TRANSMITTAL LETTER FOR BOARD MEETING OF FEBRUARY 16, 2017
COMMITTEE ON JUDICIARY
Mr. David St. Pierre, Executive Director
Authority to settle the Illinois Workers’ Compensation Claims of Dale Polak vs. MWRDGC, Cases 12 WC 19556, 12 WC 19561 in the sum of $67,107.97, Account 901-30000-601090
Dale Polak is a Truck Driver at the Stickney Water Reclamation Plant. On July 12, 2011, he sustained an injury to his right arm. He was initially seen at the Industrial clinic on July 12, 2011. He initially underwent a course of conservative treatment consisting of medicine and physical therapy. He was initially disabled from work effective August 15, 2011. On October 4, 2011 he underwent a procedure to repair his right arm. Following the procedure he underwent additional physical therapy. He was able to return to work on January 15, 2012.
On February 22, 2012, Mr. Polak sustained an injury to his right knee. He was seen at the emergency room on February 24, 2012. He underwent a procedure on his right knee on April 24, 2012. There were no lost time benefits paid on this claim.
Mr. Polak was paid a total of $20,424.00 in lost time benefits, which represents a total of 22.2 weeks of lost time benefits for the lost time injury that occurred on July 12, 2011.
Mr. Polak filed two Applications of Adjustment of Claims with the Illinois Workers’ Compensation Commission (IWCC) through his counsel. Subject to the approval of the IWCC, these cases can now be settled for $67,107.97, representing approximately 13.9% loss of person as a whole and approximately 12.5% loss of a right leg. This settlement will close out any future lost time benefits. However, medical benefits remain open as he is a Medicare beneficiary.
The Director of Human Resources believes this settlement is in the best interest of the District and requests payment of that sum be approved and she be authorized to execute such documents as may be necessary to effect the settlement.
Requested, Beverly K. Sanders, Director of Human Resources, BKS:RAJ:RG:sts
Respectfully Submitted, Mariyana T. Spyropoulos, Chairman Committee on Judiciary
Disposition of this agenda item will be documented in the official Regular Board Meeting Minutes of the Board of Commissioners for February 16, 2017