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Home My WebLink About10 CLAIM 09-01, KOERNER 04-07-09• ~~t4 AGENDA REPORT MEETING DATE: APRIL 7, 2009 TO: WILLIAM A. HUSTON, CITY MANAGER FROM: KRISTI RECCHIA, DIRECTOR OF HUMAN RESOURCES Agenda Item 10 Reviewed: City Manager Finance Director ~g_ SUBJECT: CONSIDERATION OF CLAIM OF STEVEN KOERNER, CLAIM NO. 09-01 SUMMARY: The Claimant alleges that he suffered apanic-induced asthma attack on November 8, 2008 as a result of being illegally detained by the Tustin Police Department. The Claimant was initially contacted by Tustin PD at a local bar in response to a call regarding petty theft. The victim of the petty theft did not desire to press charges, however, the Claimant was asked to leave the bar as a result of exhibiting various signs of intoxication. Approximately 30 minutes after leaving the bar, the Claimant arrived, on his own, at the Tustin Police Department to file a complaint against the Officer he had encountered at the bar. It was determined at that time that the Claimant was intoxicated, and he was arrested for being drunk in public. He was transported to Huntington Beach Jail where he was refused booking due to a medical condition. He was then taken to Western Medical Center for medical clearance, where he was eventually cited and released. RECOMMENDATION: That the City Council deny Claim Number 09-01, Steven Koerner, and direct Staff to send notice thereof to the Claimant. FISCAL IMPACT: None. DISCUSSION: The City's Claims Administrator has found no fault attributable to the City of Tustin in this incident, as it appears that probable cause .existed for the Police Department to cite Claimant for public intoxication. Staff is recommending denial of the claim. Kristi Recchia Director of Human Resources ATTACHMENT: Copy of Claim No. 09-01 s:\general liability\claims\koerner, steven 09-01\koerner, steven -agenda report - gl claim denial 03.19.09.doc Name of Claimant: 5-'~-2.~~.h hD~r ~1 Cr Home Address: Home Telephone: -~ (~ ,. ~ (- Work Telephone• Post Office address to which the person presenting the claim desires notices to be sent: (If different from above) Name of Addressee: S-fi- ~~ ~~ rvi e / Telephone• ' Post Office Address. The date, place and other circumstances of the occurrence or transaction from which the claim arises. Date of Occurrence: ~ I Location: ~C.~[v1PP_ 5 ~ Circumstances g 5 The name or names of the public employee or employees causing the injury, damage, or loss, if known. 4~-f•. ~,~~~~, Q.~~~ ~tQYI , t~-~~cL~,r l~ ~~ ~nrll ~ kk- IG~~~7~ V 1 LC J ~ -- - S 6. If amount claimed totals less than 570,000: Provide the amount claimed if it totals less than ten thousarr dollars ($10,000) as of the date of your claim, including the estimated amount of any related potential future injury damage, or loss, insofar as it may be known as of the date of your claim, together with the basis of computation c the amount claimed (include copies of all bills, invoices, estimates, etc.) Amount Claimed and basis for computation• ~ ~ , ~~} ~ (~ ~ p rrr Gt '~~ L~~~ ~? i ~ ( ' ff amount claimed exceeds 510,000: If the amount claimed exceeds ten thousand dollars ($10,000), do n~ provide a dollar amount in the claim. However, your claim must indicate whether it would be a limited civil case A limited civil case is one where the recovery sought, exclusive of attorney fees, interest and court costs, does n~ exceed $25,000. An unlimited civil case is one in which the recovery sought is more than $25,000. (See CCP 86.) ^ Limited Civil Case ^ Unlimited Civil Case You are required to provide the information requested above in order to comply with Government Co §910. Additionally, in order to conduct a timely investigation and possible resolution of your claim, 1 City of Tustin requests that you answer the following questfona 7. Name, address and telephone number of any witnesses to the occurrence or transaction from which the clai arises: 8. If the claim involves medical treatment for a claimed injury, please provide the name, address and telepho~ number of any doctors or hospitals providing treatment: 9. If the claim relates to an automobile accident: Claimant(s) Auto Ins. Co.: Telephone: Address: Insurance Policy No.: Insurance Broker/Agent: Telephone: Address: Claimant's Veh. Lic. No.: Vehicle Make/Year: Claimant's Drivers Lic. No.: Expiration: If applicable, please attach any repair bills, estimates or similar documents supporting your claim. Page 2 of 4 If applicable, please attach any medical bills or reports or similar documents supporting your claim. READ CAREFULLY For ali accident claims, place on following diagram name of streets, including North, East, South, and West; indicate place of accident by "X" and by showing house numbers or distances to street comers. If City/Agency Vehicle was involved, designate by letter "A" location of City/Agency Vehicle when you, first saw it, and by "B" location of yourself or your vehicle when you first saw _// CURB %/ City/Agency Vehicle; location of City/Agency vehicle at time of accident by "A-1" and location of yourself or your vehicle at the time of the accident by "B-1"and the point of impact by "X." NOTE: If diagrams below do not fit the situation, attach hereto a proper diagram signed by claimant. CURB Warning: Presentation of a false claim is a felony (Penal Code §72). Pursuant to CCP §1038, the City/Agency may seek to recover all costs of defense in the event an action is filed which is later determined not to have been brought in good faith and with reasonable cause. Signature: Date: 3 ~ ~ l Page 3 of 4 IF LATE CLAIM: COMPLETE ITEMS 1- 9 AND THIS APPLICATION. SIGN BOTH FORMS. APPLICATION FOR LEAVE TO PRESENT A LATE CLAIM TO THE CITY OF TUSTIN The undersigned hereby applies for leave to present a late claim to the City of Tustin. This application is being mad within a reasonable time, not exceeding one (1) year, after the accrual of the cause of action. Under some circumstance: leave to present a late claim will be granted (Government Code § 911.6). The reason for delay in presenting the claim is; Date Signature of Claimant Revised 12/2004 Page 4 of 4 ~ ~ WESTERN M.C. SANTA ANA DEPT 6743 LOS ANGELES CA 90084-6743 ~~~- ~.. IHH0124A AUTO SCH 3-DIGIT 926 7000000086 01.0002.0068 86/1 ~IIII'~11~11~I11~~~~~111~~111~1~~~~~~~~1~1~1~1~~~1~111~~~11111'll KOERNER STEVE "~ Account Number: 8753832 Statement Date: 1/24/09 ~~~~~~~~~n(~~~~~~~~~~~~~~~~~u~n~~~~u~n~~~~~~n~~~un~~~~ WESTERN M.C. SANTA ANA DEPT 6743 LOS ANGELES CA 90084-6743 Re: KOERNER STEVE Account Number: 8753832 Admit Date: 11/08/08 Current Balance: 1,607.05 Discharge Date: 11/08/08 You can resolve the balance on this account today. Please send us your check, or complete the information below. ------------------------------------------------------------------- Yes - I would like to charge this balance to my credit card. Check one: Visa Mastercard Discover Card American Express Amount: $ Expiration Date: C~Td. Ntimhcr • _ _ Cardholder Name: Cardholder `Signature: We appreciate the opportunity to have been of service to you. Thank you, Account Representative 8:00 - 4:00 800 270-0702 FUS/228-CCCCX PATIENT'S CHANGE OF MAILING ADDRESS ~d Address: City: State: New Phone #: Social Security #: Zip: Authorization for release of Medical Information: PATIENT'S CHANGE_ D INSURANCE INFORMATION Insurance Co.: Claim Office Address: Policy #: Named of Insured: Relationship of Patient to Insured: Employer Name: Employer Address: Medicare #: I authorize any holder of Medical information about me to release to Medicare, Medicaid and any insurance, as well as the provider of this service, any information or documentation in their possession needed to determine these benefits or the benefits payable for related services, now or in the future. Signature of Patient or Guardian Group #: MD-01 Rev. 3/08