Document 4E9XZkjLoYDDB1Ovy5jZra0x

o M*rCRBY.jR. ChtKAio o<K* jtmioi or ittvict rot r* tiabs Standard Accident Insurance Company ROY W. SMITH MANAOCH CASUALTY FIRE MARINE FIDELITY SURETY Northern California Branch Office fhowjunos.4000 840 WEST SAN BRUNO AVENUE San Bruno. Calif. June 15, 1959 Ol'N 19 1953 WLH Armstrong Cork Company Lancaster, Pennsylvania Attn: Mabel E* Barnet Insurance Department Res 96-C 928392 Armstronq Cork Company Roy Thorsted Date of disability: 2-18-59 Policy no: AZ 688800 I.I.50/1-I-51 Gentlemen: WE HAVE RECEIVED A COPY OF AN APPLICATION FROM THE INDUSTRIAL Accident Commission on the above captioned* We have not formally been SERVEO ANY PAPERS AS OF THIS DATE, ANO IF YOU HAVE RECEIVED ANT VE SHALL APPRECIATE YOUR FORWARDING SAME TO US* Attached to the Application is a copy of his employment record that INDICATES THAT ROY THORSTED VORKEO FOR ARMSTRONG CORK FROM 1950 TO 1952* WILL YOU PLEASE CAREFULLY CHECK YOUR RECOROS AND AOVISE US THE EXACT periods Roy Thorsted worked for your company and the exact wage received AND THE EXACT LOCATION OF EMPLOYMENT* WE SHALL APPRECIATE YOUR IMMEDIATE ATTENTION TO OUR REQUEST ANO ADVISE US AS SOON AS POSSIBLE BY RETURN AIR MAIL* VED/ms cc: V*L*P* Shriver Agency l8oi Union Bank Building PITTSBURGH 22, PENNSYLVANIA Veryxruly yours,^ . Vera Dowling Claim Representative f/ W cc: Hanna 4 Brophy, attorneys 15^0 San Pablo Avenue Oaklano, California Standard Accident Insurance Company Detroit p. tRMSTRONG^ Pilot Insurance Company. Toronto Earnings of Employes Claim No. Assured. Standard Accident Insurance Co. DETROIT Compensation Claim Department Ay -- .4 fc.SJ *j ;i gStfSKT'**- I njured .Accidents'! J9 Schedule of Weekly Earnings .. j Please give actual earnings of injured employe forweeks preceding accident. If not on daily or weekly basis, * ote" t explain basis of earnings. i \Wek No. 4 5 (, < j>> i i: i.' 14 i; i Vr i' ; .'.I ;i From Date Week To Date - Amount Paid including extra work Number of days worked | 1 j i 1 1 ) i j i i i ' Week No. 27 28 29 30 3! 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 From Week To Date Date Brought Forward Amount Paid inc'uding extra work i 1 1 j 1! i | i i i ; i i Nurnbt. of dav' workec: ; ----------------- r" i ; i ot.il Carried Forward Total M MARKS P-ARMSTRONG 1 certify that the above is a true copy of payroll record of injured's earnings .is shown on employer s record >. -0 *\ u o V, V- *>3 > Ca (A (A ^ x> =-5 V Ij ^ o* ** O On h * *3 ^ ^ ^ < < < i"> O<j Ui ^ Co Oj <^( oj t*j W W jLr ^ ^ < -V \ \ ^ . 1---- ,__ o "I -3 -<} -O -O aq >*3 ^ 0^ W 'O Xi -w c- D0) (m <r s> Jj lj -v bh <. OJ Jb -- *. 3 5 s 3 3 3 3 3 $ $ 3 s r 3 & rr'T'rrt X A 5: c >, -1 r> Sy >->_ X.. %> jj ^ >. i' *wl 1 j w X> ^ -: -ft. -c. 0/ v'T'TCi'' '(1 a33 \ ^^O Oq ^ \ bl y> - < *, > - Jo Ss ^ ^ 0/ V Sb o' w4 .5 "7? <y 5f o ou &o TT % 5 3 3 "3 & s ? ? . . " v> 'Cn :v T '0 3^ <> TS < S -fc. ns j ^* <A k ^ j } ^6 N \ XT s o i ^ Ct k <,, 0^ ur (a "O s! n. S 9 0 ~-3 _Tx. < ' js_t J *> n ~ar rnriTTj ' t j tt?0 ' t^! ........................ !? P ^ O k> ? > >* ty t N 6\ i r^ S h DJ */ f/~ P.APMcronM/* '* M (A -fe. <4 ^ Ox Ol. ,,UI .1. h - <* -fr- ^ ^ A-A-Jl ,ii_ ;.i K t. ;f l II i p.ARMSTRONG  l, V SU - - ' U X) ^ ^ xj i> - * ^ * *5 >3 jj ?L 'b ^ fj (j s- e^ <a Ov -fc < (! July C, 195? . c r* Ir.r:r;;ce Coupti.y 1 > ; . ^ JT o..u-.. i:., c:i:r. Cc 'Ui . .it Attentions Mr. !! II. Abrcu z*j}icu r--v ~ - >.- 1/V52 ,.,--46 to yo:ir Icof J\no ?09 v r.; close in <;;:r.diu;ilicnt3 tb* vi^e ^orkt.i vUlo iri ti.c employ of .Amctrer.j Cork C.~;-p-ir djrinj -2. 0n <T>. ;:; v: n_L1.4 to tin Z: y 3 xv.no, CiliCarrJLa olfico of St:rd:.rd Act- : :t Iniv.rcnto ire''-in? tno rcr..Inin.*; v^c dutr. i;r tho v?-:-*:: l^tO end Ty cII". V / -. .r:\ - 1:;.-;: V-o v-- r *1 .' ." T- O'.. r;y i, : ye- y;ll ).:v * f S'' -.t vifi /....rtr:::" "I. *" r-*.:rd of .) -f vit*: i - <- <-* v." v .. vc.' :: :* c:v -t -V. .d r.-.i '.. +: ~ - t> V. r- Ct '. .n . - , * . 7 vc-.'-iJ in 1:71 y:u ' r \ -1* e-U:Vt;-ic \ith . ^ *:r-t>a .-t c..-:.ro;. The rbovo c-plvv.rrt picfirc i: e-tec >*? r-...:"bl -;i- vr.lv.d for nc-y diffcr:.:t c:-.pl?y-:rr \..ich ir not pip-* r.r;; i'nics. Vb-r tr^v --re, A:.:c:rx3 co:s esuvu-r JC2 tn&omra r. C. S;hi'4, Jr. 1 I? rtaent . ' *, _ STRONG-"^ thw : Cv.v.r/*;-.; . t... . ..li ST. OAKLAND 12. CAUfL OXMPLHAft 2*0200 June 30, 1959 tit Armstrong Cork Company, 30b Shaw Pvoad, San Francisco, California. B-6972646 Armstrong Cork Co* re: Roy Thorsted d/a 1-1-52 Gentler.cn: Please submit, in quadruplicate, a statement showing dates of employment, hourly rate, occupation, location of employment, date of and reason for termination, gross camir.rs for tho twelve month period immediately preceding termination, whether i'r* Tlorsted was a temporary or peiranait employee.* and whether in his employment with your company his duties ex posed him to asbestos* A hearing before the Industrial Accident Ccrraission will be held very shortly, and this information is required by our attorneys so that we nay afford you a proper defense* m:JJ cc: Armstrong Cork Co*, Lancaster, Pa*.- *1.ry tnily'yours. ' l 6V^ K* 1* Abreu Adjustor p-KKWlsiVrtO^G EMPLOYER'S REPORT OF INDUSTRIAL INJURY STATE OF CALIFORNIA DEPARTMENT OF INDUSTRIAL RELATIONS DIVISION OF LABOR STATISTICS AND RESEARCH Every question must b tagwered tully to avoid further eorrespood- ene. FAILURE TO- FILE IS A MISDEMEANOR SUBJECT TO MAXIMUM FINE OF SlOO^ Claim Department THE TRAVELERS INSURANCE COMPANY 195$ Webster Street, Oakland 12, Colif. For Id.. Date: GERALD DONIS, C.S.R. Please make this report in DUPLICATE so that we can file copies with Division of Labor Statistics and ResEIfdh' lfryeiir'b7ir?!f.'--" * (w,.fl. injury to ;in t-mplmi-o which c.uim'n rli-.ilnlit v Ltsiitit: longer titan tlw* day of the injury nr which rcf|iire mctlie.tl services other than first .. I,,.............. 5>e ri-txifii c| w it hilt live dav> after the in iti ry. If the injury results in death, a report must be made by telephone or telegraph directly t(, the Division of Labor Statistics and Research not later than 24 hours after death.___ _________________ _______ _ ____ EMPLOYER '< -ivv name under winch l. V.mic c>-i.cern doitui-u.-urii) (No. a:-.d i !: rr. address Street M.innhictutinu shoes. retailing men'* N trnckinc tor hire. etc.1 injured EMPLOYEE *. Nxnr ..... i\'- and J. Vlirt'S Street)... (City or ...Town)_ (City and ............ State)____ __ Soc. See. No. DO NOT WRITE IN THIS COLUMN' Caae No, Employer No. Industry 6. 7. Sex: Cheek (vO Male... __ Female.... 8. Cheek (y) Married. Single* 0. Number f hours worked !"r day....................--...................per week--....................... . Number of day* worked per week. 10. S.......................................... Pr hour, or $............-.................. -....... per day. or S..... ............................ ___.per week. (If earning* at irregular rate, tuch Age a* cce work or on commission basis, enter actual average weekly earning* for convenient period not to exceed one year.) U | i. or other advantage* furnished in addition to wages, give estimated value S......................... -...per day. or S...... ...... ..........................per week ACCIDENT (No. and 12. !' ...e of accident Street' ....... (Yes or U. iloyer s premises No)........ (City or --Town). U. Department...................... .................... ..(County). Sex and Marital Statua Waekly Wage 15. n.te o( orosdent................................. -......................... Id- Hour of day................ .......... A.M./P.M. 17. Did injury result in disability beyond day of 1 Vos or ...... jv-t* N . ...................... 18. if yes. give date last worked............. ............... --............................... ..... ...................... 19. Was injured paid in full for ' i ts or . > \\. 20. If injured in a mine, check (y/i accident location: Surface................Mill................. Underground................Shaft.................. County -E OF ACCIDENT Accident Date > i-. (job title)......... __________________________ _ 22. How long employed by you at this .- Check U i Lets than 6 months................ ; 6 month* to 2 year*.. i Describe briefly, such as: loading truck, operating drill press, shoveling dirt, walking down stairs. etc.?._.................... over 2 years.......... - 28. What was employee doing when accident Occupation (Describe fully, stating whether the injured person fe!i. was struck, ete.: give all I t:-c accident happen? factors contributing to accident. Use other j.d* of report for additional space) Accident Type (Name the speeir.c machine, tool appliance. hide. tool, substance, or object was most Closely connected with the accident? gas. l.,,u:d, etc., involved; (State if gears, pulley. (i ; niv.-.j apparatus or vehicle, what p3rt ot itf motor, etc.) (Yes or ..............-................................................................... ......................................... ............. (Yes or ' . tm-.-h.inical guards, or oilier safeguards provided? No) -...................................... 28. \\ a* injured ujing them? No- ...... ................................... (State the speeir.c preventive measures tint ;a:-. be tiker. by employer ar.d workers. ' :.! v.mi recommend for preventing this type of accident? Do not say. "fay being mote carc: ul. " Spec::-/ what snould or tnouid not be donej Agency Agency Fart Meet. Detect Unsafe Act NAl'inr 1)1- INJURY AND PART OF BODY AFFECTED .( i the nature of the injury and the part of t;.e body affected For example: amputation '>. . : i . U \ n:.ter at second joint, fracture of ribs, lead poisoning, dermatitis of !:t hand, etc.) .......................................................... ....... Jt. N -i.ldtcis of physii-irin.___ _ .'2. N .mi.- .ici trv .s of ho-pit.i!___ 22. IU-. (Yes or returned to v.-oik? No) .............. 34. If yes. give date........................................ JS. At what wage? t............. -............... per................... - Yes or 20. I >;.t injury u oill in deutti? ................. 37. If yes, give data........ ............................-.................................. -........................ .......... ................................................... ,S. 1: -I drith. give r..mc .Hid .ul-lress of ru-.ite.t relative_____ .... Personal Defect Nature of Injury Location Extent of Injury 34 un i a.(>ir-M-s o: win Insurance Carrier ). Is injured trialed to linipl*-y<-r ?...........................-.............. If so hOw>... Date of this iepo.._,,....... ........ ........ --..... .......................... Report Lag ..Oifieial position..................................................... .............-................... Filing of this report is not an admission of li.tl'ilitv. . V- n-p< *i-t <> ii-i'ir-. n-ijinu J to U- :i!< 1 l-v ,ui i-inj >1. . \ < r i.r ..n in . hi i r I i ..i . . !i .;t i h . i 1 .i .< Inti- il .!< ,i- -t uli-it` i- tit .iits ,i- i vcr-.il \ ]>i > etvtliliK lh tul i- t lie 1 itiki->t rl.tl . \ t fii k-ul ( .-iiliiii"H m." 1 ..ibid Code, No l i' di 0 I 1.' Coded by D.flPWCTorvM/- _ June 23, 1959 r ji Co Xfi tc-ndard Accident Xhenrmce Company 40 V, S.n *;r..:io Avenue ai 3mno, Cdif. ,f G'ntlcaeni Attention! Yex'a S. Doviing In reply to your- letter of June 15, ve eacloee .'by Thorstsd* n eaployncat recora for the yeers 1950 end 1951. ------------ Very truly yours, ARMSTEKKi CORK COMPACT JE2 Ehclosure# V.L.P. Shriver Agency 1501 Union Beni: Building Pittsburgh 22, Pa, .-us- ' R. C. Scbiedt, Jr. Ineurcnco Department - .nM^TOnNH Jk I//re Office COMMONICAT/ON To J* Zeller, Lancaster f,om J, S. Taylor> San Francisco i.-i<cr h'-oort of Finclir.ps ?c Order Key Ti.cr'j tec vrst llmployers tr k'cs (Armstrong CONTRACTING January 6, I960 *. / /' / Enclosed report of Findings and Order in connection with asbestosis claim of hoy Thors ted before the Industrial Accident Commission of the otat-e of California* I assume you will want to advise our Insurance Carrier through the Armstrong Cork Conpany of this decision. DJ!1 . P-ARMSTRONG "S3 r - l P-, March 17, 1960 :{r. D. B. V. It, ?. *\ river A-rsncy .'01 Union I'-.x i.uiici.'v; > x &. _____ --# .-* 1 _ Djit CiTOJ fuvj eyfcj i;/ " -*-/ 7 i 0 1 v/ A * '/'? * Calif* )!/ tardy acV ?i'lcrs? t certainly rocs not indicate a ! of fipprecintioa on iv part ox jour rlu 9 letter regarding tho licuccitica of this dsun. As you fcnev, t.is.'.-e pisr;." `>noconior;i8 end csbc^fcosis cltHr.3 ere on the ia- cr-*r?o in r -y section.<: of the country, end vo fro C3:'.r:.nly to hear trot Citrnd'-.u-. Accident* o uafens s. suited only in an or;. ..as? itsa of Clo'3 for lorri. services. Think you* Very truly yours. R. C* Ssbiedt, Jr. Insurance Dapartnent J2 p.pRMSTRONG'^^ mu' V.L P. SHR1VER AGENCY, General Agent 1801 UNION BANK BLDG. PITTSBURGH 22, PENNSYLVANIA ____ Hm Qtm* 1-7*00 March 9> I960 Mr. R C. Schiedt, Jr. Insurance Department Armstrong Cork Company Lancaster, Penna. Dear Mr. Schiedt: Re:- Claim No. 96-C-928392 Roy Thorsted, Injured Employee - 2/18/59 Policy No. A2-688800 The Standard Accident Insurance Company has closed their file on the captioned case. No payments were made and the only expense to them vas $183.00 for legal services. The above vas an Asbestos Worker in California and suffered vhat is known as Pneumonoconiosis with date of disability indicated as February Id, 1959* You may recall furnishing the San Bruno, California office of the Standard Accident Insurance Company vith Mr. Thorsted's employment record for the years 1950 and 1951. We are closing our file in the matter. Thanking you, ve are Very truly yours, p.ARMSTRONG3