File #: 22-3632    Version: 1 Name: Mia Wolf - 6/15/22
Type: Workers' Compensation Claims Status: Approved
File created: 5/25/2022 In control: Finance Committee
On agenda: 6/15/2022 Final action: 6/16/2022
Title: Employee: Mia Wolf Job Title: Clerk V Department: County Clerk Election Division #1524 Date of Incident: 2/3/2014; 3/30/2016; 4/6/2017; and 4/9/2018 Incident/Activity: On February 3, 2014, Petitioner injured her right arm while using the ballot machine. On March 30, 2016, Petitioner injured her bilateral thumbs from peeling stickers. On April 6, 2017, Petitioner re-injured her bilateral thumbs and hands from repetitive activity while working. On April 9, 2018, Petitioner injured her right shoulder while lifting ballot bins Accidental Injuries: right arm, bilateral thumbs, bilateral hands, and right shoulder Petition and Order No: 14 WC 05782; 17 WC 11556; 18 WC 16900 Claim Amount: $48,465.01 Attorney: Celso Fuentes, Jr. and Celso Fuentes, Jr. & Associates, Ltd. Date of Subcommittee Approval: 5/9/2022 Prior/pending claims: N/A

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Employee: Mia Wolf

Job Title: Clerk V

Department: County Clerk Election Division #1524

Date of Incident: 2/3/2014; 3/30/2016; 4/6/2017; and 4/9/2018

Incident/Activity: On February 3, 2014, Petitioner injured her right arm while using the ballot machine.  On March 30, 2016, Petitioner injured her bilateral thumbs from peeling stickers. On April 6, 2017, Petitioner re-injured her bilateral thumbs and hands from repetitive activity while working.  On April 9, 2018, Petitioner injured her right shoulder while lifting ballot bins

Accidental Injuries: right arm, bilateral thumbs, bilateral hands, and right shoulder 

Petition and Order No: 14 WC  05782; 17 WC 11556; 18 WC 16900

Claim Amount: $48,465.01

Attorney: Celso Fuentes, Jr. and Celso Fuentes, Jr. & Associates, Ltd.

Date of Subcommittee Approval: 5/9/2022

Prior/pending claims: N/A 

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