Worker's Compensation Settlement_Weidenbacher ClaimTHE CITY OF
DUB TE MEMORANDUM
Masterpiece on the Mississippi
BARRY LIND Ill -
CITY ATTORN Y
To: Mayory D. Buol and
Members of the City Council
DATE: May 7, 2014
RE: Mark Weidenbacher 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 Mark Weidenbacher. Mr. Weidenbacher is an employee
of the City of Dubuque Leisure Services Department and injured his back at work while
lifting benches.
Mr. Reddick negotiated a settlement amount of $31,978.65 with Mr. Weidenbacher's
attorney, Nick Avgerinos. This settlement is intended to reflect a reasonable amount for
Mr. Weidenbacher's injury.
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
Marie Ware, Leisure Services Manager
Les Reddick, Esq.
F:\USERS\tsteckle\Lindahl\Memos\MayorCouncil_WeidenbacherWkrsCompClaim_050714.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
BEFORE THE IOWA WORKERS' COMPENSATION COMMISSIONER
MARK WEIDENBACHER
Claimant,
vs.
CITY OF DUBUQUE
: Contested Case File No. 5043692
: Compliance File No.1564639
Injury Date: 7/28/99
Employer,
and : AGREEMENT FOR SETTLEMENT
Iowa Code Section 85.35(2)
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 7/28/99 (date).
2. Jurisdiction exists because the injury occurred
85.71( ) applies. (Circle one.)
3. Claimant is married/single (circle one), entitled to 2 exemption(s) and gross
weekly earnings are $ 592.26 using Iowa Code section 85.36(1 ).
The rate of weekly compensation is $ 387.62 . (If the rate for PPD
differs it is $ per week.)
R Iowa Code section
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 may be attached.) See attached.
b. Permanent partial disability for 37.5 % loss of earning capacity
(member or earning capacity) resulting in 187.5 weeks of compensation
under Iowa Code Section 85.34(2)(4 ) payable commencing
6/28/10 (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 82.5 weeks in a lump sum
of $31,978.65
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 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. (A detailed description maybe attached.)
9. Evidence that corroborates this settlement is attached. A Claimant's
Statement is attached if claimant is not represented by an attorney.
rties request that this/Settlement,be approved.
1?
Claimant's Atte rn- Date
Employer/(nsurer Dat
Michael Van Milligen
i,?1M1
Employer/Insurer's 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 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).
14-0021 (7-05)
IOWA
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