Resolution No. 70841
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RESOLUTION NO. 7084
A RESOLUTION OF THE CITY COUNCIL OF THE CITY OF
VERNON GRANTING THE INDUSTRIAL DISABILITY
RETIREMENT OF ROBERT L. SMITH, A FIRE ENGINEER
EMPLOYED BY THE CITY OF VERNON (Government Code
Sections 21154 and 21156)
WHEREAS, the City of Vernon (hereinafter referred to as
"Agency") is a contracting agency of the Public Employees'
Retirement System; and
WHEREAS, the Public Employees' Retirement Law requires
that a contracting agency determine whether an employee of such
agency in employment in which he is classified as a fire engineer is
physically or mentally incapacitated to perform his duties for
purposes of the Public Employees' Retirement Law; and
WHEREAS, Robert L. Smith, employed by the Agency in the
position of Fire Engineer, on or about December 15, 1997, filed'an
application for industrial disability retirement with the Public
Employees' Retirement System, and the Public Employees' Retirement
System requested the Agency, on or about January 22, 1998, to make
a determination regarding whether Mr. Smith was incapacitated for
the performance of his duties and therefore eligible to retire for
industrial disability; and
WHEREAS, by letter dated January 28, 1998, the City
notified Mr. Smith that the matter of his disability retirement
based on the findings contained in the medical reports would be
considered by the City Council; and
WHEREAS, the City Council of the City of Vernon has
reviewed the medical evidence submitted by Dr. David Landers of
TechniMed and Pratap Saraf, M. D., F.A.C.P., F.C.C.P., and other
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evidence relevant to whether Mr. Smith was incapacitated, and
WHEREAS, the City Council of the City of Vernon has
reviewed evidence both as to whether any incapacity was industrial
and as to whether any third -party liability is possible with respect
to any incapacity.
NOW, THEREFORE, BE IT RESOLVED BY THE CITY COUNCIL OF THE
CITY OF VERNON AS FOLLOWS:
SECTION 1: The City Council of the City of Vernon hereby
finds and determines that Robert L. Smith is incapacitated within
Ithe meaning of the Public Employees' Retirement Law for the
performance of his duties in the position of Fire Engineer in the
Vernon Fire Department.
SECTION 2: The City Council of the City of Vernon hereby
finds and determines that such disability is industrial, in that it
is the result of injury or disease arising out of and in the course
of employment, that neither the City Council of the City of Vernon
nor Robert L. Smith has applied to the Workers' Compensation Appeals
Board for a determination pursuant to Section 21026 whether such
alleged disability is industrial, and that there is no possibility
of third -party liability in this case.
SECTION 3: The City Council of the City of Vernon hereby
determines from the November 1, 1997, medical report of Dr. David
Landers of TechniMed and the November 26, 1997, medical report of
Pratap Saraf, M. D., that Robert L. Smith is unable to substantially
perform the duties of his position as Fire Engineer and therefore
should be retired. The City Council further determines that the
permanent and stationary date for retirement purposes is November
26, 1997, that the last day Mr. Smith will be on the City's payroll
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is March 4, 1998, and that Mr. Smith's retirement is effective the
end of the business day on March 4, 1998, and that no dispute as to
the expiration of such leave rights is pending.
SECTION 4: The City Clerk shall notify Mr. Smith of the
City Council Is determination granting his application for industrial
disability retirement.
SECTION 5: The City Clerk of the City of Vernon shall
certify to the passage of this resolution, and thereupon and
thereafter the same shall be in full force and effect.
APPROVED AND ADOPTED this 3rd day of February, 1998.
ATTEST:
BRUCE V. MALKENHORST, City Clerk
-3-
LEONIS C. MALPURG, M yor
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STATE OF CALIFORNIA )
) ss
COUNTY OF LOS ANGELES )
I, BRUCE V. MALKENHORST, City Clerk of the City of Vernon,
do hereby certify that the foregoing Resolution, being Resolution
No. 7084, was duly adopted by the City Council of the City of Vernon
at a regular meeting of the City Council duly held on Tuesday,
February 3, 1998, and thereafter was duly signed by the Mayor of the
City of Vernon.
BRUCE V. MALKENHORST, City Clerk
(SEAL)
-4-
SUPPORTING
DOCUMENTS
Ices Division
P.O. Box *2796
Sacramento, CA 95812-2796
(916) 326-3232; FAX (916) 658-1280
Telecommunications Device For
The Deaf--(916) 326-3240
Robert L. Smi
136 West Cy ess Apt 7
Monrovia C /P91060
Dear Robert L. Smith :
Reply to: Section 432
Refer to: 545-40-8353
JAN 0 6 1998
This letter acknowledges receipt of an application for your
disability retirement. A copy of the application has been
forwarded to your employer for a determination of your disability.
It is required that they make this determination within six months
of our request unless you waive the requirements of this
provision (Section 21025.1, Government Code).
Following your employer's finding of substantial incapacity, your
retirement cannot be cancelled. However, if you are eligible, and
wish to change to a service retirement in lieu of disability
,retirement, you must apply for the change prior to the effective
date of your disability retirement or within 30 days after
notification of approval (Section 21025, Government Code).
Under the law, if a person (other than your employer) caused an
injury that results in certain PERS benefits being paid, then PERS
has the right to recover from the responsible person up to
one-half of the total retirement benefit costs payable due to this
injury. This right is known as a "right of subrogation" (Gov.
Code section 21450 et seq.).,
If you pursue a claim against any person for the same injuries
that also entitle you to disability retirement from PERS (other
thah a Workers' Compensation claim or an uninsured motorist claim)
YOU MUST INFORM PERS OF THE EXISTENCE OF THIS CLAIM. This is true
even if the claim has not yet resulted in a court action. PERS
has the right to participate in any such claim either through
filing its own action against the responsible party, intervening
in your claim, or filing a lien against any judgment which you may
recover. IF YOU SETTLE SUCH A CLAIM WITHOUT NOTIFYING PERS, PERS
MAY ALSO BE ENTITLED TO FILE A LAWSUIT AGAINST YOU FOR RECOVERY OF
PERS' SUBROGATION RIGHTS.
California Public Employees' Retirement System
Lincoln Plaza-400 P Street -Sacramento, CA
r
Aou entered your safety membership category after January 1,
1980, your industrial disability allowance may be less than 50% of
your final compensation. The allowance cannot exceed the amount
that would be payable for a service retirement at age 55 if you had
continued in employment until age 55. This limit does not apply if
your agency has contracted to offer the 50% - 90% industrial
disability allowance, or if you were disabled because of a direct
violent act upon your person or as a result of hazardous and dangerous
duty required for your position (Section 21292.6, Government Code).
If you are notified by PERS that your disability application has
been approved, and upon receipt of a separation document from
your employer reflecting your last day on the payroll, the
System will calculate and send the optional settlement information
that you requested on your application. This information will
be sent to you on our form PERS-BAS-898, Election of Optional
Settlement and Beneficiary Designation. The form will require the
notarized signature of both you and your spouse.
If at any time prior to the mailing of your first warrant you wish
to receive a refund of your accumulated contributions in a lump
sum in lieu of a retirement allowance, you may do so by sending
written notification to the return address shown above. Membership
in PERS terminates upon the mailing of a warrant refunding
contributions, making you ineligible for future benefits unless
you return to employment covered by PERS (Section 20390, Government
Code).
If you have any questions, please contact us.
Sincerely,
JOYCE MCKIBBEN
BENEFIT APPLICATION SERVICES DIVISION
: 0209 VERNON CITY
V91c
Attn: Personnel Officer
PERS-BAS-183B (Rev.1/91)
California Public Employees' Retirement System
Lincoln Plaza-400 P Street -Sacramento, CA
CITY COUNCIL
LEONIS C. MALBURG
Mayor
THOMAS A. YBARRA
Mayor Pro -Tern
Wm. 'BILL" DAVIS
Councilman
H. "LARRY" GONZALES
Councilman
W. MICHAEL McCORMICK
Councilman
BRUCE V. MALKENHORST
City Administrator/City Clerk
FAX: (213) 581-7924
CITY HALL
4305 SANTA FE AVENUE, VERNON, CALIFORNIA 90058
TELEPHONE (213) 583-8811
January 29, 1998
Mr. Robert L. Smith
136 West Cypress Apt. 7
Monrovia, CA 91060
RE: Application for Disability Retirement
Dear Mr. Smith:
DAVID B. BREARLEY
City Attorney
FAX (818) 330-5818
KEVIN WILSON
Director of Community Services & Water
FAX: (213) 588-2761
KENNETH J. DeDARIO
Director of Light & Power
FAX: (213) 583-1983
DAVE TELFORD
Fire Chief
FAX: (213) 581-1385
LOUIS ROSENKRANTZ
Police Chief
FAX: (213) 581-1178
The city has received a request from PERS, dated January 22, 1998, with
regard to your December 15, 1997, application for disability retirement.
You are hereby advised that approval of your disability retirement will
be recommended to the City of Vernon City Council at their regular
meeting to be held February 3, 1998. If you have any questions or
comments do not hesitate to contact the Risk Management office.
Very truly yours,
CITY OF VERNON
Bruce V. Malken O
City Administrator/City Clerk
cc: Risk Management
City Council
/gj o
:PreD9b1ty0K
CITY COUNCIL
LEONIS C. MALBURG
Mayor
THOMAS A. YBARRA
Mayor Pro -Tern
Wm. 'BILL" DAVIS
Councilman
H. "LARRY" GONZALES
Councilman
W. MICHAEL McCORMICK
Councilman
BRUCE V. MALKENHORST
City Administrator/City Clerk
FAX: (213) 581-7924
CITY HALL
4W5 SANTA FE AVENUE, VERNON, CALIFORNIA 90058
TELEPHONE (213) 583-8811
February 17, 1998
PERS
Benefits Application Division
P.O. Box 2796
Sacramento, CA 95812-2796
Attention: Ms. Joyce McKibben
DAVID B. BREARLEY
City Attorney
FAX: (818) 330-5818
KEVIN WILSON
Director of Community Services & Water
FAX (213) 588-2761
KENNETH J. DeDARIO
Director of Light & Power
FAX: (213) 583-1983
DAVE TELFORD
Fire Chief
FAX: (213) 581-1385
LOUIS ROSENKRANTZ
Police Chief
FAX: (213) 581-1178
RE: Determination of Disability Retirement of Robert L. Smith
Dear Ms. McKibben:
On January 22, 1998, you requested, pursuant to Government Code Section
21024, that the City of Vernon make a determination regarding whether
Robert L. Smith, a Local safety member employed by the City of Vernon, is
physically or mentally incapacitated to perform duties and, therefore,
eligible to retire on disability.
On February 3, 1998, the City of Vernon City Council reviewed the medical
evidence and other evidence relevant to whether Mr. Smith is
incapacitated and determined that he is incapacitated by adopting
Resolution No. 7084. A certified copy of said resolution is enclosed with
this letter.
Pursuant to Government Code Section 21025, the City Council hereby
notifies you of its determination that Mr. Robert L. Smith is
incapacitated to perform his duties.
BVM/gjo
encs.
cc: Joan Francone, Risk Manager
Resolution File
Very truly yours,
CITY OF VERNON
Bruce V. Malkenh st
City Administrat
;PERSOKd
lu
CITY COUNCIL
LEONIS C. MALBURG
Mayor
THOMAS A. YBARRA
Mayor Pro -Tern
Wm. 'BILL" DAVIS
Councilman
H. "LARRY" GONZALES
Councilman
W. MICHAEL McCORMICK
Councilman
BRUCE V. MALKENHORST
City Administrator/City Clerk
FAX: (213) 581-7924
CITY HALL
4M5 SANTA FE AVENUE, VERNON, CALIFORNIA 90058
TELEPHONE (213) 583-8811
February 17, 1998
Mr. Robert L. Smith
136 West Cypress Apt. 7
Monrovia, CA 91060
RE: Disability Determination by the City Council
Dear Mr. Smith:
DAVID B. BREARLEY
City Attorney
FAX: (818) 330-5818
KEVIN WILSON
Director of Community Services & Water
FAX: (213) 588-2761
KENNETH J. DeDARIO
Director of Light & Power
FAX: (213) 583-1983
DAVE TELFORD
Fire Chief
FAX: (213) 581-1385
LOUIS ROSENKRANTZ
Police Chief
FAX: (213) 581-1178
After conclusion of the hearing to determine your disability retirement,
the City Council determined to grant your industrial disability
retirement.
The City Council made this determination through the adoption of
Resolution No. 7084, a copy of which is enclosed herewith.
If you have any further questions regarding this matter, please do not
hesitate to contact the Risk Management Office.
Very truly yours,
CITY F VERNON
�i
ruce V. Malken orst
City Administr Lion
BVM/gjo
cc: J. Francone
:PERSMp yel OK
CITY COUNCIL
LEONIS C. MALBURG
Mayor
THOMAS A. YBARRA
Mayor Pro-Tem
Wm. 'BILL" DAVIS
Councilman
H. "LARRY" GONZALES
Councilman
W. MICHAEL MCCORMICK
Councilman
BRUCE V. MALKENHORST
City Administrator/City Clerk
FAX: (213) 581-7924
CITY HALL
4305 SANTA FE AVENUE, VERNON, CALIFORNIA 90058
TELEPHONE (213) 583-8811
January 29, 1998
City Council
City of Vernon
Honorable Members:
DAVID B.13REARLEY
City Attorney
FAX: (818) 330-5818
KEVIN WILSON
Director of Community Services & Water
FAX: (213) 588-2761
KENNETH J. DeDARIO
Director of Light & Power
FAX: (213) 583-1983
DAVE TELFORD
Fire Chief
FAX: (213) 581-1385
LOUIS ROSENKRANTZ
Police Chief
FAX: (213) 581-1178
Robert Smith applied for a disability retirement and on January
22, 1998, the City received a copy of his application and a
request from PERS to make a determination of Mr. Smith's
disability in accordance with Government Code Section 21154 and
21156.
Mr. Smith underwent his annual Respirator User Non Haz-Mat Exam
on October 29, 1997, conducted by Dr. David Landers of TechniMed.
In his report, Dr. Landers determined Mr. Smith not approved for
respirator use based on abnormal tests. Mr. Smith was directed
to obtain further examinations from his personal physician.
Mr. Smith was examined by Pratap Saraf, M.D., on November 3,
1997. In a letter dated November 26, 1997, Dr. Saraf determines
that Mr. Smith has a moderately severe obstructive pulmonary
disease, with a pattern consistent with pulmonary emphysema, with
significantly diminished diffusing capacity. Dr. Saraf concludes
that Mr. Smith is unable to perform his duties with the internal
problems that he has. It is a permanent disability.
Based on the reports of Dr. Landers and Dr. Saraf, it is
recommended that Council approve the industrial disability
retirement of Robert Smith, effective March 4, 1998.
BVM/mm
enclosure
Very truly yours,
Bruce V. Malkenhorst
City Clerk
TO: Bruce V. Malkenhorst, City Administrator
FROM: Joan Francone, Risk Manager
DATE: January 29, 1998
SUBJECT: AMENDED INDUSTRIAL DISABILITY RETIREMENT - ROBERT L.
SMITH, FIRE ENGINEER
Robert Smith applied for an Industrial Disability Retirement on December 15,
1997. On January 22, 1998, the City received by fax a copy of his application and
a request from PERS to make a determination of Mr. Smith's disability in
accordancewith Government Code Sections 21154 and 21156.
Mr. Smith underwent his annual Respirator User Non Haz-Mat Exam on October
29, 1997 conducted by Dr. David Landers of TechniMed. In his report, Dr.
Landers determined Mr. Smith not approved for respirator use based on abnormal
tests. Mr. Smith was directed to obtain further examinations from his personal
physician.
Mr. Smith was examined by Pratap Saraf, M.D. on November 3, 1997. In a letter
dated November 26, 1997, Dr. Saraf determines that Mr. Smith has a moderately
severe obstructive pulmonary disease, with a pattern consistent with pulmonary
emphysema, with significantly diminished diffusing capacity. Dr. Saraf concludes
that Mr. Smith is unable to perform his duties with the internal problems that he
has. It is a permanent disability.
Based on the reports of Dr. Landers and Dr. Saraf it is recommended that Council
approve the industrial disability retirement of Robert Smith. The effective date of
retirement is March 2, 1998.
JF/ca
Enclosures
c: City Attorney
VIA
jF RS
Benefit Application Services Division
P.O. Box 2796
Sacramento, CA 95812-2796
(916) 326-3232; FAX (916) 658-1280
Telecommunications Device For
The Deaf--(916) 326-3240
0209 VERNON CITY
Attn: Personnel Officer
Re: DISABILITY RETIREMENT APPLICATION FOR:
Name: Robert L. Smith
Social Security Number: 545-40-8353
Birth Date: 11-24-32
Application Received: 12-15-97
JAN
JA 41
JAN 13"
Enclosed is a copy of the application which is being filed with
your agency for a determination of the member's disability, in
accordance with Section 21024 and 21025, Government Code. It is
required that you make this determination within six months of
this request unless the local safety member waives the -
requirements of this provision (Section 21025.1, Government Code).
Under the Public Employees' Retirement Law, disability means the
incapacity of a member for the performance of duty in public
services for permanent or extended and uncertain duration, as
determined on the basis of competent medical opinion. Disability
is not necessarily an inability to perform every fuction of a
given position. Rather, the courts have concluded that the test
in any case is whether the employee can substantially perform the
duties of the position he occupies. These criteria apply whether
the member is being retired or is being reinstated from disability
retirement.
Disputed questions regarding the industrial relationship of the
disabling injury to the member's work will be resolved by the
Workers' Compensation Appeals Board. In the event there is no
dispute, such a finding can be made by the employer. A Workers'
Compensation Award is not sufficient evidence that a local safety
member is disabled for retirement purposes. There must be a
specific finding under Section 21026, Government Code, by the
employer, with respect to the disability for which he will be
retired.
If it is determined that the member is not disabled for the
performance of his duties, a Resolution to that effect must be
filed with the System. Please refer to Sample resolution No. 1,
Benefits Procedures, Procedures Manual for Public Agency
reporting to the Public Employees' Retirement System. If the
member is found to be disabled, the following will apply:
California Public Employees' Retirement System
Lincoln Plaza-400 P Street -Sacramento, CA
The Retirement System will require at least the following
documentation:
1. A finding that disability exists.
2. a. A finding by your agency as to whether or not the
disability is industrial.
b. In case of a dispute, a Findings and Award by the
WCAB, resolving the industrial relationship.
3. A certified statement (Resolution) by the local agency,
indicating last day member is on payroll. In case of a
dispute regarding the member's effective date of retire-
ment, a request must be filed with the WCAB for Finding
of Fact to determine on what date the member's condition
became permanent and stationary. That date then becomes
the effective date of retirement (Government Code Section
21025.4)
4. A statement identifying the type of disability retirement
determined, i.e., non -industrial disability retirement or
industrial disability retirement. A member must have a
minimum of five years of credited service to qualify for
non -industrial disability retirement. If a member does
not meet the minimum service requirements for disability
retirement, he may still qualify by redepositing
previously withdrawn contributions, or contributing an
amount for service rendered prior to membership with the
System. Time during which the member is absent from
State service by reason of injury or illness, which is
determined within one year after the end of such absence
to be job -related, shall be considered as time spent in
State service for the purpose of qualification for
retirement and death benefits.
5. A statement by the agency to the effect that there is, or
is not, a possibility of third -party liability present,
if member's disability was caused by negligence or an
intentional act of a party other than employer.
6. A statement identifying the reason for the disability,
i.e. orthopedic, psychological, cardio-vascular,
internal, neurological or other.
7. If advanced disability pension payments will be paid to
the member, include the monthly amount. Also include
where the reimbursement check should be mailed.
8. If the employee was hired after 1-1-80, include the
following in accordance with G.C. Section 21292.6:
a. Was the disability due to hazardous portions of
duty?
b. Was the disability due to a direct act perpetrated
against the employee?
California Public Employees' Retirement System
Lincoln Plaza-400 P Street -Sacramento, CA
&I
All such documentation submitted by your agency must be signed by
the governing body or its lawful delegate (City Manager, Chief
Administrative Officer, County Executive, or other comparable
individual). If the governing body chooses to delegate the
responsibility of making a determination, a certified copy of the
delegation order of this authority must accompany the findings by
such delegate in each instance.
Under the law, if a person (other than the employer) caused an
injury that results in certain PERS benefits being paid, then PERS
has the right to recover from the responsible person up to
one-half of the total retirement benefit costs payable due to this
injury. This right is known as a "right of subrogation". (Gov.
Code sec. 21450 et seq.) Accordingly, the Retirement System
requests that you, as the local agency, send us copies of all
injury reports sent to the State Compensation Insurance Fund (or
your Workers' Compensation carrier) concerning any and all
injuries sustained by this, employee.
Please advise us if you are aware our member is pursuing a claim
(other than a Workers' Compensation claim) against any person or
entity for the same injuries that also entitle the member to a
disability retirement from PERS.
We hope the above information is helpful to you. If you have any
questions, please call.
JOYCE MCKIBBEN
BENEFIT APPLICATION SERVICES DIVISION
PUBLIC EMPLOYEES' RETIREMENT SYSTEM
CC: Robert L. Smith
136 West Cypress Apt 7
Monrovia Ca 91060
PERS-BAS-175 (Rev. 1/91) California Public Employees' Retirement System
Lincoln Plaza-400 P Street -Sacramento, CA
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