Document 2jGMGkGx3eR54DRRN5EgoYXbr
FILE NAME: Fluor (FLU) DATE: 1966 DOC#: FLU001 DOCUMENT DESCRIPTION: Worker's Compensation Docket
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itatb nr California INDUSTRIAL ACCIDENT COMMISSION
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APPLICATION
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CASE NO.
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V A B IO U S - sr.g ATTACHED
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Jla lO lfly*jC a liX .o m ia------Social Seeucfiy- N o .___ 5.3.2rl?r_4i35----LI
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VARIOU _ ^ _ S EB ATTArtrrn
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Hegel
that
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employed OR.J3.0f,Gtii_lj*lt.Cnuucirll.-tl-- 19-
, .t _______ ya.S.iP(.ulf|3,_Htl II n,u_t,M...O._I_l_4__M__ . _ * ------ 1Ctliforr.i
, __h nittalncd ia/tiey iriiiag out oi and a tlx cour ot i(wemptoyaienc, 1 fell
inh.-ll.Ttinn `n f harmful m ntoriflla____
Ut* I Mil
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4, V n compcniatioa piiJ?--_ i ! o __ 1_ ------ -- ---- - ----------- --in or
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J, Cimiaji it lime cl Injury (J5HXilBUnJ__(3)__ IIIII.I mm TJibull of ptjr wi__ !_
i,.Vi mtjicil tenement mrJtAi----ye11
Vito furniilted ircitirttnt? DC*--J . --D*--COQtO,--r a d lo lt i^
nitittiii ih tintimi tiHiliWhuii . . . mu. titit. me
7, Tb! application 1 died to determine liability fori ,
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*. Temporary duibaity_X___U PirrolncaC liability--X --. ' e.
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. 'ffillinnronn, a /j rtquctttj i/ut * (mi tn3 pita Ir fati or hetrnt w liti turiti It mi.lt triniInf luci rtUtf ci :
I'tcter unire tir \7orknuni Comirnulhn Limi 0/ Cillfornlt.
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' mud .t__l_O,I rJtl.<o1I1I*n.O -- UH11 .California, _JuLy_22a-.1UM0MllC.GJ___
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ATlOtAit'llr:ill| Ak01111MONILliilll /52-2000
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EMPLOYER ` " ' ' / Armstrong Cork Co. v Liberty U Charlotte Sea. Lancaster, l'a . r 8 6 B Insulntion Co. In c. P . 0 . Box 2531 Houston I Texas * Boy C itie s Asbestos C o ., L td . , 251 F irth Avenue Oakland, C alifo rn ia C . F . Braun & Cb. 1000 So. Fremont Avenuo Alhambra, C alifo rn ia
. The Budlong Corporation Crandview Bldg. C o .,' In c .
' 717 North-Highland Los Angeles 38, C a l if .
"...The P h ilip Carey M fg. Co. Lock land C in cin n a ti 5 , Ohio
ilOttb Cos trow Company Corp. 2648 North In te rsta te Portland 12, Oregon Const Insulating Products 2604 Lacey Street . Los Angeles 31, C a lif .
ri ia o p WORKED 1051; 1953-1955; 1961 1953 1948 1950
1947
1950, 1951, 1953, 1957 1953 1956, 1957 1957
Cork In su lation Company, In c . 155 East 44th Street .> l^w York 17, New York
1945
.Lawrence Des_ Laurier Co"7~~ , 11119 South Mariposa 1 Los'Angeles 44; C a lif.
1947
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Fibreboard Paper Products Co. 1709 Montgomery Street
. San F rancisco, C a lifo rn ia
1947, 1948 *-;'
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Fluor Maintenance,'I n c ..' 406 Ward S treo t - llartincz, C a lif,
1955 , : i ' . ,;>
Cay Engineering Corpi' . .. . . . 1955 `
2063 E ast 11th Streot
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j. Los Angolas 23, C a l i f . . 1 !'' '
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Ceorgo C o llin g &'E; Cundcr 1947 - " i*; '
2918 Compton Blvd.
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Cardena9, C a l i f . ' -4\ *j *' ' 1 * ,( Wr* <,,t"1 ' i\t
Tbo In d u stria l In su la to rs ,In c . 1949
p . o . Jlo:t 2601 . ; '
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5521 Avuiour Drive '
Houston, Terrs .
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INSURANCE CARRIER
American K otoris Insurance Corepai
417 Montgomery S Sau F ra n cisco , C
Argonaut Insurat 550 C a lifo r n ia ! San F ra n cisco , < P a c ific Employe:
Insurance C ost 244 Pino S tre e t San F rancioco, `
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Wrier- . , i a s s -
' , EMR.ny--ka`
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` period worked-
> Insulation 6 Asbestos
. Industry Works o f Wo C e lli
' Vacation Trust Fund Wo. 16
200 Guerrero Street
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.V ( Sen Frenclcco, C a l i f . /'
1956, 195
ICircher Asbestos & Rubber Co;
Ho* 66S 3 .
4t p.hoe, nix .59, Ari_z. on, a , . f.,u*
` R . E . Krcaig L C o ., I n c .' * ',
' i 222*4 East 14Ch S tre e t
C in cin n a ti,. Chio >
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1954
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' 1952, 1953
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r .-'Owen S . Leln io
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1957
..'San Jo se Asbestos Co, ..>r
' 1140. Lennon l/ay
San Jo s e , C a lifo rn ia
... , Harold G ..Lorcntzcn Conpany
2257 Market Street
..,v Oakland,' C a lifo rn ia
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1'.L o u is v ille In su la tin g &' . :t
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Supply Co.
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' , 4 816-613 West Main S tree t
.< . ' L o u io v ille 2, Kentucky
1956
1951, 1952 '
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John Manvillc Sales Corp. , ' 22 East 40th S tree t , New York 16, New York
1949,' 1950, 1951, 1952, 1953, 1957
Marine Engineering 4 supply Co. 1947 ' ' . 941 Ease Second str e e t ''Los Angelos, C a lif .
INSWnANCg CATtRTET, '
' In d u s tr ia l Indnmi 350 Sonsomo S tr e e t San F ran cisco , C a l
, ' F ir s t National*Bank B ld g , . Middletown,.Ohio______,_______L
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" Kuldoon Counany, In c, 6557 E ast Shaw Avo. ' Clovis,..
1961, 1962' '
*. Mundet'Cork Corp, 7101 Tor.ncllo Ave,
, North. Eergon, New Je rs e y
/.'N o rth w est In su latin g Co.
. 809 H .E . Lombard'Street
` ' Portland 11, Oregoq
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;M95,3 * . ' ;-t: 't
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1945, 1946 *'
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*: Owens Corning F iberglass Corp. / 1955, 1956', 1957,
i P. O.. Box 901 ,
..i 1950, 1959, I960,
; Toledo. 1, Ohio r ';|. ;t V ;>/, 1961, 1962 -..
Geovgo A. Poore & Co.hY..
906 East Dorothy L n ..
Dayton 19, Ohio - .
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' p la n t Asbesto's Co, ; ' If', ,1300 - 64th S tre o t' ..Emeryville, C alif.' *
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1957
' 1940, 1949,:1950, 3.953, 1954, 1955, L957, 1950, I960,
P a c ific Employers 244 Pine Stree t Sau Fran cisco , Cn
i' : b ' I n d u s t r i a l intimili
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San F rn n cisco , c r
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'l * * ; r.PLOTltt Sorinl::.n Sens C o r p .'o f Illin ois 1010 28 S . Kashington S t . Peoria, Illin o is Standard Asbestos life* & Inculati-:; Co. 410 north C -iv o S tr e e t Kansas C it y , M issouri Luna Stevenson Co. 073 DlacUlin:.'.; S tr e e t CV.icajo, I llin o is Technical Service Co. 730 Mainer ; .v c ,, r..W. A ltucuerruo, L j Mexico J . V . Thorpe Sen , I n c . 1351 Ocean /.venue Em eryville, Californ ia
I'KLIOD WORKED 1957
1947 -,
1951, 1952 1947 1948, 1949, 1950, 1957
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Thorpe T naulticn Company 241 South Votes Avar.ua Lae Angeles 22, C a l i f .
U n iv e rsa l In su la tio n Company 3221 Miheio Ld Load Koala ParL, C a lif .
Ver. .tircdilc;
Co*
5v5 r 'i f t l i S tre e t
Jn-.nclsao,~ Callf.
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Western Asbestos Co. Leu 3784 Rincon Annex San rrav.c3co 1.9, C a l i f .
.'1 1953 I960 ` 1940 1946 1947, 1954, 1956, 1957, 1958, 1960, 1961
K a s t e Fibrous C la ss Produc t$Sg*|949
~ : r r 729 Lr.-ycnt'Srcat--------------- - .
( San F rancisco * 7:, C a l i r .
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. " h itin s Corporation ` 15700 L a tlro p Aver.ua
! Harvey, Illin o is
1945 >
INSURANCE CAtmiEP. 1 V.
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Insurance Fund 3360 Grand Avent Oakland 10, Cali
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law ornees of
SMITH, PARRISH , PAD UCK & C L A N C Y
. . FINANCIA. CNTKM aUtLOINa * ,oa<t4tH ITKItT OAKVAHB.CAUfOIIHI B4*li
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J u l y 2 2 , 1966
; Workmon'o Compensation Apponlo Board t ' | 2.) U I.Taaltcon Stro b t " ' i ' Oakland, C a lifo rn ia
, ' Ro Henry C Pilota v a . V ariauo
IK ': l aUiNCouwt f te: 3
Contiomom
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:s Enolooodhorovrith fin d .o r ig in a l and n ix copioo o f A p p lic a tio n fo r
\ r Honring on b a h a lf o f tho above namod a p p lic a n t.
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a f 0 . Wo v/ould approoia"to your 30ttinp. th in m atter down fo r h' oaring ;in' ` ' `
Oakland at your, e a r lie s t a v a iln b lo data.
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: By copy o f th io l e t t e r wo are roqueating th a t thD innurnnao company
forward a l l n o d ical roports to ua (unlooo oont.upon provioua
roquoot)
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r' ; drn . cci ..see attached l i s t
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. SMITH, PARRISH, PADUCK &. CDAITCY:
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'p A A JsjC t t / / jU n / n s C ___________________________________________________________________________ 6 Q X > A ? *Z C ?
NAME / r
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COMPANY, PLANT, DIVISION
CLAIM NUMBER
1
/ f r s 'f i /?&7
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AGE
SEX
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UsAots/j) $ / j INJURY SUSTAINED
S L<J&s7 CCriS
OCCUPATION
D/E
7d.
I.TirCLAlM " hJMfeEft
agencV
PART OF BODY INJURED U/6 MECHANICAL CONDITION AQQ'L in f o r m a t io n :
1 TYPE o r a c c id en t
agency part
u/s p e r s o n a l Fa c t o r
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FORM 553-563 (9-62) 1
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1 ________________________ ____________________________i
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FB 0503G G
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J . D, CDATE. M. D. SADfOlOOiST
as7s suMMrr srntrr MUM *. CMJfpMK
1U.II '* TliwvtMl-ipiy February 17, 1962
Ptmt: pueta, Henry C . Addrtn: R t. 2, Boiel9Z. Oakley
Aet 54
PbjtUUm: Asbestos Worker* Surrey
':v 22832
Both lung field* *how considerable granular thickening of the root shadows In both perlhilar area along with discrete m ilitary densities. These changes were noted on examination 4~156l. A direct comparison with the previous film would be important to determine the progress of this disease.
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CONCLUSIONS
Pulmonary occupational disease probably asbestosls.
JD C:me
X T K 'C t f R
PLAINTIFF'S f ^ EXHIBIT ,
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A T T O R N E Y AT LAW
ONE ELEVEN UTTER TRCET
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AN rR A N CISCO 4104
$66 ^
y
November 3 1966
vfor.'*KA1i'<*/-*.v>
Workmen' s Compensation Appeals Board, 1111 Jackso n S t r e e t , Oakland, C a lifo r n ia ,
Re: Henry C. Puetz v s. Armstrong
Cork C o ., e t a l . - Case No.
______66 OAK 2 0 6 6 3 .
________
Gentlemen;
In the a b o v e -e n title d m atter we e n clo se here
with on b e h a lf o f defendant Fibreboard C o rp o ra tio n , 6ued
herein as Fibreboard Paper Products Corporation, it
Answer, dated November 3 1966, which p le a se f i l e .
Very tru ly yours,
BROBECK, PHLEGER & HARRISON
R S:lts enc.
iU j& S ;-- Rinaldo S c ia ro n l, J r .
I s PLAINTIFFS I i EXHIBIT
11 7i
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HPfRY
V DEPARTMENT OF INDUSTRIAL RELATIONS
DIVIIIOH Or INOU1THIAL ACClOCMTI
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WORKMEN'S COMPENSATION APPEALS BOAR
TATE OF CALIFORNIA
WGf
ANSWER ^ FTRREBOARn rflRRflRATION
' 4 I356
. . ` .A HCJJ - ,: -'0
C . W1ETS. IMJtH* Mna|
C o m No. 66 OAK 20668
Do* of allogod lofvryi
*" 19&2
FIBREBOARD CORPORATION, ICMHOMtflMlMtll
S e lf-In s u re d IWIHfftoH WMtuatMMI
1*75 Brannan S t r e e t ,S a n F r a n c la c o , C a l i f * ll#Ufll MMMMl
INIIWK UHH,n MMHII 305_____________
la n p u M M M i wm * lim n
ANSV^EUNO DEFENDANTS dony oJWpoftortt o l lit Af pGcottora 0 IraftcoNrf bolow wilb tud oxpkm cAor o < prvuly m I forth and odm ll o l oAor otoMriol o89oiom.
D &AAVUMiMttMaMM
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EXPLAIN taow
. Oecvpotio*
IVMim MMIMMf|N Mf HtM M ilt 11KMmi't
Imuronc* tottrogo
J C _______ ^ ^
Uobtfc* lor M il ^fo c w j frriatmmt
Uobifily lor M v rt h io to w l
lU d ito U t^ o i cw tt
MM r ilM tO M I m i* ***
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Com*ngt
^ ---- Frkd* o l rfhobdity ^ ------ Nrmononl dhobifc+f
n 1$ PUtTHCI AOEGO.
t*t MIVUt KMKI*(UtMt U*l UHtiM Apportionm ent to p e rio d s p r io r to 1945 and .
ivVMw>VwMtwtlHiIiItt i iiau. tutu subsequent* to 1962.
1, D*ftf*donH Kev poU rfiwbJIity Indemnity M rf* lo+ol omovnf o f I A l l
tfii rah of I .
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p lL M _ r_ _ _
1 AUVrwrf,. M m n .n j montm J u r i s d i c t i o n o f Board, s t a tu te o f l i m i t a t i o n s . p r e ju d ic e f o r lacfr o f n o t i c e , s e r io u s tind w i l f u l m isconduct o f employee
in rnnt.lm itne M s exposure a ft e r d la m o s ls o f a sb csto .sls.
D tU ndoM t do rwrf wohr #>o rtgM to r a i l ed<*onoJ W uot In occordonc w|h A# pcov'rtioAt of low ord |H RuW of Froct tl od>r hw ot d m lop.
K -. h , *,<. - Unknown____________ ^ ,, San Fran e ! e c o c b , ^ . , November 3,1961
Art dfndontt mdiol nportt h it boo*
Wed Nnnjc.-&valla.ble Addiftortol riporti 40 bo 0l*d befen io Unknown
fra>triol w oahdt
*rt itwuuc rnat rram Wlitiiu M at
FIBREBOARP ^CORPORATION t sued h e r e in ae FC *ib r^7bWoU aB 1rdW\ i*****L*11**<**-P a p e g o ^ g J ^ i S n
Its Attorneys 111 S u t t e r S t r e e t .S a n F r a n c l s c b .C a l i f .
iw M tt u t it k lH M t *** i n u m i
115. 43U-0900
CERTIFICATE OP SERVICE BY MAIL
I hereby c e r tify as follow s: I am an a c tiv e ember o f the S ta te Bar o f C a lif o r n ia , counsel in t h i s cau se, and not a party th e r e to . On November 3_______________________ , 19 ^6 I deposited In the m ail at San F rancisco, C a lifo r n ia , seven (7 ) sealed envelope s , with postage f u l l y prepaid thereon, containing a true copy o f the document attach ed h e r e to , and addressed as fo llo w s :
Henry G. Sanford, E s q ., Hobart B u ild in g,S a n F r a n c is c o ,C a lifo r n ia ; ' M essrs.Sm ith ,P arrish ,P ad u ck k C la n c y , 315 F in a n c ia l Cen ter B u ild in g ,
Oakland, C alifo rn ia; M essrs. Hanna k Brophy, 15^0 San Pablo Avenue, O a k la n d ,C a lifo r n ia ; In d u s tr ia l Indemnity Company, 155 Sansome S t r e e t ,S a n F r a n c i s c o ,C a l i f . ; In d u s tr ia l Indemnity Exchange, 155 Sansome S t r e e t , San F r a n c is c o ,C a lif S . Norman H ayes, E s q ., P a c i f i c Employers Insurance Company,
222 Sansome S t r e e t , San F ra n c isc o , C a lif o r n ia ; Sedgwick, D e te r t, Moran k A rn o ld , 111 Pine S t r e e t , San F r a n c i s c o ,C a li f
Brobeck, Phleger k Harrison
111 S u tte r S t r e e t , San Francisco 4 , C a lifo rn ia .
1.9
VORXMEN"S COMPILATION APPEALS BOARD
State of Californ ia
HENRY C . PUETZ,
A pplicant,
CASE NO. 66 OAK 20668 MINUTES OF HEARINO
Ve.
(CONTINUED)
C . F . 3RAUT1, AMERICAN MOTORIST INSURANCE COI^PAIY, JOHNS KANYILLE SALES COMPANY, ARMSTRONG CO?(X COMPANY, TRAVELERS INSURANCE company, coast in su latin g products company, HAROLD C . LORENTHEI! COMPANY, ARGONAUT INSURANCE COIUVHY, GREAT AMERICAN INSURANCE COMPANY, INSULATION SERVICES, I N C ., FILRE50ARD CORPORATION, AETNA CASUALTY tc SURETY COMPANY, OUTMS CORTITNO F I BERGLASS . MU!.'PET .COIEC-CORP. , H/.RTKONDACCI DENT INDE.' S I i r f COMPANY, METAL CLAD INSULATION, WESTERN UacARTHUR C0:r?A5Y, STATE CO! MENTATION INSURANCE FLEip, WESTERN ASBESTOS COMP/VY, VAN ARSDALE HARRIS COMPANY, M. R . CARPENTER, ACCURATE INSULATION, PACIFIC EMPLOYERS INSURANCE C0MPA1Y, PLANT ASDESTOS COMPANY, J . T . THORPE it SOU, I N C ., HICKMAN BROTHERS, C01YINE:YAL CASUALTY COMPANY, FLUOR CORPORATION, DTD., INDUSTRIAL IEDEINITY EXCHANGE, WESTERN FIBROUS GLASS PRODUCTS, INDUSTRIAL IMDETiTTY CO.' IPAIY, BAY CITIES a sb e st o s co m pa iy, kuldoon com?a;y , i n c , , KILLER INSULATION C O R ?., ZT1PL0YERS LIABILITY ASSURANCE CORP. , L T D ., ASSOCIATED INSULATION COMPANY OP CALIFORNIA,
___________ _________________________________ D efen d an ts.________
P la c e & Time I Oakland
November 26, 1963
900 a .m .
R e fe re e : Reporter:
HICKMAN Lengerlch
Appearances; A p p lic an t p re se n t: Sm ith, P a r r is h , Pnduck t C la n c y , Attyo (David Nelson appearing)
D efen d an ts:
G eneral Accident F ir e & L if e Assurance Corp.. L td . Henry J . Sanford, A ttorn ey.
American M oto rist InGuronce Company, . , T ra v e le r s Insurance Company,
Argonaut In su rance Company, G reat American Insurance Company, Hanna ti Brophy, A tto rn eys (Charles H. McMillan appearing.
Guarantee Incurance Conpany, J . P a tr ic k Goodwin, A tto rn e y .
Fibroboard Corporation, Drobcc):, Phlcy.cr & Nr.rrioon, Attorneys (Rinaldo S c ia ro n l, J r . , s p e a r in g ) .
Firem an' s Fund Incurance Company, James Gnuclirnn, A ttorney.
^5 PP
Aetna Cncunlty & Surety Conpany, EeclfDfick, D c t c r t , Moran & A r n o ld , A tto rneys (W illiam Thomas a p p e a rin g ).
(See pn,;o 2)
HENRY C . PUETZ 66 OAK 20668
MINUTES -2 -
Kovember 26, 1968
Appearances Cont' d.
Defendants:
Hartford Accident & Indemnity Co. Sedgwick, D c t c r t , Moran & A rno ld , Attorney* (W illiam Thomas a p p earin g).
S ta te Compensation Insurance Fund (Harry Sherbourne, Attorney,
P a c i f i c Employers Insurance Company, S , Norman Hays, A tto rn e y .
C o n tin e n ta l C a su a lty Company, John W ilkes, Representative.
In d u s tr ia l Indemnity Exchange, and In d u s t r ia l Indemnity Company, Alexander Keenan, Attorney
WITNESS:
Henry C . Pu etz, A p p lican t.
THE PARTIES STIPULATE TO INSURANCE COVERAGE AND EMPLOYMENT AS
FOLLOWS1
Coverage
Employment
General Accident F ir e St L i f e Assurance Corp. L td .
.
P h ilip Carey K fg . Company
American M o to rist Insurance Company, C , F . Braun
T ra v e le rs Insurance Company Johns M anvllle Sales Co. Armstrong Cork
Argonaut Insurance Company Coast In su latin g Products Co. Harold G. Lorentzen
G reat American Insurance Company Insulation Services, In c.
9/1/&X-S5
12/28/641/ 26/65
Guarantee Insurance Company Lawrence L . Dea L a u fle r Co.
As indicated. Ac indicated la s t hearing S o cia l securl
record.
Flbreboard Corporation
Last quarter As indicated
I 947, l e t " s o c ia l 6 ecu rl
1948
record.
Firemans Fund Insurance Co. Plant In su lation
1/1/52-5/1/54 24 hours in 1953.
Aetna Cacualty & Surety Co. Owens Corning F ib e r C la ss Mundet Cork Corp.
1955-1962 1953
(See PoG
HENTVr C. PUETZ 66 OAK 20ouB
minutes - 3-
N o v e m b e r 2 6 , lQ o O
Stipulation Cent ' d.
Coverare
Daployr.cnt
Hartford Accident & Indemnity Co. Metal Clad Insulation
2/17/64-2/25/64 6 working days
Western MacArthur Company
9/5/67-10/26/67 38 working days
S ta te Compensation Insurance Fund Western AsbeBtos Company
For periodo a s shown in social security records.
Van Arsdale H arria Company
M. R . Carpenter Accurate Insulatlorf
10/1/61- 10/1/62. I / I / 62- I / I /63
P a c if ic Employers Insurance Company Plant Asbestos J . T . Thorpe fc Son In c .
P r io r t o 1/1/52 as ohov/n in s o c ia l security records. P r io r to 1/1/52 as shown In s o c ia l security records
Hickman Brother
1963
In d u s tr ia l Indemnity Exchange Western Fibrous Glass Products a
In d u s tr ia l Indemnity Company Bay C it ie s AabeBtos Company
1949 1948-1949
Plant Asbestos Company
1/ 1/52 to 1 9 6 2 .
Harold G. Lorentzen Company
1956
J . T . Thorpe Company
1957
Muldoon Co. I n c .
12/ 31/ 61- 3/ 31/62
K eller In su lation Corp.
1/ 18/ 63-12/ 28/63
Metal Clad In su lation
2/1 5/63-2A 5/64
ISSUES 1 Other than the s tip u la tio n s sb to insurance coverage and employment, a l l m aterial fa c ta are in is s u e , including affirm ative defenses o f:
8tatuto o f Limitations Prejudicial lack of notice W illfu l mlcconduct o f the Employee, in'
accordance with page 10 o f the deposition * Ju r is d ic tio n o f the Appeals Board
(See Page 4}
AHEintf C . PtTET2 66 OAK 20668
MINUTES - 5-
Hoveraber 26, i 960
EXHIBITS: A p p lican t: A -l - Report o t Dr. Paul E. Crantz 11/15/62.
A-2 - Rcportc o f D r. Leon Lewis 7/5/68, 8/20/68 and 10/2V S8 , w ith copies o f reports from UC M edical C e n te r, and b i l l s fo r $190 and $25; b i l l o f 2^35 Webster Jt r e e t Laboratory $8 0.5 0 .
A -3 - D ep o sitio n o f A pplican t 11/8/68.
i D e fe n d a n t :
D -l D*2 -
D-fc D-5 -
Report o f D r. H. Corv/in Hinshaw 10/8/68 (State Compensation Insurance Fund). L e tte r dated 12/20/67 from Owens-Com ing Ffcberglao Aetna C a su a lty It Surety Company), e t t e r 3/29/60 from Western JlacArthur Co. (Hartford Accident & Indemnity C o .) . Records o f D r. J . D. Coate (T ra v e le rs Insurance C o .) Photocopies of Records o f Dr. Crants ( In d u s t r ia l Indemnity Company).
REFEREE:
I t appearing th a t A p p lic a n t's employment by the P h ilip Carey M anufacturing Co. vas out o f 6t a t e under a c o n tr a c t o f enoleyment vfhlch wa3 not made in the S t a t e o f C i l i f o r n i a , and GOOD CAUSE APPEARING THEREFOR, IT I S ORDERED THAT:
P h ilip Carey M anufacturing Company, and G eneral A ccid en t F ire & L ife Assurance Corp. L t d ., be and they are hereby d ism issed .
GOOD CAUSE APPEARIIIO THEREFOR, IT I S ORDERED THAT:
Lawrence Des L a u rie r and L . L . Dcs L a u rie r Company and Guarantee Insurance Company, and Firemans Fund Inaurance Company be and they are hereby dism issed as p a r t ie s defendant.
DISPOSITION
F ifte e n days to the p arties fo r fu rth er f i l i n g , in c lu d in g p o in ta and a u t h o r itie s ; seven d a ys, th e re a fte r, fo r re b u ttal; matter then to stand su bm itted.
*
HENRY C . P U m 66 OAK 20668
5-
Xovenber 26, 1968
SUMMARY OF EVIDENCE
ci-C*
APPLICANT t e s t i f i e d th a t he i s working now d o in g o s b e B t o s w ork. I t does not In v o lv e much p h y s ic a l a c t i v i t y . He i s working on the ta r p o t. V ith regard to h is p h y sic a l r e s t r ic t io n s , he has a hard t in e doin an y th in g bccauce o f sh ortn ess o f b r e a th . He cannot clim b a f l l g h o f s t a i r s w ithout sto p p in g . He can walk about s ix hundred f e e t w ith out s to p p in g , a t a aiedium p a ce . He can be on h is f e e t a l l day lo n g . He cannot c lim b , but he can vork on a s i x or e ig h t fo o t la d d e r . I n 1968, he haB worked fo r about th re e months. H He drew UCD b e n e fit s in 1963. He s ta r te d drawing such b e n e fit s i n November, 1967, when he went to th e h o s p it a l . He did n o t work from November, 1967, u n t i l Septem ber, 1968. H is l e s t day o f work was noveober 11, 19o7, and he retu rned to work on about Septem ber 2 1 , 1968. He van a ie k d u rin g t h a t p e r io d . S in c e Septem ber, 19*00* ha has had about s i x Jo b s . He g e ts l a id o f f . He cannot do the work because he cannot clim b . He in r e c e iv in g m e d ica l treatm ent f o r h is lu n g c o n d itio n from D r. C ra n tz . He has p aid a l l o f the b i l l s f o r m e d ica tio n . H is Condition 16 g e ttin g worse.
On C ross-exam in atio n by Mr. M cM illan, A p p lic a n t t e s t i f i e d th a t he has read h is d e p o sitio n and i t i s co rre ct to the b e s t o f h is re c o lle c tio n . ( A p p lic a n t's A tto rn e y s ta te d th a t A p p lic a n t 's Income ta x re tu rn s show earnlngo o f $ 10,023 i n 1965* and $ 12,713 in 1966.) He re ceiv e d unemployment in su ran ce b e n e fit s f o r fo u r weeks p recedin g September 21, 1968. He 1 b working a t Standard O i l Now fo r A sso cia te d I n s u la t io n Company, Ho has been working f o r f i v e days there. He worked fo r Arm strong.Cork in B e v e r ly , O h io , but a ls o o u t h e re. He c o t the Jtibs through the u n io n . H is work in 1955 was .in C a l i f o r n i a , but hiB work. for_A_rmatrong Cork I n 195\_and 1954 w as,.. in O h io . H is work fo r Johno M a n v llle Company was in C a l i f o r n i o . Hie work f o r C . F . Braun and Johns K a n v ille was not on board s h ip . Armstrong C o n tractin g and Supply is the sane ns Armstrong Cork. I.e did not work on.aboard h ip f o r th a t company in 1961. H is work fo r Coast In s u la t in g Proaucta XDi:;psny~Tn_ T96!ran'd'1066 was in C a l if o r n ia . H is work fo r Lorcntzcn in 1963 and 1964 was vao Sh io r e p a ir work. H is work fo r In s u la t io n S e r v ic e s in 19^5 and 1964 was in Walnut C ree k , C a l if o r n ia . Ho does not remember se e in g a cheBt s p e c i a l i s t in Oakland in 1964.
On CroGfl-cxom ination by Mr. Thomas, A p p lic a n t t c o t if ic r i t h a t when working f o r Ovens Corning F ib e r g la o o , from 1035 to l'.ioli, he 'ns uoing fib e r g la ss in su la tio n but a lco asb e sto s. I t Jo d i f f i c u l t t o say how ouch o f tho time was spen t i n u s in g c it h e r m a t e r ia l. He d id not n c c c s o a r lly uoa f i b e r g la s s more than a c b c o to s .
IIEKRY C . PUCTZ 66 0AX 20668
-6-
Kovcobcr 26, 1968
W hile working fo r Western KacArthur Company, he used fib e r g la s s and a sb e sto s. H lo work f o r Mundet Cork was back e a s t . He waa h ire d b ack e a a t for that Job. H is work fo r Owens Corning F ib e r G la s s woo in C a l i f o r n i a , b u t about t h i r t y p er ce n t o f t h a t employment wub aboard s h ip .
On Cross-e::nral n a tio n cn b e h a lf o f H r. Sherbourne, A p p lic a n t t e s t i f i e d t h a t in 1963 hl3 c a r turned over as a r c c u lt o f which he had a sp rain ed n e ck . 1ic was i n th e h o s p ita l fo r e ig h t d a y s. lie re c e iv e d trectm cnt fo r hio neck and a lso fe r his lunge w hile in the h o s p ita l, A ntioch Memorial H o s p ita l. Hie neck and back were tre a te d fo r about th re e days by D r . C r a n tz . He d id not have an appointm ent f o r the h o sp ital p rior to the accid en t. In 1565 he had q u it a Job fo r P la n t Asbestos because he c o u ld n 't c lim b . Ee q u it s e v e r a l Job3 because o f t i l l s . He went t o A tto rn e y S m ith 's o f f i c e i n 1952 because o f h is lu n g s . H is work fo r Western A sb esto s Company was in C a l i f o r n i a . About twenty p er cen t o f th a t employment in vo lved r e p a ir work on s h ip s . H is work fo r Van A r sd a le K a r r is was on s h ip s .
Or C ross-exam in atio n by Mr. Keenan, A p p lica n t t e s t i f i e d t h a t he l a a b le to handle a Job which req u ires clim b ing a few s t a i r s in the m orning. K is jn e c k and back a rc not bothering him noiv. He was tr e a te d in 1966 or 19o7 f o r a kin k in h is neck by D r. C r a n t s . He has no tro u b le w ith h is r ig h t knee now, nor w ith h is low b a c k . He d id not re c e iv e treatm ent f o r nose b leed s now, nor s in c e 19S5 . H is work f o r Western F ib e r G la ss in I 9U9 was i n C a l i f o r n i a , a s waa h lo work fo r Bay C i t i e s A sb estos In 1JA8 and 19^9 H is work f o r P la n t A sb estos Company was in C * l i f o r n i a .
On C ross-exam in atio n by fir . S c ia r o n i, A p p lic e n t t e s t i f i e d t h a t h ia work f o r F ibrcbo ard In 19^7 and 19^0 vras In A n tio c h . Kc docs not remember working f o r F ib rcb o a rd ; he remembers v o r k in g f o r P la n t Rubber and A sb esto s Company which was ov.ncd by F ib r c b o a r d . What work was on sh ip s which wore b ein g re p a ir e d . He worked f o r two months a t the Mark Hopkins H o te l f o r P la n t Rubber and AobestOH Company. Tho sh ip work he d id f o r Armstrong was on new d e s t r o y e r s , n o t on sh ip s under r e p a ir .
On C ross-exam in atio n by Mr. H ays, A p p lic a n t t e s t i f i e d t h a t he cono to C a lif o r n ia in 19^5. He took a t r a v e le r in li>'*3 and spent two y ears back o u c t. lie returned to C a lif o r n ia in 1959 nnd stayed two y e a r s . IIo then went back ea6t u n t i l 195^ . He engaged in asb esto s work back c a s t . He has uced a r e s p ir a t o r e v e r s in c e I 9M . He used a r e s p ir a t o r on a l l C a lifo r n ia Jo b s . Tho re s p ira to r s aro not vary good. Ti.oy
KrrrsY c . p u rrs 66 OAK 20668
-7-
November 26, 1968
co v er th e mouth and n o s e . He d id not n o t ic e any Bhortneco o f b re a th p r io r t o 1 9 ^ . He f l r o t n o tic e d 6hortneoe o f b r e a th In 1961. He saw A tto r n e y S n it h in 1962, f o r h la e h o rtn e a s o f breath.
On C ro s s-e x a m in a tio n b y J l r . W ilk e s , A p p lic a n t t e s t i f i e d t h a t he warkod f o r F lu o r C o rp o ratio n a t the Union O il Conpany, a t Oleun I n 1955 195'J, and 1957* T h is was a s b e s to s w ork. H is e a r n in g s a t th a t tim e were about $5 p er hour.
On fu r t h e r D ir e c t E :^ u r.in stio n , A p p lic a n t t e s t i f i e d t h a t h i s
employment w ith A rm strong Cork Company in 1951 was out o f s t a t e . H is employment i n 1553 .was out o f s t a t e . H is employment w ith Thorp; and P la n t , i n l s S S , were in C a lif o r n ia , b u t h is employment
w ith Arm strong was b ach c a s t . He re tu rn e d t o C a l i f o r n i a i n 195^
H crw orkod^f.or-Afm strona on_Ehips a t.B e th le h e m S t e e l . He worked
f e r X i i c h c r in A rizo n a and then came t o ' C a l i f o r n i a r The work
ho d id _f ir Arms t r o ng p r io r t o h is employment w ith K ir e h e r was
out o fs t a t e .
-------
RAHshlq
RICHARD A . HICKMAN, R o fe re o
DEPARTMENT O F INDUSTRIAL RELATIONS
DIVISION O F IN D U S T R IE ACCIDEN TS
WORKMEN'S COMPENSATION APPEALS
ST A T E O P CA LIFO R N IA .
BOARD
E E M C . PU2Z
Applicant
AKBTRD;a c o r k co:i?Airr, et n l . and STANDARD A C C IC C .ir i i i s u s a :?c C O ., et a l .
Difendenti
C ase N o. 56 0. 23C6G
ORDEPv TAKING OFF CALENDAR.
Pursuant to request of applicant. and GOOD CAUSE APPEARING:
It Is H er eby O rdered T h a t the above-entitled matter be and tbs same hereby is taken cS
calendar, and all further action herein suspended, subject to being reset upon request o f any o f the parties hereto.
RICKARD A. HICKMAN
~ Referee, WORKMEN'S COMPENSATION APPEALS BOAFJJ
PARTIES SERVED AS CHECKED O N O R IC I AL ADDRESS RECORD
D*" : l l / l S / S *8 hz (ZEAL)
PIAW(CA0re*f 00*0M(4M0V*. 9ee>
wi Ml T-4* <a
August 31, 1966
R elirr.co Insurance Companies
Pacific Depart-mt 320 C a lifo rn ia Street P . 0. Box 2567
San Francisco, C a lifo rn ia 94126
Gantlenenj
Attention*
Mr, E . W. Hauck VorkE3n*o Compensation Supervisor P a cific Deporiaeat
Re: C lain Ho. 96 C D23147
'
Insured - Armstrong C ork Company
Claimant - Henry Fuats
Ve regrot wo can give you no information regarding the above claimant fo r th9 year 1951. Under our Retention o f Records Schedule a l l payroll i*ecord3 prior to 1956 have boon destroyed.
Va had our Payroll Department check a l l information availablo fo r the yoars lis te d fo r Armstrong C ork Company on the Application to
the In d ustrial Accident Ccnnissicn. lie attach a copy o f th is information fo r vhat i t nay be worth to you.
Very truly youre,
Enclosure
Kabol E . Carnet Insurance Department
Fzyroll Dcpzrtzont
C m C. FCT3 - California.
Cilj cm r- T--rru=~crTlzr*d~f--c r ^rcjrczjj Corle C0070i07 (inoolatlco Diviolco) CT.J 70
I li
-*?P^7 Cc: icnJ CnrlEj Iho yeera 1331;! 1953-1;?33; cpl131 . I .! | I l|
Aa yen v ill c : j Tren attached coiy c f lc* Tren r.rlrrco IroJ Geo. ttcy n i'tl e r r in g -*2=3 ^
year 1331.';
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Trtelero prvrpco- Cerpery, end tic 7 too v ill to urltina uo Ter pcyroll cim irco Ter heci) yerre; Co ;|
vnilo you ero cp e 'rir; 1351 v ill you plceco clco coo \:hzt inforcuilcu youLoro Ter tleo'yccro 5335-1353 ( s lll
frv strcrj) eel free! thy yeer 1931 (L0C3)?
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Ikyroll Department
_
___________
^
HEKHT C PTSTZ - California - S.S.# 5^2-12^188 ^ _____ ________ - --
Thio man presunoblyj worked for Armstrong Cork Ccnpany ^Insulation d|iv! b1oo!| and Armstrong Contracting and
Supply Corporation taring the years 1951j 1953-1955;j end 1961 j
| |, | j
| j.
Aa you will 8** froa attached copy of letter from Relianoe IheJ Coo. they want hlo earnings during the
year 1951. Do you have any information atj a ll for^ the year 1951? j
I |
j j
While this Insurance company only asks far 1951, during the years 1953-1955 end 1961 vo were Insured by
Travelers Insurance Conpanyj and they too w ill bo writing ua for payroll earnings for those yearej So ; while you ere chocking 1951# will you pleace also cee what Information youinve for the'years 1953-1955 (still Armstrong) end then the year 1961 (AC4G)?
//*/ S'
'Um''
RELIA N CE INSURANCE COM PANIES
PACIFIC DEPARTMENT, 320 CALIFORNIA STREET. P. 0. BOX 2567, SAN FRANCISCO, CALIF. W12S
TEL 981-7600 August 24, 1^66
Armstrong Cor'.: Company Luncasser,
Pennsylvania 176ot
Attention: Hiss Label 2 . Barnet - Insurance Dept.
RZ: Claire Uo. Insured Claim ant
Gentlemen:
: 95 C DO81U7 ' : Arrsstrong Co rk Company : Henry P u etz________
/
Acknowledging re c e ip t o f a carbon copy o f your le t t e r dated J u l y 2 ? , i 960 to tue {retention o f the fo rk e e n 's Condensation Appeals Board in Oakland, C a li f o r n i a . ;,7e have s e t up a f i l e under the above - capt io r.cd number and are G iv in g th is m atter our p re fe rre d a tte n tio n .
A t t h is t i n e , we would l ik e your a s s is ta n c e in o b ta in in g whatever inform ation you can give us concerning th e employment o f Mr. Puetn during the y ea r o f 1?51 wh.en Armswrong Cori; Company was insu red by Standard A ccid en t Insurance Company. b e , o f cou rse, would l i k e copies o f h is '.2 f o m s , h is p a y r o ll earnings during t h is year and any in fo rm atio n which you con fu r n is h concerning the whereabouts o f where he was employed and the typ e o f work done, be, o f c o u rse, are f i l i n g the necessary answers w ith she ./orkaon's Coi.pcnsauion A ppeals Board, making a general d e n ia l *.;hich w i l l enable us uo `move a l i t t l e tin e p rio r to hearing before making a d e cisio n .
Any a s s is ta n c e tiia t you can g iv e 113 i n "this n a tte r w i l l be g r e a t ly appreciated.
E'.iH: cks
c c : R e lia n c e Insurance Coripcny P ittsb u rg h Claim Deport:-.cut A t t ' n: C . 11. Konculuuip
Rollane Insurance Company | Rollane Standard Life Insuronco Company I Plonot Insuranco Com pany
& M
DEPAJTUtNT OP IK n uSD U A l Rfil ATION'S ^
d i v i s i o n o r jsnisnTuRIAALL Aa Cc Cc IiDd Ee Nn Tt Ss ***
. WORKMEN'S COMPENSAMTiIoOrN APPEALS BOARD
VTATt OP CAUrORNIA
HENRY C . PUETZ
i
.* C s t e N . 66 O AK 20668 N o tic e o f H e a r in g
A p p lica n t-- vi
ARMSTRONG CORK CO. e t a l and STANDARD ACCIDENT INSURANCE COMPANY,
et al
Defendant-- J
Y m V I hereby ootibed that aa applkatioo lot cpgipw rion h u fcrea fikd with the W O R K M E N 'S C O M P E N S A T IO N A P P EA LS B O A R D of the State of California. Yco arc further ootibed that a>d application ims beta act for ^ | at
November 3rd, 1966
3000 State Building 1111 Jackson Street Oakland, California
9:00 A.M. Before (ALL A*M.)
Referee Hickman
text dut at add time and p lia the V O R D tE K S CO M P E N SA T IO N APPEALS B O A R D v ill proceed to bear mod dpoac of the aid apptkmtioo 0 the manner prescribed by la .
WORKMEN'S COMPENSATION APPEALS BOARD
*?
Atritltei Iw b r )
Di* August 11th, 1966
amiable N O TE The panics ate eapeetod to submit all disputed bract foe derisum ml thb b w in *. AJI wltoeues, evidence. medical report*. pay*
ro ll, mod other p*>f mut be
at the hearing. C O N T IN U A N C E S W ILL BE G R A N T ED O S 'L Y U P O N A C L E A R SH O W IN G
O P G O O D C A U SE . Rrquntx for contiouM cn are to be made m ihm 5d tp of the date of this notice.
N O TE TO fV V f/JCrn r M n .n v r X S : Yovc attendance at thw bovine nuy oot be srem ary. Atk your a m r a c e coropaoy.
SERVED O N A l l PARTIES LISTED O N TH E O FFIC IA L ADDRESS RECORD
Date? 8 - 1 1 - 6 6 " K fc 53
DCA toCAh TortronMM CIlc*.
iaaan
._!/... l!
t ' > u.
IM * l
Before the Industrial Accident Commission of the State of California
HENRY C . PUETZ
Applicant
ARMSTRONG CORK C O ., e t a l and STANDARD ACCIDENT INSURANCE COMPANY, e t a l
Difendenti
O u t N o . 66 OAK 2066S
Order Joining Party Defendant
Good Cause Appearing Therefor:
IT IS HEREBY ORDERED THAT ARMSTRONG CONTRACTING & SUPPLY CORPORATION STANDARD ACCIDENT INSURANCE COMPANY and TRAVELERS INSURANCE COMPANY
be joined u a party defendant in the above-entitled came.
N *a * xtui Addren of Peroni Served
---- O B I S y T T i r u T f
industrial a c o d e n t commission
Date August; 1 1 th , 1966
ALL PARTIES SERVED AS SHOWN ON OFFICIAL ADDRESS RECORD
fc 53
tfpnan ai fern Str*i*S
OAWC A O D I M A C C K C A K P
TKLTYAK AO
A L E X A N D E R A G E N C Y , INC
/ IN SU R A N C E-W O R LD W ID E SIN C E 1853 ! ' 316 F O U R T H A V E N U E - P IT T S B U R G H , P A . 1S 2 2 2
Claims Department . R elian ce Insurance Company
Arrott Building P itts b u r g ] , Pa* 15222
Gentlemen: / J f
/ /
j Insured - Armstrong Cork Company
/ Claimant - Henry C . P i^ ts vs Various
j
8*8 #532-12-U 38.
We are en clo sin g herewith v a rio u s papers in connection with th e above claim . The Standard A ccid en t Insurance Company were tho insurors on t hiis r is k back in 1951* Please l e t th is have your a tte n tio n ,
i. Thanking you^ we are
- 1
t
ti Very tru ly yours
f
B .R * S h r iv e l
By
/
/ S.A.Huy* /
H.
! }
ends. !
c c : Armstrong Cork Company Lancaster, Pa.
OUR SECOND CENTURY OF INSURANCE SERVICE
I I
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4 f
*
^
T .,~ Com)
^ ti -V
LAW O FFICES OF
SMITH, PARR ISH , P A D U C K & C L A N C Y
u* FINANCIAL CINTCB I/IUDIHO . 408 - I4TM STRECT OAKLANO.CALIFORNIA 84812
' July 22, 1966
Workmen's Compensation Appeals Board1111 Jackson S tre e t Oakland, C a lifo rn ia
Re;
Henry C . Puetz v a . V ariou s
UHCOUM *-
Gentlemen:
Enclosed herewith fin d o rig in a l and s ix copies of A p p licatio n fo r Hearing on b e h a lf o f the above named a p p lic a n t .
- We would ap p reciate your s e t t in g t h i s m atter down fo r h e a rin g in Oakland at your e a r lie s t a v a ila b le d ate.
By copy o f t h is l e t t e r we are re q u e stin g th a t th e insurance company
forward a l l medical reports to us (unless sent upon previous
request).
DRN cc: see attached list
Very tru ly yours,
SMITH, PARRISH, PADUCK & CLANCY
. I ....................... *
(TATI OF CALIFORNIA IN D U STR IA L A C C ID E N T COMM JSSION
APPLtCATiON
n u SIGNED ORIGINAL AND SIX c o rn s
(PLEASE C3 TYPEKU-3 O ADDRESSES)
CASE NO.
H E K R Y C . P U E T Z ____________________________ yw m it--
FL V A R IO U S - S E E A T T A C H E D __________________________
HPUttl
R t . 2 , B o x 1 0 1 - D ________________________ . O a k l e y * J C a l i f o m i a _________________________________ Social Security N o ._____ S .3 2 * 1 2 * 4 1 8 8
IkfittU UMIH
V A u r n n s - s r a a t t a p h t t i __________________________ ism rtl MumKt UIMII
iKHMItl PHHUI ftUHIM
1------------- H e n r y _ C _ ;--P llt ;C 2 --------------------- - A / .2 5 / .0 2 , iHcxo tkt
UKN
MTNrfttVTt
employed o n ..K j _ a .t t C h e d 1______
kUNIWMT
"
U .1_____S k S t o s j ) o r k e r --------------------, 1 _______x a k S S H S _______________________________________________________d / o m a . br
m m it m t Tiai ar mimt
mr. ia n run vttit imt K n t iu
*7*
wi *r (rum
----- - i __ he fUJtained injury iritiag out of and ta tbe course of tha employment u fo'.lowi
_________________________ i n h a l a t i o n o f . h a r m f u l j a t f i r l a l s ____________________________________________________ m u lti** u x a ii iiuiif t o stein'll
_________________________ I m g s __________________________________________________________________________________________ ______ ______________________ m f l Ml Mlf| M IMT HJVIII til nnilVlIT l|lin
2. _______ ___V flT jLO U S_______________________________________ __________________________ was the employer'* insurance carrier on dice of injury.
MM m MHMIU BINIT M. ITlN4t(l Oil Mt *. (till ffT|l
M IMWfll
i. - . none t c u f e t e __________________________ ____________ ________________________ ___________________________
nM N irrtM im m unn
mtv i m m i i p m m t* *t
at utT m iul n n tM ii
4. V u compcaation paid?____ K O
lu w ii
*-
ttm no
f
-- ---
- - ---------
uiirun
mti m u ii Ntur
J. Earaiap it tune of injury lJP22Xii5M5)------- ______________________________ The ba*is of piy * u __________________________________________
M nw VtU
m i l Ml HUMM MIHI UT|. MM * |*T tM MTI AMitt
(. V a i medical treatment needed? . . - . y g S . mMM
V h o furnished treatment? D r - J - D r - C C A t C , __ X g d i o l o s l C t -
9
m i u * t i if u c tiii i m m iT ii nit n n ir m i m i l m m o n m iiu j 7, Thii application ia filed co determine liability Ion
e. Temporary duability_X-- . b. Permanent d isab ility__X __ e. Medical treatment__ X ______ d. Medical eoari X ----------- --
VOMM
TO M M
mMM
m MM
t. Iiu fttion epeie X
L
TU M M
IflflM IVT IIM U lM
-- ----
. _____________________________________________ _____________________________________________________________ -
IMTMl llk ltll M iT M ill tMliCATMMMM
W H L R L IO R J-. H u eaqunted tbgt g time and place be fixed foe bearing gad that sm guard be made granting *aicb relief at may ke
roper under the Workmen't Compensation Lewt of CaUforma.
Dated i l
O a k l a n d _________ California _ J . u l y _ 2 2 * - 1 9 6 6 ------------ --
MTV
MTI
Hearing requested at_____________________________________________ _ m
Number of witncua___________________________________________ ____.
`A / / / J M - c/
/J
(*?
*--/ *
w - A - < ______ --------------------------------------
* * "" **
: '
Enim iud .im . f m .-.i 1 / 2 h o u r _____________________ __
e ^ * _ i ^ S H * _ ? A W . C K . f c C L A K C . Y ________________inKMT itiim it
315 F in a n c ia l C e n te r B u ild in g O a k l a n d 1 2 . C a l i f o r n i a __________________________________ .
i m m i IMMHMM TIUIMM M IH I
4 5 2 -2 00 0
RMIMM
M* R| WHUH
IH *IMMIM* MK H*H* H *.n***M *N T W(*M^|m Nf,,
m.m in
0' (M MlMCUM f .nMfl<c1(n .tl>*I*#MTU>I ***La., ** .
(HIMNM Ml MNMNDM MNMM, H |<^lltt W
in n m
i iiw im. mi mn i m n un * n m i 1
Armstrong Cork Co. 1 Liberty & Charlotte Sts. Lancaster, re. B A B Insulation C o ., Inc. P . 0 . Box 2531 Houston 1, Texas Bay C it ie s Asbestos C o ., L t d . 251 F ift h Avenue Oakland, C a lifo rn ia C . 7 . Braun & Co. 1000 So . Fremont Avenue Alhambra, C a lifo rn ia
PERIOD WORKED 1951; 1953-1955; 1961 1953
. 1948
1958
The Eudlong Corporation Grandview b ld g . C o ., In c . 71? Horth Highland Los Angeles 33, C a lif . The P h ilip Carey M fg. Co. Lockland C in cin n a ti 5 , Ohio Otto Cestrow Company Corp 2648 North In te rsta te Portland 12, Oregon Coast In su la tin g products 2684 Lccey S tre e t Los Angeles 31, C a lif .
1947
1950, 1951, 1953, ,1957
1953 1956, 1957 1957
Cork In su la tio n Company, I n c . 155 East 44th S tree t New York 17, New York Lawrence Bes L au rier Co. 11119 South Mariposa Los Angeles 44, C a lif . Fibreboard Paper Products Co. 1789 Montgomery S tree t San F ran cisco , C a lifo r n ia Fluor Maintenance, In c. 405 Ward S tr e e t Martinez, C a lif. Cay Engineering Corp. 2353 E ast 11th S tree t Los Angeles 23, C a lif . George C-olling & E . Gunder 2S1S Compton E lv d . Gardena, C a li f . The In d u s tr ia l In s u la to r * ,In c . P . 0 . Box 2501 5521 Armour Drive Houston, Texas
1945 1947 1947, 1948 1955 1955 1947 1949
INSURANCE CARRIES
American M oto rists Insurance Company
417 Montgonery S t . San F ra n c is c o , C a l i f .
Argonaut Insurance Co 550 C a lif o r n ia S tr e e t San F ra n cisco , C a l i i . P a cific Ecployers
Insurance Company 244 Pine S tra e c San Fran cisco , C a l i i .
r . r? : . c \ m
PERIOD KORXED
INSURANCE CARRTFR
Ir:ul::-:cr. Asbestos
Industry Tor:;- cf No. Calif* Vast tier. Truss Turd No. 16 200 Cu-rrero Street San Ttwra-Sco, Calif.
1956, 1958
Xdrakar Asbestos Rubber Co.
lo r 6652
x 5, itstsona
1954
R. 1. xrsrig L Co.. Inc.
2 2 2 - 4 l a s s 14 sh S tr e e t
C***..U.-*, L-^.O
1952, 1953
Cvar* I, Leizio
San Jest Asbestos Co. 1140 Lezzon Uay San Jose, California
1957
Karold G . Lcrcr.teen Ccrpany 2257 Market Street Os--c^zr.s3 Califcruxa
1956
Industrial Indennity Co, 350 Sansone Street San Francisco, Calif.
Louisville Insulating &
C*
it P q
SIS-SlS*;;est Mein street Louisville 2, Xsncucky
1951, 1952 /
Joan Msnville Sales Corp. 22 Zest 43 sa Street Neu York 15, New York
1949, 1950, 1951, 1952, 1953, 1957
~r.s~Cori.-.s L Supply Co. 1547
-
541 I " ; Sssc^L S:rc3t
Loo
Colif.
Middlesex levaleanert &
Supply Co., Ire.
First National Lark 3ldg.
.`. . C w . c
, Cn,o
1953
Muicosn Coutery, Inc. 6557 lust Szsv Mve. Clovis, Calif.
1961, 1962
Mur.dot Cork Corp.
7101 Terra lie Ave. ksrtr Larger, Me;; Jersey
1953
Lor truest Ir.suM/sir.g Co. SO9 i:.Z. Lorbrri Street Portland 11, Oregon
1945, 1946
Cvers Coming Fiberglass Corp.
-T'* U . _ S Iv S^ .L
Toledo 1, Crio
1955, 1956, 1957, 1958, 1959, 1960, 1961, 1962
Cssrje A. Pease * Co. --w S t ,ervt*.y Ln.
Dayran 1.^ Crio
1957
Plant Asbestos Co.
1 i f ' _ / W*i 0c.---Wwfc*
Enaryvilla, Calif.
1948, 1949, 1950, Pacifie Employerc 1rs* v-
1953, 1954, 1955, 244 Pine Street 1957, 1958, 1960, San Francisco, Calit.
Industriel Indennity Co.
550 Sansone Strezz San Francisco, C a l i i *
I
t
S u in '::.t::i is t e C e ro . o f i ~1... 0 z
1010 10 $ . V s - O t lr .^ c n S t .
pv v io d worked
1957
ik su r .v :c ? c a s s i r t
S c -r d _ .i
V Jz. &
I r s u l os*** Co*
410 1er s t :^ lv 2 S tr e e t
Lues Stevenson Co. w/i _ ~wU>v.._ . .V i _ _ ccw C rice to , Illin o is
" u e s r ie s l lib ic a C o . 7 : : : ._r:.c ,.v . , i:/..\ A e e u ru e rcu o , .v-:; ,,.e x e co
U - -r. -..--^.0 L_ *C>/W-*t-#s , _w- * 1251 C ^ ;:.* A v :?.u a Z z+ jyv-L ic, C a lifo rn ia
Vrcrua Itr u l^ s ic r Cctosny
2141 South V ita s A v itu a - f 1 11 A,9 ^ C l l 4--
C t i v e r u l Ir o u ls ie ic n Coarseny
~ ..............~j
- . . . - , ,, .
.* *
V it .s rs ie le letrrio C o . it o iv s e t suait it :v s is iio o 3 c a lif .
; .'U S f t l . J .S 11S t l ! CO*
i n u e * .c i s e o 1>> C l I l f .
' co {,.
V ests--
G -tos Prccucts
721 l / u t a t -- i
1947t
1951, 1952
1947
1948, 1949, 1950, 1957
/ 1953
P a c ific E rn lo ycrs Ins 244 P - t e S t r e e t San F ra n c isc o , C o l i f .
In d u stria l Iid tm ic y i 350 S t n s c ia S t r e e t San F r a n c is c o , C a l i f .
ISSO
1948
1945, 1955, 1950,
1947, 1957, 1951
1954, 1958,
1949
S ta te C o zrar.seeio n
In su ran ce . uud 3260 Grand Avenue Otic la n d 1 0 , C a l i f *
'` v ls 'ii C o tio ii's lc i
L57S2 _*:o
Karvey> Illinois
1945
t A
BETRE THE
WORKMEN'S COMPENSATION APPEALS x i H t t M i l J.)
OF THE
STATE OF CALIFORNIA
BOARD
Case N o.
66 OAK 20668
HENRY C . PUETZ
Applicant
C . P . BRAUN, e t a l . , and AMERICAN MOTORISTS INSURANCE COMPANY, e t a ll
/ Defendants
Order Dismissing Party Defendant
Good Cause Appearing Therefor:
IT IS HEREBY ORDERED THAT
Guarantee Insurance Company General Accident F ire & L ife Assurance C o rp ,, L td . The P h ilip Carey M anufacturing Company Lawrence D esLaurler L . L . D esLaurler Company and Firem an's Fund Insurance Company
WORKMEN'S COMPENSATION APPEALS BOARD
December 6 ,
Cfrpie mailed On____
68
i t _____ coj
a l l p a rtie s lis t e d on O f f i c i a l Address Record, (hg)
Fm w M l i m w ?.*>
BEFORE THE WORKMAN'S COKPFUSATTOfJ APPRAT? BOARD
OF THE STATE OF CALIFORNIA
Caie No.
6 6 OAK 20668
HENRY C , PUETZ
Applicant VS. C . P . BRAUN, et a l . , and AMERICAN MOTORISTS INSURANCE COMPANY, et a l1
D rfm danti
Order Dismissing Party Defendant
Good Cause Appearing Therefor: IT IS HEREBY ORDERED THAT
Guarantee Insurance Company Oeneral Accident Fire 4 L ife Assurance C orp ., L td . Tbe P h ilip Carey Manufacturing Company Lavrence DesLaurler L . L . DesLaurler Company and Fireman's Fund Insurance Company
be dismissed as a party defendant in tbe above entitled case.
RICHARD k { EICKMAN
Rrftrtt
xx9m3cmioucnELizPcrcxa:GKxi WORKMEN'S COMPENSATION APPEALS BOARD
December 6 ,
68
Copici roaiW oq_
-19-
a l l p a rtie s lis t e d on O f f i c i a l Address
Record, (hg)
f n . M * tmw t-w
mstrcr Contracting h Supply 120 Forth l i r e U
L a n c a s te r p B u n o y lT a n iji
r VW 3 *CV i t4 d A D O R ISI !N5PT
O E P A H T M C N T O ir IN D U ST R IA L RELATIONS^'"
Division or industhi^l acCiulnts
WORKMEN'S COMPENSATION APPEALS BOARD
STATC O r C a l if o r n ia
' ^
C tfirN ft. Co OAK
y c. puetz
AppltCnt....
V.
/
CAREY MEG, CQMPATY, e t a l " c,
^ ":3 E A ^ ACCIDENT, F IE E & L IF E ASSURANCE CC.-PCPATIC;, L T D ., e t a l
S
D ffrn dtitfS.. J
Notice of Time and Place of
Further Hearing
ip id
NOTICE T O ALL PARTIES
Y ou re hereby notified chat further hearing will be held inthe above-entitled action at
MoverLaer 26th , lj S
3000 State 3uildin~ 1111 Jackson Street
*A
REQUEST 0 ? APPLICANT
:o c A .;-;. B efore lie fe re t
ORKMEN*S COMPENSATION APPEALS BOARD
vers, c o n t in u a n c e s a n d fu r t h e r h e a r in g s a r e n o t fa vo red .
'A'
V MAIL O N PERSONS M K W N ON
IC
ADDRESS RECORD
*A ' V.
*r> - c -
r^ 1 *
O
BEFORE THE WORKMEN'S COMPENSATION APPEALS BOARD OF THE STATE OF CALIFORNIA
AKZA& 5D Notice and Request for Allowance of lie n
g m Nq 66 OAl 20668 V ixio u * d ates irom
feU ef jnjcry . M * 5 t h r o u - i l c;6 7 . _____
STATE OF CALIFORNIA DzpAfcTMZNT OF EMrLOWINT
(RI CUIMBT
P. O. o. 3,857 Otiland A _.S?*60^
fio&ry C P u etft.
...YatLou*
M m K11: 1*4. a t t a c h l i s t __
J^ ._ 2 .^ x ..lO J-p _ .O a a a e j.. A ...S I*563>.........
_ J f t u d o u s . - . A . Ait t a c k e d .H a t ..
MMUC| utini
4WIIW
1. The usvdesvigned hereby requests the Workmen's Compcma tior. Appeals Board to determine and alknr as a lien the sum
Mated below "TotaL" which represents the mount of unemployment compensation disabilicr benefits paid to date,
and in addition a lies is requested for anr further benefits which map he paid, up to the amounts stated an paragraph
bilow.
(1 ) 7- 10- 6? th r u 7- 25-67
( 2) B-22-67 thru ? J-67
2. Hied voder Labor Code Section 490 ( f ) :
Dioblliry benefits at the wetkiv rate of S 70*00 ______
paid for the period___ ( 3 ) 1 2 - 2 - 6 ? - . - * --5 -5 L --6?____
S-- --..ZvZOaOtt
(---- 07__.d3yi at J. 10*90 . . --- per day)
FUad under Labor Code Section 4901(b):
Additional benefit! for hoipital confinement at the daily rate of S .0 2 .0 0 ____________ i l l . S t 8 . 0 0
paid to __ CL) E cn ry C ? u e t 2 . ,, i 2 ) P elt . K g a o r in l B o B p ltftl._ .l2 ). ,62L00
7 2 .0 0
foe the period. ...C l) 7 - 1 & - 6 ? __ t o --------------- 7 - 21- 6?___________ inclusive |____ ___ __.__
(2) 12-2-67
thjm
12-3-67
Total <____ 2 1t 2 .C 0
9, Further unemployment compensation disability benefits will be paid, whenever the employee 0 eligible, foe both daDy
indemniry and additional benefits for hospital confinement which wilt not exceed S______________P ------------ .------ --- and
$ _( >
_______ respectively. If further benefits arc paid, amended " Notice and Request for Allowance
f L i " will be filed by the Department of Employment upon cemtsoo of payment or upon quest from the Board.
4* The undersigned declarer he has delivered oe mailed a copy of this document on_____jQ. iO.ua----- -- ---- to each of the persons named above and Iistrd below. IF OTHER PERSONS SHOULD BE SERVED wrTH THIS DOCUMENT. PLEASE NOTIFY THE DEPARTMENT OF EMPLOYMENT AT THE ABOVE ADDRESS.
I. Copies alto served osthe following representstires and attorneys of record:
Soltfc P a rrish ?aduck & CIa &c j
3X3 fin a n c ia l Center Id c OaklAsd CA $L6l2
Btatb or C a u f m k u DtPAlYXfXT or EaertOTMtXT
-------J S c h a lt x ....................... ................................ BAT E SCHULTS, LIETX1CT KGS. a*.--
EMPLOYEE'S CONSENT TO ALLOW ANCE OF LIEN I understand thst tlie amount shown above at "Total" may not irpmcnt the total amount of disability benefit) that may be paid on my cLum tv the Department of Fmplovnwnr pending the Iburds decision on my workmen's compendium claim, t content to the allowance uf a lien in the twul amount puJ on my claim by the Department of Employment as dvn on *4f final "Notice and Request Jur Allowance of Iacu" died by the Department * i Looploymcxit.
H w gx.?L?u
-------. m .
1. s u rn .n t- rr to at, n g v r r- g HJ'XT c. rtTr i ta, V-**vIOuS 66 OAT 2CCB
. .. ^
Rstloyer
T*ar(s) of * ft^'loyncnt
Inrurance Carrier
. ^ - . ^ . ^ . . . . ----------------------------- .
--------------------------------------------------------------------------------------------------------------------------------------* * * - --" - 1 :-------------
Cork Insulation C o ,, Inc 155 la s t 44th Street Hev York 17, S . l .
Western Aobertos Co. Box 37S4 Rincon Annex Son F rancisco,C a l i f .
$4119
Western-IiacArthur Co. (foraorly Lestera Aabcrtos}
Box J7o4, T^Lncon Annex San F rancisco, C a l i f . 94119
lb s Budlonj Corporation randTiev Building C o l, In c . A . Jo in t Venture
* 7 1 7 Korth Highland Los Angelas >3, C a ll fonda
Karine Fn^iiieering & Supply Co. 941 Fant Second Street
Los Angeles 12, Californ ia
Lawrence Des Laurier L .L . Dec Laurie? Co.
11119 Couth Kaxiposa Los Angelas 44, Californ ia
George Col lin g h E . Gnndar 2$l3 Conpton Bird* Gardena, C a lifo rn ia
Tibreboard Corporation 475 Bra"nia Street San F rancisco, C a l i f . 94111
Plant Asbestos Co. 1300 - 6Uth Street Jh eryrille, C a lif.
94603
1945
1946, 194? 1954, 1956 1957, 1953 i960 thru
1966 196? f 194?
1947
1947
1947
19 4 ?, 1$43
1943, 1949 1950
1953, 1954 1955, 1957 19 5 3 , I 960 1963, 1964
1967
Bay C it ie s Asbestos C o ., L td . 251 F ifth Avenue Oakland, Californ ia
j $ 48
Unknown*
State Compensation la su re o c * Fund 3360 Grand Avenue
Oakland, C a lif o r n ia 94610
State Cocpensation Insurance Fuad
Unknown*
Unknown*
Unknown*
Unknown*
S e lf- lii cured
P a c ific Employer* Group 44 Pine Street San Vxneiaco, C a lifo r n ia 9^104 Industrial Indennity Co. 35C Sannoae S tre e t San Francisco, C a lifo r n ia 9^104 American Usployern Group Ru m Building San Francisco, C a lifo rn ia In d u stria l Indcem.J ty C o .
*1
}
'
J*wefc5 r . V a r io u s - 66 CMC 206i
--------------------------------
------
P*e 2
J . 7 , Thorp tr Soa, I a s . 13^1 'Or can Arenas Useryrllle, California
Van Aredale IU rris Co. 595 i l f t h Street San Francisco, C a l i f .
9A107
19A5, 191,9 1950
1957 19W
P a cifio Employers Group
In d u strial Indemnity C o . Unknown*
Weetern Fibrous Glass Producta Co.
739 2ryant Street San Francisco, C a li f .
9A207
19A9
In d ustrial Indemnity Co.
Zb* In d ustrial In su lato rs, l e a . P . 0 . 3or c6Cl
5521 Anacur C rirs
Houston, Texas
/
19A9
Unknown*
John K anrllle Colas Corp. 22 la s t teth Street Maw Xork 16, r .T .
1951. 1952 1953. 1957
TreTclcrs Insurance Co. 1936 L'ebster Street Oakland, C a lifo rn ia 9^612
Tha P h ilip Cv c j Ktgm Co. Lockland C in cin n ati, Ohio_ A5215
^
1953. 1957
General Accident F irs L L ifo
AiBumnce Corp.
P . 0 , tox 3733 San FTancieci, C a l i f .
9^120
Arcstrong Cork Co. / Liberty !r Charlotte S ts .
195**. 1955 j
^ Lancaster, Pennsylvania
___y
Mundet Cork Corp. 7101 Tonnelle Arenas Eorth Bergen, H .J .
1953. 1962
Thorpe Insulation Company 27Al South I cx'-c Avenue Los Angeles 22, California
1953
Cay Engineering Coro. 2663 Sant l i t a Street Loa Angeles 3, Californ ia
0\tna Comiruj Fiberglass Corp. P .0 . Sox 901 Toledo 1 , Chio
Fluor Hsintcnancs, In c. 2500 So. A tlm tio S . Los Angelos, C a l i f .
*
1955
1955 through
1967 1955
1956, 1957
Travelers Insurance Co.
Aetna Casualty A Surety Co. 1330 Broadway Oakland, C a lifo rn ia 9^612 Dnicnovn*
Unkaova*
Aetna Casualty A Surety Co.
Continental Casualty Co. %J> C a lifo rn ia Street San Franclaco, C aliforn ia Unknown*
\
*r"n '
,,
............... ...
M il
--
\
f u e l s T . V -^ rlr-JC - j * o .T y
l T * cta
Lo /-D" tlc .0 | l ^ i i f o m i *
JUrold C, Lor*ntten
Lores!son Co:.>any 225? Market S tre e t Oakland, v a lifo m ia
Owen te la lo "-nn Jo&C /.febeatos Co
I I 50 lercion **ay Caa J 08Q 25, C a lifo r n ia
C| T* Braun U Ce-rpanj 1000 South *rc=oat Avenu
Alhtrjbm , C aliforn ia
TJnivareul In su la tio n Co >221 R id d i c i!eld .-'oad Menlo i'nrk, C a lifo r n ia
.''Araetrcn- Contraction fT u p
C
120 fo r th Lnrcaator,
Line Street T cnaaylvTTiA
Vuldooa Corrrany, In c 557 fa c t whav Avenue CIot , C o llfo rn i*
M J Carpenter, Inc
Box 153** Lacraaento* C a lifo rn ia
Ac cur* t e In s o la tio n Co, Inc $00 Louth Cypress str e e t la Habra, C alifo rn ia
Klcksan srothcre, Inc* 3170 -act 11th S tr e e t
lo a An^elco, C alifo rn ia
fe lle r In su lation Carp* l 71 n o r t h .' e re e d i l Koote, California
195* . 1957 ; 1956
5.
Irp o n a n t Ic ru ro n o ii Co 55O C a lifo rn ia - t r it Can i 'r u n c i r c o , - r l a i o r n i a
(before 5 /X / L ?}
P a c ific I^ployern Croup 2Vf ine ..tro tt S&n rrn n eisco , C a lifo r n ia
( a fte r 5/1/57)
In d u s tr ia l Indem nity Co
1963, 196J*
1957 '
Arcooaut Incurcnce Company Unknown*
195S
i 960
.
1961, 1963'
,
y
Aaeriean M otorista* lr.suror.ee Co ^17 l.ontr^ocry C t r s a t Can frase le c e , C a li fo rr ia Vnknavs*
Traveler Insurance Co
1961, 1962
Unknown*
1G2 1962
State Cocpeneatioa I adirano o fu n i State Cooponaatlon Insurance fund
1-963
P a c i f i e Employers Group
19^3
Unknown*
---------
i n - .......................... II ............ ... .......................... ..
w
-cr
C--
Pu Pt r. t . Various CC QJT. 2069 Metal Clad Insulation Co. In c. 21759 '-'estera Avenue Torrance, Califorcia
Insulation-Service, lad . Bo* W95 T u lta , Oklahoma
/ iasoelated Insulation of9
California 238 South 2Hh Street Sichnond, California
Pgt ^
196%
1 9 , 1965
.
1965, 1966 1967
In d u stria l Indemnity Co. (before 2/1 5/& )
Hartford Accident t Iad eslity 2150 fra n k lin Street Oakland, C alifo rn ia ^ 2 1 2
(after 2/15/(M)
fid e lity & Casualty o f R .l. 160 Pine Street San francioso, C aliforn ia
(before 12/1/CA)
Great American Insurance Co. 1 Maritime lia n a
San fr a c c ic c o , C a lifo rn ia (after IZ/l/iM")
American Haploycra Croup
1 ..
MOTS: *Tb C a lifo rn ia Inspection Sating Bureau advices that they have "So record o f coverage" forthese employers during the period applicant worked for then. Ve have written to each such employer, advising then o f t h is pending claim and acklng thea to contact th e ir Insurance ca rrie rs promptly do that they nay he properly repreaentod a t the hearing on March
DEPARTMENT o f in d u s t r ia l r e l a t io n s
-DIVISION o r IN D U ST R IA L A CC ID EN TS
WORKMEN'S COMPENSAT.ON APPEALS BOARD
STATE OR CALI'OM NIA
/' ^ r
HENRY C . PUETZ
Appliant
Yt. F iilL I? CAHiY MFG. COMPANY and GENERAL ACCIDENT, PIRE & L IF E ASSURANCE CORPORATION, L t d . , et a l.
DefenJtnit
C ase N o. 66 Oak
ORDER TAKING OFF CALENDAR
By agreement o f th e p a r t ie s , and GOOD CAUSE APPEARIN G :
It Is H ekest O wdewed That the abore-entitled matter be end the same hereby is taken off calendar, and all further action herein suspended, subject to being reset upon requesr o f any o f the parties h t m a
RICHARD A . HICKKAN
ju k m T W ORKM EN 'S CO M PEN SATIO N APPEALS B O A R D
SERVED BY MAIL O N PERSONS S H O W
O N THE O EHCIAL ADDRESS RECO RD
Dju: 4 / 2 / 6 8
hg
(SEAL)
D(rIAiWamCAuIi ro940C*.
---1 f d .^ i A ,i ,- i U ^ --------------------------------------------------------- -.---------------------------------- ------- --
/:
o
BEFORE THE WORKMEN'S COMPENSATION APPEALS BOARD OF THE STATE OF CALIFORNIA
Notice and Request for Allowance of Lien
Cita No. -CAS-2C:c8 ta rio u a C u l t iro n
B*tt i f Injiry
.
STATE OF CALIFORNIA
Depaatm evt or Em ploim ent
Vita cuiwrt
* O. Box 1 E5 7 c t i a c s d cA -m w c A
UWIM
----- ----- -- ^
- J e n x y .,C .,? p e tg.
-S 2 4 Z rttM .
IIMTII MCUl Ntlin
--y a r ia u - ~ .a e * .A t .t & c L * d .llc t .
2 P o x l a - D C a ld o y CA ^
____
--f a z i o s a .w ..c fc * .n t.tn s h e d .X l t............................. l(fki(Kf bMKI
....................................................... .............. .................................. |M|U
I* *Hm undenigned hereby requests the Vorhnd:n*i Compensation Appeals Board to determine and allow as a lien the turn stated below as `T otal," which represents the amount of unemployment compensation liability benefits piid to date, sod ia addition a lien is requested for any further benefits which may he paid up to the amounts stated in paragraph -a.-* below.
2. Filed ondrr Labor Code Section 4905 ( f ) :
qq
Disability benefits at the weeklv rate of S ___ ____ ---- --
paid for the period___. . 1 2 . - 2 - 6 7 ________ to------------______________ inclusive
(------f c j ___ days at $1 0 * 0 0 _______ per day)
t - A ^ Q .C 0 -_____
Filed under Labor Code Section 490} (b ):
Additional benefits for boipits! confinement at the daily rate of $.Q
--...
paid to_______________________ 0 __________ _______ _____ ____ _____________ __________________________________
for die period--._____ Q
_M -- _ ft -------
nghmV
Toul
-- 1-A S C k C C _____
3. Farther unemployment compensation disability benefits will be paid, whenever the employe b eligible, for both daily
mdemniry and additional henefiu for hospital confinement which will not exceed J
ML ...-- - -
__ -- and
f 0
___
, ir*pecUelv. If further benefits are pud. amended " Notice and Request for Allowance
of Lien" wilJ be filed by the Department of Employment upoo ctaution of payment or upon request from the Board.
4. The undersigned declares he has delivered or mailed a copy of thii document o s ---------------------- --- ---- .,,to each of she penom named above and listed below. ]F O T lirR PERSON'S SHOULD BE SERVED UTTH THIS DOCUMENT. PLEASE NOTIFY THE DEPARTMENT OF EMPLOYMENT A T THE ABOVE ADDRESS.
9 Copies also served on the following representative sod attorneys of reord:
odth P arrin h I>-uc)c fr C lan cy
J15
C arter Bld
CaX Ioe4 CA & & Z
Stays or C autokmia Do a st m in t or EunorH tNT
P A T a S C ir O -T S * T 1L T .1I C 7 K A K A G L 3 U la
WTiaj
EMPLOYEE'S C O N SE N T T O ALLO W AN CE OF L IE N
I unJcnunJ that the amount shown above as 'Total** may not represent the total amount of disability benefit that imv be pa-don mv clami by the l>ipirtn.tnr I mj'lmnvnt pcinliqi; tl*c ILunT* deenum on my w,rimer*1 cnmpcnviiim vlaim. I con cm tu the allowanvc uf a lien tn (he total amount paid on my claim by the Department of Employment as d>vii un
any final "Notice and Rcquot for Allowance of Lien" filial by the Department of Employment.
OC 2*01 Mv t tv svi V * WWi
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street
- . 1 *'.* *1. c --. * 1 . A - -
a
/'w '::r:i A sb e sto s C o . F.c;: 371-, l:i**ee.-. Anna:: 3?,:. f ^ r .c i s c c , C a l i f .
94119
1945
A
29-'.5, 194 7 2954, 1913 1957, 1933 1930 thru
1333
*
Ur.br. even
S *.? .z a Cor.pe-.eet i e r In s u r e 2230 Grand .-.v-:v:a O aklan d , C a l i f o r n i a 9431
bus -crn-bac.-r bur C c .
( icr...aru v
Asneceos;
bo:: 2734, F ir. con ^r.na:-:
Sor. b r in e i s e c , G o l i i . <-120
1957
S t a t e CoTTpeusaticr* In s u r e
iu e Guio.-, g C o rp o ra tio n Grar.rvicv.* b u ild in g C o ., I n c .
u ^ i n i W .'.b U r i.'
717 b e rth -.ighlur.e I c s Angelas 23, C a lifo rn ia .
2947 /
Unknown
b o rin e Z n gin earir.g 3 Supply Co 3-,I E ast Second 5t r e a c
Ic e A n geles 12, C a lif o r n ia
1947
Unknown*
l\cncs e s 1`e o r ia r X ..L . Des L a u r i:: C e
lin o South llarip esc
I c s A n g e le s 4.4, C a l i f e r n ia
1947
Unknown*
G io rg a C o llin g I . Gur.dar
1013 Cc.r.poor. b i v i . Carcera, C a lifo rn ia
FIbreboar Corporation 475 Bronnan S tr e e t Sen F r a n c i s c o , C a l i f . 9-1111
p jc '.n t Asbestos Co. 131-' o 4 tn S t r e e t
Fm c ryv i l l e , C lif-
94-303
u
m
2947
Unknown*
1947, 1948 S a if- I n s u r e d
1948, 1349 1950
1953, 1934 1955, 1957 2950, 1930
1931, 1954 2957
P a c ific Em ployers Group 24*4 P in e S t r e e t San F ra n cisco , C a lifo r n ia
In d u s tr ia l Indem nity C o . 350 Sur.scr.E S t r e e t ` . San F ra n c isco , C a lifo r n ia
Am erican Em ployers Group Puss b u ild in g Sen F ran clo co , C a lifo r n ia
*.-.y Ci-cicz ..bestes C o . , L t d .
1943
In d u s tr ia l Indem nity C o .
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1557
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2410?
i-w.v. F i n r c u s C i u u s
?7 C ;` u c : C o .
rv c.:.7 S tr w :* : . . r . v r r . c j . . e o , C i \l i>r-ff Or
1 2 -; s 1549
he in c u s lir ic i in s u la r c r ,? ,
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1549
1251, 1532 1 S 5 3 ,'1 2 5 7
in e P n iii? C c r a y y f e . C o . C ir .c ir .r .it i, O h io 4 52 15
1553, 1237
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r-.-ir.can C o r k C o r e . 7 1 0 1 D o n n e ile v e r .c e
\wrch D c r c s n , > T .J.
-- 7" , -- S o u t h T .cs A n r c l a s
Y Z 03 Ave; 22, C e lia .
l u y Ir .r in c e .r in c 2 ; 5 5 ^t c^. S iv. l i t h
I c s A a c e le s 2 3 ,
C ero, S tr ie C a i lf<
C ' rr .s C o r n in e ; F i d e r e i C 3 3 > . C . :;c>: S C I - ` ir io 1, C h io
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1253, 1532
1553
1555
1555 th re u ch
1567 1955
1 53 3, 1257
P a c ific In o lo ^ u rs C ro co
i n d u s t r i a i Ir .c .c n u iit y C c f r i cnov/r. I n d u s t r ia i In c e r .n it y C o .
.idOsVn
C tra v e l& rs I n s u r a n c a C c .
155-3 I v e h s t o r S t r e e t
O ik lm e , C a liio r n ia
5 -1 6 1 2
G a n a ra l A c c ic a n t F ir e A s s u r a r .e e C o r o .
P - 0 . 3 o:< 3 7 3 3 San F r a n c is c o , C a l l i .
tifa 54120
T r a v a le r s In s u r a n c e C o .
A stn a C a s u n lty & S u r e ty C c .
1330 B r o t u y
O a k la n d , C n li i o r n i a
54612
Cn3cncn-.n*
U rJcn o v n *
A e tn a. C a r u a lt v & S u r e iy C o
C e n tin a ia t a l 423 C a lifc Sun F r a n c is
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In d u s t r ia l (b o re ra
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( a f t e r 2/ 1 5 / 1 0
f i c c l i t v t C t s u r . It v o r lx .V . 150 P in * S t r e e t Str. Ir e r c is c o , C e lir o r r . it
Coe f o r e 1 2 / 1/ o -i)
G r e e t 2c \ a r i c c r . I n s u r a n c e 1 iia r ic ir . a P la rr.
Sa n "r e r .c iic o , C f liic r r . it ( a f t e r 12/ l / 6 i>
Co.
im s r ic a n Ir e c o v e r s G re c o
- - --L:
fr.e C r i i . a r n r a . "n a ^ c ; lo r . I t i r . a I c r a t u a a v is a s t n a t t h e y h a v a
. r. r a c o r c c f c o v a r t r a " f o r t h e c a a r . p l c y a r s u r i r . r f ~ e p a r i c c a p p l i e s . - . - :
. . r . . a c f o r t h a n . V.'a h a v a f r i t t e r . r e a r c h s c o n e r . p l o y o r , a a v r : i r . g tf-.;:.'. o f
i.-.ir p ir . d ir . j a l t i r a r.i t s k ir . o t h a n t o c o n t a c t t h a i r ir . s u r t r . c o c a r r i e r s
s o t.-.sc tr.o y r a y i a p r o p a r l y r e p r a s s r . t a o a t t h e h a i r i e r or. r a r e r *
or d e p a r t m e n t o p i n d u s t r i a l r e l a t i o n s
D IV IS IO N
IN D U S T H IA L A C C ID E N T S
WORKMEN'S COMPENSATION APPEALS
ST A T E O F C A L IF O R N IA
BOARD
HENHT C . FOTTZ
Ai/Jir*/ rv PHILIP CARHY K70. COMPANY, e t a l . , and
GENERAL ACCECLTT FXRS te L IF E ASSURANCE
CORPORATION, L T D ,, c t a . , Dejendmlt
/
Caif JVo, 6 OAK 'JO-iV-'
Order Joining P arty Defendant
Good Cause Appearing: IT IS O R D E R E D T H A T
FXRZXAN'S FUND INSURANCE COMPANY and
GUARANTEE INSURANCE CCStfKNY
be joined is i party defendant herein.
RICHARD A . HICKMAN
I 5 ^ W O R R ) t N COklTENSATlON APPEALS AOAAD
SERVED ON ALL PARTIES LISTED O N THE OFFICIAL ADDRESS RECORD
Date: 2/21/68 ,y: fag
(SEAL)
D Pi AMWMCUAklr FMI **im S > M i
'
*
:
DEPARTMENT O f INDUSTRIAL RELATIONS
1 D IVISION OF I N D U r H A L A CCID EN TS
WORKMEN'S COMPENSATION APPEALS BOARD
5
' 4
You arc hereby notified that the time and place for tbe hearing in the above entitled action has been changed to and will be held at
3
3000 S ta te B uildinn
1111 JatKsor. S tree t
Oakland, C aliforn ia
March Uth, 1.68
2:CC P.M .Before R eferee Hlcv-.ar.
REQUEST OF APPLICANT'S ATTOP.'iEY
1
VoEXMEN'l COMPENSATION APPEAL* BoAAD
i
1
By
1
A
-i
A :
Al; 3
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\
Served by nur! o pmom
on the o&uul ddmt record
n / l/ 6 7 By: fc 39
4
Date Deceiver 1 s t , l n67
O<imwieKiTt rraM* >N>nr* Mai
*
< ~7m
&
R*-
DEPARTM EN T O F INDUSTRIAL RELATION S
P lV f^ lO N O F IN D U M RIAL. A C C ID E .N T S
WORKMEN'S COMPENSATION APPEALS
T A T E o r C A LIFO R N IA
BOARD
C A S E N O . 6-- "DAK ?..
HV'.TY C , PIT7? ?
l
Applicant '
n,
r
P H IL IP CAREY KrO. COMPANY* e t a l .
and
GENERAL ACCIDENT F IR E k L IF E ASSURANCE
CORPORATION, LTD. ,
al
N o t ic e o f P r e -t r i a l
CONFERENCE
D e fe n d a n t*.. _________________/
Y ou ire R eteb> a&u&td that in ipfliffttion for compermtion H u b*tn filed w ith the W orkm en*t C m p cm u io n A p p o lt Baird o f tHc State o f California. You irr Ju rth ff notified that w>d application h u been art for pfe*trrl conference at
January_8th*_ 2068
3000 State Building 1111 Jackson Street Oakland* California
1:30 P.M.Before Referee Hie
PETITION TO D ISM ISS CASE FOR LACK OF PROSECUTION and MOTION TO D IS M IS S
'
PARTIES DEFENDANT
X X D 6X tt 3U [ X X ?a6 Z X X X f >t 1 1 K K X X 3 U U X X atM M > X * im D Z a Z !^ d l ) X ^ R X 3 U U O tX P O O C *3 <
lOQW flXXlt
30U
XY >tKXXX lCSjppLXXJCXSDpcXDEAXXu^XJtXdC
xfcjpuaL)uacxxxia0XiixxxrtjiXXxXxxWQtKjrjc*itJtoOdcacxxatMxxx3lasrtxaex^ itocxjcxjcx.
iftx?tfl^xxix3c^xxxjiZ.\xxxjcjocxAxxootx^xxaQB3axx3t^x^ x^ ^ x3 & xxaaxtondxxjcxiKJucxx Mbx^te^xJTOuc^TrxTyrxxxxxiD cw ttxxjcx^ xaJatiX X TXV.yxflfanpaunxyxn.
IT IS IM PERA T IVE T H A T M ED ICA L REPO RTS BE FILED , A N D CO P Y SER VED O N O P P O SIN G P A R T Y , A S 5 0 0 N A S POSSIBLE, IN A D V A N C E O F T H E S C H E D U L E D C O N F E R E N C E .
V O R K M E N -S CO M PEN SA TIO N A PPEALS B O A R D
h A//ee#r
Dto November 2 1 3t, 1 ^ 7
SERVED B Y M AIL O N PFRvONS I O V N
O N TH F O m U A L ADPRFsS R fU U R l)
Ib tc :
It:
11/21/67
fc * 39
p*4
F?a)| a*Mnv* M i l
i.v
I
.
BEFORE THE
________ r a i l ' s c c :.::-e --:s .\t x c :: appea ls p o ; ? d
rK D C SS K ^ E C A C C iU ^ X o C C ^ L M iS Sia Ix
OF THE
STATE OF CALIFORNIA
C * u No.
66 OAK 20558
HENRY C . PUETZ
Applicant
ARMSTRONG CORK COMPANY, e t a l . , and RELIAICS INSURANCE COMPACTES, e t a l .
D eftnJnti
Order Dismissing Party Defendant
and NOTICE 0? CANCELLATION OP
VR.-t-TRIAL" cc-:..- --- ' . C Z
Good Cause Appearing Therefor:
IT IS HEREBY ORDERED THAT STANDARD ASBESTOS INSULATING COMPANY and AMERICAN MUTUAL LIABILITY INSURANCE COMPANY
be digniiv-d u a party defendant In the above entitled Caac.
The P re -T ria l Conference, heretofore scheduled herein on September 15, I 961 a t 10:30 A.M ., has been ca n ce lle d .
------- SICIIARD-A.-IilCKXAH-----------------Rtfrre
Workmen's Cosipcnsation Appeals Board
Cf u iU ^ n>pf. 1 1 _ a l l p a rtie s lis t e d on O f f i c i a l Address Record.
hg
! in i
1. Me a
J~ i
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DEPARTM ENT OP INDUSTRIAL RELATIONS
D IV ISIO N O F IH D U S tK lA L A C C lD K N T S
WORKMEN'S COMPENSATION APPEALS
^ *----- ^
STATE OP CALIFORNIA
BOARD
*0 *
EENHY C . PUEZ
I A ip iic tn t__
CASE NO. 66 OAK 30668 N otice of P re-trial
C onference
ARMSTRONG CORK COMPANT, e t m l end RELIANCE INSURANCE COMPANIES, e t U
f
D r fm J m t__ *
Totr it kw fiy iriAwl tk*t ia im plication for CM iprnutian h u bun filed rick the V o rim rn 'i Com pm ution Appeal* Board of tke State of California. Ytm it ie rtW notified that id appkitio hat bee act or pn<trU! t oni t f W t it
Septem ber 15t b , 1967
3000 S tate B uilding 1X11 Jackson S t r e e t O akland, C a lif o r n ia 10<30 A. M. B e fo r e R e fe r e e
PETITION TO DISM ISS AMERICAN MUTUAL L IA B IL IT Y COMPANY and STANDARD ASBESTOS MANUFACTURING * INSULATING COMPANY
H lctaan *
. aoaMOcKX*K3UgxJtxg*3cx3KErocaxx^xxy*xxiLdXjtaMcxa3a^^
mtutaipn
x r r ya t Junfaqucy* *
ttwxKX3DcanLX3mjtxx3t3BsapuajuocxDcxJUdfc*xKaiicrexxxio6ioiK50U06X3oouaauacKjqc
TT B IM PERATIVE T H A T M ED ICA L REPORTS BE FILED . A N D C O P Y SER VED O N O PPO SIN G P A R T Y ,
AS SO O N A S POSSIBLE, IN A D V A N C E O F T H E SCH EDU LED C O N FE R E N C E ,
O R IM IN T COM PEN SATION APPEALS B O A R D
If Dm Au|ut 15th, 19^7
SER VED ON A U PARTIES LISTED
O N THE OFFICIAL ADDRESS RECORD
Dm:
%r
6-15-67
10 46