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CIgt'OF SAN BERNARD()IO - REQUryT FOR COUNCI&ACOoN
From: Marshall W. Julian,
City Administrator
Subject:
Authorization to Initiate Process
to Employ Consultant for Workers'
Compensation Services - Risk
Management Division
Dtpt:
One: June 29, 1989
Synopsis of Previous Council action:
None.
Recommended motion:
That the concept of entering into consultant contract for the purpose
of training workers' compensation personnel in Risk Management and
making needed corrections to workers' compensation files be approved,
and that the City Attorney prepare a contract governing the duties of
the consultant for approval and execution by the Mayor and Common
Council, with the compensation to be paid said consultant to be
decided at the time the contract is executed.
~fJ!.~.~
Ignature
Contact person:
Arthur Schubert
Phone:
5308
Supporting data ntached:
Staff Report
Ward:
FUNDING REQUIREMENTS:
Amount:
Source: (Acct. No.)
001 451 5 3150
( Acct. Descriotion)
Profe8sinn~1/rnn~r~~tu.l
Finance:
Council Notes:
Agenda Item No. S - ID
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Cli'i OF SAN BERNARDICb - REQUIOr FOR COUNCIL ACQoN
STAFF REPORT
The city has been advised)based on an operations audit by the
S~ate, that the Workers' Compensation self-insurance program
is not acceptable and that a major overhaul will be necessary
if the City wishes to continue to administer the program.
A number of needed corrections were indicated by the audit in
individual files, as well as recommendations for some
procedural changes. The City has also failed to submit
certain documentation in a number of instances. The letter
from the Department of Industrial Relations Self-Insurance
Plans also points out that the claims processing is currently
being performed by a clerical employee who does not have ~e
certification required by the Labor Code to administer
workers' compensation claims.
It is necessary that the City proceed immediately to certifv
staff personnel and to correct the deficiencies in several
of the files. Staff has discussed the matter and concluded
that the most effective manner of solving this situation is
to employ a qualified consultant to work full-time (on-site.)
The consultant would train current personnel and prepare them
to pass the certification test, and also supervise/correct
the file problems noted in the audit.
It is anticipated that the period of
consultant will be at least 6 months
months. The program will be closely
consultant contract will be concluded as
time required of the
and not exceed 12
supervised and the
soon as possible.
Compensation for a qualified consultant (particularly in
light of the short-term of the "employment" and/or tentative
duration of the contract) is not knoWlat this time. We are
presently contacting various firms, agencies, other insurers,
etc. in order to locate an appropriate person to handle the
above responsibility. At such time as we believe we have
located a qualified individual, the Mayor and Common Council
will be requested to authorize the execution of a contract.
The cost will be negotiable and is not known at this time.
JUSTIFICATION FOR PLACEMENT
ON SUPPLEMENTAL AGENDA
This action is considered
state recommendations on
compensation program by the
urgent in order to comply with
the self-administered workers'
State.
75-0264
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C I T Y .. 0 A N B E R 0 R D IeO
INTEROFFICE MEMORANDUM
8906-1903
C//y C.c:::c~
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TO: Art Schubert, Director of Risk Management
FROM: Marshall W. Julian, City Administrator
SUBJECT: Self Insurance -- Workers Compensation
DATE: June 16, 1989
COPIES:
James E. Robbins, Deputy City Administrator
Administrative Services
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After discussing this matter with you, I concur withyout
recommendation that we proceed to hire a third party adllni~
trator, for a term not to exceed one year, whose duties~wifd
be accomplished in house. It is equally important tftBt ii
take positive steps, such as those you have outlined, to
insure that we are in compliance with State-established
standards.
This is in response to your memorandum relative to
insured Workers' Compensation program.
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Please coordinate your efforts to meet these standards with
Jim Robbins, Deputy City Administrator/Administrative
Services. It is anticipated that, through your combined
efforts, we will be in a much better position at this time
next year and able to operate this program without the
benefit of an outside third party administrator.
It is my understanding that you will be corresponding,
periodically, with the Department of Industrial Relations to
I would appreciate a copy
MWJ/djn
Soot:
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C I T Y 0 F SAN B ERN A R DIN 0
INTEROFFICE MEMORANDUM
8906-3904
FROM:
MARSHALL JULIAN, CITY ADMINISTRATOR
ARTHUR J. SCHUBERT, DIRECTOR OF RISK MANAGEMENT
TO:
SUBJECT: TERMINATION OF CONSENT TO SELF-INSURE WORKERS'
COMPENSATION LIABILITIES
DATE:
June 15, 1989
COPIES:
JAMES E. ROBBINS, DEPUTY CITY ADMINISTRATOR
-------------------------------------------------------------
As you know, the State of California, Department of
Industrial Relations, Self-Insured Plans has terminated our
permission to self-administer workers' compensation claims
effective July 23, 1989. We are instructed to obtain the
services of a competent third party administrator or face
revocation of our Certificate of Consent to Self-Insure. A
copy of the State letter dated May 24, 1989, is attached (the
audit report is available).
Although the State letter is rather strongly written, I
believe they have made several administrative errors which
will not allow them to promptly follow through with their
threat to revoke our certificate. I do not ordinarily
recommend delaying tactics: however, in this case it may be
to our advantage to slow down the process so that the City
maintains some control over the future of our workers'
compensation program. I simply do not want the State dic-
tating the method we use to administer our program and will
continue to delay any actions on their part. We have several
options which will be explored later in this memo.
To solve our problem, we need to accomplish the following.
First, we must retain the services of a certificated third
part administrator or consultant. Second, we need to improve
our workers' compensation claim handling, correct the
deficiencies noted in the audit and convince the State to
reauthorize self-administration. Third, we must get one or
more of our own people certified to administer workers'
compensation claims.
The next State test is in December, 1989. However, until
that time it will be necessary to work through a third party.
This approach will work to our favor in two ways. It will
permit us to stay in the workers' compensation business of
self-insurance and will provide a certificated person to
overhaul our program and train our personnel. Along this
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INTEROFFICE MEMORANDUM: 8906-3904
TERMINATION OF CONSENT TO SELF-INSURE WORKERS' COMPENSATION
LIABILITIES
June 15, 1989
Page 2
line, it will be important to maintain the integrity of our
workers' compensation program while insuring that no current
employees become redundant.
What follows is an outline of our options along with the pros
and cons of each:
1.
Hire third party administrator (outside
company)
adjusting
A. Pros-
1. Competent handling of workers' compensation
claims.
2. Certified administrator.
3. Insulation between City employees and City
Administration provided by TPA.
4. Better fix on reserves/costs/exposure/loss
control.
B. Cons-
1. High initial cost to City.
2. Less control over w/c program.
3. Possible termination of City employee current-
ly administering w/c program.
2. Hire third part administrator (in-house consultant) .
A. Pros-
1. Competent handling of w/c claims.
2. Certificated administrator.
3. Lower cost to City than outside TPA.
4. Would train current City employees.
5. Maintain control over w/c program.
B. Cons-
1. May be temporary solution only.
2. No certificated City employee on staff.
3. Moderate cost to City.
3. Purchase workers' compensation insurance through State
Compensation Insurance Fund.
A. Pros-
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INTEROFFICE MEMORANDUM: 8906-3904
TERMINATION OF CONSENT TO SELF-INSURE WORKERS' COMPENSATION
LIABILITIES
June 15, 1989
Page 3
1. Instant administration and handling of new w/c
claims.
2. Release of w/c self-insured reserves.
3. No training or certification requirements.
4. Loss control/safety services provided.
B. Cons-
1. Old w/c claims would not be covered.
2. TPA needed to administer old w/c claims.
3. High cost.
4. Probable loss of City employee currently
administering w/c program.
We can discuss our optionsl however, it appears that option
'2 would be our best choice. The hiring of a certificated
in-house consultant for an initial period of one year,
renewable as needed, would satisfy the State requirement for
self-administration and would allow us to improve the quality
of our workers' compensation claim handling. I would expect
the consultant to train Josie Nagy and Nancy Fogassy in the
areas of medical terminology, disability rating,
rehabilitation, the Labor Code and other important areas
found on the State workers' compensation administrator exam.
We obviously need to have a certificated administrator on
staff and must be prepared to reclassify the Workers'
Compensation Specialist position to a higher range and
require State certification for all future incumbents.
Option '2 would also appear to be the most cost efficient to
the City at approximately $60,000/year.
We need to move on this problem fairly soon. Your thoughts
would be appreciated, particularly in the area of funding.
a;
Arthur J. Schubert
Director of Risk Management
AJS/sf
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GEORGE DEUKMEJIAN, Gcwemor
STATE OF CAUFORNlA
DEPARTMENT OF INDUSTRIAL
SELF-INSURANCE PLANS
2848 Arden Way, Suite 105
Sacramento, CA 95825
Phone (916) 924-4866
FAX (916) 920.7095
RELATIONS
May 24, 1989
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MAY 2 6 1989
Our
File :P-0124
RISK MANAGEMENT
Mr. Tom Cain
Risk Manager
City of San Bernardino
300 North Delta Street
San Bernardino, CA 92418
Dear Mr. Cain:
I have received the recent audit of the City of San Bernardino
workers' compensation self-insurance program by our staff.
The audit describes a program that is not acceptable and a
major overhaul will be necessary if your City wishes to
continue to self-insure workers' compensation liabilies.
The existing program is run by a person who has not
demonstrated competency as required by California Labor Code
Title 8, Section 15401.1 and, it would appear, your adjusting
location does not have a competent person either as required
by Section 1501.'2. Your administrator, perhaps due to her
lack of competence, fails to maintain required case file
pursuant to Section 15400 and has no case log as required by
Section 15400.1. The estimates of future liability are
routinely understated by your administrator and she apparently
does not know the difference between an indemnity claims or a
medical only claim. You do not send DIA Form 500's and file
documentation is minimal at best.
I cannot permit thj.s type of ~rogram a~~inistration to
continue. The City of San Bernardino's permission to self
administer workers' compensation claims is terminated and you
are hereby notified to obtain the services of a competent
third party administrator to administer all of the City's
workers' compensation claims within 60 days. If you have not
done so by that date, we will move to revoke the City's
Certificate of Consent to Self-Insure for cause. If the
Certificate -is revoked, the City will have to purchase
insurance for workers' compensation coverage and the prior
self-insured claims will still have to be administered by a
competent third party administrator.
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Hr. Tom Cain
Page 2
Should you have any questions regarding this matter, please
contact this office.
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Enclosures
cc: Kim Kunkel, Self Insurance Plans, Los Angeles
Gary O'Hara DIR Legal Unit
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GEORGE DEUKMEJ'AN. Governor
STATE OF CALIFORNIA
DEPARTMENT OF INDUSTRIAL RELATION
SELF-INSURANCE PLANS
107 South Broodwoy, Room 5043 JUN 9 iSE3
Lo. Angele.. Callfornta 90012
Phone (21 S) 620-SS78 RISK MANAGEMENT
FAX (21S) 620-6130 .
Our File: 6-0124-0 I
May 12, 1989
Mr. Tom Cain
Risk Manager
CITY OF SAN BERNARDINO
300 North Delta Street
San Bernardino, California 92418
Dear Mr. Cain:
A routine audit was conducted of your workers' compensation
files at your San Bernardino office, Ms. Jose Nagy, Claims
Administrator.
A total of seventy six indemnity files and 79 medical only
files were reviewed for the fiscal years 1985-86, 1986-87 and
1987-88. The City was self-administered for each of the fiscal
years audited. Files were under the administration of Ms. Nagy
for each year.
The following general comments were applicable:
AVAILABILITY OF FILES
All files requested were available for audit.
CASE LOAD
Self-Insurance Plans recommends no more than 250 active
indemnity files per certified Administrator. Ms. Nagy'S
claims count is 283. This number should be reduced.
QUALIFICATIONS OF ADMINISTRATOR
To be considered qualified by this office to undertake the
Administration of your self-insurance workers' compensation
files, your Administrator must have taken and passed the
Administrator's certification examination. Ms. Nagy has not
taken and passed the examination and cannot be considered
qualified by this office. It is necessary that Ms. Nagy pass
the test at her earliest convenience and in the meantime that
her case load be supervised by a certified Administrator.
,:)
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CITY OF SAN
Certificate
Page -2-
BERNARDINO ~ IE ~ IE U ~. \ill
No. 6-0124-01 JUN ~1?~~
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RISK MANAGEMENT
ESTIMATES OF LIABILITY OF CLAIMS
Our variance analysis shows, that your Administrator raises
estimates of incurred liability of claims between the first
and third years, on an aggregate basis by approximately 100%.
The extent of the reserve increase noted is cons~dered
excessive. The Administrator should endeavor to place an
adequate estimate of incurred liability on the files at the
end of the first year. By the end of the third year, claims
reserve appear to be adequate. Of the files reviewed one was
in need of a reserve increase. That file is listed in the
Appendix to this letter.
ANNUAL REPORTS AND CASE LOGS
Annual reports appear to be completed in accordance with the
California Code of Regulations, Title 8, Section 15252. The
total number of indemnity claims reported according to the
annual reports, for the three years, totaled 291.
The Administrator does not keep "case logs". Beginning with
the 1988, 1989 fiscal year, logs must be kept in accordance
with the California Code of Regulations, Title 8, Section
15201. Your case logs must be a listing of work injury cases
by fiscal year reported and must contain the following:
1. Injureds Name;
2. Date of Injury;
3. An indication as to whether the file is an indemnity
or medical only file;
4. An indication as to whether the claim was accepted
or denied.
The Administrator is unaware of what constitutes an indemnity
versus medical only claim. The following definition is
applicable: An indemnity claim is any claim in which an
inde~~ity reserve is placed. &~ inderr~ity reserve should be
placed on all files when it appear that the payment of
temporary disability or permanent disability will be made.
Temporary disability must be paid on all files in which the
injured has lost more than 3 days from work.
Your Administrator computes temporary disability on a 5-day
week and does not consider files indemnity files unless
disability extends past the City'S automatic one week wage
continuance. This is improper. Temporary disability is to be
computed on a 7-day week and is to be paid on the fourth day
of lost time. If salary is continued in lieu of temporary
disability, the file must still be considered an indemnity
file. This includes safety members that are paid 4850 time
for up to one calendar year, even if they only receive 4 days
of 4850 time.
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CITY OF SAN BERNARDINO
Certificate No. 6-0124-01
Page -3-
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JUN ~ l~?J
RISK MANAGEMENT
LITIGATION RATE
The litigation rate for the 1987-1988 fiscal year as a
percentage of new indemnity claims reported was 17%. The
industry for that same time period approximately 27%. This
17% number is unreliable since the number of indemnity claims
reported is unreliable.
TIMELINESS OF FIRST TEMPORARY DISABILITY PAYMENTS
According to the sample audited, your average late pay
percentage for the 3 years was 5.7%. The Administrative
Director views as exceptable any percentage under 20%. Again,
it was noted that in the majority of the indemnity claims
reported to the City, 4850 time was paid and in those cases in
which 4850 time was not paid, the injured worker received one
week of salary continuation.
DIA SOD'S AND CHECK COPIES
It was noted that your Administrator is not reporting temporary
disability payments to the Division of Labor Statistics via
DIA Form sOO's. This is unacceptable. Your Administrator
must begin reporting all temporary disability payments to the
Division. Again, the payment of temporary disability has
occurred by either the direct payment of temporary diSability
to the injured or upon the fourth day of lost time from work
when salary is continued.
Your Administrator also does not send DIA Form SOD's to the
injured worker. This is not acceptable.
Check copies are not contained in the claims files, but are
available for audit.
FILE DOCUMENTATION
Your Administrator utilizes employers' first report of work
injury forms (DIA 5020) which are not acceptable. The Form
5020 must be the form approved by the Division of Labor
Statistics and must not be altered. Your Administrator should
begin using the proper form at once.
Again, DIA Form 500's are not sent and therefore do not appear
as required in the claims files.
File documentation was good relative to dates off work and
medical control.
Documentation relative to the exact dates temporary disability
or salary continuation was paid was sketchie. The exact dates
TD or salary continuation was paid must appear in the files.
C CITY OF SAN
Certificate
paqe -4-
BERNARDINO
No. 6-0124-01
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JUN Q lc': ~
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REHABILITATION
RISK MANAGEMENT
Your Administrator does not send "WEBB/RENFRO" letters to the
injured workers at the appropriate time nor does your
Administrator send proper notification to the rehabilitation
bureau at the desiqnated time. The Administrator must beqin
properly advisinq injured workers of their riqhts to
rehabilitation benefits and must properly advise the
rehabilitation bureau.
NOTE
Section 15400 of the California Code of Requlations, Title 8,
Administration of Self-Insurance indicates one case file
should be made up for each work injury case. Your
Administrator consistently puts all applications for each
injured in one file. In the future, it is necessary that the
Administrator make one file for each application.
MONETARY ERRORS
Of the files reviewed it appears there are 16 in further need
of indemnity payments. This number is tentative since further
clarification must be made of file documentation.
Specifically, since your Administrator computes temporary
disability due on a 5 day week and since 5 days of waqe
continuation are paid and since reqular days off are
considered, it was difficult to determine whether further
temporary disability was due. Of the 16 case, however, 5
appear to be in need of permanent disability advances. All
files are listed in the appendix of this letter.
Within 45 days from the post audit conference April 7, 1989 we
require a written response to each item listed on the addendum
of this letter. If a medical examination is requested, the
appointment must be arranqed and a copy of the letter to the
injured employee must accompany first reply letter. Also
required are copies of checks in payment TO, PO, Medical, etc.;
copies of F & A's or C & R's; copies of waqe statement for a
period or one year prior to the date of injury or as otherwise
stated in the addendum; and any other document to prove
compliance. Each 45 day period thereafter a follow-up letter
must be received by this office or as otherwise instructed by
this consultant.
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JUN ~ E:::
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CITY OF SAN BERNARDINO
Certificate No. 6-0124-01
Page -5-
Should you have any questions regarding this matter, please
do not hesitate to contact Kim T. Kunkel in the Los Angeles
Office.
RISK MANAGEMENT
Sincerely
. VV\
KIM T. L
Workers' Compensation Consultant
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APPENDIX
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It is noted that the City continues full salary for 1 week in
the event a non-safety member is injured. The files listed
below appear to be in need of further temporary disability
payments. The dates listed begin on the 8th day after the
injury date inaccordance with the 1 week salary continuation.
Darryl Brooks
November 25, 1986
~ E~E~WE
JUN 91SE9
.lW=
Datp- nf Inju~y
According to file documentation, it appears temporary
disability is due for the period December 3 through December ~ ~
7, 1986 at $223.04 per week for a total of $159.31. Please
insure that this amount has been paid to the injured.
Victor Alexander
August 14 1985
According to file documentation, temporary disabilities due
for the August 23 through September 8, 1985 at $112.00 per
week for a total of $272.00. $144.00 was paid. Please pay
the remainder to the injured at this time.
Jeff Velliquette
October 24, 1985
According to file documentation, temporary disabilities due
for the period November 1 through November 6, 1985 at $156.00
per week a total of $133.71. Since $111.40 was paid, please
pay the additional $22.31 at this time.
Curtis Lee
August 10, 1985
According to file documentation, temporary disabilities due
for the period August 18 through August 19, 1985 at $224.00
per week for a total $64.00. Since $32.00 was paid, please
pay the additional $32.00 to the injured.
David Tatman
June 19, 1987
According to file documentation, temporary disabilities due
for the period June 27 through July 6, 1987 at $224.00 per
week for a total of $320.00. Since $224.00 was paid, please
pay the additional $96.00 to the injured.
Gilbert Lopez
November 13, 1986
According to file documentation, it appears temporary
disabilities due for the period November 21 through December
10, 1986 at $200.00 per week for a total of $571.43. Since
$485.71 was paid, please pay the additional $85.72 to the
injured.
Martk Becerra
July 31, 1987
According to file documentation, it appears temporary
disabilities due for the period August 8 through August 9,
1987 at $117.33 per week for a total of $33.52. Since zero
was paid, please pay the $33.52 at this time.
'. (.) 0 0 !WlEiHlfl~
Appendix
CITY OF SAN BERNARDINO
Certificate No. 6-0124-01 JUN 111C'~:)
Page -2-
be nA~~ nf tn':"ury RISK MANAGEMENT
Darryl Brooks December 12, 1987
According to file documentation, temporary disability is due
for the date December 20, 1987 in the amount of $32.00. Since
zero was paid, please pay the $32.00 at this time.
Oliver Aguayo
March 16, 1988
According to file documentation, temporary disability is due
for the period March 28 through March 30, 1988 at $224.00 per
week for a total of $96.00. Since zero was paid, please pay
the $96.00 at this time.
Kevin Ware
April 2, 1988
According to file documentation, temporary disability is due
for the period April 14 through May 4, 1988 at $133.33 per
week for a total of $399.99. Since $361.90 was paid, please
pay the additional $38.09 at this time.
The claims listed below are in need of the corrective action
indicated.
Gary McCafferty
June 23, 1986
The injured was due temporary disability for the period of
June 27 through July 1, 1986. He received full salary in lieu
of temporary disability. Temporary disability should have
been charged against the case in a DIA Form 500 sent. Neither
was done. This should be done on all such cases in the
future.
Charles Randsom
August 3, 1986
The injured is a fireman and received full salary in lieu of
temporary disability. However, no DIA Form 500 was sent.
This should have been done.
In addition, the file does not appear to have temporary
disability payments charged against it. Please account for
temporary disability against this case at this time.
Please obtain a final medical report which outlines any and
all factors of permanent disability, and need for
rehabilitation, and the need for lifetime medical care.
Please advance permanent disability inaccordance with Labor
Code Section 4650. We will look for a lump sum payment and
the appropriate week benefit thereafter.
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Appendix
CITY OF SAN BERNARDINO
Certificate No. 6-0124-01
Page -3-
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RISk ~
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ntl!l~flII of Tnjury
Maurice McKnight
June 20, 1985
Please advise the injured that if he in the need of further
medical care or has any permanent residuals as the result of
his injury that he is entitled to the further care or
compensation for residuals. This should be done via letter.
David Baily
The injured is a fire fighter and received full salary in lieu
of temporary disability. The injured did not receive a DIA
Form 500 nor was temporary disability charged against this
case. No action is required.
Robert Clayton
February 8, 1988
Please obtain a final medical report.
John Terry
October 20, 1986
This injured is a fireman. It is noted that the public safety
disability and rehabilitation committee of the City of San
Bernardino decided that the injury was industrial and that
said injury incapacitated the injured from returning to his
usual customary occupation. Commission additional granted
disability retirement effective November 28, 1988. You should
be aware that a certified Administrator only (in non-disputed
cases) should be the only City employee to make the
determination of injury RB-101. In addition, Administrator
through his/her Doctor, and with the assistance of a job
analysis, should make the determination as to whether the
injured is capable of returning to his/her customary
occupation.
Since permanent disability is obvious in this case, please
advance permanent diSability inaccordance with Labor Code
Section 4650. We will look for a lump sum advance to be
followed by bi-weekly checks.
Have you offered vocational rehabilitation? Did you report
the case to the rehabilitation bureau of the RB-101?
Your permanent stationary medical report is inadequate. The
Doctor indicates the condition is permanent stationary but
does not outline permanent disability factor. Please
therefore obtain a definitive permanent stationary medical
report.
We do not appear to have reserved for temporary disability.
It appears that because you paid 4850 time that you did not
so. Please do so at this time.
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Appendix {F? re~IE~WIE rID
CITY OF SAN BERNARDINO
Certificate No. 6-0124-01
Page -4-
JUN !ll?e?
lWII& n"t:~ nf Tn;nry RISK MANAGEMENT
. Cezar Rodriquez June 5, 1986
Please use payroll records to determine temporary disability
needs and insure that the proper amount of temporary
disability has been paid.
Robert Reynolds
Please pay permanent disability
continuing to the extent to the
permanent disability.
February 20, 1988
from February 23, 1989 and
non-disputed portion of the
There are three applications in
one file for each injury date.
office of your action.
one file. Your must establish
Please do so and advise this
Chad Williams
February 15, 1988
Please advance permanent disability from February 16, 1989 and
continuing through the extent of the non-disputed portion of
the permanent disability.
You have two application in one file. Please establish a new
file and advise this office of your action.
Your Dr. Rouhe does not outline the permanent disability in a
timely fashion or at all. Timely insure you receive a
definitive permanent and stationary medical report which
outlines any and all factors of permanent disability, etc.
Terry Wood
August 25, 1987
There appears to be 3 applications in one file. Please insure
that there are 3 files opened, one for each application.
Was a RB-101 filed with a Bureau and a Webb/Renfro sent to the
injured? If not, do so at this time.
Unless the injured desires rehabilitation, please advance
permanent disability from August 25, 1988 and continuing
through the undisputed portion of the permanent disability.
Daniel Adomy
May 17, 1988
Using payroll records, please determine the last day worked
and insure that the proper amount of disability has been paid.
Please also realize that this should be an indemnity and not a
medical only file.
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Appendix
CITY OF SAN BERNARDINO
Certificate No. 6-0124-01
Page -5-
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Dat".. n~ Tnjllrv RISK ~
'Bill DeBarr
March 16, 1988
The injureds last day at work was March 16, 1988 and his
return to work day was March 22, 1988. Full salary was paid.
The file is a medical only file, but should be an indemnity
file with an indemnity reserve and a DIA Form 500 sent to the
injured.
Paul Florres
June 30, 1988
The injureds last day of work was June 30, 1988 and the return
to work date was July 5, 1988. Full salary was paid. The
same comments as for William DeBarr above applies to this
case.
Kevin Gladden
February 9, 1988
The injureds last day of work was February 9, 1988 and the
return to work day was February 15, 1988. Full salary was
paid for the period February 10 through February 12, 1988.
This claim should be an indemnity file and a medical only file
and a DIA Form 500 should have been sent to the injured
worker.