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Home My WebLink About10-31-2013 Safety Committee Meeting Minutes 10-31-2013 Safety Committee Meeting Minutes City Hall 2 North Main Canton Illinois 12:30pm Chairman Jason Strandberg COMMITTEE MEMBERS PRESENT: Greg Pollitt, Danny Dare, Bill Terry, Diana Pavley-Rock,Jason Strandberg, Rick Nichols,Joe Carruthers, Tom Shubert OLD BUSINESS Safety Manual Jason Strandberg will locate the original safety manual. It was determined that it would be best to start with the original safety manual and insert additional items as necessary. NEW BUSINESS Claim Review The workers compensation claims and liability claims were reviewed from May 1-current. There were two new liability claims and four new workers compensation claims(two police, one fire,one administration) Each claim was discussed and recommendations were made to prevent the accidents from happening in the future. Motion and second were made by Jason Strandberg Danny Dare to adjourn at 1:00pm. ADJOURNMENT The safety com eeti djourn at 1• pm Diana Pavley-Roc City Clerk Claim Summary 010042-015129-WC-01 BRYANT, BARBARA Page 1 of 2 Claim Summary MUNICIPAL INSURANCE COOPERATIVE AGENCY(MICA) 010042-015129-WC-01 BRYANT,BARBARA +Basic Claim Information Claimant: BRYANT,BARBARA Medicare No Match-Query did not find a match Reporting CA002 Reporting OFFICE Accident 10-Jul-2013(Wed) Time: 02:00 Claim STRAIN TO NECK AND UPPER BACK AND ARMS-FINGERS ON BOTH Description: HANDS NUMB.PULLING OUT BOX FROM BOTTOM SHELF OF RECORDS ROOM. Part of Body: 0090 Multiple Body Parts Benefit State: IL Illinois Occupation: SECRETARY Loss Images Document Description Date Received INDEMNITY MEDICAL REHABIL EXPENSE TOTAL Payments 0.00 0.00 0.00 0.00 0.00 Recoveries 0.00 0.00 0.00 0.00 0.00 Net Paid to Date 0.00 0.00 0.00 0.00 0.00 Remaining Reserve 0.00 0.00 0.00 0.00 0.00 Total Experience 0.00 0.00 0.00 0.00 0.00 Financial Information Valued As Of: 31-Oct-2013 GO Claim Status: Closed(30-Aug-2013) Electronic Funds Transfer: No Date of Birth: 09-Dec-1950 Date of Hire: 13-Jan-2003 Average Weekly Wage: Compensation Rate: Controverted: No Bill Review Vendor: GBMCS Claim In Suit: No Subrogation: No State Fund: No Adjuster: 013848 KUHN,GINA E-Mail Address: GINA_KUHN @GBTPA.COM Branch: 000012 GB-ITASCA(METRO),IL Phone: 800-227-7391 Prior TPA Number: Initial Period of Disability Summary Last Date Worked: Reportable Lost Time: No Full Pay Day of Injury: Disability Started: Employer Notified of Disab: Claim Administrator Notified: First Lost Time after Waiting Period: Return to Work Medical Release to Return: With Restrictions: Employer Can Accommodate: Restricted Return to Work: Restrictions: Same Employer: Same Position: Full Hours: Same Duties: https://www.risxfacs.com/cl/clsummary.asp?txtClaimNum=010042%2D015129%2D WC... 10/31/2013 Claim Summary 010042-015129-WC-01 BRYANT, BARBARA Page 2 of 2 Same Position: Full Hours: Same Duties: Did Not Return to Work: Reason: Full Duty Return to Work: Same Employer: Benefits Discontinued: Reason: menu I contact us I daily message I print I log off For Phone Support,call 1-877-RISXFACS(1-877-747-9322) Support Hours:Monday thru Friday-7am to 6pm CST Gallagher Bassett Services, Inc. Copyright 2013 https://www.risxfacs.com/cl/clsummary.asp?txtClaimNum=010042%2D015129%2D WC... 10/31/2013 Claim Summary 010042-015051-WC-01 SMITH, JARROD Page 1 of 2• Claim Summary , MUNICIPAL INSURANCE COOPERATIVE AGENCY(MICA) 010042-015051-WC-01 SMITH,JARROD +Basic Claim Information Claimant: SMITH,JARROD Medicare No Match-Query did not find a match Reporting CA003 Reporting POLICE Accident 30-May-2013(Thu) Time: 14:30 Claim INVESTIGATING DOMESTIC INCIDENT WALKED UNDER LOW OVERHANG Description: AND STRUCK FRONT OF HEAD Part of Body: 0328 Head Benefit State: IL Illinois Occupation: PATROL OFFICER Loss Images Document Description Date Received INDEMNITY MEDICAL REHABIL EXPENSE TOTAL Payments 0.00 212.58 0.00 11.16 223.74 Recoveries 0.00 0.00 0.00 0.00 0.00 Net Paid to Date 0.00 212.58 0.00 11.16 223.74 Remaining Reserve 0.00 0.00 0.00 0.00 0.00 Total Experience 0.00 212.58 0.00 11.16 223.74 Financial Information Valued As Of: 31-Oct-2013 GO Claim Status: Closed(24-Jul-2013) Electronic Funds Transfer: No Date of Birth: 29-Aug-1982 Date of Hire: 02-Sep-2008 Average Weekly Wage: Compensation Rate: Controverted: No Bill Review Vendor: GBMCS Claim In Suit: No Subrogation: No State Fund: No Adjuster: 013848 KUHN,GINA E-Mail Address: GINA_KUHN @GBTPA.COM Branch: 000012 G8-ITASCA(METRO),IL Phone: 800-227-7391 Prior TPA Number: Initial Period of Disability Summary Last Date Worked: Reportable Lost Time: No Full Pay Day of Injury: Disability Started: Employer Notified of Disab: Claim Administrator Notified: First Lost Time after Waiting Period: Return to Work Medical Release to Return: With Restrictions: Employer Can Accommodate: Restricted Return to Work: Restrictions: Same Employer: Same Position: Full Hours: Same Duties: Did Not Return to Work: https://www.risxfacs.com/cl/clsummary.asp?txtClaimNum=010042%2D015051%2D WC... 10/31/2013 Claim Summary 010042-015051-WC-01 SMITH, JARROD Page 2 of 2 Full Hours: Same Duties: Did Not Return to Work: Reason: Full Duty Return to Work: Same Employer: Benefits Discontinued: Reason: I menu I contact us daily message I print I log off For Phone Support,call 1-877-RISXFACS(1-877-747-9322) Support Hours:Monday thru Friday-7am to 6pm CST Gallagher Bassett Services, Inc. Copyright 2013 https://www.risxfacs.com/cl/clsummary.asp?txtClaimNum=010042%2D015051%2D WC... 10/31/2013 Claim Summary 010042-015196-WC-01 LUSK, LANCE Page 1 of 2 Claim Summary MUNICIPAL INSURANCE COOPERATIVE AGENCY(MICA) 010042-016196-WC-01 LUSK,LANCE +Basic Claim Information Claimant: LUSK,LANCE Medicare Eligible: No Match-Query did not find a match Reporting Unit Number: CA004 Reporting Unit Name: FIRE Accident Date: 12-Aug-2013(Mon) Time: 05:45 Claim Description: PATIENT WAS FALLING FROM AMBULANCE. Part of Body: 0040 Shoulder,right Benefit State: IL Illinois Occupation: FIREFIGHTER Loss Images Document Description Date Received INDEMNITY MEDICAL REHABIL EXPENSE TOTAL Payments 0.00 596.67 0.00 48.23 644.90 Recoveries 0.00 0.00 0.00 0.00 0.00 Net Paid to Date 0.00 596.67 0.00 48.23 644.90 Remaining Reserve 0.00 0.00 0.00 0.00 0.00 Total Experience 0.00 596.67 0.00 48.23 644.90 Financial Information Valued As Of: 31-Oct-2013 23H GO Claim Status: Closed(27-Sep-2013) Electronic Funds Transfer: No Date of Birth: 27-Jan-1978 Date of Hire: Average Weekly Wage: Compensation Rate: Controverted: No Bill Review Vendor: GBMCS Claim In Suit: No Subrogation: No State Fund: No Adjuster: 013848 KUHN,GINA E-Mail Address: GINA_KUHN @GBTPA.COM Branch: 000012 GB-ITASCA(METRO),IL Phone: 800-227-7391 Prior TPA Number: Initial Period of Disability Summary Last Date Worked: Reportable Lost Time: No Full Pay Day of Injury: Disability Started: Employer Notified of Disab: Claim Administrator Notified: First Lost Time after Waiting Period: Return to Work Medical Release to Return: With Restrictions: Employer Can Accommodate: Restricted Return to Work: Restrictions: Same Employer: Same Position: Full Hours: Same Duties: Did Not Return to Work: Reason: https://www.risxfacs.com/cl/clsummary.asp?txtClaimNum=010042%2D015196%2D WC... 10/31/2013 Claim Summary 010042-015196-WC-01 LUSK, LANCE Page 2 of 2 Full Duty Return to Work: Same Employer: Benefits Discontinued: Reason: menu I contact us daily message print I log off For Phone Support,call 1-877-RISXFACS(1-877-747-9322) Support Hours:Monday thru Friday-7am to 6pm CST Gallagher Bassett Services, Inc. Copyright 2013 https://www.risxfacs.com/cl/clsummary.asp?txtClaimNum=010042%2D015196%2D WC... 10/31/2013 Claim Summary 010042-015297-WC-01 PAVLEY-ROCK, DIANA Page 1 of 2 Claim Summary MUNICIPAL INSURANCE COOPERATIVE AGENCY(MICA) 010042-015297-WC-01 PAVLEY-ROCK,DIANA •Basic Claim Information Claimant: PAVLEY-ROCK,DIANA Medicare Query In Progress Reporting CA002 Reporting OFFICE Accident 14-Oct-2013(Mon) Time: 08:30 Claim PULLED BACK LIFTING HEAVY BOX WHILE MOVING OFFICES. Part of Body: 0008 Back,lower Benefit State: IL Illinois Occupation: CITY CLERK Loss Images Document Description Date Received INDEMNITY MEDICAL REHABIL EXPENSE TOTAL Payments 0.00 0.00 0.00 0.00 0.00 Recoveries 0.00 0.00 0.00 0.00 0.00 Net Paid to Date 0.00 0.00 0.00 0.00 0.00 Remaining Reserve 0.00 900.00 0.00 75.00 975.00 Total Experience 0.00 900.00 0.00 75.00 975.00 Financial Information Valued As Of: 31-Oct-2013 GO Claim Status: Open(18-Oct-2013) 'a' Electronic Funds Transfer: No Date of Birth: 18-Sep-1966 Date of Hire: 10-Jul-2006 Average Weekly Wage: Compensation Rate: Controverted: No Bill Review Vendor: GBMCS Claim In Suit: No Subrogation: No State Fund: No Adjuster: 013848 KUHN,GINA E-Mail Address: GINA_KUHN@GBTPA.COM Branch: 000012 GB-ITASCA(METRO),IL Phone: 800-227-7391 Prior TPA Number: Initial Period of Disability Summary Last Date Worked: Reportable Lost Time: No Full Pay Day of Injury: Disability Started: Employer Notified of Disab: Claim Administrator Notified: First Lost Time after Waiting Period: Return to Work Medical Release to Return: With Restrictions: Employer Can Accommodate: Restricted Return to Work: Restrictions: Same Employer: Same Position: Full Hours: Same Duties: Did Not Return to Work: Reason: https://www.risxfacs.com/cl/clsummary.asp?txtClaimNum=010042%2D015297%2D WC... 10/31/2013 Claim Summary 010042-015297-WC-01 PAVLEY-ROCK, DIANA Page 2 of 2 Full Hours: Same Duties: Did Not Return to Work: Reason: Full Duty Return to Work: Same Employer: Benefits Discontinued: Reason: menu I contact us I daily message I print I log off For Phone Support,call 1-877-RISXFACS(1-877-747-9322) Support Hours:Monday thru Friday-7am to 6pm CST Gallagher Bassett Services, Inc. Copyright 2013 https://www.risxfacs.com/cl/clsummary.asp?txtClaimNum=010042%2D015297%2D WC... 10/31/2013 Claim Summary 010042-015278-RB-01 CITY OF CANTON Page 1 of 2 Claim Summary MUNICIPAL INSURANCE COOPERATIVE AGENCY(MICA) 010042-016278-RB-01 CITY OF CANTON +Basic Claim Information Claimant: CITY OF CANTON Reporting Unit Number: CA006 Reporting Unit Name: WATER Accident Date: 18-Apr-2013(Thu) Time: 12:00 Claim Description: WATER DAMAGE TO DAM DURING HEAVY STORMS Loss Images Document Description Date Received BUILDING EXTD.COVG V&M.M. EXPENSE TOTAL Payments 0.00 0.00 0.00 0.00 0.00 Recoveries 0.00 0.00 0.00 0.00 0.00 Net Paid to Date 0.00 0.00 0.00 0.00 0.00 Remaining Reserve 1,000.00 0.00 0.00 0.00 1,000.00 Total Experience 1,000.00 0.00 0.00 0.00 1,000.00 Financial Information Valued As Of: 31-Oct-2013 fJ• GO Claim Status: Open(03-Oct-2013) Electronic Funds Transfer: No Date of Birth: Date of Hire: Claim In Suit: No Subrogation: No Adjuster: 025349 BECICH,MICHAEL E-Mail Address: MICHAEL_BECICH @GBTPA.COM Branch: 000461 GB-ST.PETERS PROPERTY,MO Phone: 636-447-5400 Prior TPA Number: Latest Note For Subject 001 File Notes 07-Oct-2013 D.F.I. - Reservation of Rights Letter Category : Correspondence Date Attached : 10/7/2013 9:39:23 AM User ID : BECICH, MICHAEL (025349) File Name : CITY OF CANTON ROR.PDF Description : 010042-015278-rb-01 canton ror System Information: Category ID : 027 Document ID : 30578301 File Name : EX2013100397105EC0323B424996F720BF19CB37EC.PDF File Location: Attachments\2013\10\03\0021\ menu I contact us I daily message I print I log off For Phone Support,call 1-877-RISXFACS(1-877-747-9322) Support Hours:Monday thru Friday-7am to 6pm CST Gallagher Bassett Services, Inc. Copyright 2013 https://www.risxfacs.com/cl/clsummary.asp?txtC laimNum=010042%2D015278%2DRB... 10/31/2013 Claim Summary 010042-015278-RB-01 CITY OF CANTON Page 2 of 2 https://www.risxfacs.comlcl/clsummary.asp?txtClaimNum=010042%2D015278%2DRB... 10/31/2013 Claim Summary 010042-015104-RB-01 CITY OF CANTON FD Page 1 of 2 Claim Summary MUNICIPAL INSURANCE COOPERATIVE AGENCY(MICA) 010042-016104-RB-01 CITY OF CANTON FD +Basic Claim Information Claimant: CITY OF CANTON FD Reporting CA004 Reporting FIRE Accident 30-Jun-2013(Sun) Time: 12:00 Claim FIRE TRUCK SIDE APPARATUS STRUCK BRICK POST BETWEEN OVERHEAD DOORS Loss Images Document Description Date Received BUILDING EXTD.COVG V&M.M. EXPENSE TOTAL Payments 4,725.00 0.00 0.00 0.00 4,725.00 Recoveries 0.00 0.00 0.00 0.00 0.00 Net Paid to Date 4,725.00 0.00 0.00 0.00 4,725.00 Remaining Reserve 0.00 0.00 0.00 0.00 0.00 Total Experience 4,725.00 0.00 0.00 0.00 4,725.00 Financial Information Valued As Of: 31-Oct-2013 [GO LIE Claim Status: Closed(10-Oct-2013) Electronic Funds Transfer: No Date of Birth: Date of Hire: Claim In Suit: No Subrogation: No Adjuster: 025349 BECICH,MICHAEL E-Mail Address: MICHAEL_BECICH @GBTPA.COM Branch: 000461 GB-ST.PETERS PROPERTY,MO Phone: 636-447-5400 Prior TPA Number: Latest Note For Subject 001 File Notes 11-Oct-2013 D.F.I. - Masonry repair invoice Category : Invoices - All Other Date Attached : 10/11/2013 9:53:11 AM User ID : BECICH, MICHAEL (025349) File Name : M0980414132835882400.tif Description : 010042-015104-rb-01 canton invoice System Information: Category ID : 029 Document ID : 30747011 Late Npteigf*Subject AlPoi?4111074 T y®gQ'A338A3C3470C127FOED.of File Location: Attachments\2013\10\10\0029\ Diary Review/POA: Facts: An extension arm used to stabilize the fire truck was accidentally left extended sideways out of the back of the truck. When the fire department attempted to back the truck into the garage, the arm struck the brick column between garage doors. There is damage to numerous courses of bricks. https://www.risxfacs.com/cl/clsummary.asp?txtClaimNum=010042%2D015104%2DRB... 10/31/2013 • Claim Summary 010042-015104-RB-01 CITY OF CANTON FD Page 2 of 2 What has been done to date: Since the last POA, the City has not submitted any repair quotes and/or invoices. I have spoken with the City and was promised a status report, but have not received one to date. Coverage: Loss location verified to be listed on client pyramid. Loss date verified to have occurred within policy period. Policy limit of $1,000,000 with $150,000 SIR and no applied deductible. Peril of damage by vehicle is covered to policy limits. What remains to be done: 1. Obtain quote and agreed cost for repairs. Subrogation / Salvage: No subrogation. Damage was caused by the insured while on duty. There is no responsible third party. Salvage via repair methods. Reserve: RB reserve currently set at $15,000 until otherwise known. I menu I contact us I daily message I print I log off For Phone Support,call 1-677-RISXFACS(1-677-747-9322) Support Hours:Monday thru Friday-7am to 6pm CST Gallagher Bassett Services, Inc. Copyright 2013 https://www.risxfacs.com/cl/clsummary.asp?txtClaimNum=010042%2D015104%2DRB... 10/31/2013