CALPERS IDR - DARREN J. SIMPKINS - CITY ADMIN APPROVED 09/25/17 CONFIDENTIAL
INDUSTRIAL DISABILITY
RETIREMENT APPROVED BY THE
CITY ADMINISTRATOR ON
SEPTEMBER 25, 2017 - *SEE CLERK
DEPARTMENT FILES (INTERNAL) -
CALPERS DISABILITY RETIREMENT
RESOLUTIONS FOLDER IN
LASERFICHE FOR RESOLUTION
**RESOLUTION IS ON FILE IN THE
CITY CLERK'S OFFICE
**CONTACT H.R. BEFORE
RELEASING ANY INFORMATION
FOR PUBLIC RECORDS REQUESTS
A RESOLUTION OF THE CITY ADMINISTRATOR OF THE CITY
OF VERNON APPROVING THE INDUSTRIAL DISABILITY
RETIREMENT APPLICATION OF DARREN J. SIMPKINS, A
LOCAL SAFETY MEMBER FORMERLY EMPLOYED BY THE CITY
OF VERNON (GOVERNMENT CODE SECTIONS 21154 AND
21156)
(1) Pursuant to the authority delegated to me by action of
the City Council of the City of Vernon (hereinafter referred to
as Agency) via Resolution No. 2016-45, dated August 2, 2016, and
pursuant to the authority under Government Code section 21173,
after review of medical and other evidence relevant thereto, I
hereby determine that Darren J. Simpkins, a local safety member
of the California Public Employees' Retirement System (CalPERS)
employed by the Agency, is incapacitated within the meaning of
the California Public Employees' Retirement Law for performance
of his duties in the position of Firefighter for an orthopedic
(low back) condition. I hereby certify under penalty of perjury
that this determination was made on the basis of competent
medical opinion and was not used as a substitute for the
disciplinary process . If the disciplinary process occurred
before the member' s separation from employment, all relevant
personnel documents were forwarded to CalPERS for determination
of the member' s eligibility for disability retirement and
CalPERS' determination that the member is eligible to apply for
disability retirement was obtained prior to starting the process
of determination.
(2) Darren J. Simpkins had filed a Workers' Compensation
claim for his disabling condition. The Workers' Compensation
claim was accepted.
(3) Pursuant to such authority I also determine that such
incapacity is a result of injury or disease arising out of and
in the course of his employment as a local safety member. I
certify that neither the Agency nor the member has filed a
petition for determination under Government Code section 21166,
to be made by the Workers' Compensation Appeals Board.
(4 ) I hereby certify that the member was separated from his
employment in the position of Firefighter after expiration of
his leave rights under Government Code section 21164, effective
September 2, 2017, and that no dispute as to the expiration of
such leave rights is pending. His last day on pay status is
September 2, 2017 .
(5) There is not a possibility of third party liability.
(6) Advanced Disability Pension Payments will be made . The
payments will be made monthly in the amount of $4 , 572 . 00
beginning October 3, 2017 .
(7 ) The primary disabling condition is orthopedic, low
back.
(8) The duration of the disabling condition is expected to
be permanent or last at least twelve consecutive months from the
date of the application for benefit or will result in death,
which is certified by competent medical opinion, as determined
on the basis of competent medical opinion.
APPROVED this 25th day of September, 2017 .
NAME: Carlos R. F dino, Jr.
TITLE: City Administrator
ATTEST:
Maria E. Ayala, ty Clerk
APPROVED AS TO FORM:
Zay a' #' oussa,
Sen ' .r. Deputy City Attorney
TRANSMITTAL COMMUNICATION
CITY CLERK'S OFFICE
INTEROFFICE MEMORANDUM
DATE: September 27, 2017
TO: Michael Earl, Director of Human Resources
FROM: Deborah Juarez, Records Management Assistant
RE: Confidential—A Resolution of the City Administrator of the City of Vernon Approving the
Industrial Disability Retirement Application of Darren J. Simpkins, a Local Safety Member
Formerly Employed by the City of Vernon (Government Code Section 21154 and 21156)
Please find attached for your transmittal to the proper party, one certified copy of the above-referenced
resolution that was approved by the City Administrator on September 25, 2017.
Please ensure that a copy of the transmittal letter is sent to my attention for the file.
Thank you.
Attachment
c: CALPERS IDR File
CERTIFICATE
STATE OF CALIFORNIA )
ss
COUNTY OF LOS ANGELES)
I, Maria E. Ayala, City Clerk of the City of Vernon, County
of Los Angeles, State of California, hereby certify that the
attached is a full and complete copy of:
A Resolution of the City Administrator of the City of Vernon
Approving the Industrial Disability Retirement Application of
Darren J. Simpkins, a Local Safety Member Formerly Employed
by the City of Vernon (Government Code Sections 21154 and
21156)
IN WITNESS WHEREOF, I have hereunto set my hand and affixed
the official Seal of the City of Vernon, County of Los Angeles,
State of California, on this 2-70. day of September 2017 .
SEAL:
Mari E . Ayala
City Clerk
, er,
' tno
. 0..:. e ,
HUMAN RESOURCES DEPARTMENT
Michael A.Earl,Director of Human Resources
4305 Santa Fe Avenue,Vernon,California 90058
Telephone (323)583-8811
October 3, 2017
Stacey Olsen
CaIPERS Benefit Services Division
CaIPERS Disability Retirement Section
P.O. Box 2796
Sacramento, CA 95812-2796
Re: Darren J. Simpkins
Occupation: Firefighter
CaIPERS ID No: 4940907910
Employer ID No: 3431795727
Dear Mr. Olsen:
Pursuant to the authority delegated to the City Administrator by the City Council of the City of Vernon under
Government Code Section 21173, and consistent with Government Code Sections 21154 and 21156,and based
on competent medical evidence,the City Administrator has determined that Darren J.Simpkins, a local safety
member of the California Public Employees Retirement System, is substantially incapacitated from the
performance of his duties in the position of Firefighter for a permanent or extended and uncertain duration
within the meaning of CaIPERS Retirement Law.
A certified copy of Resolution 2016-45 delegating the authority to the City Administrator to make
determinations regarding industrial disability retirements for local safety members is attached. Also attached is
a certified copy of the Resolution of the City Administrator approving the industrial disability retirement for
Darren J. Simpkins.
Mr. Simpkins' retirement is effective September 3, 2017 and his last day on paid status with the City of Vernon is
September 2, 2017. The City of Vernon will issue Advanced Disability Pension Payments (ADPP) on a monthly
basis in the amount of$4,572 beginning October 3, 2017 and continuing until CaIPERS notifies the City that Mr.
Simpkins has been placed on the retirement rolls.
Please contact the undersigned if there are any questions regarding this matter or if further information is
needed.
E cl-usivel-y Industrial-
October 3, 2017 Page 2
Sincerely,
L�
hael A. Earl
irector of Human Resources
cc: Darren J. Simpkins
City of Vernon,4305 Santa Fe Avenue,Vernon,California 90058—Telephone(323)583-8811
STAFF REPORT
.444N) RECENVED
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a{ i 474 ,� 5 2017
CONFIDENTIAL `
<GfVELT 1 Ov�4
CITY ADMINISTRATION
INTEROFFICE MEMORANDUM og � .
HUMAN RESOURCES DEPARTMENT 26ti1
DATE: September 25,2017
TO: Carlos R. Fandino,Jr. City Administrator
FROM: Michael A. Earl,Director of Human Resources
RE: A RESOLUTION OF THE CITY ADMINISTRATOR OF THE CITY OF
VERNON APPROVING THE INDUSTRIAL DISABILITY RETIREMENT
APPLICATION OF DARREN J. SIMPKINS, A LOCAL SAFETY
MEMBER FORMERLY EMPLOYED BY THE CITY OF VERNON
(GOVERNMENT CODE SECTION 21154 AND 21156)
Background
On June 22, 2017, the City of Vernon received notice from Ca1PERS that Mr. Simpkins filed an
application for an Industrial Disability Retirement ("IDR") based on an orthopedic (low back)
condition. In accordance with Government Code Sections 21154 and 21156, the City is required
to determine the member's disability eligibility within six months of the IDR request. On its
own a Worker's Compensation Award is not 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 from the performance of his or her
own duties, a resolution to that effect must be submitted to Ca1PERS. On August 2, 2016, City
Council passed Resolution No. 2016-45, delegating the authority for making such determinations
for local safety members to the City Administrator.
Mr. Simpkins was hired on February 26, 1990. At the time of injury, Mr. Simpkins was a 47-
year-old Firefighter who sustained an injury to the lower back on April 18, 2016, while
advancing a 4" hose line. On May 16, 2016, his treating physician, Dr. Gordon, issued a report
where he indicated that this injury was an exacerbation from a previous injury sustained on
November 10, 2010. Based on Dr. Gordon's report, the claim was denied and instead was a
continuance of treatment of the November 10, 2010 injury. On June 7, 2016, Mr. Simpkins filed
an application for adjudication of claim with the Worker's Compensation Appeals Board, by and
through his attorney of record, William G. Cotter, and by process of elimination Dr. Tran,
PQME, was selected. Mr. Simpkins was evaluated by Dr. Tran on September 14, 2016, and Dr.
Tran found that the April 18, 2016 injury, was a new injury.
On April 3, 2017, Mr. Simpkins attended a Functional Capacity Evaluation ("FCE")
administered by Terry Lawson, PT. Based on the FCE, Mr. Lawson indicated that, "the patient
did not demonstrate sufficient ability to complete all required job tasks, and is apparently not
safe to perform this job". Mr. Lawson also indicated that "Mr. Simpkins is significantly limited
to lifting thirty-five pounds compared to the job requirements and he is currently continuing to
complain of pain increased with even moderate activity".
A deposition of Dr. Tran took place on May 5, 2017, where he indicated that there should be
permanent work restrictions of lifting no more than thirty pounds and a preclusion from
repetitive twisting and turning of the back. He also precluded Mr. Simpkins from climbing
ladders due to the occasional numbness in his legs. Furthermore, the FCE report was given to
Dr. Tran to review. Subsequently, on June 7, 2017, Dr. Tran issued a supplemental report where
he indicated that the FCE findings supported his work restrictions of no lifting more than thirty
pounds, and a preclusion from repetitive bending and twisting at the waist.
On July 25, 2017, Mr. Simpkins was sent a notice inviting him to participate in the Interactive
Process so that we can explore any options that may exist to support return to work possibilities.
On July 27, 2017, Mr. Simpkins responded to the notice by completing and returning the Waiver
of Good Faith Interactive Process/Reasonable Accommodation Meeting and instead indicating
his intent to retire from the City of Vernon.
In conclusion, in accordance with government code 21156, a local safety member shall be retired
for disability only upon the employer's determination that the member is substantially
incapacitated physically or mentally for the performance of the usual job duties with the current
employer. The disability decision is based upon competent medical opinion and all medical and
vocational information provided by the member, employer, and workers' compensation carrier.
The determination is based on actual/present disability, not prospective inability to perform the
job duties. Based on the competent medical opinion of Dr. Tran, PQME, where he found Mr.
Simpkins substantially incapacitated with permanent work restrictions due to his orthopedic (low
back) condition, I am therefore recommending the approval of an industrial disability retirement
effective September 2, 2017.
Fiscal Impact
None.
Attachment(s)
1. Resolution
cc: Hema P. Patel, City Attorney
MAE/kr
SUPPORTING INFORMATION
CERTIFICATE
STATE OF CALIFORNIA )
ss
COUNTY OF LOS ANGELES)
I, Maria E. Ayala, City Clerk of the City of Vernon, County
of Los Angeles, State of California, hereby certify that the
attached is a full and complete copy of:
RESOLUTION NO. 2016-45 - A Resolution of the City Council of
the City of Vernon Delegating Authority to the City
Administrator to Make Determinations Regarding Industrial
Disability Retirements
IN WITNESS WHEREOF, I have hereunto set my hand and affixed
the official Seal of the City of rnon, County of Los Angeles,
State of California, on this ISI leday of September 2017 .
SEAL:
Maria E. Ayala
City Clerk
RESOLUTION NO . 2016-45
A RESOLUTION OF THE CITY COUNCIL OF THE CITY OF
VERNON DELEGATING AUTHORITY TO THE CITY
ADMINISTRATOR TO MAKE DETERMINATIONS REGARDING
INDUSTRIAL DISABILITY RETIREMENTS
WHEREAS, the City of Vernon (hereinafter referred to as
"Agency") is a contracting agency of the California Public Employees'
Retirement System ("Ca1PERS") ; and
WHEREAS, the Public Employees' Retirement Law requires that
a contracting agency determine whether an employee of such agency in
employment in which he/she is classified as a local safety member is
disabled for purposes of the Public Employees' Retirement Law and
whether such disability is "industrial" within such meaning of such
Law; and
WHEREAS, the City Council of the City of Vernon has
determined upon staff and legal advice that it may delegate authority
under Government Code Section 21173 to make such determinations to the
incumbent of the office/position of City Administrator.
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 the above recitals are true and correct .
SECTION 2 : The City Council of the City of Vernon finds
that this action is exempt from California Environmental Quality Act
("CEQA") review, because it is an administrative activity that will
not result in direct or indirect physical changes in the environment,
and therefore does not constitute a "project" as defined by CEQA
Guidelines section 15378 .
SECTION 3 : The City Council of the City of Vernon hereby
delegates to the incumbent of the office/position of City
Administrator the authority to make determinations of disability on
behalf of the Agency under Government Code Section 21156 and whether
such disability is industrial and to certify such determinations and
all other necessary information to CalPERS .
SECTION 4 : The City Council of the City of Vernon also
delegates to the incumbent of the office/position of City
Administrator the authority to make applications on behalf of the
Agency pursuant to Government Code Section 21152 (c) for disability
retirement of all employees and to initiate requests for reinstatement
of such employees who are retired for disability.
SECTION 5 : The City Clerk, or Deputy City Clerk, of the
City of Vernon shall certify to the passage, approval and adoption of
this resolution, and the City Clerk, or Deputy City Clerk, of the City
of Vernon shall cause this resolution and the City Clerk' s, or Deputy
City Clerk' s, certification to be entered in the File of Resolutions
of the Council of this City.
APPROVED AND ADOPTED this 2nd day of August, 2016 .
Name : William J. Davis
Title : Mayor / -
/ATT _ .
Aggg
Aa
Maria E . Aye'la
City Clerk / ?- : . -
APPROVED AS TO FORM:
Zayn h oussa, Senior Deputy City Attorney
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STATE OF CALIFORNIA
ss
COUNTY OF LOS ANGELES
I Maria E E . AYala, City Clerk / igepttty City C erlf of the City
of Vernon, do hereby certify that the foregoing Resolution, being
Resolution No . 2016-45, was duly passed, approved and adopted by the
City Council of the City of Vernon at a regular meeting of the City
Council duly held on Tuesday, August 2, 2016, and thereafter was duly
signed by the Mayor
or Mayor Pro-Tem of the City of Vernon.
Executed this day of August, 2016, at Vernon, California.
(7LMaria E E . 1a _
City Clerk /
(SEAL)
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