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Resolution No. 75151 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 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. - 2 - 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 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 - 3 - 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 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 -3- 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 r cc: 0209-Vernon City b • ♦ h �y O G 1 W e0 n Ry y i �} •�-' C-' ul - r. N �° � X In.+ 0 w �... 4+ rr••�� _ a 20 Z Q L, cn 841 co O.�rrr -cc: c0• r�i y W 1 Cn cn cn pia ao v . '� L •ems-° �� � �> cc 3 Qj rncc 0 O � C .3 ,;•� ry G CA l� .7 �(U v '� G CcU 41 ja rW6 cc cc ❑ ,.. v 'A •� O v� ti v v F v s G 1 ., v w id 'J � a• C y �' °�° E OC R! M u v v CO \•� a C cn C C z 0cc: Q i W d' .X F" y O� G❑ 2 r .> tf1 N< Gcc to �O�/j C C Cn yy x0 'tNO C 4+ U 1 v v m co v w x v v PC u 1 z .. C f Ooff u Cd o6 Q} c0 mr FID po n IV NiO f -I E t� ,2 , �• R" y~ Uj °o d O u Go 0 r w "a CA RW oo O r+ � cn p, M • cc y f; Co p O•y y ��„ ca V u C Oj � •y�.o.O � ks u S ' cc, O, •C' IdZ cc dD ++ O 41 _ a cc a N u cs N O p, cn 0 U u..Q c 4)•�3 a c U CvP.— •�NC3 Q 8 a co;v 4) .a a- y y Q °x w� $ co h �' ti .L."C-+ ar CA u � y o " o 'u'g ee C1O u ® a, CA An A IL ca 'w o, V V v Q Cc �• , ^p 7 cc c V y cd V a- 3 ai C R. �� a W O p " p ... .b OCc ,.. �, .� ,, -0 w V o p.0. Q =i y) G w cisca 0 y Cl) 3 y :I-,i cd W p4 0 Od tv- a 'co to 0 0 -9 d E a0 cis 6.d o 3�° 3 0E., „.0 ,.. y 3 0- E >. a ° 8 a ai V °� o ° ° v Cd p C 0 W rJ CIS c ;, °. a o i. a" a o �. bCd o a E= 0 O w ° '� C a" 3cc co C Q o i w, u 3 Q O. e co Z a" 4 :;c co Z Q w a V, 0ci C �O• ..00N L . - 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