Document 6wp5y89KEaZGwRbrz390exDno
FILE NAME Manville JMA
DATE 1964 DOC JMA146
DOCUMENT DESCRIPTION Contract Unit Claim File Ollie Rogers
WORKERS COMPENSATION APPEALS BOARD -
COMISION INDUSTRIAL ACCIDENT
CALIFORNIA
prior COMMISSION
to 1966
APPLICANT
OLLIE ROGERS -_
Insulation Mechanic
DATE CLAIM FILED
June 23 1964
INJURY ALLEGED
Pulmonary Fibrosis
ALLEGED DATE OF INJURY
1942-1962
,
CASE LB 26779
EMPLOYER INSURER
Co. Thorp Insulation Co./Firemen's Co./Firemen's Fund Ins
et al
including M Products Corp./Travelers Corp./Travelers
OTHER NOTES
No apparent Canadian carrier
Asbestosis fibrosis
Applicant condition
reopened
case
1970
due
to deteriorating
DATE OF RESOLUTION July 11 1966
RESOLUTION
Findings & Award
14,280 settlement
ad
Oct. 22 1971
Compromise & Release
11,294 settlement
- DOCUMENTS COPIED
1 Compromise & Release & Order Approving
# OF PAGE 7
2 May 26 1966 Rpt of Dr. Urabec to Pacific Employers
4
CLAIMANT
Ollie Rogers
California Workers
|
Compensation Appeals Board
CARRIERS INVOLVED
The AETNA Casualty & Surety Co.
oAmerican Automobile Ins Co.
oAmerican Employers Ins Co.
oAmerican Motorists Ins Co.
oArgonaut Ins Co.
OAssociated California California
Indemnity Corp.
Casualty Indemnity Exchange
Compensation & Fire Co.
oCasualty Ins Co. of California
Employers Liability Assurance Corp. Employers Mutual Liability Ins Co. of Wisconsin -
|
oFidelity & Casualty Co. of New York
Fireman's Fund Ins Co.
Assurance
oGeneral Accident Fire oGlobe Indemnity Co.
_
& Life Assurance Corp. .
Ltd.
oGuarantee Insurance Co.
oGreat American Ins Co.
oHardware Mutual Casualty Co. Industrial Indemnity Co.
Sentry
oIndustrial Indemnity Exchange
oInsurance Co. of North America
Ins
Co.
Co.
oLiberty Mutual Ins Co.
OLumberman's Mutual Casualty Co.
Maryland Casualty Co.
oMichigan Mutual Liability Co.
oMission Insurance Co.
oNational Automobile & Casualty ONew Amsterdam Casualty Co.
Ins
Co.
oOcean Accident & Guarantee Corp. Ltd. Pacific Employers Ins Co.
oPacific Indemnity Co.
oReliance Ins Co. Standard Accident Ins
oRoyal Indemnity
Co.
U.S. oSecurity Ins Co. of Hartford
State Compensation Insurance Fund
oTransport Indemnity Co.
The Travelers Ins Co.
Casualty
Ins
Co.
oThe United Pacific Ins Co. OU.S. Fidelity & Guaranty Co.
oZenith National Ins Co.
oZurich Ins Co.
o0 0
34
5/81 mmfmmf
e
SCHEDULE OF CONTRIBUTIONS
' LOUIS FIRE BRICK & INSULATION COMPANY
< .IFORNIA COMPENSATION & FIRE COMPANY
MANVILLE PRODUCTS CORPORATION
THE TRAVELERS INSURANCE COMPANY
.034 .185
ROTHSCHILD OIL COMPANY
MARYLAND CASUALTY INSURANCE COMPANY
BECHTEL CORPORATION
INDUSTRIAL INDEMNITY INSURANCE COMPANY
.
.003
.005
MARINE ENGINEER
PACIFIC EMPLOYERS INSURANCE COMPANY
A DET CORPORATION
A NA CASUALTY & SURETY COMPANY
.220 .008
GOLDEN BEAR OIL COMPANY STATE COMPENSATION INSURANCE FUND
.013
PURITAN ICE COMPANY
CALIFORNIA CASUALTY INDEMNITY COMPANY
.005
FIBERGLASS ENGINEERING & SUPPLY COMPANY
AETNA CASUALTY & SURETY COMPANY
.006
THORPE INSULATION COMPANY FIREMAN'S FUND INSURANCE COMPANY
.521
1 AL CONTRIBUTIONS
OLLIE W. ROGERS - WCAB Case No 64 LB 26779
CONTRIBUTION
CONTRIBUTION
$ 384.00
2,089.39
33.88
56.47
2,258.80
90.35
146.82 146.82
56.47
67.76
6,110.06
11,294.00 11,294.00
PROCES AND OCT DIY
STUD
:
OPRECT 20 PROCESPROCES
42
'71
(
C
Re Ollie Rogers
The patient was referred to the ray department of the Hospital of the Good Samaritan for chest rays These were reported as follows
Chest anterior and lateral views of the chest show the heart
to measure 14 cm while the chest measures 31 cm Both costophrenic
angles are blunted and there is thickened pleura along both lateral chest
walls The bronchovascular markings are prominent in both bases
more so on the right near the heart border There is a fibrotic
ance with the possibility of small cysts in the right apex with a coanpspiedaerr--
able pleural cap Minor fissure is depressed A lateral film
considerable degenerative change of the dorsal spine
demonstrates
There is an ..
overlying soft tissue density on the lower two or three vertebral bodies which would suggest parenchymal lesion Whether this is acute the findings
are not known as old films are not available for comparison " *
s R. E. Levis
a The diagnosis of this pulmonary condition is established by the lung
biopsy which showed the findings of an asbestosis
He has a
disability but at this time it is partial only
permanent
He is physically able to
perform light type of work As regards liability of his condition I believe
this must be apportioned by his various employers and this is
on the duration of his employment and by the type of work in whdiecphenhdeenwtas
engaged
As stated above he is physically able to do light type of work and should be encouraged to do so However he should avoid an atmosphere of potentially harmful dusts since it might cause an aggravation of his present underlying condition
Very truly yours
John H. Urabec M. D.
WORKERS COMPENSATION APPEALS BOARD
2
STATE OF CALIFORNIA
3
OLLIE M. ROGERS
F&F
| CASE No. 64 LB 26779
5
Applicant
DB
VS. 0 ) 7
FIBERGLASS ENGINEERING &
8 SUPPLY COMPANY
CERTIFICATION CERTIFICATION
o
Defendant' }
I hereby certify that the attached documents are true and correct copies of the original documents filed in the records of this office in the entitled matter
ATTEST my hand and the Seal of the Workers Compensation
14 Appeals Board of the State of California
19 ---- --"--
20
Workers
Compensation
Compensation
Judge Appeals
Board Board
21
23
24
Dated at San Francisco
21
California this of April 1981
3rd
day
DIA WCAS FORM 15 NEW 1.75
CONT
OF
DEPARTMENT OF INDUSTRIAL RELATIONS DIVISION OF INDUSTRIAL ACCIDENTS
VORCEN'S COMPENSATION APPEALS BOARD
ay
|
7
STATE OF CALIFORNIA
3 | OLLIE M. ROGERS )
15
Applicant
}
"
)
1 FIBERGLASS ENGINEERING & SUPPLY CO
i AETNA CASUALTY & SURETY CO
)
{
, MARINE ENGINEERING CO
)
* PACIFIC EMPLOYERS INSURANCE CO
, BALDWIN HILL
)
; AETNA CASUALTY & SURETY CO
)
Case No. 64 LB 25779
; THORPE INSULATION COMPANY FIREMAN'S FUND INSURANCE CO
,
MANVILLE PRODUCTS CO THE TRAVELERS INSURANCE CO
ORDER APPROVING COMPROMISE AND RELEASE
)
PURITAN ICE CO
)
; CALIFORNIA CASUALTY INDEMNITY CO
|
)
GOLDEN BEAR OIL CO
' STATE COMPENSATION INSURANCE FUND
)
i ST LOUIS FIRE BRICK CO
)
} CALIFORNIA COMPENSATION & FIRE CO
)
ROTHCHILD OIL CO
)
MARY LAND CASUALTY CO
)
| BECHMEL CORPORATION
)
' INDUSTRIAL INDEMNITY CO
)
Defendants
Applicant received a Findings and Award July 11 1966 of
: 68 based on a limitation to light work without dust environment and
further medical treatment this has been paid in full in the amount of 14,280.00 A Petition to Reopen is filed and the parties now settle this case for the additional sum of 11,294.00 Applicant ha
worsened Dr. Goldfarb finds him limited to sedentary work Dr.
Dickstein finds him totally disabled Based upon the fact that deat
benefits cannot be awarded in the future due to jurisdictional limi tation the settlement is adequate for lifetime benefits and will
: permit the Applicant to enjoy present benefits thereby
-1-
1
The
, contributions are in accordance with the agreement Fireman's
i
2
Fund Insurance Company shall pay the following liens
Levy Endriss a
Dr. Edward Dickstein 294.00 294.00
= ; Levy & Van Bourg costs 55.18
Photocopy Service 21.00
& Van Bourg fees 1,000.00
5
The parties to the above
entitled action have filed a
6 Compromise and Release herein on October 20
settling this
1971 ca 7
11,294.00 for
in addition to all sums which have been
previou 8 paid
and requesting that it be approved and this Board having considere
the entire record including said Compromise and Release now finds
10
that it should be approved and
11
IT IS ORDERED that said Compromise and Release is approved
12
AWARD is made in favor of OLLIE W. ROGERS
Against AETNA CASUALTY & SURETY CO PACIFIC
EMPLOYERS 14
| INSURANCE CO INDUSTRIAL INDEMNITY CO MARYLAND CASUALTY INSURANCI
INDEMNITY 15 CO CALIFORNIA CASUALTY &
CO STATE COMPENSATION INSURA
.16
| FUND CALIFORNIA COMPENSATION & FIRE CO FIREMAN'S FUND INSURANCE (
17
TRAVELERS INSURANCE CO
18
Payable as follows
| 19 By CALIFORNIA COMPENSATION & FIRE CO
20
To Ollie W. Rogers applicant
;
$ 384.00
By
21
22
By
ct
THE TRAVELERS INSURANCE CO
To Ollie W. Rogers applicant
MARYLAND CASUALTY INSURANCE CO To Ollie W. Rogers applicant
1 By INDUSTRIAL INDEMNITY CO
24
To Ollie W. Roger applicant
25
| By PACIFIC EMPLOYERS INSURANCE CO
|
26
|
To Ollie W. Roger applicant
By AETNA CASUALTY & SURETY CO
27
.
To Ollie W. Roger applicant
73 | By
4
STATE COMPENSATION INSURANCE FUND
To Ollie W. Roger applicant
By ai:
CALIFORNIA CASUALTY INDEMNITY CO
To Ollie W. Roger
applicant .
2,089.39 2,089.39
33.88
56.41
56.41
2,258.8c
158.11
146.82
146.82
56.47
56.47
|64 LB 26779
|
-2-
[
; By FIREMAN'S FUND INSURANCE CO
f 2
ji 10
i
vanes j
To Dr. Edward Dickstein lien claimant $ 294.00
Endriss Photocopy Service lien
21.00
Levy & Van Bourg lien claimant
55.18
Levy & Van Bourg attys
1000.00
_ Total liens 1370.18
re
W. Ollie Rogers applicant
... We
eae #
Total due
oN ^
4739.88
6,110
| Sys ; ao
fe
/ Long Beach California
| SERVED ON ALL PARTIES LISTED ON OFFICIAL ADDRESS RECORD
Byjily
Byjily
i
|
Boris Raynes Referee WORKMEN'S COMPENSATION APPEALS BOA
t
i
|
cae
1971 | a iz? CCT 22
j
LONG LONG BEACH OFFICE
|
4
228
64 LB 25779
-3-
Fa
/
3.
;
/ 4
(+ INSTRUCTIONS not
" not use this form in death cases Use Form 16. Do not use in party cases Use 17
the injured employee be under 21 years of age and a guardian ad litem has not been
guardian ad litem and trustee must accompany this agreement
previously appointed a
The guardian must sign this agreement on behalf of an injured employee who is under 21
are of 14 such minor should also sign this agreement
years of age If
ach all medical reports not heretofore submitted to the Workmen's Compensation Appeals Board and advise when
-
petition for appointment
the minor is above the other reports were filed
COMPROMISE AND RELEASE
STATE OF CALIFORNIA
HUMAN RELATIONS AGENCY DEPARTMENT OF INDUSTRIAL RELATIONS
WORKMEN'S COMPENSATION APPEALS BOARD
.
CASE NO.64 26779
99
-
Mr. ( 99 )
OLLE
OLLE
VS.
W.
ROGERS
ROGERS
APPLICANT
VARIOUS EMPLOYERS
RIOUS CARRIERS
CORRECT NAME NAME OFOF ENPLOYER ENPLOYER
.
NAME OF
SOCIAL SECURITY 555-01-3895 6351.Ridgeview Avenue
Mira Loma CaliforniCa alifornia 91752 .
ADDRESS
ADADDDRERSSESS
v 087/209/01
087/209/01 087/209/01 CROCESS 087/209/01
CORRECTE CROCESS
087/209/01
CORRECTE FILM 087/209/01 CROCESS
087/209/01 7)
087/209/01
es
COR ECTE
087/209/01
ae
087/209/01
1
Ollie W. Rogers
Between 1942
through December claims that he was employed on
17 Insulation
Worker IOGEOPATION
employee herein born oFn ebruary
through December
1963
of
MONTH
19_fat
YEAR
CITY )
_by Various Employers
NAME OF EMPLOYER
13 1905 ys STATE then insured as to
workmen's compensation liability Various
Carriers
STATE NAME OF CARATER ON WHETHER INGUASD
_and that
of exposure to asbestos follows he sustained an injury arising out of and in the course of his employment as employment
lungs and chest and respiratory system result
Alleges
injury
to his and
other
parts
materials The Compromise and Release is intendedto cover any and all
of the body claimed to have been injuredas aresult of said exposure
E he actual weekly wages of the employee at the time of injury were Maximum
while the average weekly wages
were $ 1000 ny pocorn commen tet ecemmremnt
3. The employee's present disability is in dispute
d the employee noreturned to work
STATE PRESENT DISABILITY RESULTING FRON THE INJUNT
IP DO STATE WHEN
4. a Temporary disability indemnity has been paid to the employee in the sum of .3,730.00at .3,730.00at 70.00
-per week
including 5/6/65 4/29/64 4/29/64to and
The amount due and
to
unpaid 14,280.0 14,280.0
14,280.00
covering b Permanent disability indemnity has been paid to the employee in the sum of 1111
employee is $.None_
period .to
5. The parties hereby agree to settle any and all claims on account of said injury by the payment of the sum of 11,294,00
in addition to any sums heretofore paid by the employer or the insurer to the employee said sum to be payable as follows
any attorney's fees as allbo y w theed Appeals Board loss lien of 355 pi
6.
Medical
and
hospital
expenses
have
been
paid
None
..by
the
employee
and
Service
All _by the
employer
or
carrier
Unpaid bills amount to .... None Future medical and hospital expense is estimated at .. Unpaid and
* ture medical and hospital expense is to be assumed as follows All applicannonte by
DIA WAS WAS Le 15 PAGE ) REV 6.69
41161.901 9-75 734
C SP oa he
.
Beach Calif Name and address of employee's attorney if any Levy
&
Van
Van
Bourg
110 W. Long
Ocean Boulevard 90802 _
* Said attorney requests a fee of 1,000.00
Amount of attorney fee previously paid if any $ .
an ree
Reason for Compromise SEE PAGE TWO AND HALF
10. The undersigned request that this Compromise Agreement and Release be
approved
Upon approval of this Compromise Agreement by the Workmen's
payment in accordance with the provisions hereof said
Compensation Appeals Board or a Refree and
insurance carrier from all claims and
of
employee releases and forever discharges said employer and
rdevelop as a result of said
causes action whether now known or ascertained or which may hereafter arise
injury including any and all liability of said employer and said insurance
carrier
of them to the dependents beirs executors representatives administrators or assigns of said employee
and each
12. It is agreed by all parties hereto that the filing of this document is the
and that the W.C.A.B. may its discretion set the matter for
filing of an application on behalf of the employee
hearing as a regular application reserving to the parties
13. For the purpose of determining the lien claim filed herein for the
unemployment
compensation
benefits
and
extended
duration
unemployment benefits
compensation
disability
benefits
or
California Unemployment Insurance Code the
which have been paid under or pursuant to the
parties propose the following division of the sum
agreed upon for
settlement and release of this case
$e _ for temporary disability covering the period _for accrued medical expense paid or incurred by the empl- oyee .to $ for neem for future medical care $ eraeeesssnnenenneee for permanent disability
The above segregation must be fair and reasonable and must be based on the real facts of the
no attempt made to deprive the lien claimant of a reasonable
case There should be
Rule
$$ requires proof of service
of a
copy
of this
recovery consistent agreement on such Lien
with
all
the amounts
involved
W.C.A.B.
Claimant ,
}
this 29 .day as ke 1971 7 a WITNESS the signature hereof
by
of
a
yi
1971
at
-
WITNESSES THE INJURED APPLICANT'S SIGNATURE SIGNATURE MUST BE ATTESTED BY TWO
DISINTERESTED PERSONS OR ACKNOWLEDGEO BEFORE A MOTARY PUBLIC
STATE OF
CALIFORNIA
RICHARDROGERS APPLICANT RICHARD J CANTRELL
BY : JOSEPH JOSEPH
INSURANCE COMPANY , & NELSON
,
JONESJONESJONES
7
On this
2.2 day tory
Public in said County .
of ?
and the
for said
nny A.D. 19.7 , before me
.
and
State
residing
therein
duly
commissioned
and
suom
personally
~
appeared
and Oe residing
known to me to be the person whose name 22282400
coco.
subscribed to the within Instrument and acknowledged to me that
he
..
IN WITNESS WH^reopI have hereunto set
hand and
cxecuted the same
cse cse written
my
affixed my official seal the day and year in this Certificate first
See
Dawn Dawn F Ose 15 IPAGE 2 IPEV 6.001
fi
bah Kb
Kot
$
Notary Public in and for said County and State of California
41 93-85 41193-85 3.90 73M
..
0 03S
1 . REASONS FOR COMPROMISE There is a dispute as to whether or not
, ,the Petition to Reopen for new and further disability should be
3 granted The parties desire to avoid the hazards delays and
4 costs of further litigation Defendants desire to buy their peace
an
The applicant desires to control any and all further medical
OO which may be necessitated as a result of the injury The applicant
7 desires a sum certain at this time
8
9
10
11
In further consideration of the payment in accordance
to
herewith applicant agrees that this release will apply
all unknown and unanticipated injuries and damages resulting
from such accident casualty event and employment as well
as all those now disclosed and all rights under Section 1542
of the Civil Code of California are hereby expressly waived
Section 1542 of the Civil Code of California reads as
follows
A general release does not extend to claims which the creditor does not know or suspect to exist in his favor at the time of executing the release which if known by him must have materially affected his settlement
with the debtorIt
In further consideration of the payment of the aforesaid
sum applicant agrees that this release extends to and
covers the executors administrators heirs representatives successors assigns officers directors agents servants and
employees of the defendantansd each of them and the physicians
surgeons and nurses of the defendants and each of them whether acting individually or on behalf of them or either of them
4
.
Soa.
Attorney for
a
a,
BAe
ef
Applicant
or,
eae ae og .
re
ee
Applicant
& Rev 2.64
42 20
ASTRA CASUALTY INSURANCE COMPANY FACIFIC EMPLOYERS INSURANCE COMPANY INDUSTRIAL INDEMNITY INSURANCE COMPANY - MARYLAND CASUALTY INSURANCE COMPANY CALIFORNIA CASUALTY & INDEMNITY INDEMNITY COMPANY STATE COMPENSATION INSURANCE FUND
KEND
Gast Gast STOCKWELL :GLEASONGLEASON
ROBERTS ROBERTS & THOMASO THOMASO
-
+t] Pm.
MANSELL & MANSELL GIpOE
BY
<q
.
{
=
GINOCCHIO ZONNI
BY
ee
& TAYLOR
6-77
THE TRAVELERS INSURANCE COMPANY
5 NELSON
OLLIE W. ROGERS - WCAB Case No 64 LB 26779
PROCESS
ASCH
35EUSE
209