File #: 22-3093    Version: 1 Name: James Andres - 05/11/22
Type: Workers' Compensation Claims Status: Approved
File created: 4/26/2022 In control: Finance Committee
On agenda: 5/11/2022 Final action: 5/12/2022
Title: Employee: James Andres Job Title: Carpenter Foreman Department: Facilities Management Date of Incident: 10/09/2017; 09/23/2021 Incident/Activity: On October 9, 2017, Petitioner injured his right shoulder when he slipped and fell and liquid on the floor. On September 23, 2021, Petitioner injured his lower back while removing floor tiles. Accidental Injuries: Right shoulder; Lower back Petition and Order No: 18 WC 31297 Claim Amount: $56,946.19 Attorney: Horwitz Horwitz & Associates, Ltd. Date of Subcommittee Approval: 03/15/2022 Prior/pending claims: 07/19/1999 ($21,854.25)

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Employee: James Andres

Job Title: Carpenter Foreman

Department: Facilities Management

Date of Incident: 10/09/2017; 09/23/2021

Incident/Activity: On October 9, 2017, Petitioner injured his right shoulder when he slipped and fell and liquid on the floor. On September 23, 2021, Petitioner injured his lower back while removing floor tiles.

Accidental Injuries: Right shoulder; Lower back

Petition and Order No: 18 WC 31297

Claim Amount: $56,946.19

Attorney: Horwitz Horwitz & Associates, Ltd.

Date of Subcommittee Approval: 03/15/2022

Prior/pending claims: 07/19/1999 ($21,854.25)

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