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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.