File #: 20-4970    Version: 1 Name: Karl Jacobsen - 11-18-2020
Type: Workers' Compensation Claims Status: Approved
File created: 10/23/2020 In control: Finance Committee
On agenda: 11/18/2020 Final action: 11/19/2020
Title: Employee: Karl Jacobsen Job Title: Correctional Officer Department: Department of Corrections Date of Incident: 05/23/2016; 03/03/2017; 08/15/2018; 05/07/2019 Incident/Activity: On May 23, 2016, Petitioner injured his head when he was struck by a detainee. On March 3, 2017, Petitioner injured his lower back while restraining a detainee. On August 15, 2018, Petitioner injured his nose when he was struck by a detainee. On May 7, 2019, Petitioner injured his right knee while restraining a detainee. Accidental Injuries: Head, lower back, nose, right knee Petition and Order No: 17 WC 22508; 17 WC 22509; 19 WC 7785; 19 WC 23250 Claim Amount: $38,150.96 Attorney: Krol, Bongiorno & Given, Ltd. Date of Subcommittee Approval: 10/21/2020 Prior/pending claims: n/a

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Employee: Karl Jacobsen

Job Title: Correctional Officer

Department: Department of Corrections

Date of Incident: 05/23/2016; 03/03/2017; 08/15/2018; 05/07/2019

Incident/Activity: On May 23, 2016, Petitioner injured his head when he was struck by a detainee.  On March 3, 2017, Petitioner injured his lower back while restraining a detainee.  On August 15, 2018, Petitioner injured his nose when he was struck by a detainee.  On May 7, 2019, Petitioner injured his right knee while restraining a detainee. 

Accidental Injuries: Head, lower back, nose, right knee

Petition and Order No: 17 WC 22508; 17 WC 22509; 19 WC 7785; 19 WC 23250

Claim Amount: $38,150.96

Attorney: Krol, Bongiorno & Given, Ltd.

Date of Subcommittee Approval: 10/21/2020

Prior/pending claims: n/a 

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