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Workers' Compensation Settlement Agreement for Doug Brehm Copyright 2014 City of Dubuque Consent Items # 19. ITEM TITLE: Workers' Compensation Settlement Agreement for Doug Brehm SUMMARY: City Attorney recommending approval of a Workers' Compensation Settlement Agreement filed by Transit employee Doug Brehm. SUGGESTED DISPOSITION: Suggested Disposition: Receive and File; Approve ATTACHMENTS: Description Type Staff Memo Staff Memo Reddick Letter Supporting Documentation Compromise Settlement Supporting Documentation THE CITY OF DUB-�6 E MEMORANDUM Masterpiece on the Mississippi BARRY LINDAHL SENIOR COUNSEL To: Mayor Roy D. Buol and Members of the City Council DATE: November 1 , 2016 RE: Doug Brehm Workers Compensation Settlement Attached is a letter from Attorney Les Reddick recommending settlement of the workers' compensation claim of Doug Brehm. Doug Brehm was a City employee who injured his shoulder while driving a bus as a City employee. The City has paid workers' compensation benefits for the injury. The City has reached a compromise settlement with Brehm for a lump sum payment of $5,000.00, with all future liability released with respect to this work-related injury. Mr. Reddick is of the opinion that the settlement is fair and reasonable. I agree with that opinion and recommend approval of the attached settlement agreement. BAL:tls Attachment F:\Users\tsteckle\Workers Comp-Reddick Cases\Brehm Doug\MayorCouncil_Settlement_110116.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 KANE, NORBY & REDDICK, P.C. ATTORNEYS Brian J.Kane 2100 ASBURY ROAD,SUITE 2 Les V.Reddick* DUBUQUE,IOWA 52001-3091 Brad J.I-Ieying Todd L.Stevenson* Retired: Kevin T.Deeny** Gary K.Norby Bradley B.Kane Joseph P.Kane Nicholas J.Kane David J.Kane All admitted in Iowa Phone: (563)582-7980 *Also admitted in Illinois Facsimile: (563)582-5312 **Also admitted in Wisconsin E-mail:Ireddick@kanenorbylaw.com October 24, 2016 Mr. Barry A. Lindahl City Attorney Harbor View Place, Suite 330 300 Main Street Dubuque, Iowa 52001-6944 RE: DOUG BREHM V. CITY OF DUBUQUE WORKERS COMPENSATION SETTLEMENT Dear Barry: I am attaching a Settlement Agreement for City Council approval.Doug Brehm was a City employee who injured his shoulder while driving a bus as a City employee. The City has paid workers' compensation benefits for the injury. The enclosed Settlement Agreement is for $5,000, in a lump sum payment, and releases the City for all future liability with respect to this work-related injury. After the shoulder surgery the treating doctor rated Brehm as having 0% permanent impairment. Brehm then had an independent medical examination performed and that doctor found impairment of 2%and because Brehm has an industrial disability we felt he would most likely be awarded another 3% for the industrial part of the injury.That would amount to$11,886.75.Given all of these factors,including the complete release of any future care for Brehm's shoulder,the settlement is fair and reasonable under benefits owing under Iowa's Workers' Compensation Statute. I would ask for City Council approval for Mike to sign the Agreement and I will forward to the Workers' Compensation Commissioner for approval. Very truly yours, KA-NE,NORBY&REDDICK,P.C. ByQh Les V. Reddick LVR/bmo Enc. Masterpiece on the Mississippi TRACEY STECKLEIN PARALEGAL MEMO To: Kevin Firnstahl City Clerk MEMORANDUM 1AP DATE: November 2, 2016 RE: Item for 11/07/16 Council Agenda — Doug Brehm Workers' Comp Claim Kevin: Attached for the November 7, 2016 City Council meeting is an original Compromise Settlement Agreement regarding the Doug Brehm. Workers' Comp claims. Once it is approved by the City Council and signed by the City Manager, I would appreciate it if you would forward the executed Agreement to me so that I can provide Les Reddick with the original agreement. Thanks. © cc: Jenny Griffin, Paralegal F:\Users\tsteckle\Workers Comp - Reddick Cases\Brehm Doug\Firnstahl_OriginalAgreement_110216.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 tsteckle@cityofdubuque.org BEFORE THE IOWA WORKERSCOMPENSATION COMMISSIONER DOUGLAS BREHM Claimant, Contested Case File No.: 5047836 vs. Compliance File No.: 1534670 CITY OF DUBUQUE Employer, and SELF-INSURED Insurance Carrier, Defendants. • • Injury Date: 6/14/14 COMPROMISE SETTLEMENT [lovva Code Section 85.35(3)1 (6) 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 and nature and extent. B. If claimant is not represented by an attorney; a claimant's statement and evidence of the dispute is attached. Rule 876 Mr` 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:. $5,000.00 lump SUIT1 payment. 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) 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. have either done :, freely waive my right to do so. p/ Ili 41Ik • 0 S v'imant's Att Nick J. Avge Date 0474 Claimant Douglas Brehm Subscribed and sworn to by claimant before me on this / 7 day of OH L, '79/14 E z ,r rAm h;• •!. W-hVIAJ4V.,11 MY COMM. En, Date Notary Public Employer/Insurance Carrier: The employer/insurance carrier consents to the compromise settlement. Employer/Insurance Carrier's Attorney Les V. Redd • Employer/Insurance Carrier Michael C. Van Milligen Date //ij /,‘; 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 WorkersCompensation Commissioner The information provided will be open for public inspection under Iowa Code §§ 22.11 and 86.45(1). 14-0025 (02/15) lowA ORK iCIP\CE DEVELOPMENTr