Preview
ELECTRONICALLY FILED
Superior Court of California
County of Santa Barbara
McNICHOLAS & McNICHOLAS, LLP Darrel E. Parker, Executive Officer
Matthew S. McNicholas, State Bar No. 190249 5/24/2023 6:35 PM
Loren Nizinski, State Bar No. 144345 By: Narzralli Baksh , Deputy
10866 Wilshire Blvd., Suite 1400
Los Angeles, California 90024
Tel: (310) 474-1582
Fax: (310) 475-7871
Attorneys for Plaintiff
KATHY TORRES
-PUBLIC REDACTS-
materials from conditionally sealed record
SUPERIOR COURT FOR THE STATE OF CALIFORNIA
COUNTY OF SANTA BARBARA
10
11
12 KATHY TORRES, CASE NO.: 21CV02933
(Assigned for all purposes to Hon. Thomas P.
13 Plaintiff, Anderle, Dept. 3)
14
Vv. PLAINTIFF’S EVIDENCE IN SUPPORT OF
15 PLAINTIFF’S OPPOSITION TO
COUNTY OF SANTA BARBARA, a DEFENDANT COUNTY OF SANTA
16 government entity; SANTA BARBARA BARBARA’S MOTION FOR SUMMARY
COUNTY SHERIFF’S DEPARTMENT, a JUDGMENT OR IN THE ALTERNATIVE,
17 government entity; and DOES | through 100, SUMMARY ADJUDICATION
inclusive,
18
[Filed concurrently with Plaint 's Opposition;
19 Separate Statement in Opposition; Request for
Defendants. Judicial Notice]
20
Date: June 7, 2023
21 Time: 10:00 am
Dept.: 3
22
23 Trial Date: October 4, 2023
Complaint Filed: July 23, 2021
24
25
-PUBLIC REDACTS-
26
materials from conditionally sealed record
27
28
1
PLAINTIFF’S EVIDENCE IN SUPPORT OF PLAINTIFF’S OPPOSITION
TO THE HONORABLE COURT, ALL PARTIES, AND THEIR ATTORNEYS OF RECORD
Plaintiff Kathy Torres (“Plaintiff’ or “Torres”) submits the following Evidence in
Opposition to Defendant’s Motion for Summary Judgment or, in the Alternative, Summary
Adjudication.
INDEX OF PLAINTIFF’S EVIDENCE
DECLARATION OF KATHY TORRES
7
10
11
12 ee :
3
13
14
15 =
16
17 ee
18
19 ee
20
21 a
22 Exhibit 10 - a
23
2
25
26 a.
27
28
PLAINTIFF’S EVIDENCE IN SUPPORT OF PLAINTIFF’S OPPOSITION
DECLARATION OF SUSAN JERICH
DECLARATION OF KEVIN DALY
REQUEST FOR JUDICIAL NOTICE
Exhibit 16 — Preliminary Hearing Transcript from People v. Kathy Carmen Bass Torres
Case No.: 18CR0946 dated October 22, 2020. (See concurrently filed Request for Judicial Notice.)
DECLARATION OF LOREN NIZINSKI
Exhibit 17 — Loren Nizinski took the deposition of Commander Ryan Sullivan on March 1,
2023, Attached are relevant excerpts of the deposition transcript.
10 Exhibit 18 — Loren Nizinski took the deposition of Sarah Allison on March 9, 2023
11 Attached are relevant excerpts of the deposition transcript.
12 Exhibit 19 - Loren Nizinski took the deposition of Chief Vincent Wasilewski on March 15,
13 2023, Attached are relevant excerpts of the deposition transcript.
14 Exhibit 20 - Loren Nizinski took the deposition of Matt Harvill on March 31, 2023.
15 Attached are relevant excerpts of the deposition transcript.
16 Exhibit 21- Loren Nizinski took the deposition of Commander James Meter on April 1,
17 2023. Attached are relevant excerpts of the deposition transcript.
18 Exhibit 22 - Loren Nizinski took the deposition of Stuart Hutchinson, M.D. dated May 17,
19 2023.Attached are relevant excerpts of the deposition transcript. Also attached are the following
20 Exhibits to the Deposition of Dr. Hutchinson.
21 Deposition Exhibit 17 -
22
23 ee
24 Dated: May 24, 2023 McNICHOLAS & McNICHOLAS, LLP
py. RA Mg
25
26
Matthew S. McNicholas
27 Loren Nizinski
Attorneys for Plaintiff
28 KATHY TORRES
3
PLAINTIFF’S EVIDENCE IN SUPPORT OF PLAINTIFF’S OPPOSITION
DECLARATION OF
KATHY TORRES
DECLARATION OF K. Ty ORRES
Iam a competent adult over the age of eighteen years old. I am the Plaintiff in the above
3 aptioned matter. The facts set forth in this document are based on my personal knowledge
except for those that I have stated are based on information and belief. If called upon to testify as
a witness to these facts, I reasonably believe I could and would competently render testimony.
This Declaration is made in support of my Opposition to Defendant’s Motion for Summary
7| Judgment or Summary Adjudication.
8] 1 a: Santa Barbara County Sheriff's Department (SBSD)
9| hired me as a Custody Deputy. At the time I was hired I was known as Kathy Gardner. In
10 November 2012, I got married and changed my name to Kathy Torres. Prior to working for
11 SBSD, I worked for the County of Ventura as a Sheriff's Service Technician (correction officer)
12 for eight (8) years.
9
13 2 On or about November 20, 2010, I injured my back at work while I was assisting
14 another deputy walking an inmate back to housing when the inmate turned on us as we were
15 entering the elevator and a struggle occurred to get control of him. Pursuant to SBSD policy and
16
17
18
19
20
21 3 Shortly after I submitted ee
22
23
24
25 4 Around that time, I was referred to Sansum occupational health clinic for medical
26 treatment for the pain I was experiencing in my back that was shooting down my legs as well. I
Bi began to treat conservatively but my back was not improving. I was then sent to Dr. Hutchinson,
28 an orthopedic surgeon, for additional evaluation and treatment. Dr Hutchinson diagnosed me
1
DECLARATION OF KATHY TORRES
with a herniated disc, and | underwent surgery to my lumbar spine on March 2 2011. Lwas off
work after the surgery until sometime in December of 2012. I continued to treat with Dr.
Hutchinson after I returned to work. During the time I was off work, ee
6
5 On or about March 20, 2014, I began to feel pain in my left heel from continuous
standing and walking on concrete floors in my work shoes. Since the pain did not go away, |
9
10
11
12
14
15
16 6 Dr. Andrew Samuels, a Podiatrist, was the treatir physician for my heel injury. |
17, underwent plantar fascial rele: surgery to my left foot sometime around December of 2014
|
18 After the surgery | experienced complications associated with the surgery and switched podiatrist
19 to Dr. Leslie Levy, who indicated I had nerve damage from the surgery.
20 7 While I was out on disability for my heel injury,
21
22
23
24 8 During the time I was out on disability for my heel injury, the pain in my back got
25 worse. Dr. Hutchinson then performed a second surgery to my lumbar spine on November 16,
26| 2015. I returned to work in or around July 2016. I continued to treat with Dr. Hutchinson after I
27 returned to work and would see him a few times a year. Dr. Hutchinson would prescribe physical
28 therapy, aquatic therapy, and pain management with Dr. Kenly.
2
DECLARATION OF KATHY TORRES
9. On September 19, 2017, I was working at the Santa Barbara County jail facility.
On that date I was conducting a security check when some inmates flagged me. As | opened the
door to talk to the inmate, I saw a fellow custody deputy, Richard Vargas walking through the
hallway, he looked as if he was in a hurry. As Vargas passed by me his backpack brushed
against her lower back, catching my cuffs and pulling me to the left a little bit. Approximately
10 minutes later I felt some increased pain in my already injured back. I did not seek medical
attention at that time. Pursuant to SBSD policy
10 10. Unfortunately, the pain in my back did not improve so on September 26, 2017, I
ll used my own health insurance and went to Dignity Health Medical Group, and saw Dr. Bindhu,
12|| who took me off work until October 1, 2017. I did not request or receive any Labor Code § 4850
13 or Workers’ Compensation temporary disability benefits but instead used my own sick time
14 during this period, since it was my belief that the incident of September 19, 2017, did not cause a
15 new injury, but was a flare up of my November 23, 2010 injury.
16 Ths On September 27, 2017, I had an appointment that had been scheduled prior to the
17| September 19, 2017, incident at work with my orthopedic surgeon Dr. Hutchinson, who | was
18
v9
still under care for my November 23, 2010, back injury. At that time, I told Dr. Hutchinson that I
had a flare up of my 2010 back injury. Dr. Hutchinson continued to treat me for my November
0} 23, 2010, injury until approximately February 2018. I also continued to see Dr. Kenly, the pain
21 management specialist Dr. Hutchinson recommended.
22| 12. On November 8, 2017, I was summoned into Lt, Sullivan’s office, Both he and
23) Lt. Espinoza were in the office. Lt. Sullivan told me that he had spoken to Sarah Allison at
4) human resourees and that she had said to him hat as
25) ee later discovered that this was not
26 true. I did not understand why I needed to fill out a HD ccause I was not making a new
27 claim, since the incident of September 19, 2017, a flare up of my already existing November 23,
28 2010, back injury. Also, I was treating with Dr. Hutchinson under the November 23, 2010, claim
3 —
DECLARATION OF KATHY TORRES
for which I had lifetime medical treatment for my back, and I was not seeking any new Workers’
Compensation Benefits.
13. Lt. Sullivan handed me the oom and said I needed to fill it out. Since he
was my Lieutenant, I took this as an order and felt I had no other choice. Although I filled out
5 ine MEE cic not signi, mms
8
9
10 14. The following week, on or about November 16, 2017, I received a phone call from
11 Kathie Stumpf at CorVel. She was calling to discuss the “new” claim since she had received the
12 November 9, 2017, DWC-1 for the September 19, 2017, incident. I explained to Ms. Stumpf that
I never had any intent to file a new claim since this was a flare up of my November 23, 2010,
14 injury that I was still receiving treatment for. She then scent mc gqamieleaimmmmmieleeenieieesiens
15 mailed back to her, however she apparently did not receive it, so he
16
17
18
19 15 On February 7, 2018, Dr. Levy, the Podiatrist took me off work for my heel
20 injury. I then went to Human Resources and spoke with Sarah Allison to provide her with Dr.
21 Levy’s note for time off relating to my heel injury. I also provided Ms. Allison with a note from
22 Dr. Hutchinson for my back injury since he was giving me work restrictions. I explained to Ms.
Allison at that time that I did not intend to file a new workers’ compensation claim and that the
24 September 19, 2017, incident had aggravated my back injury from November 23, 2010, it was
25 not a new injury.
26 16. On March 28, 2018, while I was off work on disability, | received a phone call
27 from District Attorney Investigator Matthew Harvill Mr. Harvill began questioning me about
28 the September 19, 2017, incident. It was not until about 10 minutes into our conversation that he
po per 4
DECLARATION OF KATHY TORRES
told me that | was being investigated for Workers’ Compensation Fraud for making a False
Workers’ Compensation claim. He accused me of receiving medical treatment and workers’
compensation benefits as a result of the September 19, 2017, incident. I explained to him that I
had not received any benefits, and the medical treatment I was receiving was because of my
> November 23, 2010 injury. I further explained that I had no intention of pursuing a claim for the
September 19, 2017, incident. That was the first time I discovered that I was being investigated
for workers’ compensation fraud. I was shocked because I had legitimately injured my back on
8 November 23, 2010 resulting in two back surgeries. At no time prior to this date did anyone say
9 I was committing fraud.
10 17. On May 6, 2018, Dr. Levy released me to return to work. Eleven days later on
11
12
14
15
16
17
18 18. My attorney informed me that a Criminal Complaint alleging 5 counts of Workers
19 Compensation Fraud was also filed against me on May 16, 2018, in Santa Barbara County
20 Superior Court. The Criminal Complaint w based primarily on the Hi
21
22
22 even though I did not want to, and which I told the Kathie Stumpf at CorVel I was not purst 25
23 nor ever wanted to pursue, when I first spoke to her a week later on November 16, 2017.
24 Because of the criminal filing I was forced to retain the services of a criminal defense attorney.
The Deputy Sheriff's Association (my union) informed me that the Legal Defense Fund did not
26 cover alleged Workers’ Compensation Crimes. In order to pay for my defense, I had to borrow
27 money from my family.
28
3
DECLARATION OF KATHY TORRES
19. a i: waiting for the preliminary hearing I retired from the
SBSD. I did not want to retire; however, the stress of the continued harassment, discrimination
3 and retaliation, and the stress of the criminal proceedings made it impossible for me to continue
to work for SBSD. Also, the Santa Barbara District Attorney’s office led me to believe that if]
retired, the criminal charges against me would be dismissed. As the preliminary hearing date
6 approached, | discovered that the District Attorney’s office was not going to dismiss the charges
and we would have to move forward with the preliminary hearing. Had I known that the District
Attorney would not dismiss the charges, | would not have retired.
20. The matter went to a preliminary hearing on October 22, 2020, before The
10 Honorable Judge Thomas Adams. At the end of the hearing and presentation of the prosecutor’s
11 case, Judge Adams dismissed all of the charges against me and stated that there was “a woeful
12 lack of evidence” to indicate that I had committed any criminal violation. It was at that time that
13 T also found out that Lt. Sullivan had lied to me about Ms. Allison needing me to fill out a i |
14 Hs. Allison testified at the preliminary hearing that a DWC-1 form was not required and
15 that it was up to the employee if they wanted to make a claim or not.
16 21. At the time the matter went to a preliminary hearing, on October 22, 2020, ==
17 I continued to treat with Dr
18 Kenly, the pain management doctor the entire time up until sometime in or about of March 2022
19 when I settled out the future medical aspect of my 2010 Workers’ Compensation claim to my
20 back as well as the 2014 continuous trauma claim to my foot/heel for a lump sum buyout. At no
21 time did CorVel ever question my injuries. In fact, during this time, Dr. Kenly was authorized
22
22 and approved to perform two rhizotomies, an outpatient surgical procedure to remove nerve
23 fibers responsible for sending pain signals to the brain.
24 22 Despite Judge Adams’ findings and opinion that there was no evidence, {i
25
25
26
27
28
6
DECLARATION OF KATHY TORRES
work
not be able to find any work at any other law enforcement agency, and my ability to
security for a private company would bc limited since ee
23 i
24,
10
1}
12
13 I declare under penalty of perjury ler the laws of thi atc of California
that the
14 foregoing is truc and correct. Executed this 24th day of May 2023 ai t Oxnard, California
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18
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1 a —
- DECLARATION OF KATHY TORRES
EXHIBIT “1”
Memorandum
Date: November 23, 2010 S35eZ
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EXHIBIT “2”
State of California Gi ae
Department of Industrial Relations is 2\ Estado de California
(Sosa aA Departamento de Relacion es Endustriales
DIVISION OF WORKERS' COMPENSATION DIVISION DE Cc 'OMPENSACION AL TRABAJADOR
4
WORKERS’ COMP N SATION CLAIM FORM (DWC 1) any PETITION DEL EMPLEADO PARA DE COMPENSACI( DEL
TRABAJADOR (DWC 1)
Employee: Complete the “Employee” section and give the form to Empleado: Complete la ccién “Empleado” y eutregue la forma a sit
your employer. Keep a copy and mark it “Employ “s Temporary
Receipt” until you receive the signed and duted copy from your er
empleador, Quédese con copia designada “Recibo Temporal del
ployer. You may call the Division of Workers’ Compensation and Empleado” hasta que Ud. rei iba la copia firmada y fechala de su empleador.
hear recorded information at (800) 736-7401. An explanation of work- Ud. puede llamar a la Division de Compensaci al Trabajador al (800) 736-
ers‘ compensation benefits is included as the cover sheet of this form. 7401 para oir informacién gravada. En la hoja cubierta de esta
forma esta la explication de los bi eficios de compensacion al trabajador.
You should also have received a pamphiet from your employer de-
scribing workers’ compensation benefits and the procedures to obtain Ud. también deberia haber recibido de su empleador un folleto describiendo los
them, benficios de compensacién al trabajador lesionedo y los procedimientos para
obtenerlos.
NB Te On ost iask Ooh Ped Pode aes
ENC TTS REET
a TET OL ooo EG TICS ay On see CMC et tect
a meee Bees reset re tm Ce TENG ate ou bree tM yo ora tat
DEE OMe ie tr S|
TS Ty DCCL TM og on Cee Cornu eTente Coa ato PS aie a stolen ni A ouee tiem art pt Gee
Lo ED PATE IE OT Ny TESTE Ke Kaa eure Reg eneA pomer ts Cotten
employer: You sre required to date th s form and provide copies to Empleador: Se requiere que Ud. feche esta forma y que provéa copias a su com-
your insurer or claims administrator and to the employee, dependent
or representative who filed the claim within one working day of
paiita de seguros, adm rador de reclantos, o dependientelrepresentante de recla-
mos y al empleado que hayan presentado esta peticin dentro del, pla de un dia
reccipt of the form from the employee,
hidbil desde el momento de haber sido recibida (a forma del empleacio.
SIGNING THIS FORM IS NOT AN ADMISSION OF LIABILITY EL FIRMAR ESTA FORMA NO SIGNIFICA ADMISION DE RESPONSABILIDAD
OQ Employer copy/Copia det Empleudor O Employ -opy! Copia del Empleado 1 Clims Administeator/tci suraclor dle Reclamos D Temporary ReceipRecibo del Empleada
6/10 Rev.
EXHIBIT “3”
CORVEL
—serertnmmrmeceE
December 06, 2010
Notice of Acceptance of Workers’ Compensation Claim and Notice Regarding 485i nefits
Dear Kathy Gardner:
Please be advised that | will be handling your accepted Workers’ Compensation claim for the above captioned
injury on behalf of your employer. We would like to explain some of the benefits to which you are entitled
under the Workers’ Compensation system:
1 Payments of temporary disability are made every day of a seven-day week while you are unable to work
because of your injury. Your temporary disability will be paid in accordance with Labor Code 4850, which
provides full salary for one year while you are disabled due to your work related injury.
We will pay for all necessary medical care and reimburse you for your necessary transportation expenses
at the rate of 50 cents per mile. If you receive any medical bills, please send them to us.
You are entitled to a change of physician after 30 days from the date you reported your injury unless, prior
to your injury, you had a notation in your personnel file that you would like to be treated by your personal
physician. “Personal Physician” means a DULY LICENSED PHYSICIAN OR SURGEON who has
previously directed your medical treatment and who retains your medical history and records. Should you
desire to be treated by your personal physician, please inform us of the doctor’s name, address and phone
number. Once we have established communication with your physician, he/she will be notified of the
reporting requirements of an employee-selected physician for Workers’ Compensation claims.
There may be other benefits to which you are entitled. In addition, we have enclosed a pamphlet explaining the
benefits you may be entitled to receive under workers’ compensation. Please feel free to contact me at
(805) 389-4224 to discuss your claim.
Ene: Benefit Pamphlet
Mileage Form
Med Release Auth
EE Statement
ee
A CorVel Corporation P.O. Box 5166 806.389.4200 phone
vaww.corvelcom Oxnard, CA 93034 805.389.4231 fax
866.785.2835
EXHIBIT “4”
on
~ 3OR VE
a SrneremmaNT
—
You may lose important rights ifyou do not take certain actions wit! hin 10 days. i
Bead this letter and a ny Snnlosed fact sheets very. carefully. |
bac! ais ead - ~ wa
February 3, 2012
Notice Regarding Actual 4850 Benefits
a
CorVel Corporation is handling your Workers’ Compensation claim for the above captioned
injury on behalf of the County of Santa Barbara. ne
ee
ee
evaluation, you may obtain an evaluation by a Qualified Medical Evaluator obtained from a
panel issued by the DWC Medical Unit. Attached is a form with which you may request
assignment of a panel of Qualified Medical Evaluators. You have 10 days to request the
panel. Once you have received the panel, you have 10 days to make the appointment.
The State of California requires that you be given the following Information:
A GorVel Corporation P.O. Box 6166 805.389.4200 phone
ww.corvel.com ‘Oxnard, CA 93031 806.389.4231 fax
866.785,2835
RT ON SE SS EST ETNA TS IS FNS TELS TET
You have a right to disagree with decisions affecting your claim. If you have any questions
regarding the information provided to you in this notice, please call: Olayemi Olatunji at
(805) 389-4224. However, if you are represented by an attorney, you should call your
attorney, not the claims adjuster. If you want further information on your rights to benefits or
disagree with our decision, you may contact your local state Information & Assistance Office
of the Division of Workers’ Compensation by calling (805) 485-3528.
For recorded information and a list of offices, call (800) 736-7401. You may also visit the
DWC website at: htto:/Avww.dir.ca.gow/DWC/dwe_home_page.htm
You also have a right to consult with an attorney of your choice. Should you decide to be
represented by an attorney, you may or may not receive a larger award, but, unless you are
determined to be ineligible for an award, the attorney's fee will be deducted from any award
you might receive for disability benefits. The decision to be represented by an attorney is
yours to make, but it is voluntary and may not be necessary for you to receive your benefits.
WARNING: You are required to report to your employer or the insurance company any
money that you earned for work during the time covered by this check, and before cashing
this check. If you do not follow these rules, you may be in violation of the law and the penalty
may be jail or prison, a fine, and loss of benefits.
ADVERTENCIA: Es necesario que usted Je avise a su patrén o a su comparila de seguro
todo dinero que usted ha ganado por trabajar, durante el tiempo cubierto por éste cheque, y
antes de cambiar éste cheque. Si usted no sigue estos reglamentos, Usted puede estar en
violacion de la ley y el castigo podria ser carcel o prisién, una multa, y pérdida de beneficios.
To resolve a dispute, you may apply to the Workers’ Compensation Appeals Board.
Enc.: TD Fact Sheet
QME Fact Sheet
PQME Request Form 105 & Attachment
QME Waiver
oo EVEL
mc
— ———— ee ~ ~ ~
You may lose important rights if you do not take certain actions within 10 days.
Read this letter and any enclosed fact sheets very carefully.
Le. a ———____. _ ——————
December 05, 2012
NOTICE REGARDING TEMPORARY DISABILITY BENEFITS
PAYMENT TERMINATION
CorVel Corporation is handling your workers' compensation claim on behalf of the County of Santa
Barbara PWC. This notice is to advise you of the status of disability benefits for your workers'
compensation injury on the date shown above.
if
you are unrepresented, and have not received a comprehensive medical evaluation, you may
obtain an evaluation by a Qualified Medical Evaluator obtained from a panel issued by the DWC.
Medical Unit. Attached is a form with which you may request assignment of a panel of Qualified
Medical Evaluators. You have 10 days to request the panel. Once you have received the panel, you
have 10 days to make the appointment.
GorVel Corporation P.O. Box 6186 805.389.4200 phone
www.CorVel.com Omard, CA 93031 805.389.4231 fax
868.785.2835
—_—
EXHIBIT “5”
State of Califomin p Estado de California
Department of Indust Relations Departamento de Relaciones Industriates
DIVISION OF WORKERS' COMPENSA’ 2 DIVISION DE COMPENSACION AL TRABAJADOR
ry
WORKERS’ COMPENSATION CLAIM FORM (DWC 1) Sais or PETITION DEL EMPLEADO PARA DE COMP. ACTON DEL
TRABAJADOR (DWC 1)
Employee; Complete the “Employee” secti and give the form to Empleado: Complete la seccién “Empleado” y entregue la forma a su
your employer. Keep a copy and mark it “Employee’s Temporary empleadar, Quédese con la copia designada “Recibo Temporal del
Receipt” until you receive the igned and dated copy fr m your em-
ployer. You may call the Di ion of Workers’ Compensation and Empleado” hasta que Ud. reciba la copia firmada y fechada de su empleador,
hear recorded information at (800) 736-7401. n explanation of work-
Ud. puede lamar a la Division de Compensaci al Trabajador al (800) 736-
ers' compensation benefits is includedus the cover sheet of this form. 7401 para oir informacién gravada. En la hoja cubierta de esta
Jorma esta ta expli ation de los beneficios de compensacién al rabajador.
You should also have received a pamphlet from your employer de-
scribing workers’ compensation benefits and the procedures to obtain Ud. también deberia haber recibido de sn empleador un folleto describiendo los
them, benficios de contpensacién al trabajador lesionada y los procedimientos para
obtenerlos.
Cp Se Or ce reer Os Copa ees BOER COD HM Toner Lies ma (TL | DOS COM ET Re So TSN Dee)
CUBIC Dune eon aes eore) Maes mec ue Ce Rrra ener ria OREO PEO Reece RRA
Co aOR eta eo R oem aes en Tat oe eens a tere era rm ter Steerer
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ete eee Ree ok USOT Oke a ri GLa ar btn heer aha to Cntran
Employer: You are required to date this form and provide copies ta Empleador: So requiere que Ud. feche esta forma y que provéa copias a su con-
your insurer or claims administrator and to the employee, dependent paiita dle seguros, acministrador de reclames, o de dientelrepresentante de ré la-
or representative who filed the cluim within one working day of mos y al enpleado que hayan presentado esta peticién dentro del plazo de un
receipt of the form from the employee. hidhil desde el momento de haber s ido recibida la forma del enppleado.
SIGNING THIS FORM IS NOT ADMISSION OF LIABILITY EL FIRMAR ESTA FORMA NO SIGNIFICA ADMISION DE RESPONSABILIDAD
O Employer copy/Copt det Empleudlor Oem ve copy/ Copla det Empleado O ctoims Administrmorfeictuintsiractor de Reetamos O Temporary ReceipuRecibe det Empteada
6/10 Rev.
EXHIBIT “6”
Memorandum
Date: April 12, 2014 F SD <=
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EXHIBIT “7”
OQ R
an nrorstesenisenenen—
September 19, 2014
Notice of Acceptance of Workers’ Compensation Claim and 4850 Benefits
Dear Kathy Gardner Torres:
Please be advised that | will be handling your Workers’ Compensation claim for the above captioned injury
on behalf of your employer. We would like to explain some of the benefits to which you are entitled under
the Workers’ Compensation system:
1 Payments of temporary disability are made every day of a seven-day week while you are unable to
work because of your injury. Your temporary disability will be paid in accordance with Labor Code
4850, which provides full salary for one year while you are disabled due to your work related injury.
We will pay for all necessary medical care and reimburse you for your necessary transportation
expenses at the rate of 0.56 cents per mile. If you receive any medical bills, please send them to us.
You are entitled to a change of physician after 30 days from the date you reported your injury unless,
prior to your injury, you had a notation in your personnel file that you would like to be treated by your
personal physician. “Personal Physician” means a DULY LICENSED PHYSICIAN OR SURGEON
who has previously directed your medical treatment and who retains your medical history and records.
Should you desire to be treated by your personal physician, please inform us of the doctor's name,
address and phone number. Once we have established communication with your physician, he/she
will be notified of the reporting requirements of an employee-selected physician for Workers’
Compensation claims.
There may be other benefits to which you are entitled. In addition, we have enclosed a pamphlet
explaining the benefits you may be entitled to receive under workers’ compensation. Please feel free to
contact me at (805) 389-4224 to discuss your claim.
Enc: Benefit Pamphiet
Mileage Form
ee
A CorVel Corporation P.O. Box 5166 805.369.4200 phone
www.corvel.com Oxnard, CA 93031 805.389.4231 fax
865,785,2835
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EXHIBIT “8”
@# CORVEL
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July 28, 2016
NOTICE REGARDING TEMPORARY DISABILITY BENEFITS PAYMENT TERMINATION
CorVel Corporation is handling your workers' compensation claim on behalf of the County of Santa Barbara.
This notice is to advise you of the status of disability benefits for your workers' compensation injury on the
date shown above.
f you disagree with the results of the evaluation of the treating physician, you may obtain
an evaluation by a Qualified Medical Evaluator (QME).
If you are represented, you may contact your attorney with any questions.
Additional information may be found in the publication Workers’ Compensation in California: A
Guidebook for Injured Workers. A complete copy of the Guidebook may be obtained on the Division of
Workers’ Compensation website (see URL below) or by contacting an Information and Assistance (I&A)
Officer of the Division of Workers’ Compensation.
Guidebook for Injured Workers:
hettp://www.dir.ca.gov/InjuredWorkerGuidebook/Injured WorkerGu idebook.html
Temporary Disability is discussed in chapter 5 of the Guidebook.
Chapter 5; Temporary Disability: http:// w.dir.ca.gov/InjuredWorkerGuidebook/Chapter5.pdf
Chapter 4: Resolving Problems with Med: al Care & Medical Reports
http://www.dir.ca.gov/InjuredWorkerGuidebook/Chapter4.pdf
CorVel Corporation | PO Box $166 | Oxnard,GA 93031 | p 805.389.4200 | 805.389.4231
CQRVEL
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September 24, 2015
Notice Regarding Ending of 4850 Benefits
Dear Kathy Gardner Torres:
CorVel Corporation is handling your Workers’ Compensation claim for the above captioned
injury on behalf of the County of Santa Barbara. This notice is to advise you of the status of
salary continuation payments under Labor Code 4850 for your Workers’ Compensation injury
to your left heel.
These benefits will not continue as you have reached your maximum 4850 benefits due.
The State of California requires that you be given the following information:
You have a right to disagree with decisions affecting your claim. If you have any questions
regarding the information provided to you in this notice, please call: Sheryl Pedersen at
(805)389-4224. However, if you are represented by an attorney, you should call your
attorney, not the claims adjuster. If you want further information on your rights to benefits or
disagree with our decision, you may contact your local state Information & Assistance Office
of the Division of Workers’ Compensation by calling (805)485-2533.
For recorded information and a list of offices, call (800)736-7401. You may also visit the DWC
website at: http:/Awww.dir.ca.gov/DWC/dwe home _page.htm
A CorVel Corporation P.O, Box 5186 805.389.4200 phone
wrew.corval.com Oxnard, CA 93031 805.980.4281 fox
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EXHIBIT “9”
Memorandum
Date: September 19, 2017 uy
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EXHIBIT “10”
Stare of Califorato ST Estado de Colffornin
Departnent of fadustriol Relations qparicimeinocle Relacloues Unbrsir’
DIVISION OF WORKERS" COMPENSATION a DIVISION, oe ‘COMP ENSACIONAL TRA BAJADOR
WORKERS’ COMPENSATION CLAIM FORM (DWC 1) 8 “ah
fi ?y PETITION DEL EMPLEADO PARA DE COMPENSACION
TRABAJADOR (DWC 1)
DEI,
Employee: Complelo the "Employes" section and give the Zorn to your Eupieator Complete ta secciin “Emplendo™ y untregue fa forma a su
omployer, Keep i copy aud mack i Employee's Temporary Recelpt" until emgleador, Quédese con ta copia destgnada “Reclbe ‘Teinpornt del
you reenive the signed and deted copy from your employer. You may cat the Enipleaito" hasta yiva'Ud. rectba ta copia frwade y feokaie de sw anplecctor.
Division of Workers’ Compensation nad hear recorded fnformation at (800) Ud, pide Hamar a is Division de Compensacisn a Trabafador a (880) 736-
736-7401, An explanation of workers! compensation benefits fs fncloded fn 7401 pare clr iujormacion gcamada, Una explicacisir de. los benfcios de
ie Notice of Potential Eligibitity, which is the cover sheet of thts form, compensacién de tratinjawtores esth Inchitto ute Nosfcdeidn ce Pasible
Elegibtidad, que ex la aja de porta de esta foria. Separe y gutzde esta
Detnch and save this notice fis future reference. nolfficactén eario referencia parcel fannro,
‘You should alse. havo reteived @ pamphlet from your oinployor déscribing
workers’ compass n benefits and the procedures.to abiain tham, You may Ud tainbidn dederio haber recibtes de su enpleidor wi folleto dexeribtends
Jos benficlas de compensacién al trabijador teslonauo 9 los procectinkintor
receive written notices from your employer or its claims administrator about pare obienerios, is posible que recita naritcaciohes excites de su
your etsim, f your claims rdministrator offers to send you notices einpleador 0 de su ocintuistrador de reclamor sobre 0 reclaswns, i
Cicetronically, and yeu agree to receive thes notices only by email, please achahitstradior de.rectwuros ofrece enviarle nviificactones tectrdulcamente, ) ,
provide your tanail adkiress below und check the appropriate box, If you later usted acepta recibir astas notificaciones sole par correo sleciréuico,
decitle you watt to receive the notices by mail, you must informs your Savor proporcioin su dlreeoién de correa elenirénleo abajo y marque to caf
ployee Inawrting.
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Preview
ELECTRONICALLY FILED Superior Court of California County of Santa Barbara McNICHOLAS & McNICHOLAS, LLP Darrel E. Parker, Executive Officer Matthew S. McNicholas, State Bar No. 190249 5/24/2023 6:35 PM Loren Nizinski, State Bar No. 144345 By: Narzralli Baksh , Deputy 10866 Wilshire Blvd., Suite 1400 Los Angeles, California 90024 Tel: (310) 474-1582 Fax: (310) 475-7871 Attorneys for Plaintiff KATHY TORRES -PUBLIC REDACTS- materials from conditionally sealed record SUPERIOR COURT FOR THE STATE OF CALIFORNIA COUNTY OF SANTA BARBARA 10 11 12 KATHY TORRES, CASE NO.: 21CV02933 (Assigned for all purposes to Hon. Thomas P. 13 Plaintiff, Anderle, Dept. 3) 14 Vv. PLAINTIFF’S EVIDENCE IN SUPPORT OF 15 PLAINTIFF’S OPPOSITION TO COUNTY OF SANTA BARBARA, a DEFENDANT COUNTY OF SANTA 16 government entity; SANTA BARBARA BARBARA’S MOTION FOR SUMMARY COUNTY SHERIFF’S DEPARTMENT, a JUDGMENT OR IN THE ALTERNATIVE, 17 government entity; and DOES | through 100, SUMMARY ADJUDICATION inclusive, 18 [Filed concurrently with Plaint 's Opposition; 19 Separate Statement in Opposition; Request for Defendants. Judicial Notice] 20 Date: June 7, 2023 21 Time: 10:00 am Dept.: 3 22 23 Trial Date: October 4, 2023 Complaint Filed: July 23, 2021 24 25 -PUBLIC REDACTS- 26 materials from conditionally sealed record 27 28 1 PLAINTIFF’S EVIDENCE IN SUPPORT OF PLAINTIFF’S OPPOSITION TO THE HONORABLE COURT, ALL PARTIES, AND THEIR ATTORNEYS OF RECORD Plaintiff Kathy Torres (“Plaintiff’ or “Torres”) submits the following Evidence in Opposition to Defendant’s Motion for Summary Judgment or, in the Alternative, Summary Adjudication. INDEX OF PLAINTIFF’S EVIDENCE DECLARATION OF KATHY TORRES 7 10 11 12 ee : 3 13 14 15 = 16 17 ee 18 19 ee 20 21 a 22 Exhibit 10 - a 23 2 25 26 a. 27 28 PLAINTIFF’S EVIDENCE IN SUPPORT OF PLAINTIFF’S OPPOSITION DECLARATION OF SUSAN JERICH DECLARATION OF KEVIN DALY REQUEST FOR JUDICIAL NOTICE Exhibit 16 — Preliminary Hearing Transcript from People v. Kathy Carmen Bass Torres Case No.: 18CR0946 dated October 22, 2020. (See concurrently filed Request for Judicial Notice.) DECLARATION OF LOREN NIZINSKI Exhibit 17 — Loren Nizinski took the deposition of Commander Ryan Sullivan on March 1, 2023, Attached are relevant excerpts of the deposition transcript. 10 Exhibit 18 — Loren Nizinski took the deposition of Sarah Allison on March 9, 2023 11 Attached are relevant excerpts of the deposition transcript. 12 Exhibit 19 - Loren Nizinski took the deposition of Chief Vincent Wasilewski on March 15, 13 2023, Attached are relevant excerpts of the deposition transcript. 14 Exhibit 20 - Loren Nizinski took the deposition of Matt Harvill on March 31, 2023. 15 Attached are relevant excerpts of the deposition transcript. 16 Exhibit 21- Loren Nizinski took the deposition of Commander James Meter on April 1, 17 2023. Attached are relevant excerpts of the deposition transcript. 18 Exhibit 22 - Loren Nizinski took the deposition of Stuart Hutchinson, M.D. dated May 17, 19 2023.Attached are relevant excerpts of the deposition transcript. Also attached are the following 20 Exhibits to the Deposition of Dr. Hutchinson. 21 Deposition Exhibit 17 - 22 23 ee 24 Dated: May 24, 2023 McNICHOLAS & McNICHOLAS, LLP py. RA Mg 25 26 Matthew S. McNicholas 27 Loren Nizinski Attorneys for Plaintiff 28 KATHY TORRES 3 PLAINTIFF’S EVIDENCE IN SUPPORT OF PLAINTIFF’S OPPOSITION DECLARATION OF KATHY TORRES DECLARATION OF K. Ty ORRES Iam a competent adult over the age of eighteen years old. I am the Plaintiff in the above 3 aptioned matter. The facts set forth in this document are based on my personal knowledge except for those that I have stated are based on information and belief. If called upon to testify as a witness to these facts, I reasonably believe I could and would competently render testimony. This Declaration is made in support of my Opposition to Defendant’s Motion for Summary 7| Judgment or Summary Adjudication. 8] 1 a: Santa Barbara County Sheriff's Department (SBSD) 9| hired me as a Custody Deputy. At the time I was hired I was known as Kathy Gardner. In 10 November 2012, I got married and changed my name to Kathy Torres. Prior to working for 11 SBSD, I worked for the County of Ventura as a Sheriff's Service Technician (correction officer) 12 for eight (8) years. 9 13 2 On or about November 20, 2010, I injured my back at work while I was assisting 14 another deputy walking an inmate back to housing when the inmate turned on us as we were 15 entering the elevator and a struggle occurred to get control of him. Pursuant to SBSD policy and 16 17 18 19 20 21 3 Shortly after I submitted ee 22 23 24 25 4 Around that time, I was referred to Sansum occupational health clinic for medical 26 treatment for the pain I was experiencing in my back that was shooting down my legs as well. I Bi began to treat conservatively but my back was not improving. I was then sent to Dr. Hutchinson, 28 an orthopedic surgeon, for additional evaluation and treatment. Dr Hutchinson diagnosed me 1 DECLARATION OF KATHY TORRES with a herniated disc, and | underwent surgery to my lumbar spine on March 2 2011. Lwas off work after the surgery until sometime in December of 2012. I continued to treat with Dr. Hutchinson after I returned to work. During the time I was off work, ee 6 5 On or about March 20, 2014, I began to feel pain in my left heel from continuous standing and walking on concrete floors in my work shoes. Since the pain did not go away, | 9 10 11 12 14 15 16 6 Dr. Andrew Samuels, a Podiatrist, was the treatir physician for my heel injury. | 17, underwent plantar fascial rele: surgery to my left foot sometime around December of 2014 | 18 After the surgery | experienced complications associated with the surgery and switched podiatrist 19 to Dr. Leslie Levy, who indicated I had nerve damage from the surgery. 20 7 While I was out on disability for my heel injury, 21 22 23 24 8 During the time I was out on disability for my heel injury, the pain in my back got 25 worse. Dr. Hutchinson then performed a second surgery to my lumbar spine on November 16, 26| 2015. I returned to work in or around July 2016. I continued to treat with Dr. Hutchinson after I 27 returned to work and would see him a few times a year. Dr. Hutchinson would prescribe physical 28 therapy, aquatic therapy, and pain management with Dr. Kenly. 2 DECLARATION OF KATHY TORRES 9. On September 19, 2017, I was working at the Santa Barbara County jail facility. On that date I was conducting a security check when some inmates flagged me. As | opened the door to talk to the inmate, I saw a fellow custody deputy, Richard Vargas walking through the hallway, he looked as if he was in a hurry. As Vargas passed by me his backpack brushed against her lower back, catching my cuffs and pulling me to the left a little bit. Approximately 10 minutes later I felt some increased pain in my already injured back. I did not seek medical attention at that time. Pursuant to SBSD policy 10 10. Unfortunately, the pain in my back did not improve so on September 26, 2017, I ll used my own health insurance and went to Dignity Health Medical Group, and saw Dr. Bindhu, 12|| who took me off work until October 1, 2017. I did not request or receive any Labor Code § 4850 13 or Workers’ Compensation temporary disability benefits but instead used my own sick time 14 during this period, since it was my belief that the incident of September 19, 2017, did not cause a 15 new injury, but was a flare up of my November 23, 2010 injury. 16 Ths On September 27, 2017, I had an appointment that had been scheduled prior to the 17| September 19, 2017, incident at work with my orthopedic surgeon Dr. Hutchinson, who | was 18 v9 still under care for my November 23, 2010, back injury. At that time, I told Dr. Hutchinson that I had a flare up of my 2010 back injury. Dr. Hutchinson continued to treat me for my November 0} 23, 2010, injury until approximately February 2018. I also continued to see Dr. Kenly, the pain 21 management specialist Dr. Hutchinson recommended. 22| 12. On November 8, 2017, I was summoned into Lt, Sullivan’s office, Both he and 23) Lt. Espinoza were in the office. Lt. Sullivan told me that he had spoken to Sarah Allison at 4) human resourees and that she had said to him hat as 25) ee later discovered that this was not 26 true. I did not understand why I needed to fill out a HD ccause I was not making a new 27 claim, since the incident of September 19, 2017, a flare up of my already existing November 23, 28 2010, back injury. Also, I was treating with Dr. Hutchinson under the November 23, 2010, claim 3 — DECLARATION OF KATHY TORRES for which I had lifetime medical treatment for my back, and I was not seeking any new Workers’ Compensation Benefits. 13. Lt. Sullivan handed me the oom and said I needed to fill it out. Since he was my Lieutenant, I took this as an order and felt I had no other choice. Although I filled out 5 ine MEE cic not signi, mms 8 9 10 14. The following week, on or about November 16, 2017, I received a phone call from 11 Kathie Stumpf at CorVel. She was calling to discuss the “new” claim since she had received the 12 November 9, 2017, DWC-1 for the September 19, 2017, incident. I explained to Ms. Stumpf that I never had any intent to file a new claim since this was a flare up of my November 23, 2010, 14 injury that I was still receiving treatment for. She then scent mc gqamieleaimmmmmieleeenieieesiens 15 mailed back to her, however she apparently did not receive it, so he 16 17 18 19 15 On February 7, 2018, Dr. Levy, the Podiatrist took me off work for my heel 20 injury. I then went to Human Resources and spoke with Sarah Allison to provide her with Dr. 21 Levy’s note for time off relating to my heel injury. I also provided Ms. Allison with a note from 22 Dr. Hutchinson for my back injury since he was giving me work restrictions. I explained to Ms. Allison at that time that I did not intend to file a new workers’ compensation claim and that the 24 September 19, 2017, incident had aggravated my back injury from November 23, 2010, it was 25 not a new injury. 26 16. On March 28, 2018, while I was off work on disability, | received a phone call 27 from District Attorney Investigator Matthew Harvill Mr. Harvill began questioning me about 28 the September 19, 2017, incident. It was not until about 10 minutes into our conversation that he po per 4 DECLARATION OF KATHY TORRES told me that | was being investigated for Workers’ Compensation Fraud for making a False Workers’ Compensation claim. He accused me of receiving medical treatment and workers’ compensation benefits as a result of the September 19, 2017, incident. I explained to him that I had not received any benefits, and the medical treatment I was receiving was because of my > November 23, 2010 injury. I further explained that I had no intention of pursuing a claim for the September 19, 2017, incident. That was the first time I discovered that I was being investigated for workers’ compensation fraud. I was shocked because I had legitimately injured my back on 8 November 23, 2010 resulting in two back surgeries. At no time prior to this date did anyone say 9 I was committing fraud. 10 17. On May 6, 2018, Dr. Levy released me to return to work. Eleven days later on 11 12 14 15 16 17 18 18. My attorney informed me that a Criminal Complaint alleging 5 counts of Workers 19 Compensation Fraud was also filed against me on May 16, 2018, in Santa Barbara County 20 Superior Court. The Criminal Complaint w based primarily on the Hi 21 22 22 even though I did not want to, and which I told the Kathie Stumpf at CorVel I was not purst 25 23 nor ever wanted to pursue, when I first spoke to her a week later on November 16, 2017. 24 Because of the criminal filing I was forced to retain the services of a criminal defense attorney. The Deputy Sheriff's Association (my union) informed me that the Legal Defense Fund did not 26 cover alleged Workers’ Compensation Crimes. In order to pay for my defense, I had to borrow 27 money from my family. 28 3 DECLARATION OF KATHY TORRES 19. a i: waiting for the preliminary hearing I retired from the SBSD. I did not want to retire; however, the stress of the continued harassment, discrimination 3 and retaliation, and the stress of the criminal proceedings made it impossible for me to continue to work for SBSD. Also, the Santa Barbara District Attorney’s office led me to believe that if] retired, the criminal charges against me would be dismissed. As the preliminary hearing date 6 approached, | discovered that the District Attorney’s office was not going to dismiss the charges and we would have to move forward with the preliminary hearing. Had I known that the District Attorney would not dismiss the charges, | would not have retired. 20. The matter went to a preliminary hearing on October 22, 2020, before The 10 Honorable Judge Thomas Adams. At the end of the hearing and presentation of the prosecutor’s 11 case, Judge Adams dismissed all of the charges against me and stated that there was “a woeful 12 lack of evidence” to indicate that I had committed any criminal violation. It was at that time that 13 T also found out that Lt. Sullivan had lied to me about Ms. Allison needing me to fill out a i | 14 Hs. Allison testified at the preliminary hearing that a DWC-1 form was not required and 15 that it was up to the employee if they wanted to make a claim or not. 16 21. At the time the matter went to a preliminary hearing, on October 22, 2020, == 17 I continued to treat with Dr 18 Kenly, the pain management doctor the entire time up until sometime in or about of March 2022 19 when I settled out the future medical aspect of my 2010 Workers’ Compensation claim to my 20 back as well as the 2014 continuous trauma claim to my foot/heel for a lump sum buyout. At no 21 time did CorVel ever question my injuries. In fact, during this time, Dr. Kenly was authorized 22 22 and approved to perform two rhizotomies, an outpatient surgical procedure to remove nerve 23 fibers responsible for sending pain signals to the brain. 24 22 Despite Judge Adams’ findings and opinion that there was no evidence, {i 25 25 26 27 28 6 DECLARATION OF KATHY TORRES work not be able to find any work at any other law enforcement agency, and my ability to security for a private company would bc limited since ee 23 i 24, 10 1} 12 13 I declare under penalty of perjury ler the laws of thi atc of California that the 14 foregoing is truc and correct. Executed this 24th day of May 2023 ai t Oxnard, California 15]| 2 16) Kath C 14.5 7 Terre: Orr isoyem 7a 6sa1 FO esas 17 Kathy Torres 18 19] 20)| 21 22 ax 23 24 <| 25 1 a — - DECLARATION OF KATHY TORRES EXHIBIT “1” Memorandum Date: November 23, 2010 S35eZ HERTS a SHaN We Si y A ee if EAS BAR’ a = i) cc. \sbe shf.ccldfs$\Userstkeg4160\Documents\PersonalGardner hurt knee doc EXHIBIT “2” State of California Gi ae Department of Industrial Relations is 2\ Estado de California (Sosa aA Departamento de Relacion es Endustriales DIVISION OF WORKERS' COMPENSATION DIVISION DE Cc 'OMPENSACION AL TRABAJADOR 4 WORKERS’ COMP N SATION CLAIM FORM (DWC 1) any PETITION DEL EMPLEADO PARA DE COMPENSACI( DEL TRABAJADOR (DWC 1) Employee: Complete the “Employee” section and give the form to Empleado: Complete la ccién “Empleado” y eutregue la forma a sit your employer. Keep a copy and mark it “Employ “s Temporary Receipt” until you receive the signed and duted copy from your er empleador, Quédese con copia designada “Recibo Temporal del ployer. You may call the Division of Workers’ Compensation and Empleado” hasta que Ud. rei iba la copia firmada y fechala de su empleador. hear recorded information at (800) 736-7401. An explanation of work- Ud. puede llamar a la Division de Compensaci al Trabajador al (800) 736- ers‘ compensation benefits is included as the cover sheet of this form. 7401 para oir informacién gravada. En la hoja cubierta de esta forma esta la explication de los bi eficios de compensacion al trabajador. You should also have received a pamphiet from your employer de- scribing workers’ compensation benefits and the procedures to obtain Ud. también deberia haber recibido de su empleador un folleto describiendo los them, benficios de compensacién al trabajador lesionedo y los procedimientos para obtenerlos. NB Te On ost iask Ooh Ped Pode aes ENC TTS REET a TET OL ooo EG TICS ay On see CMC et tect a meee Bees reset re tm Ce TENG ate ou bree tM yo ora tat DEE OMe ie tr S| TS Ty DCCL TM og on Cee Cornu eTente Coa ato PS aie a stolen ni A ouee tiem art pt Gee Lo ED PATE IE OT Ny TESTE Ke Kaa eure Reg eneA pomer ts Cotten employer: You sre required to date th s form and provide copies to Empleador: Se requiere que Ud. feche esta forma y que provéa copias a su com- your insurer or claims administrator and to the employee, dependent or representative who filed the claim within one working day of paiita de seguros, adm rador de reclantos, o dependientelrepresentante de recla- mos y al empleado que hayan presentado esta peticin dentro del, pla de un dia reccipt of the form from the employee, hidbil desde el momento de haber sido recibida (a forma del empleacio. SIGNING THIS FORM IS NOT AN ADMISSION OF LIABILITY EL FIRMAR ESTA FORMA NO SIGNIFICA ADMISION DE RESPONSABILIDAD OQ Employer copy/Copia det Empleudor O Employ -opy! Copia del Empleado 1 Clims Administeator/tci suraclor dle Reclamos D Temporary ReceipRecibo del Empleada 6/10 Rev. EXHIBIT “3” CORVEL —serertnmmrmeceE December 06, 2010 Notice of Acceptance of Workers’ Compensation Claim and Notice Regarding 485i nefits Dear Kathy Gardner: Please be advised that | will be handling your accepted Workers’ Compensation claim for the above captioned injury on behalf of your employer. We would like to explain some of the benefits to which you are entitled under the Workers’ Compensation system: 1 Payments of temporary disability are made every day of a seven-day week while you are unable to work because of your injury. Your temporary disability will be paid in accordance with Labor Code 4850, which provides full salary for one year while you are disabled due to your work related injury. We will pay for all necessary medical care and reimburse you for your necessary transportation expenses at the rate of 50 cents per mile. If you receive any medical bills, please send them to us. You are entitled to a change of physician after 30 days from the date you reported your injury unless, prior to your injury, you had a notation in your personnel file that you would like to be treated by your personal physician. “Personal Physician” means a DULY LICENSED PHYSICIAN OR SURGEON who has previously directed your medical treatment and who retains your medical history and records. Should you desire to be treated by your personal physician, please inform us of the doctor’s name, address and phone number. Once we have established communication with your physician, he/she will be notified of the reporting requirements of an employee-selected physician for Workers’ Compensation claims. There may be other benefits to which you are entitled. In addition, we have enclosed a pamphlet explaining the benefits you may be entitled to receive under workers’ compensation. Please feel free to contact me at (805) 389-4224 to discuss your claim. Ene: Benefit Pamphlet Mileage Form Med Release Auth EE Statement ee A CorVel Corporation P.O. Box 5166 806.389.4200 phone vaww.corvelcom Oxnard, CA 93034 805.389.4231 fax 866.785.2835 EXHIBIT “4” on ~ 3OR VE a SrneremmaNT — You may lose important rights ifyou do not take certain actions wit! hin 10 days. i Bead this letter and a ny Snnlosed fact sheets very. carefully. | bac! ais ead - ~ wa February 3, 2012 Notice Regarding Actual 4850 Benefits a CorVel Corporation is handling your Workers’ Compensation claim for the above captioned injury on behalf of the County of Santa Barbara. ne ee ee evaluation, you may obtain an evaluation by a Qualified Medical Evaluator obtained from a panel issued by the DWC Medical Unit. Attached is a form with which you may request assignment of a panel of Qualified Medical Evaluators. You have 10 days to request the panel. Once you have received the panel, you have 10 days to make the appointment. The State of California requires that you be given the following Information: A GorVel Corporation P.O. Box 6166 805.389.4200 phone ww.corvel.com ‘Oxnard, CA 93031 806.389.4231 fax 866.785,2835 RT ON SE SS EST ETNA TS IS FNS TELS TET You have a right to disagree with decisions affecting your claim. If you have any questions regarding the information provided to you in this notice, please call: Olayemi Olatunji at (805) 389-4224. However, if you are represented by an attorney, you should call your attorney, not the claims adjuster. If you want further information on your rights to benefits or disagree with our decision, you may contact your local state Information & Assistance Office of the Division of Workers’ Compensation by calling (805) 485-3528. For recorded information and a list of offices, call (800) 736-7401. You may also visit the DWC website at: htto:/Avww.dir.ca.gow/DWC/dwe_home_page.htm You also have a right to consult with an attorney of your choice. Should you decide to be represented by an attorney, you may or may not receive a larger award, but, unless you are determined to be ineligible for an award, the attorney's fee will be deducted from any award you might receive for disability benefits. The decision to be represented by an attorney is yours to make, but it is voluntary and may not be necessary for you to receive your benefits. WARNING: You are required to report to your employer or the insurance company any money that you earned for work during the time covered by this check, and before cashing this check. If you do not follow these rules, you may be in violation of the law and the penalty may be jail or prison, a fine, and loss of benefits. ADVERTENCIA: Es necesario que usted Je avise a su patrén o a su comparila de seguro todo dinero que usted ha ganado por trabajar, durante el tiempo cubierto por éste cheque, y antes de cambiar éste cheque. Si usted no sigue estos reglamentos, Usted puede estar en violacion de la ley y el castigo podria ser carcel o prisién, una multa, y pérdida de beneficios. To resolve a dispute, you may apply to the Workers’ Compensation Appeals Board. Enc.: TD Fact Sheet QME Fact Sheet PQME Request Form 105 & Attachment QME Waiver oo EVEL mc — ———— ee ~ ~ ~ You may lose important rights if you do not take certain actions within 10 days. Read this letter and any enclosed fact sheets very carefully. Le. a ———____. _ —————— December 05, 2012 NOTICE REGARDING TEMPORARY DISABILITY BENEFITS PAYMENT TERMINATION CorVel Corporation is handling your workers' compensation claim on behalf of the County of Santa Barbara PWC. This notice is to advise you of the status of disability benefits for your workers' compensation injury on the date shown above. if you are unrepresented, and have not received a comprehensive medical evaluation, you may obtain an evaluation by a Qualified Medical Evaluator obtained from a panel issued by the DWC. Medical Unit. Attached is a form with which you may request assignment of a panel of Qualified Medical Evaluators. You have 10 days to request the panel. Once you have received the panel, you have 10 days to make the appointment. GorVel Corporation P.O. Box 6186 805.389.4200 phone www.CorVel.com Omard, CA 93031 805.389.4231 fax 868.785.2835 —_— EXHIBIT “5” State of Califomin p Estado de California Department of Indust Relations Departamento de Relaciones Industriates DIVISION OF WORKERS' COMPENSA’ 2 DIVISION DE COMPENSACION AL TRABAJADOR ry WORKERS’ COMPENSATION CLAIM FORM (DWC 1) Sais or PETITION DEL EMPLEADO PARA DE COMP. ACTON DEL TRABAJADOR (DWC 1) Employee; Complete the “Employee” secti and give the form to Empleado: Complete la seccién “Empleado” y entregue la forma a su your employer. Keep a copy and mark it “Employee’s Temporary empleadar, Quédese con la copia designada “Recibo Temporal del Receipt” until you receive the igned and dated copy fr m your em- ployer. You may call the Di ion of Workers’ Compensation and Empleado” hasta que Ud. reciba la copia firmada y fechada de su empleador, hear recorded information at (800) 736-7401. n explanation of work- Ud. puede lamar a la Division de Compensaci al Trabajador al (800) 736- ers' compensation benefits is includedus the cover sheet of this form. 7401 para oir informacién gravada. En la hoja cubierta de esta Jorma esta ta expli ation de los beneficios de compensacién al rabajador. You should also have received a pamphlet from your employer de- scribing workers’ compensation benefits and the procedures to obtain Ud. también deberia haber recibido de sn empleador un folleto describiendo los them, benficios de contpensacién al trabajador lesionada y los procedimientos para obtenerlos. Cp Se Or ce reer Os Copa ees BOER COD HM Toner Lies ma (TL | DOS COM ET Re So TSN Dee) CUBIC Dune eon aes eore) Maes mec ue Ce Rrra ener ria OREO PEO Reece RRA Co aOR eta eo R oem aes en Tat oe eens a tere era rm ter Steerer t ors) ete eee Ree ok USOT Oke a ri GLa ar btn heer aha to Cntran Employer: You are required to date this form and provide copies ta Empleador: So requiere que Ud. feche esta forma y que provéa copias a su con- your insurer or claims administrator and to the employee, dependent paiita dle seguros, acministrador de reclames, o de dientelrepresentante de ré la- or representative who filed the cluim within one working day of mos y al enpleado que hayan presentado esta peticién dentro del plazo de un receipt of the form from the employee. hidhil desde el momento de haber s ido recibida la forma del enppleado. SIGNING THIS FORM IS NOT ADMISSION OF LIABILITY EL FIRMAR ESTA FORMA NO SIGNIFICA ADMISION DE RESPONSABILIDAD O Employer copy/Copt det Empleudlor Oem ve copy/ Copla det Empleado O ctoims Administrmorfeictuintsiractor de Reetamos O Temporary ReceipuRecibe det Empteada 6/10 Rev. EXHIBIT “6” Memorandum Date: April 12, 2014 F SD <= Spe RIES Pz ee Say a qi! y ARB = 7 C:AUsors\lde2964AppDatelLocal\Microsoft\Windows\Temporary Internet Files\Content, Outlook\ELOFB379\04121 4Ltheolpain.doc EXHIBIT “7” OQ R an nrorstesenisenenen— September 19, 2014 Notice of Acceptance of Workers’ Compensation Claim and 4850 Benefits Dear Kathy Gardner Torres: Please be advised that | will be handling your Workers’ Compensation claim for the above captioned injury on behalf of your employer. We would like to explain some of the benefits to which you are entitled under the Workers’ Compensation system: 1 Payments of temporary disability are made every day of a seven-day week while you are unable to work because of your injury. Your temporary disability will be paid in accordance with Labor Code 4850, which provides full salary for one year while you are disabled due to your work related injury. We will pay for all necessary medical care and reimburse you for your necessary transportation expenses at the rate of 0.56 cents per mile. If you receive any medical bills, please send them to us. You are entitled to a change of physician after 30 days from the date you reported your injury unless, prior to your injury, you had a notation in your personnel file that you would like to be treated by your personal physician. “Personal Physician” means a DULY LICENSED PHYSICIAN OR SURGEON who has previously directed your medical treatment and who retains your medical history and records. Should you desire to be treated by your personal physician, please inform us of the doctor's name, address and phone number. Once we have established communication with your physician, he/she will be notified of the reporting requirements of an employee-selected physician for Workers’ Compensation claims. There may be other benefits to which you are entitled. In addition, we have enclosed a pamphlet explaining the benefits you may be entitled to receive under workers’ compensation. Please feel free to contact me at (805) 389-4224 to discuss your claim. Enc: Benefit Pamphiet Mileage Form ee A CorVel Corporation P.O. Box 5166 805.369.4200 phone www.corvel.com Oxnard, CA 93031 805.389.4231 fax 865,785,2835 (rn eae eae EXHIBIT “8” @# CORVEL tae g4 July 28, 2016 NOTICE REGARDING TEMPORARY DISABILITY BENEFITS PAYMENT TERMINATION CorVel Corporation is handling your workers' compensation claim on behalf of the County of Santa Barbara. This notice is to advise you of the status of disability benefits for your workers' compensation injury on the date shown above. f you disagree with the results of the evaluation of the treating physician, you may obtain an evaluation by a Qualified Medical Evaluator (QME). If you are represented, you may contact your attorney with any questions. Additional information may be found in the publication Workers’ Compensation in California: A Guidebook for Injured Workers. A complete copy of the Guidebook may be obtained on the Division of Workers’ Compensation website (see URL below) or by contacting an Information and Assistance (I&A) Officer of the Division of Workers’ Compensation. Guidebook for Injured Workers: hettp://www.dir.ca.gov/InjuredWorkerGuidebook/Injured WorkerGu idebook.html Temporary Disability is discussed in chapter 5 of the Guidebook. Chapter 5; Temporary Disability: http:// w.dir.ca.gov/InjuredWorkerGuidebook/Chapter5.pdf Chapter 4: Resolving Problems with Med: al Care & Medical Reports http://www.dir.ca.gov/InjuredWorkerGuidebook/Chapter4.pdf CorVel Corporation | PO Box $166 | Oxnard,GA 93031 | p 805.389.4200 | 805.389.4231 CQRVEL ~scne ws te September 24, 2015 Notice Regarding Ending of 4850 Benefits Dear Kathy Gardner Torres: CorVel Corporation is handling your Workers’ Compensation claim for the above captioned injury on behalf of the County of Santa Barbara. This notice is to advise you of the status of salary continuation payments under Labor Code 4850 for your Workers’ Compensation injury to your left heel. These benefits will not continue as you have reached your maximum 4850 benefits due. The State of California requires that you be given the following information: You have a right to disagree with decisions affecting your claim. If you have any questions regarding the information provided to you in this notice, please call: Sheryl Pedersen at (805)389-4224. However, if you are represented by an attorney, you should call your attorney, not the claims adjuster. If you want further information on your rights to benefits or disagree with our decision, you may contact your local state Information & Assistance Office of the Division of Workers’ Compensation by calling (805)485-2533. For recorded information and a list of offices, call (800)736-7401. You may also visit the DWC website at: http:/Awww.dir.ca.gov/DWC/dwe home _page.htm A CorVel Corporation P.O, Box 5186 805.389.4200 phone wrew.corval.com Oxnard, CA 93031 805.980.4281 fox CE TET LE EI ELT TH TD IP ET APSE LID TR EEE EXHIBIT “9” Memorandum Date: September 19, 2017 uy PSERIES i he Da) y ff < BRO cc: Y ws0r804 sb<.shi,colDO1KEG4 160\Dacumonte\HersoneltVargas091917inctdontexioo EXHIBIT “10” Stare of Califorato ST Estado de Colffornin Departnent of fadustriol Relations qparicimeinocle Relacloues Unbrsir’ DIVISION OF WORKERS" COMPENSATION a DIVISION, oe ‘COMP ENSACIONAL TRA BAJADOR WORKERS’ COMPENSATION CLAIM FORM (DWC 1) 8 “ah fi ?y PETITION DEL EMPLEADO PARA DE COMPENSACION TRABAJADOR (DWC 1) DEI, Employee: Complelo the "Employes" section and give the Zorn to your Eupieator Complete ta secciin “Emplendo™ y untregue fa forma a su omployer, Keep i copy aud mack i Employee's Temporary Recelpt" until emgleador, Quédese con ta copia destgnada “Reclbe ‘Teinpornt del you reenive the signed and deted copy from your employer. You may cat the Enipleaito" hasta yiva'Ud. rectba ta copia frwade y feokaie de sw anplecctor. Division of Workers’ Compensation nad hear recorded fnformation at (800) Ud, pide Hamar a is Division de Compensacisn a Trabafador a (880) 736- 736-7401, An explanation of workers! compensation benefits fs fncloded fn 7401 pare clr iujormacion gcamada, Una explicacisir de. los benfcios de ie Notice of Potential Eligibitity, which is the cover sheet of thts form, compensacién de tratinjawtores esth Inchitto ute Nosfcdeidn ce Pasible Elegibtidad, que ex la aja de porta de esta foria. Separe y gutzde esta Detnch and save this notice fis future reference. nolfficactén eario referencia parcel fannro, ‘You should alse. havo reteived @ pamphlet from your oinployor déscribing workers’ compass n benefits and the procedures.to abiain tham, You may Ud tainbidn dederio haber recibtes de su enpleidor wi folleto dexeribtends Jos benficlas de compensacién al trabijador teslonauo 9 los procectinkintor receive written notices from your employer or its claims administrator about pare obienerios, is posible que recita naritcaciohes excites de su your etsim, f your claims rdministrator offers to send you notices einpleador 0 de su ocintuistrador de reclamor sobre 0 reclaswns, i Cicetronically, and yeu agree to receive thes notices only by email, please achahitstradior de.rectwuros ofrece enviarle nviificactones tectrdulcamente, ) , provide your tanail adkiress below und check the appropriate box, If you later usted acepta recibir astas notificaciones sole par correo sleciréuico, decitle you watt to receive the notices by mail, you must informs your Savor proporcioin su dlreeoién de correa elenirénleo abajo y marque to caf ployee Inawrting. ica, Si sted wscide despirds gnu quiere reelétr las nolifleacioes po cnet inte be de tr samp poreszr ata i f rua aba ne CURD a iki eres UK ie Meter vas enter coy Kt ny eo RUNVOPSOEE ona ats core rita Mor CONST aaa oaRenT yes rs Neer a nas ea Cents yen