Workers' Compensation Settlement Agreements_KosterTHE 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: November 14, 2012
RE: Randall Koster vs. City of Dubuque
Attorney Les Reddick, representing the City of Dubuque, is recommending approval of
three Compromise Settlement Agreements regarding the Randall Koster workers'
compensation claims that were filed against the City of Dubuque. Mr. Koster was a long
time City employee who retired on July 13, 2011 after having been on restricted driving
duty for a number of years due to certain physical problems.
The City and Mr. Koster mediated the three claims; all three claims were resolved for
$10,000 each.
I recommend approval of the three Compromise Settlement Agreements.
BAL:tls
Attachments
cc: Michael C. Van Milligen, City Manager
Cindy Steinhauser, Assistant City Manager
Randy Peck, Personnel Manager
Don Vogt, Public Works Director
Les Reddick, Esq.
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
BEFORE THE IOWA WORKERS' COMPENSATION COMMISSIONER
RANDALL J. KOSTER
Claimant, : Contested Case File No.: 5038555
vs.
CITY OF DUBUQUE, IOWA
Compliance File No.: 1 5371156
Injury Date: 2 -16 -11
Employer,
and COMPROMISE SETTLEMENT
[Iowa Code Section 85.35(3)]
Insurance Carrier,
Defendants.
The undersigned parties submit this Compromise Settlement pursuant to Iowa Code
section 85,35(3).
A. 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 dispute is work- related causation of injury claimed
in the petition to, left arm and hand, neck, back and bilateral Ghnjllder
D. If claimant is not represented by an attorney; a claimant's statement and evidence of the
dispute is attached. Rule 876 IAC 6,1.
C. As a compromise of their competing interests, the parties agree to the payment and other
terms of settlement contained in the attached page(s) or as follows:.
$10,000 lump sum payment. See attached Exhibit A.
D. Release. In consideration of this payment, claimant releases and discharges the
above employer and insurance carrier from all liability under the Iowa Workers'
Compensation Law for the above compromised claim.
Statement of Awareness of Claimant: I have read the compromise settlement and
attached page(s). 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 /insurance carrier 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 the Iowa Workers Compensation Law.
I have either done so or freely waive my right to do so,
Claimant's Attorney
Date Claimant Date
Subscribed and sworn to by claimant before me on this day of
Notary Public
Employer /Insurance Carrier: The employer /insurance carrier consents to the
compromise settlement.
Employer /fnsuran Carrier's Attorney Date
Employer /Insurance Carrier Dat
Michael Van Milligan, City Manager
ORDER
1 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 .
Iowa Workers' Compensation Commissioner
The information provided will be open for public inspection under Iowa Code §§ 22.11 and 86.45(1).
14 -0025 (7/05)
DEvEtoPhitvi
EXHIBIT A
It is further agreed by and between the parties that this settlement was entered
into with the understanding that there will be a lump sum payment of $10,000.00
and that from said $10,000.00 figure, the Claimant is responsible for paying
attorney /legal fees and litigation case costs equal to $3,568.72, resulting in a
net lump sum to be received by Claimant equal to $6,431.28, which represents the
final and only award that the Claimant will ever receive from the Claimant's
former employer and its Workers' Compensation insurance carrier with respect to
the injuries the Claimant sustained on February 16, 2011, and is therefore to be
allocated to that period of time extending from the date this settlement was
approved by the Iowa Workers' Compensation Commissioner through the period of
Claimant's life expectancy. According to the table set out in Chapter 6 of the
Administrative Rules promulgated by the Iowa Workers' Compensation Commissioner's
office, see Section 876 of the Iowa Administrative Code, Rule 6.3(1) ( "Life
Expectancy Table "), the Claimant who has the birth date of July 12, 1956, and who
is presently 56 years of age, has a remaining life expectancy of 1,310 weeks.
Dividing this number of weeks into the net lump sum amount of $6,431.28 produces
a weekly settlement rate of $4.91, a weekly settlement rate envisioned by and
stipulated to by the parties.
No money is being paid for future medical expense because of the disputed nature
of this claim as set forth in Paragraph A above and as shown in the attached
medical records. The parties stipulate and the Commissioner finds that no
portion of this settlement represents payment of past, present or future medical
expenses. Accordingly, the amount to be set aside for Medicare future injury
related medical expenses is $0.00.
BEFORE THE IOWA WORKERS' COMPENSATION COMMISSIONER
RANDALL J. KOSTER
Claimant, Contested Case File No _5038556
vs.
CITY OF DUBUQUE, IOWA
Employer,
and
Insurance Carrier,
Defendants.
Compliance File No.: 1537054
Injury Date: 1_91_11
COMPROMISE SETTLEMENT
[Iowa Code Section 85.35(3)]
The undersigned parties submit this Compromise Settlement pursuant to Iowa Code
section 85,35(3).
A. 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 dispute is work- related causation of injury claimed
in the petition to bilateral arms and hands, neck, back and bilateral
shoulder.
B. If claimant is not represented by an attorney, a claimant's statement and evidence of the
dispute is attached. Rule 876 IAC 6.1.
C. As a compromise of their competing interests, the parties agree to the payment and other
terms of settlement contained in the attached paoe(s) or as follows:.
$10,040 lump sum payment. *See attached. Exhibit A.
D. Release: In consideration of this payment, claimant releases and discharges the
above employer and insurance carrier from all liability under the Iowa Workers'
Compensation Law for the above compromised claim.
E. Statement of Awareness of Claimant: I have read the compromise settlement and
attached page(s). I understand that the money I receive under this settlement is the
total amount I will receive from my claim and that there will not be a hearing and
decision on my claim. I am aware that if the Workers' Compensation Commissioner
approves this compromise settlement and the employer /insurance carrier pays me the
agreed sum, then I am barred from future claims or benefits under the Iowa Workers'
Compensation Law for the injury(ies) compromised. I understand I may 1) consult
with an attorney of my own choosing, or 2) call the Iowa Division of Workers'
Compensation at (515) 2815387, or both in order to receive a full explanation of the
terms of this document and of my rights under the Iowa Workers' Compensation Law.
I have either done so or freely waive my right to do so.
Claimant's Attorney
Date Claimant
Subscribed and sworn to by claimant before me on this day of
Date
Notary public
Employer /Insurance Carrier: The employer /insurance carrier consents to the
compromise settlement.
Employer /lnsuran ejCarrier's Attorney
Employer /Insurance Carrier
Michael Van Milligen, City Manager
ORDER
I find that substantial evidence supports the terms of the foregoing settlement, the employee
knowingly waives hearing, decision, and resulting statutory benefits and the settlement is a
reasonable and informed compromise of the competing interests of the parties. The foregoing
settlement is therefore approved this day of , 20
Date
Iowa Workers' Compensation Commissioner
The information provided will be open for public inspection under Iowa Code §§ 22.11 and 86.45(1).
14-0025 (7/05)
`7't r.
V4 ) t;
_$" ' tDi Lr
/TA# : r
EXHIBIT A
It is further agreed by and between the parties that this settlement was entered
into with the understanding that there will be a lump sum payment of $10,000.00
and that from said $10,000.00 figure, the Claimant is responsible for paying
attorney /legal fees and litigation case costs equal to $3,568.72, resulting in a
net lump sum to be received by Claimant equal to $6,431.28, which represents the
final and only award that the Claimant will ever receive from the Claimant's
former employer and its Workers' Compensation insurance carrier with respect to
the injuries the Claimant sustained'on March 23, 2011, and is therefore to be
allocated to that period of time extending from the date this settlement was
approved by the Iowa Workers' Compensation Commissioner through the period of
Claimant's life expectancy. According to the table set out in Chapter 6 of the
Administrative Rules promulgated by the Iowa Workers' Compensation Commissioner's
office, see Section 876 of the Iowa Administrative Code, Rule 6.3(1) ( "Life
Expectancy Table "), the Claimant who has the birth date of July 12, 1956, and who
is presently 56 years of age, has a remaining life expectancy of 1,310 weeks.
Dividing this number of weeks into the net lump sum amount of $6,41.28 produces
a weekly settlement rate of $4.91, a weekly settlement rate envisioned by and
stipulated to by the parties.
No money is being paid for future medical expense because of the disputed nature
of this claim as set forth in Paragraph A above and as shown in the attached
medical records. The parties stipulate and the Commissioner finds that no
portion of this settlement represents payment of_past, present or future medical
expenses. Accordingly, the amount to be set aside for Medicare future injury
related medical expenses is $0.00.
BEFORE THE IOWA WORKERS' COMPENSATION COMMISSIONER
RANDALL J. ]:FOSTER
Claimant, Contested Case File No.: 5038557
vs, Compliance File No.: 1577055
CITY of DUBUQUE, IOWA Injury Date: 7 -13 -11
Employer,
and COMPROMISE SETTLEMENT
[Iowa Code Section 85,35(3)j
Insurance Carrier,
Defendants.
The undersigned parties submit this Compromise Settlement pursuant to Iowa Code
section 85.35(3).
A. 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 dispute is work - related causation of injury claimed
in the petition to the neck, back, bilateral shoulder, bilateral arms,
and bilateral hands.
B. If claimant is not represented by an attorney; a claimant's statement and evidence of the
dispute is attached. Rule 876 IAC 6.1,
C. As a compromise of their competing interests, the parties agree to the payment and other
terms of settlement contained in the attached page(s) or as follows:.
$10,000 lump sum payment. *See attached Exhibit A.
D. Release: In consideration of this payment, claimant releases and discharges the
above employer and insurance carrier 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 and
attached page(s). l understand that the money I receive under this settlement is the
total amount l 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 /insurance carrier pays me the
agreed sure, 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 the Iowa Workers' Compensation Law.
I have either done so or freely waive my right to do so,
Claimant's Attorney
Date Claimant Date
Subscribed and sworn to by claimant before me on this day of
Notary Public
Emvlover /Insurance Carrier: The employer /insurance carrier consents to the
compromise settlement.
Employerl(nsur nce Carriers Attorney
Date
Employer/ Carrier f / Date
Michael Van Milligen, City Manager
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
Iowa Workers Compensation Commissioner
The information provided will be open for public inspection under Iowa Code §§ 22.11 and 86.48(1).
14 -0025 (7/05)
,r
DE vELoPmEN1
EXHIBIT A
It is further agreed by and between the parties that this settlement was entered
into with the understanding that there will be a lump sum payment of $10,000.00
and that from said $10,000.00 figure, the Claimant is responsible for paying
attorney /legal fees and litigation case costs equal to $3,568.72, resulting in a
net lump sum to be received by Claimant equal to $6,431.28, which represents the
final and only award that the Claimant will ever receive from the Claimant's
former employer and its Workers' Compensation insurance carrier with respect to
the injuries the Claimant sustained on. July 13, 2011, and is therefore to be
allocated to that period of time extending from the date this settlement was
approved by the Iowa Workers' Compensation Commissioner through the period of
Claimant's life expectancy. According to the table set out in Chapter 6 of the
Administrative Rules promulgated by the Iowa Workers` Compensation Commissioner's
office, see Section 876 of the Iowa Administrative Code, Rule 6.3(1) ( "Life
Expectancy Table "), the Claimant who has the birth date of July 12, 1956, and who
is presently 56 years of age, has a remaining life expectancy of 1,310 weeks.
Dividing this number of weeks into the net lump sum amount of $6,431.28 produces
a weekly settlement rate of $4.91, a weekly settlement rate envisioned by and
stipulated to by the parties.
No money is being paid for future medical expense because of the disputed nature
of this claim as set forth in Paragraph A above and as shown in the attached
medical records. The parties stipulate and the Commissioner finds that no
portion of this settlement represents payment of past, present or future medical
expenses. Accordingly, the amount to be set aside for Medicare future injury
related medical expenses is $0.00.