innovation and team work.
ACCEPTABLE EXPERIENCE AND TRAINING: Some experience in the repair and
maintenance of equipment, grounds, streets, sewers and buildings including some
experience in construction work as a building or mechanical trade apprentice; possession of
a high school diploma or its equivalent; or any equivalent combination of experience and
training that provides the essential knowledge, skills and abilities,
SPECIAL REQUIREMENT: Possession of or ability to obtain any or all of the following:
• a valid commercial drivers license with air brakes and tanker endorsements.
• Pesticide applicators license.
BEFORE THE IOWA WORKERS' COMPENSATION COMMISSIONER
MICHAEL CLANCY,
SELF- INSURED,
Claimant,
vs.
CITY OF DUBUQUE,
Employer,
Defendant,
Contested Case File Numbers:
5004896 & 5013605
Compliance File No.:
Injury Dates: March 9, 2001 &
September 10, 2003
COMPROMISE SETTLEMENT
BETWEEN CLAIMANT AND
EMPLOYER
Iowa Code Section 85.35 (3)
COMES NOW the undersigned parties and submit this Compromise Settlement
pursuant to Iowa Code §85.35(3).
A. Dispute exists under the Iowa Workers' Compensation Law, which the parties
seek to resolve by a full and final compromise disposition of claimant's claim for
benefits. The subject and nature of the disputes are: whether a substantial
portion of the claimed disability is related to physical or mental conditions other
than caused by the injury, the extent of the claimant's injury, industrial disability,
odd -lot status and whether recent medical treatment is related to the work injury.
Attached is evidence of such disputes.
B. The claimant is represented by an attorney.
C. As a compromise of their competing interests, the parties agree to the payment
and other terms of settlement as follows:
The employer shall, upon approval by the Iowa Workers' Compensation
Commissioner, pay unto the Claimant the lump sum of $22,899.60 for a full and
final settlement of his contested case injuries of March 9, 2001 and September
10, 2003.
It is further agreed by and between the parties that this settlement was entered
into with the understanding that the lump sum payment of $22,899.60 represents
the final and only award Claimant will ever receive from his employer with
respect to the contested workplace injuries alleged herein. From this amount will
be deducted litigation expenses in the amount of $1,796.38, and payment of
attorneys' fees of $5,275.00, leaving the Claimant with a lump sum settlement of
$15,828.22 which should be allocated to that period of time extending from the
date this agreement is approved by the Iowa Workers' Compensation
Commission through the period of Claimant's life expectancy.
According to the table set out in U.S. Bureau of the Census, National Center for
Health Statistics and United States Life Tables, dated 2004, claimant, who has a
birth date of September 12, 1952 and is presently 56 years of age, has a
remaining life expectancy of 1216 weeks or 23.4 years. Dividing this number of
weeks into the net recovery amount Claimant will receive of $15,828.22 produces
the weekly settlement rate of $13.01, a weekly settlement rate envisioned by and
stipulated to by the parties. Payment of the settlement amount is not to be
construed as payment of weekly benefits, medical benefits, or any other benefits
under the workers' compensation laws of the state of Iowa.
The Claimant is presently receiving Social Security benefits. In conjunction with
this settlement, the parties have reasonably considered Medicare's interests that
the Claimant's future medical expenses not be unfairly shifted to Medicare
pursuant to 42 CFR Subsection 411.40 et seq., and other applicable regulations.
However, the parties assert that the total settlement amount does not meet the
threshold criteria for submission to the Centers for Medicare and Medicaid
Services (CMS), pursuant to CMS memoranda.
Furthermore, the parties rely on the medical reports attached as follows:
1. Dr. Michael Stenberg's report dated July 13, 2006, attached
as Exhibit A, which states that any future medical care
Claimant may require for his back condition would be related
to a pre-existing condition not aggravated by his work injury.
2. Dr. Patrick Sterrett's report dated August 12, 2006, attached
as Exhibit B, which states the Claimant suffers from post
concussion syndrome as a result of a car accident on June
29, cervical radicular pain on the left which is resolving,
myofascial pain of the neck, resolved left hip pain, and x-
rays indicating degenerative disc disease and no disc
protrusions or spondylotic changes.
For these reasons, the parties do not believe it is necessary to set aside any portion
of the settlement for medical expenses representing future medical care.
D. Release: In consideration of this payment, claimant releases and discharges the
above employer from all liability under the Iowa Workers' Compensation Law for
the above compromised claim.
•
E. Statement of Awareness of Claimant: I have read the compromise settlement. I
understand that the money I receive under this settlement is the total amount I
will receive from my claim and that there will not be a hearing and decision on my
claim. I am aware that if the Workers Compensation Commissioner approves
this compromise settlement and the employer pays me the agreed sum, then I
am barred from future claims or benefits under the Iowa Workers' Compensation
Law for the injury (ies) compromised. I understand I may: 1) consult with an
attorney of my own choosing, or 2) call the Iowa Division of Workers'
Compensation at (515) 281-5387, or both in order to receive a full explanation of
the terms of this document and of my rights under he Iowa workers'
Compensation law. I have either done so o eely waive ri ht to do so.
Claim nt
Subscribed and sworn to b
claimant be
KAY ACKMANN
Commission Numbs 7331
My Comm. Ex..
Cla mant's
•
re me on this
Employer: T employer consents to the compromise settlement.
V
Date
Ctc
City of Dubuque, Iowa
By: Crenna Brumwell
Assistant City Attorney
A S 1/4 14 /
ney Date
ay of 2009
o ary Public
ORDER
I find t substantial evidence supports the terms of the foregoing settlement,
the em ee knowingly waives hearing, decision, and resulting statutory benefits and
the -ettlement is a reasonable nd informed compromise of the co eting interests of
parties he foregoing ettlement is therefore approved this day of
2009.
•
ri Iowa orke Compensation ommissioner
FILED
AUG 1 8 2009
,WORKER8' COMPENSATION