Resolution No. 75151
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RESOLUTION NO. 7515
A RESOLUTION OF THE CITY COUNCIL OF THE CITY OF
VERNON GRANTING THE DISABILITY RETIREMENT OF PAUL
ROBERT ZOOK, A LOCAL SAFETY MEMBER 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 local safety member is
physically or mentally incapacitated to perform his duties for purposes
of the Public Employees' Retirement Law; and
WHEREAS, on or about February 17, 2000, Paul Robert Zook,
employed by the Agency in the position of Engineer in the Vernon Fire
Department, filed an application for service pending industrial
disability retirement with the Public Employees' Retirement System, and
the Public Employees' Retirement System requested the Agency, on or
about February 28, 2000, to make a determination regarding whether Paul
Robert Zook was incapacitated from the performance of his duties and
therefore eligible to retire for disability; and
WHEREAS, by letter dated March 30, 2000, Bruce V. Malkenhorst,
the City Administrator, notified Paul Robert Zook that the matter of
his orthopedic 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
1 medical evidence and other evidence relevant to whether Mr. Zook was
2 incapacitated; and
3 WHEREAS, the City Council of the City of Vernon has reviewed
4 evidence both as to whether any incapacity was industrial and as to
5 whether any third -party liability is possible with respect to any
6 incapacity.
7 NOW, THEREFORE, BE IT RESOLVED BY THE CITY COUNCIL OF THE CITY
8 OF VERNON AS FOLLOWS:
9 SECTION 1: The City Council of the City of Vernon hereby
10 finds and determines that Paul Robert Zook is incapacitated within the
11 meaning of the Public Employees' Retirement Law from the performance of
12 his duties in the position of Engineer in the Vernon Fire Department.
13 SECTION 2: The City Council of the City of Vernon hereby finds
14 and determines that such orthopedic disability is industrial, in that it
15 is the result of injury or disease arising out of and in the course of
16 employment, that neither the City Council of the City of Vernon nor Paul
17 Robert Zook has applied to the Workers' Compensation Appeals Board for a
18 determination pursuant to Section 21026 whether such alleged disability
19 is industrial, and that there is no possibility of third -party liability
20 in this case.
21 SECTION 3: The City Council of the City of Vernon hereby
22 determines from the orthopedic evaluation report of Dr. David B. Landers,
23 that Paul Robert Zook is unable to substantially perform the duties of
24 his position as an Engineer in the Vernon Fire Department and therefore
25 should be retired. The City Council further determines that the
26 permanent and stationary date for retirement purposes is March 22, 2000,
27 that the last day Paul Robert Zook was on the City's payroll was
28 March 11, 2000, and that Mr. Zook retired effective March 11, 2000.
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SECTION 4: The City Clerk shall notify Paul Robert Zook of the
City Council's determination granting his application for 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 4th day of April, 2000.
f
LEONIS C. MALB G, Ma or
ATTEST:
BRUCE V. MALKENHORST, City Clerk
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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.
7515, was duly adopted by the City Council of the City of Vernon at a
regular meeting of the City Council duly held on Tuesday, April 4,
2000, and thereafter was duly signed by the Mayor of the City of
Vernon.
(SEAL)
BRUCE V. MALKENHORST, City Clerk.
- 4 -
SUPPORTING
DOCUMENTS
w
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 (323) 581-7924
CITY HALL
4305 SANTA FE AVENUE, VERNON, CALIFORNIA 90058
TELEPHONE (323) 583-8811
April 18, 2000
Ms. Joyce McKibben
Disability Determination Section
CALIFORNIA PUBLIC EMPLOYEES' RETIREMENT SYSTEM
P.O. Box 2796
Sacramento, CA 95812-2796
EDUARDO OLNO
City Attorney
FAX: (562) 927-8722
KEVIN WILSON
Director of Community Services & Water
FAX: (323) 588-2761
KENNETH J. DeDARIO
Director of Municipal Utilities
FAX: (323) 583-1983
DAVE TELFORD
Fire Chief
FAX: (323) 581-1385
BRUCE W. OLSON
Police Chief
FAX: (323) 583-5236
Re: Determination of Disability Retirement of Paul Robert Zook
Dear Ms. McKibben:
On February 28, 2000, you requested, pursuant to Government Code
Section 21154 and 21156, that the City Council of the City of
Vernon make a determination regarding whether Mr. Paul Robert
Zook, a local safety member employed by the City of Vernon, is
physically or mentally incapacitated to perform duties; and
therefore, eligible to retire for disability.
On April 4, 2000, the City Council reviewed the medical evidence
and other evidence relevant as to whether Mr. Zook is
incapacitated for the performance of duties and determined that
he is incapacitated by adopting Resolution No. 7515, a certified
copy of which is attached to this letter and incorporated herein
by this reference.
PERS Disability Determination Section April 18, 2000
Re: Paul Robert Zook
Page 2
Pursuant to Government Code Section 21155, the City Council
hereby notifies you of its determination that Paul Robert Zook
is incapacitated.
Very truly yours,
CITY OF VERNON
Oiori/
J. Or s
z4jom
Chief Deputy City Clerk
GJO:rcm
Attachment
cc: Joan Francone, Risk Manager
I
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 (323) 581-7924
CITY HALL
4305 SANTA FE AVENUE, VERNON, CALIFORNIA 90058
TELEPHONE (323) 583-8811
March 30, 2000
City Council
City of Vernon
Honorable Members:
DAVID B. BREARLEY
City Attorney
FAX: (626) 330-5818
KEVIN WILSON
Director of Community Services & Water
FAX: (323) 588-2761
KENNETH J. DeDARIO
Director of Municipal Utilities
FAX: (323) 583-1983
DAVE TELFORD
Fire Chief
FAX: (323) 581-1385
BRUCE W. OLSON
Police Chief
FAX: (323) 583-5236
Paul Zook, Fire Engineer, applied for a Service Pending
Industrial Disability Retirement on February 17, 2000. In
accordance with Government Code Sections 21154 and 21156, PERS
requested that the City make a determination as to his
industrial disability in a letter dated February 28, 2000 and
received by the City on March 8, 2000. Mr. Zook retired on a
Service Retirement March 11, 2000.
According to a report dated March 23, 2000, Dr. David B. Landers
opines that Mr. Zook cannot perform the essential functions of
his job in the Fire Department. Dr. Landers bases his opinion
on the following Medical Diagnosis:
1. S/P LS injuries 1985 - requiring back surgery.
2. Low back injury on January 8, 2000 (Lumbosacrae Spine
Musculo ligamentous strain - acute with chronic
exacerbation).
3. Left shoulder strain - chronic.
4. Abdominal (Umbilical) hernia - new - diagnosed on March 22,
2000.
Mr. Zook is permanent and stationary as of March 22, 2000.
Paul Zook
March 30, 2000
Page 2
No third -party liability exists. Neither the City Council of
the City of Vernon nor Paul Zook has applied to the Workers'
Compensation Appeals Board for a determination whether such
disability is industrial.
Based on the above, it is hereby recommended that Council
approve the industrial disability retirement of Paul Zook
effective April 5, 2000, and that his primary disabling
condition is orthopedic.
Very truly yours,
Bruce V. Malkenhorst
City Clerk
BVM:gst
TO:
FROM:
DATE:
SUBJECT:
JF/ca
Enclosures
c .. t� Xt-J1--/
3�
Bruce V. Malkenhorst, City Administrator
-4�
Joan Francone, Risk Manager/Personnel Assistant )11
March 30, 2000
INDUSTRIAL DISABILITY RETIREMENT
PAUL ROBERT ZOOK, FIRE ENGINEER
Paul Zook, Fire Engineer, applied for a Service Pending Industrial Disability
Retirement on February 17, 2000. In accordance with Government Code Sections
21154 and 21156, PERS requested that the City make a determination as to his
industrial disability in a letter dated February 28, 2000 and received by the City on
March 8, 2000. Mr. Zook retired on a Service Retirement March 11, 2000.
Mr. Zook was hired as a firefighter on January 1, 1967. He became a fire engineer
on July 6, 1986. During his employment Paul suffered several work related injuries.
According to a report dated March 23, 2000, Dr. David B. Landers opines that Mr.
Zook cannot perform the essential functions of his job in the Fire Department. Dr.
Landers bases his opinion on the following Medical Diagnosis:
1. S/P LS injuries 1985 — requiring back surgery.
2. Low back injury on January 8, 2000 (Lumbosacrae Spine Musculo
ligamentous strain — acute with chronic exacerbation).
3. Left shoulder strain — chronic.
4. Abdominal (Umbilical) hernia — new — diagnosed on March 22, 2000.
Mr. Zook is permanent and stationary as of March 22, 2000.
Based on the above, it is recommended that Council approve the industrial disability
retirement of Paul Zook effective April 5, 2000 and that his primary disabling
condition is orthopedic. No third -parry liability exists. Neither the City Council of
the City of Vernon nor Paul Zook has applied to the Workers' Compensation
Appeals Board for a determination whether such disability is industrial.
c: City Attorney
TECHNIMED - VERNON
INDUSTRIAL MEDICAL CENTER, INC.
3364 E. SLAUSON AVENUE
VERNON, CA. 90058
FAX (323) 584-0059 - TEL (323) 584-7242
DAVID B. LANDERS, M.D.
- MEDICAL DIRECTOR -
MARCH 23, 2000
CONFIDENTIAL MEDICAL REPORT
CITY OF VERNON
JOAN FRANCONE
RISK MANAGEMENT F: 585-4661
RE. ZOOK`PAIIL ROBERT
EMPL: CITY OF VERNON
SUBJ: SPECIAL EXAMINATION - DISABILITY. STATUS
Dear Ms. Francone:
HISTORY:
Mr. Paul Robert Zook is a 58 year old male who has been a City of Vernon employee for
33 (1967 - 2000) years. He is an Engineer in the Fire Department.
I examined Mr. Zook on 3-22-2000 for the purpose of determining whether or not he
could perform the essential job functions of a Firefighter.
He was noted to have the following Medical Diagnoses:
• 1. S/P LS INJURIES 1985 - REQUIRING BACK SURGERY
• 2. LOW BACK INJURY 1-8-2000 (LUMBOSACRAL SPINE MUSCULO-
LIGAMENTOUS STRAIN ACUTE WITH CHRONIC EXACERBATION)
• 3. LEFT SHOULDER STRAIN - CHRONIC
- 4. ABDOMINAL (UMBILICAL) HERNIA - NEW - DIAGNOSED ON 3-22-2000
WORK STATUS: It is my medical opinion the Mr. Paul Robert Zook can not perform
the essential job functions of a Firefighter. It is my opinion that no appropriate
reasonable accommodation can be made to allow him to do so. He is P & S (Permnaent &
Stationary) as of 3-22-2000. Therefore, I would recommend that Mr. Zook be retired
from the City of Vernon Fire Department.
Sincerely,
David B. Landers, M.D.
Medical Director
Fellow, ACOEM
American College of Occupational & Environmental Medicine
Diplomate, American Board of Family Practice
QME Qualified Medical Evaluator 1993-94, State of California
Benefit Services Division
P.O. Box 2796
Sacramento, CA 95812-2796
Amo,�- (916) 326-3232; (800) 352-2238
Ca1PERS TDD - (916) 326-3240; FAX (916) 658-1280
February 28, 2000
0209-000 Vernon City Of
4305 SANTA FE AVE.
VERNON, CA 90058
Dear Personnel Officer:
Reply To: SM.M E
Refer To: 527-50-5129
'00 MAR -8 P 1 :48
STY 01 YF:RNON
RIS-K PA,IN' °,,GE.HCE14T
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 21154 and 21156,
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
(Government Code Section 21157).
Under the California 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 function 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
membees 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 hot sufficient evidence that a local safety member is disabled
for retirement purposes. There must be a specific finding under Government Code
Section 21166, by the employer, with respect to the disability for which the member will
be retired.
If it is determined that the member is not disabled for the performance of his or her
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:
The Retirement System will require at least the following documentation:
1,, Ah' is
PERS-BAS-175-W (3/96)
California Public Employees' Retirement System
Lincoln Plaza - 400 P Street - Sacramento, CA 95814
-2-
2a. A finding by your agency as to whether or not the disability is industrial.
2b. 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, last day member is on
payroll. In case of a dispute regarding the member's effective date of retirement,
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 21164).
4. A statement identifying the type of disability retirement determined, i.e., non-
industrial disability retirement or industrial disability retirement. A member must
have 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 re -depositing
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 advance 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 Government Code Section 21417:
a. Was the disability the result of an injury which was a direct
consequence of a violent act perpetrated upon his or her person?
b. Did the disability occur during the performance of those portions of his
or her duties which are particularly hazardous and dangerous?
(For the particularly hazardous and dangerous exception to apply the disability must
have occurred during the performance of job duties which had an especially high risk of
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danger when compared to other duties which were performed. It is not sufficient that the
overall job duties were hazardous or dangerous to some degree; the exception pertains
to hazards or dangers which stand above or apart from the expected hazards of the job.
This exception does not apply simply because a member has an inherently hazardous
and dangerous job.)
All such documentation submitted by your agency rust 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 finding by such delegate in each instance.
Under the law, if a person (other than the employer) caused an injury that results in
certain CalPERS benefits being paid, then CalPERS 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". (Government Code section
20251 et seq.) Accordingly, the Retirement System request 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.
Sincerely,
Joyce McKibben
Disability Determination Section
Enclosure: Copy of BAS-369D & BAS-183B
cc: Paul Zook
Benefit Services Division
P.O. Box 2796
Sacramento, CA 95812-2796
(916) 326-3232; (800) 352-2238 Reply To: Section 432
C E S TDD - (916) 326-3240; FAX (916) 658-1280 Refer To: 527-50-5129
February 28, 2000
Paul Zook
1758 Antelope Ave
Ventura, CA 93003
Dear Paul Zook:
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. Your employer is required to make a determination within six months of this
notice unless you waive the requirements of this provision (Government Code Section
21157).
Following your employer's finding of substantial incapacity, your -retirement cannot be
canceled. 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 (Government Code
Section 21156).
Under the law, if a person (other than your employer) caused an injury that results in
certain CalPERS benefits being paid, then CalPERS 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" (Government Code section
20251 et seq.).
If you pursue a claim against any person for the same injuries that also entitle you to
disability retirement from CalPERS (other than a Workers' Compensation Claim or an
uninsured motorist claim) YOU MUST INFORM CALPERS OF THE EXISTENCE OF
THIS CLAIM. This is true even if the claim has not yet resulted in a court action.
CalPERS has the right to participate in any such claim either through filing its own
action against the responsible parry, intervening in your claim, or filing a lien against any
judgment which you may recover. IF YOU SETTLE SUCH A CLAIM WITHOUT
NOTIFYING CALPERS, CALPERS MAY ALSO BE ENTITLED TO FILE A LAWSUIT
AGAINST YOU FOR RECOVERY OF CALPERS' SUBROGATION RIGHTS.
If you 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 to a member
PERS-BAS-183E-W (3/96)
California Public Employees' Retirement System
Lincoln Plaza - 400 P Street - Sacramento, CA 95814
r'..
. i
-L-
whose disability resulted from an injury which was a direct consequence of a violent act
perpetrated upon his or her person or occurred during the performance of those
portions of his or her duties which are particularly hazardous and dangerous
(Government Code Section 21417).
For the 12artl6ulady hazardous and dangerous exception to apply you must show that
your disability occurred during the performance of job duties which had an especially
high risk of danger when compared to other duties which you performed. It is not
sufficient that the overall job duties were hazardous or dangerous to some degree; the
exception pertains to hazards or dangers which stand above or apart from the expected
hazards of the job. This exception does not apply simply because a member has an
inherently hazardous and dangerous job.
If you are notified by CalPERS that your disability application has been approved, and
upon receipt of a separation document form your employer reflecting your last day on
the payroll, the System will calculate and send the optional settlement information. 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. You
should be advised that membership in the Retirement System terminates upon the
mailing of a warrant refunding contributions, making you ineligible for future benefits
unless you return to employment covered by CalPERS Government Code Section
20340).
If you have any questions, please contact us.
Sincerely,
Joyce McKibben
Disability Determination Section
Enclosure: BAS-175
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cc: 0209-Vernon City
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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 (323) 581-7924
DAVID B. BREARLEY
City Attorney
FAX: (626) 330-5818
KEVIN WILSON
Director of Community Services & Water
FAX: (323) 588-2761
CITY HALL
4305 SANTA FE AVENUE, VERNON, CALIFORNIA 90058
TELEPHONE (323) 583-8811
March 30, 2000
Mr. Paul Robert Zook
1758 Antelope Avenue
Ventura, CA 93003
Re: Application for Disability Retirement
Dear Mr. Zook:
KENNETH J. DeDARIO
Director of Municipal Utilities
FAX: (323) 583-1983
DAVE TELFORD
Fire Chief
FAX: (323) 58JL1385
BRUCE W. OLSON
Police Chief
FAX: (323) 583-5236
The City has received a request from PERS, dated February 28,
2000, with regard to your February 8, 2000, 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 April 4, 2000. If
you have any questions or comments, do not hesitate to contact
the Risk Management Office.
Very truly yours,
CITY OF VERNON
"ceV.alvkenh rst
City Administrat r/City Clerk
c: Risk Management
City Council