Document 6wYV1qbOqZNEaX28JVB9ao83g

* STATE OF CONNECTICUT) ) SS. Bridgeport COUNT OF FAIRFIELD ) u.s. District court eastern district of TENNESSEl - CERT IF1CATI0N THIS IS TO CERTIFY that the attached Is a true and accurate copy of the Agreement to Compromise, Petition to Compromise and Order from the records of the Office of Workmen's Compensation Commission, State of Connecticut, Fourth District, in the case of: Frank Torok vs . Raybestos Company, now Raybestos-Manhattan, Inc. and The Travelers Insurance Company; : The Hartford Accident and Indemnity Company, The American Surety Co.; The Employers' Liability Assurance Corporation. Given under my hand 1978. PLAINTIFF'S EXHIBIT \ !wyrCaQ3Q&6| FRANK TOROK, CLAIMANT VS RAYBESTOS COMPANY now RAYBESTOS*MANHATTAN, INC. Employer , end t CORAHt *.. fort i r w. - . t I COMPENSATION COMMISSIONER . \ - *. : v t ' t t FOURTH CONGRESSIONAL DISTRICT THE TRAVELERS INSURANCE COMPANY t HARTFORD ACCIDENT AND INDEMNITY CO. t BRIDGEPORT , CONNECTICUT. AMERICAN SURETY COMPANY EMPLOYERS LIABILITY ASSURANCE CCRP. I MAY Insurers RESPONDENTS I d ' AGREEMENT TO COMPROMISE PETITION TO COMPROMISE And , 1939. %&%% C ^ * *2 W\ ORDER WHEREAS on or about the 4th,dayof November, 1938 and for a numbers of years prior thereto, the claimant, Frank Torok, of Bridgeport, Connecticut, was an employe of the Raybestoa Company, now Raybestoa-Uanhattan, me., of Bridgeport, Connecticut, and, WHEREAS the said employe and employer had accepted and were at all times herein mentioned subject to Part B of the Workmen's J. * _ .' v I, ' - - - ' Compensation Act of the State of Connecticut, as amended, and the t < . .i; * " employer had insured its liability thereunder for various periods during which the said claimant was employed with the Travelers In surance Company, the Hartford Accident and Indemnity Company, the American Surety Company and the Employers Liability Assurance Corp oration, all of which said companies exist and do business under th laws of this State and are duly authorised to take such risks in this State, and WHEREAS '* * . . claimant claim* that rm nr> nHpnl-. fcfe* Atb A.* * November, 1938 he suffered an occupational disease, to wit, asbesto .'.a 4 . * and further claims that said occupational disease arose out of and in the course of his employment with the said employer! and further claims that said disease is compensablej and further claims that he has been disabled from all work since the 4th of November, 1938| and further claims that he will be disabled in the future, all of which said claims each and all of said respondents deny, and WHEREAS a partial hearing of said claim was held before the Compensation Commissioner of said Fourth Congressional District as will more fully appear In the files of aald office, and WHEREAS the said Frank Torok is a widower and has a mother, Julia and three minor children, to wit, Frank, JS*., George and ' Helen Torok, all of wham are potential dependents, and WHEREAS the said claimant was represented at the aforesaid hearing and Is now represented by counsel, and WHEREAS It is the desire of the claimant and the said re spondents to reach an amicable adjustment of the above disputed claims to the end that further litigation be avoided' end doubtful and disputed claims be rendered certain* THIS IS TO CERTIFY' that I, the claimant have agreed to receive from The Travelers Insurance Company the sum of $426.28 The Hartford Accident and' Indemnity Comoany the sum of $429.49 The American Surety Company of Mew York ^he sum of $1060.90 The Employers Liability Assurance Corporation the sum of $83.33 making a total sum of Two Thousand Dollars ($2,000.00); and we the insurer respondents do agree to pay to the said claimant the sum above specified, to wit, The Travelers insurance Company $426.28; The Hartford Accident and Indemnity Company $429.49; The American Surety Company of New York $1060.90; The Employers Liability Assurance Corporation $83.53; In full accord and satisfaction of above disputed claims. AND TO FURTHER CERTIFY that In consideration or said sums so paid, I, the claimant, do hereby remise, release and forever discharge the employer and all the insurer respondents from all claims for compensation benefits whether for compensation in any form payable to me under said Act or for surgical, medical or hospital benefits payable on my behalf and whether said claims have already arisen or hereafter might arise by reason of aforesaid claim of occupational disease.  AND TO FURTHER CERTZFT that I, JUlla Torok, mother of afore- - aaid claimant, Frank Torok, do agree that in consideration of said sums so paid to remise, release and forever discharge each and all the above named respondents freon any and all claims vhlch I might hereafter have against any and all of them by reason of the all eged Incurring of an occupational disease by the said Frank Torok while in the employ of the said employer-respondents, AND TO FURTHER CERTIFY that I, the claimant, Frank Torok, as parent, natural guardian and next friend of aforesaid minor children, potential dependents, do, in further consideration of said sums so paid, discharge each and all the above named respondents from all claims which might hereafter be made by them against any or all of the above named respondents by reason of the aforementioned all eged Incurring of an occupational disease by the said frank Torok, while In the employ of the above named employer-respondent, AND TO FURTHER CERTIFY that w4, the claimant and the respondents, hereby submit the written agreement to the Compensation Commissioner of the Fourth Congressional District and respectfully ask that said agreement may be approved with the farce of a full and final award. In witness thereof we hereunto set our hands the day and date first above written. Witnesses j '/,. /. d-i: SI-,</-- Claimant^ parent, natural guardian and next friend of Frank, JT., George and Helen Torok, pptentlal claimants. ientlal cla and mother. RAYBESTOS COMPANY now RAYBESTOS-MANHATTAN, INC. a? THE TRAVELERS, INSURANT nrsWhr THE AMERICAN SURETY COMPANY OF NEW YORE By ^ vsv:-.^Ax EMPLOYERS LIABILITY ASSURANCE CORP. Approved 0 day of May, 1939,By <-C . c> OriTC.. r/. Comnensotlon (foi.mil nVi Oner ^