Document 3J8L6VMG7xwJM4x685yxQp33D

Workmen's Compensation T Ohe Industrial Commission of hio DEPARTMENT OF INVESTIGATION 1 PLAINTIFF'S ]| EXHIBIT, . Columbus REPORT OF INVESWPTW Claim No...... .QD...lQ.7.5i.Q... S. S. No. 270-07,pli05 ................ . Case of....... HenrZ. H.f...Hoorst.,.. dec'd............... Iola T. Hoerst, Yiidow-Ciaimant Address 101<ff Jayne Aygnug........................ Cincinnati l5. Ohio Employer The Phij4P. Carey.Co... Address ....3?0...S-...vfayne Ayenus............ - Cincinnati. Ohio To the Industrial Commission of Ohio, Pursuant to instructions, the above numbered claim has been made the subject of an investigation and the following report relative to same is herewith submitted: Date Dictated.....?.ciQ.7.^k Date of this report....?.7.?:.?~k..Dates of investigation............................................Date Transcribed.k.riP^kk Investigation covered following matters:... (Her live brief etetement ai to matter* covered by laveetlfatioe.) OCCUPATIONAL DISEASE; Asbestosis Claim allowed as an 0. D. Claim on 11-15-60 and decedant has been a P. T. D. since 11-16-60. DaTE OF DEATH; CAUSE OF DEATH: 10-17-63 Pulmonary Edema Cor Pulmonale Asbestosis AVERAGE YiEEKLY AAGS; $96.71 INVESTIGATIONS C-2 Death Certificate C-10S-R C-5 Autopsy Report C-07 C-ltU Marriage Certificate Being duly sworn, Iola T. Hoerst, who resides at 10109 V.'ayne Ave., Cincinnati 15, Ohio, deposes and states she is the legal widow of Henry N. Hoerst, deceased, hereinafter known as the decedant. The affiant further states she was born Iola Knueven,Sept. 25, 1900 at Reading, Ohio. Her mother's maiden name was Catherine Medasch and her father's name was Henry Knueven, both deceased. The affiant and decedant were married by Father Joseph Rolfes at S^. James Church now in Wyoming, Ohio, on October 5, 1927. There was no previous marriage by either party. There were two daughters born of this union, Joan, aged 3k and Ruth Blout 30 y.-ars of age. The decedant and affiant were living together as man and wife and had never contemplated separation or divorce. The decedant worked dt.'Philip Carey for twenty-four years. (Continued) Investigator or Deputy. OD 107910 Henry N. Hosrst, Dec'd 10109 Wayne Avenue Cinci nati, Ohio The Philip Carey Mfg. Co 320 S. Wayne Avenue Cincinnati, Ohio In 1957 the affiant had his first attack, he was off for eight months and the asbestosis was found and he went back in another department. The decedant was declared a Permanent Total on November lp, I960, by the Industrial Commission. In March of 1963 the decedant was placed in Christ Hospital and was hone until the fourteenth of September 1963 at which tine he was placed in Good Samaritan Hospital, where he died October 17, 1963. An autopsy was performed. The Schmidt-Bhonau Co., Funeral Directors, were paid $1263.27 by widow-claimant for burial. good health. The affiant was wholly dependant for support frcm the decedant and is in fairly History of a slight heart attack some four years ago. allowed. The C-I1I4 shows a direct relationship to Occupational disease for which claim was EMPLOYS': Philip Carey Mfg. Co. - Claim.is Certified RECOMMENDATION; That file be referred to Mr. Lahiey for referral, if necesoary, to a specialist. Then to Mr. Lawrence Gibbs for review and payment of fee bills as are approved. EPF/mh * EVERET P. FRaDY Claims Investigator <