HomeMy WebLinkAboutClaim 559 - D.Minorvi c
REQUEST:
DATE:
CONTENTS:
Recommendation:
CITY OF PALM DESERT
COMMUNITY SERVICES DIVISION
CITY CLERK OPERATIONS
STAFF REPORT
CLAIM AGAINST THE CITY (#559) BY DENISHA RENEE MINOR IN THE
ESTIMATED AMOUNT OF $9,000
February 23, 2006
I. Staff Report
II. Claim No. 559
By Minute Motion, reject the Claim and direct the City Clerk to so notify the
Claimant.
Background:
Based on a review of the subject Claim and the recommendation of the Claims Adjuster,
Risk Manager, City Attorney, and staff, it is recommended that the Claim be rejected.
Discussion of this item should be held in Closed Session pursuant to Government Code Section
54956.9(b), potential litigation.
Submitted by:
RA HELLE D. KLASS , CMC
CITY CLERK
Approved:
CARLOS L. O GA
CITY MANAGE
rdk
Attachment (as noted)
SHEILAR. I IGAN ST. CITY MANAGER
FOR COMMUNITY S ICES/P.I.O.
H:IWPdatal WPOOCSlCLA1MS1559-staff report.wpd
1
CLAIM AGAINST THE CITY OF PALM DESERT
(For Damage(s) to Person(s) or Personal Property)
CITY OF PALM DESERT
ASSIGNED CLAIM NO.559
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Received by:
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via: U.S. Mail Interoffice Mail Over -the -Counter -{oo
A CLAIM MUST BE FILED WITH THE CITY CLERK OF THE CITY OF PALM DESERT WffHIR29X
MONTHS AFTER WHICH THE INCIDENT OR EVENT OCCURRED. BE SURE YOUR CLAL IS
AGAINST THE CITY OF PALM DESERT, NOT ANOTHER PUBLIC -ENTITY. WHERE SPACE IS
INSUFFICIENT, PLEASE USE ADDITIONAL PAPER AND IDENTIFY INFORMATION BY
PARAGRAPH NUMBER. COMPLETED CLAIMS MUST BE MAILED OR DELIVERED TO THE CITY
CLERK, CITY OF PALM DESERT, 73-510 FRED WARING DRIVE, PALM DESERT, CA 92260.
TO THE HONORABLE MAYOR AND CITY COUNCIL, City of Palm Desert, California:
The undersigned respectfully submit(s) the following claim and information relative to damage(s) to
person(s) and/or personal property:
1. CLAIMANT INFORMATION:
NAME
ADDR
PHON;
SOCIA
2. Name, telephone number and post office address to which claimant desires notices to be
sent, if other than above:
1
3. Occurrence or event from which the claim arises:
a. DATE: b. TIME: c. PLACE (exact and s ecific
location)
d. How and under what circumstances did damage or injury occur? Specify the particular
occurrence, event, act or ommission you claim caused the injury or damage. (Use
additional paper if necessary.) J�,
e. What particular
injury? _"k
Page 1 of 2
action b the City, or its employees, caused the alleged
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to ) a�S
damage or
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•
is
4.
5.
6.
7.
8.
9.
10.
Give a general description of the indebtedness, obligation, injury, damage, or loss incurred
so far as it may be known the time of presentation of the claim. If there were no
injuries, state "no injuries":
= Wa.�.�
Give the name(s) of the City, employee(s) causing the damage or injury: '
_
Name and address of any other person(s) injured:
Name and address of the owner of any damaged property: 1
Damages claimed:
a. Amount claimed as of this date: $
b. Estimated amount of future costs: $_ � o (per
c. Total amount claimed: $ (� C)nn
d. Basis for computation of amount claimed (include copies of
estimates, etc.): 20 ki,
Names and addresses of ali v
h.d. , \n L. ,r. f,•-
all bills, invoices,
(A IJ4 110
Any additional information, including police reports, which might be helpful in considering
this claim:
WARNING:IT IS A CRIMINAL OFFENSE TO FILE A FALSE CLAIM! (PENAL CODE 72;
INSURANCE CODE 556.1).
I have read the matters and statements made in the above claim, and I know the sarne *o be true of
my own knowledge, except as to those matters stated upon information or belief as to such matters
I believe the same to be true. I certify under penalty of perjury that the foregoing ,is TRUE AND
CORRECT.Da -afto
Q
g tday of, , 20 at Signed this ,
l
SLWgAi'(JRE LAIM SIGNATURE OF CLAIMANT
Office of the City Clerk, Palm Desert, California DOC. NO. DATE FILED
Page 2 of 2
..ERI"S OFFICE
17 CA
2P96 JAN 31 AM 11: 02
wl
3
DEMSAA RENEEMINOR
q0=W
November 29, 2005
To:
Management
California Villa's
77-101 California Dr.
Palm Desert ca. 92211
Cc:
Palen Desert Redevelopment Agency
The Housing Department
City of Palm Desert
73-510 Fred Waring Dr.
Palm Desert Ca. 92260
RE: Injuries sustained on November 12, 2005.
CITY. OF. PALM DESERT
ASSiGNEO. CLAIM NO
On November 12, 2005 I fell while exiting the bathtub in apartment #E-5. the fall
was due to the bathtubs resurface material chipping away leaving a highly slippery
surface. The apartments scheduled routine maintenance inspection about 6 months ago I
could not be present so I left a list of items that needed attention the bathtub was included
in the written summary. When I returned the inspection was over and the list was gone,
How ever prior to the accident no efforts were made by management to fix the problems
noted on the list.
SUMMARY OF EVENTS:
The first thing I need to make clear is I live at the California Villa Apartment as a low
income resident. This accident was caused by faulty surfacing materials used on the
bathtub prior to my taking up residency.
• On the evening of November 12, 2005 while exiting my bathtub I fell and
received severe injuries to right knee, and painful cuts to my hand. I was helped
to my bed by a friend, where I thought if I rested all would be well.
• On November r3, 2005,1 was in such severe pain that my friend took me to the
emergency room at Eisenhower Hospital. I was admitted and examined by Doctor
Francis Domzalski. After ex -rays and examination I was told that I had chipped
my femur bone and would require follow up care by an orthopedic doctor. I was
released and returned to my apartment.
• On November 14, 2005, my mother went to the office to report the accident, she
relayed the information to the assistant manager who stated she would inform the
manager. About 20 minutes later the on cite Manager Addie Angles came to the
apartment. She informed me that I had not filled out a maintenance request
regarding the bathtub; therefore the apartments were not responsible. She
requested to inspect the bathtub but it was in use. She stated she could not wait
and requested a good time to return. On November 15, 2005 I received written 24
hour notice of management intent to inspect residency. On November 16, 2005
she sent the maintenance personnel to the aparunent to check out the tub. While
there I overheard them making comments about the resurfacing material used. To
my best recollection the statements where about the inadequacy of the material.
Their conversation amongst themselves sounded as if they had had problems with
bathtubs that were resurfaced using the same material.
• On or about November 17, 2005 I was notified by management that the bathtub in
my apartment was slated for resurfacing on November 18, 2005. I would not be
able to be in the apartment for two days. I was advised that the cost for
alternative housing could be deducted from my upcoming rent. I was further told
that $69.00 a night was the fee allowed.
• On November 18, 2005 with the help of my mother I was able to stay at Villa's on
the Green I was there on the 18d, 19t' and part of the 20'' at a cost of $138.00 that
did not include any meals.
• On November 25, 2005 I received written notice from my job stating that I was no
longer employed.
SUMMARY OF PERSONAL LOSS AND CONDITION:
I am a low income resident with no insurance. I was working and on
probation waiting for my benefits to kick in.
My visit to Eisenhower hospital is listed as self- pay cash quote. I have not received
the bill as of this date. I was provided with an application for County of Riverside
insurance Med-Cal. I immediately filed. I have been unable to do follow up with an
orthopedic doctor as I have no funds. I continue to wear a full leg brace and I still
suffer severe pain. I am unable to work, and my mobility is limited as I cannot drive.
The cuts and bruises sustained during the fall are heeling but were painful and limited
my ability to do simple chores, my ability to do personal hygiene is very limited. I
continue to be in severe pain in my leg, without medical insurance I am unable to get
medical attention or prescriptions for pain. I am depressed and suffer anxiety when I
have to stand or try to walls for fear I will fall.
I require immediate care! It is to this end that I insists your insurance company
contact me within five days of receipt of this letter, to make arrangements for medical
care, restitution for loss of income, pain and suffering.
I can be contacted by phone at' I " ►or mail to the above address.
t_
Denisha Renee Minor
November 29, 2005
EIS$NHOWER MEDICAL CENTER
PATIENT INFORMATION FORM
------------------------------------------------------------------------------------------------
1/13/05 1610
CORP #: 00493285 MR ;: 024SS816 ACCOUNT #: A0531700127 �Dhrs S
PATI 180.. PREY NAME: -
DOB. SEX: F FEMALE M/S: S P/C: SP
--- ------- ---------:----------------------------------:---------.- -----------------
ADMIT TYPE: 1 ADMIT SOURCE: 7 cb'SYtViCBD=
ADMITTING PHYSICIAN:248 DOMZALSKI,FRANCIS ATTENDING PHYSICIAN:' 248 DOMZALSKI,FRANCIS
AMUTTING DX: R:I($3T �w G a:dr PRIMARY CARE PHYSICIAN:
PREVIOUS: CCIDENT DATE: 11/12/05 COMPLAINT:
------------------- --------------------------------------------------------------
PERMANENT ADD PALM DESERT CA 92211 RIVERSIDE
PHONE: PHONE MESSAGE: Yes
MAILING
PHONE: RELIGION: NO
PATIENT OCCUPATION: ADMINISTRATOR
PATIENT EMPLOYER: ELDORADO COUNTRY CLB
EMPLOYER ADDRESS: 46000 FAIRWAY OR INDIAN WELLS CA 92210
EMPLOYER PHONE: (760)346-8081 RETIREMENT DATE:
------------------------------------------------------------------------------------------------
GUARANTOR: MINOR, RELATION TO PT
BILLING ADD PALM DESERT 92211 PHONE•
EMPLOYER:
EMPLOYER
EMPLOYER PHO AT ION:ADMINISTRATO
---------------- -- ------ -----
--------------------------- --
INS: SELF -PAY CASH QUOTE GROUP -NAME: POLICY #: 56481414S
ADDRESS: GROUP #:
AUTH #:
INSURANCE CO PHONE: AUTH PHONE:
INSURED NAME: MINOR, DENISHA R
INS:
rEOPESS:
FNSUR.ANCE CO PHONE:
INSURED NAME:
INS:
MCRESS
RELATION TO PATIENT: 1
GROUP NAME: POLICY #
GROUP #:
AUTH #:
AUTH PHONE:
RELATION TO PA -^:ENT:
GROUP NAME : POLICY x
GROUP #
AUTH #:
!NSUP kNCE CO PHONE: AUTO: PHONE:
INSURED NAME: RELATION TO PATIENT:
NEXT OF KIN jCIHNSON,NIELA---------------------RELATICNSHIn MOTHS PHONE:
OFFICE
AL-J'ANCED DIRECTIVES: NCD DATE:
EMERGENCY CONTACT: RELATIONSH_'P: PHONE:
COMMENTS: COMPLETE MXC
------------------------------------------------------------------------------------------------
DISCHARGE DATE/TIME: 11/13,/05 2020 DISCHARGE STATUS: H ROOM/BED: DIS
ADMITTED BY: MXC
NATICNAPT ITY: NON-HISPALNIC LANGUAGE: ENCLISH
December 30, 2005
TO: The City of Palm Desert
ATTENTION: Rachelle D.Klassen, City Clerk
RE: Claim
Claimant
D/Event
Rec'd Y/Office
Our File
CA
?M, JAN -9 PM 2= 49
Minor vs. The City of Palm Desert
Denisha Renee Minor
11/12/2005
12/ 15/2005
S-1397901-PMQ
We have received and reviewed the above claim and request that you take the action indicated below:
CLAIM REJECTION: Send a standard rejection letter to the claimant.
Please provide us with a copy of the notice sent, as requested above. If you have any questions please
contact the undersigned.
Very truly yours,
CARL WARREN & COMPANY
and D. Marque
cc: CJPIA w/enc.
Attn.: Executive Director
CARL WARREN & CO. 0
CLAIMS MANAGEMENT CLAIMS ADJUSTERS COPY TO� b ' ECLA)''n
750 The City Drive • Ste 400 •Orange, CA 92868
Mail: P.O. Box 25180 • Santa Ana, Ca 92799-5180
Phone: (714) 740-7999 Ext 140 • (800) 572-6900 • Fax: (714) 740-9412 DATE .—..)
February 5, 2006
TO: The City of Palm Desert
ATTENTION: Rachelle D.Klassen, City Clerk
RE: Claim
Claimant
D/Event
Rec'd Y/Office
Our File
t �'IV ED
^1 1` {:i- RK'S OFFICE
?r : rI JDGSERT. CA
2006 FEB 13 PM 2: 34
Minor vs. The City of Palm Desert
Denisha Renee Minor
11/12/2005
1/31/2005
S-1397901-PMQ
We have received and reviewed the above claim and request that you take the action indicated below:
CLAIM REJECTION: Send a standard rejection letter to the claimant.
Please provide us with a copy of the notice sent, as requested above. If you have any questions please
contact the undersigned.
Very truly yours,
WARREN & COMPANY
D. Marque
cc: CJPIA w/enc.
Attn.: Executive Director
CARL WARREN & CO.
CLAIMS MANAGEMENT CLAIMS ADJUSTERS �, W j
750 The City Drive • Ste 400 •Orange, CA 92868 COPY TO
Mail: P.O. Box 25180 • Santa Ana, Ca 92799-5180 4 � 1fn
Phone: (714) 740-7999 Ext. 140 • (800) 572-6900 • Fax: (714) 740-9412
DATE c�- I3+0�