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HomeMy WebLinkAboutItem #03 Approval of Workers' Compensation Settlement Agreement with Employee Jeff Dyer type Center of Good Li AGENDA ITEM COVER SHEET Meeting Date: April 3, 2012 Item # 3 Reviewed By: Contact Name: Gene Williford Department Director: Contact Number: 1032 City Manager: " Subject: Workers' Compensation Settlement Agreement with Employee Jeff Dyer. Background Summary: The employee has suffered a medical incident that resulted in a workers' compensation claim. The employee and the city have negotiated an agreement whereby the employee will not seek further work related claims and waives present and future benefits under the Florida Statutes. Issue: By accepting the settlement amount reflected the employee will waive any present and future claims concerning workers' compensation and will retire from employment with the City. This will minimize and contain future costs to the City. Recommendations Staff respectfully recommends the Commission approve the terms of the attached agreement. Attachments: Mediation Report and Memorandum of Settlement Financial Impact: $50,000 to be paid from the Workers' Compensation Fund. Type of Item: (please mark with an `x') Public Hearing For Clerk's Dept Use: Ordinance First Reading X Consent Agenda Ordinance Second Reading Public Hearing Resolution Regular Agenda X Commission Approval Discussion & Direction Original Document/Contract Attached for Execution by City Clerk Original Document/Contract Held by Department for Execution Reviewed by City Attorney N/A Reviewed by Finance Dept. N/A Reviewed by () N/A • STATE OF FLORIDA OFFICE OF THE JUDGES OF COMPENSATION CLAIMS ` ORLANDO DISTRICT OJCC NO. : 09- 012720WJC: 09-0121 25NPP: 09-01271 3NPP DATE OF ACCIDENT : 12/27/2008: 01/29/2009: 03/31/2009 EMPLOYEE : Jeffrey D. Dyer REPRESENTED BY : Paolo Longo, Jr.. Esq. EMPLOYER : City of Ocoee REPRESENTED BY : Thomas A. Moore, Esq. CARRIER /SA : Broadspire REPRESENTED BY : Thomas A. Moore. Esq. MEDIATION REPORT AND MEMORANDUM OF SETTLEMENT 1. A private Mediation Conference w as conducted by Monte R. Shoemaker on March 23, 2012. 2. The Petition(s) for Benefits being mediated today is(are) dated: _il {� � l S s , 3. At the Mediation Conference, the parties: Agreed to enter into a Lump Sum Settlement in accordance with §440.20(11)(c). No additional Court action is necessary. Completely resolved all issues. No additional Court action is necessary. Resolved only some of the issues as set forth in the Memorandum of Settlement. The unresolved issues require Court action. Did not resolve any issues and reached an Impasse. Additional Court action is necessary. Have recessed and will reconvene as soon as is mutually agreeable. Possible dates follow: MEMORANDUM OF SETTLEMENT Pursuant to the Mediation Report. the parties have rep hed an areem Nnt s set forth below: dek 5P� inclusive '7 N lb e 1. 1 1 (c) Settlement for $ lusive of indemnity, medicals, attorney's fees and costs. a. Claimant to receive $ b. Attorney's Fees of $ . c. Taxable Costs of $ . 2. Joint Petition For Past Benefits / Medicals. a. Claimant to receive $ . b. Attorney's Fees of $ . c. Taxable Costs of $ d. ' 3. Mediation Fee of $ 1 t . a. To be paid by Claimant. b. To be paid by Employer /Carrier /Servicing Agent. d 4. This agreement resolves the following D /A: GL ,//i G - G(ll k4 M I:" a 5. Special Terms, If any: ��M�M.AM X 11 / 61.-1--j_ 7, i 1 0 ' MO 2 G ©s Ts / The above settlement is contingent upon the following: ( ) The claimant's counsel's approval of the general release and /or other documents to be prepared and submitted by the employer /carrier /servicing agent for signature. ( ) The claimants signature of an acceptable general release and/or other documents required by the employer /carrier /servicing agent. ( ) The Judge of Compensation Claims approval of attorney's fees and consideration of child support allocation. ( ) All previously authorized and related medical treatment, including mileage, that has not been paid be paid by E/C in addition to the settlement, once submitted on proper form, specifically Yes No ( ) Attached hereto and incorporated herein by reference is the Addendum to the Mediation Agreement. The foregoing agreement is stipulated and agreed to by the undersigned parties. DATE / // }/% EM' O i� EMPLOYER mo ATTORNEY FO PLOYEE CAR' _ ' MONTE R SHOEMAKER, MEDIATOR A O RNEY OF R EMPLOYER/CARRIER This is to certify that a copy of this Mediation Report has been furnished to the above individuals physically present at the Mediation Conference. Monte R. Shoemaker, Mediator P.O. Box 151057 Altamonte Springs, FL 32715 -1057 407 - 332 -4451 Exhibit 1 G�1 � � ,i• Employer agrees to pay to the Employee $50,000.00,Employer agrees to waive its lien against the 3r party recovery. In exchange, the Employee agrees to retire from his employment with the Employer under the following terms: 1. The Employee will continue to receive paid leave benefits until eligibility is exhausted (PTO) 2. Then, Employee will be placed on unpaid administrative leave status until retirement. 3. The Employee shall exercise his right to buy time for the retirement plan and to retire immediately thereafter. 4. Right addressed in paragraph 3 shall be exercised within 10 days of receipt of settlement proceeds by Employee's attorney and while the Employee remains employed, paid or unpaid, by the Employer. The Employee agrees to sign a General Release resolving any and all other potential claims that could be asserted against the Employer. 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