Colbeth, John (Metropolitan Council) �� Metropolitan Council
�� October 3, 2012
Risk Management
City Of St Paul ���'�"`�.'hq '
City Clerk Q�;� (j � � �:.,
15 W Kellogg Blvd
310 City Hall '��'�;"`«` v�; .. ,,
St Paul MN 5102
RE: Worker's Compensation Claim for JOHN W COLBETH
Your Dept: St. Paul Regional Water Svcs
Your Vehicle: 2009 STRG. MN Plate 930320
Your Driver: Robert Hamm
Our Claim Number: 2012-00963-0001
D/L: 6/18/2012
Dear Sir or Madame,
As a result of the above-captioned accident, benefits have been paid under the provisions
of the Minnesota Workers Compensation Act for injuries sustained by our driver, an
employee of Metro Transit. Your insured was responsible for our driver's injuries.
To date we have paid $273.49 in wage loss benefits. We have not yet processed any
medical payments. He has returned to work and is no longer treating.
This letter's purpose is to put you on notice of intent to pursue reimbursement for the
workers' compensation benefits paid to or on behalf of our injured employee. We will
provide you with further information once the medical bills have been paid.
Sincerely,
�����
Becky Dingley
Claims Representative
(651) 602-1782
Enc
SUBROREQ.DOC
ww�v.metrocouncil.org
390 Robert Street North • St. Paul, MN 55101-1805 • (651) 602-1000 • Faac(651) 602-1771 • TTY(651) 291-0904
Ari Gqual Opportunity Employer