File #: 21-5667    Version: 1 Name: David Krupa - 11/03/2021
Type: Workers' Compensation Claims Status: Approved
File created: 10/1/2021 In control: Finance Committee
On agenda: 11/3/2021 Final action: 11/4/2021
Title: Employee: David Krupa Job Title: Painter Department: Provident Hospital Date of Incident: 12/02/2015 Incident/Activity: Petitioner injured his head, back, tail bone, right leg, left elbow, and bilateral hips when he fell from a ladder. Accidental Injuries: Head, back, tail bone, right leg, left elbow, bilateral hips Petition and Order No: 16 WC 21910 Claim Amount: $66,081.75 Attorney: Stilberth, Scarlati & Boudreau, LLC Date of Subcommittee Approval: 09/22/2021 Prior/pending claims: 07/08/1996 & 09/30/1997 ($98,989.34)

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Employee: David Krupa

Job Title: Painter

Department: Provident Hospital

Date of Incident: 12/02/2015

Incident/Activity: Petitioner injured his head, back, tail bone, right leg, left elbow, and bilateral hips when he fell from a ladder. 

Accidental Injuries: Head, back, tail bone, right leg, left elbow, bilateral hips 

Petition and Order No: 16 WC 21910

Claim Amount: $66,081.75

Attorney: Stilberth, Scarlati & Boudreau, LLC

Date of Subcommittee Approval: 09/22/2021

Prior/pending claims: 07/08/1996 & 09/30/1997 ($98,989.34)

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