Workers' Compenstation Settlement_Hillard ClaimTHE CITY OF
DUB TE MEMORANDUM
Masterpiece on the Mi 'issippi
BARRY LINDA
CITY ATTORN
Y
To: Mayor Roy D. Buol and
Members of the City Council
DATE: May 7, 2014
RE: Richard Hillard 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 Richard Hillard. Mr. Hillard was an employee of the City
of Dubuque Water Department and injured his knee while at work.
Mr. Reddick negotiated a settlement amount of $5,000.00 plus an IME (independent
medical examination) amount of $1,250.00 with Mr. Hillard's attorney, Nick Avgerinos.
This settlement is intended to reflect a reasonable amount for Mr. Hillard's injury.
This settlement is final and releases the City from any future liability for this 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
Bob Green, Water Department Manager
Les Reddick, Esq.
F:\USERS\tsteckle\Lindahl\Memos\MayorCouncil_HillardWkrsCompClaim_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
RICHARD HILLARD
Claimant,
vs.
CITY OF DUBUQUE
Employer,
and
Insurance Carrier,
Defendants.
Contested Case File No.: 5044197
Compliance File No.: 1540198
Injury Date: 11/28/11
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 causation of condition to em�,lca_ment.
See attached medical reports.
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:. *See attached
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 Divisibn of Workers'
Compensation at (515) 281-5387, or both in order to receive a full explanation of the
rms of this document and of my rights under the Iowa Workers' Compensation Law.
haveither d • � so or freely waive my right to do so.
�4r53Iy V�
Claimant's rnev 1) Date Claimant Date
ei5fJC Jowa�
Subscribed and sworn to by claimant before me on this d0 day of
SANDRA K. ERNST
Commission Number 121349
My Commission Expires
2014
Notary Public
Employer/Insurance Carrier: The employer/insurance carrier consents to the
compromise settlement.
Employer/Insuranc,,er Carrier's Attorney
Employer/Insu'rance Carrier
Michael Van Milligen
Date
4/(4'j('
ate
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).
14-0025 (7/05)
IOWA,
WORKFORCE
DEVELOPMENT
*The settlement is a lump sum payment of $5,000 plus an IME cost. of $1,250. It is agreed by the
parties that this settlement was entered into with the understanding that the lump sum payment of
$5,000.00 represents the final and only award Claimant will ever receive from his employer with
respect to the workplace injuries alleged herein. From this amount will be deducted litigation
costs in the amount of $708.11, and payment of attorneys' fees of $1,287.00, leaving the
Claimant with a lump sum settlement of $3,004.89 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 2010, Claimant, who has a birth date of November 12, 1957 and is presently 56 years of
age, has a remaining life expectancy of 1,258.4 weeks or 24.2 years. Dividing this number of
weeks into the net recovery amount Claimant will receive of $3,004.89 produces the weekly
settlement rate of $2.39, 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 parties acknowledge that regulations provide that Medicare's interest must be considered in
any workers' compensation settlement where the Claimant may be relying upon Medicare to
cover possible future medical costs associated with the Claimant's injury. In conjunction with
this settlement, the parties have reasonably considered Medicare's interests and the applicable
regulations that the Claimant's future medical expenses not be unfairly shifted to Medicare. In
this case, the Claimant is not a Social Security recipient and is not a Medicare beneficiary, and
has no reasonable expectation of becoming Medicare eligible within the next 30 months. The
settlement amount does not meet the threshold criteria for submission to the Centers for
Medicare and Medicaid Services (CMS), pursuant to CMS memoranda.
The parties further agree that at the time this Compromise Case Settlement was achieved, it was
not contemplated that the Claimant would require any future medical care for any work related
injuries sustained as evidenced by the medical records and reports. For these reasons and those
previously set forth, the parties do not believe it is necessary to set aside any portion of the
settlement for medical expenses representing future medical care.