TRANSMITTAL LETTER FOR BOARD MEETING OF JUNE 15, 2017
COMMITTEE ON JUDICIARY
Mr. David St. Pierre, Executive Director
Title
Authority to settle the Workers’ Compensation Claim of Rolinda Dominguez vs. MWRDGC, Claim 14 WC 09756, Illinois Workers’ Compensation Commission (IWCC), in the sum of $30,860.00, Account 901-30000-601090
Body
Dear Sir:
Rolinda Dominguez is a Lab Assistant at the Calumet Water Reclamation Plant. On February 19, 2014, she sustained an injury to her right shoulder. Ms. Dominguez was initially seen by the doctor at the industrial medical clinic on February 19, 2014. She underwent a procedure on her right shoulder on September 25, 2014. The employee was disabled from work effective September 25, 2014. Following her surgical procedure the employee underwent a course of physical therapy. She was able to return to work on November 5, 2014.
Ms. Dominguez was paid a total of $2,858.45 which represents 5.80 weeks of lost time benefits.
Ms. Dominguez filed an Application of Adjustment of Claim with the Illinois Workers’ Compensation Commission (IWCC) through her counsel. Subject to the approval of the IWCC, this case can now be settled for $30,860.00, representing approximately 13.9% loss of use of the person as a whole. This settlement will close out future lost time benefits, as well as any future medical benefits associated with this injury.
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, BKS:RAJ:RG
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 June 15, 2017