Document 8RDenvpLyBvDY6ZjdexGwL0aZ
STATE Or CALirOaNlA OEPAflrMENr OF iNOUSTHfAl RELATIONS
DIVISION OF I'JOUSTRIAL ACCIDENTS--WORKMEN'S COMPENSATION APPEALS 80ARD
SHc REVESSc 5IOE FOR INSTRUCTIONS
APPLICATION :03 ADJUDICATION OF CLAIM
CASE No. 74 5P2 5 04 4ft
Mr. x.-xjc:US& "ARL BAUMANN
(INJURKO EMPLOYEE)
Social Securitv No____ 5 4 5 -- 23 9 83 3-
1527 Petersen Avenue
I JJYED EMPLOYEE*! A BORIS! >
San Jose, CA 95129_______
(APPLICANT*! A9DREAS*
STRONG CONTRACTING & SUPPLlA&g^
120 K. Lime Street
(CNLDYCR*S ABORTS!)
Lancaster, PA_____________________
T-^velsrs Indemnity Company
( I M PLOT CR' 9 I NSURANCE CARRIER OR STATE IF YELP. INSURED 01 PC RMISSISLY UNINSUAED)
550 California Street, San Francisco
(ADDRESS 09 IRStftAaCI CtHlf*. IF ANTI
IT IS CLAIMED THAT:
l. The injured employee, horn 3/27/15, while employed as a__________ pips coverer-insulator
CUTf Ct 2(KT*>
(OCCUPATION AT TIH OP INJUPT}
nn unknown
( DATE OP POUR?)
ot Stanford
(CITY)
_Calirorn_lgy the employer sustained injury arising out
(iSiTnATrEft>
of and in the course of employment tolungs,__back__and__other__parts__of body
< STATE WHAT PARTS OF ROOT WERE INJURED)
2. The injury occurred_as follows:__________ exposure_tQ--yaflj.afc3,.Qft
(EXPLAIN WHAT EMPLOYEE WAS COINS AT TINS Op INJURY AND NOW INJURY WAS RECEIVED
3. Actual earnings at time of injury were:------- EaXiEUEl--
(QIVE WEEKLY OR MONTHLY SAURY OR HOURLY RATE AND NUNSED OF HOURS WORKED PER WEIR) --
I SEPARATELY STATE VALUE PER Wttl OR NORTH OF TIPS, NEALS. LOUOIN4 OR OTHER ADVANTAGES IlfiUUAU RtCSYVCOI
4. The injury caused disability as follows:^ .1
(SPECIFY LAST DAT OPP WORE DUB TO THIS INJURY AND SEOINNINO AND ENOINO DATES DP ALL PERIODS OFF DUS TD THIS INJURY)
(WEEKLY RATO
(DATE OF UST PAYMENT)
6. Medical treatment was received
(YES)
(NO)
All treatment was furnished by the employer or
(BATE OF UST TREATMENT)
insurance company____ ^ other treatment was provided or paid for by----- Aps.1 Leant-------------------------------------
rriS)
INO)
(NANI PERSON OR ASIMCV PROVIDING OR PATINO FOR MEDICAL CARD
Doctors not provided or paid for by employer or insurance company, who treated or examined for this injury are
n-r. Stephenson and others
(STATE NAMES AND AOORtSSIS OF SUCH OOCTOIS AND NAMES OF NOSPITAU TO WHICH SUCH DOCTORS ADMITTED INJURES)
7. Unemployment Insurance or Unemployment Compensation Disability benefits have been received since the date of
injury
(YES)
(NO)
8. Other cases have been filed for industrial injuries by this employee as follows:-------1A--F--250
(irtcirr oil
054
.up cmr wxiai dun
9. This application is filed because of a disagreement regarding liability for: Temporary disability indemnity X
Permanent disability indemnity X Reimbursement for medical expense--X_ Medical treatment__ 2L Compen
sation at proper rate____ Other____ Specify: and applicant requests a hearing and award of the same, and for all other appropriate benefits provided by law.
Hearing requested at San Franciqcn____ , Dated at__ San . jQSe----------------- California, .2/3/74
McCarthy, Johnson & miller. firm Market, fit-reeh, Sui be L3QQ
k
(APPLICANT'S ATTORNEY)
San Francisco, CA 94105; telephone 362-0726
OIA WCAR FOAM 1 (HIV. 2-7 21
'Me
Please file signed original and six copies and print or type names c.rc addresses
3EFORE THE WORKMEN S COMPENSATION APPEALS BOARD OF THE STATE OF CALIFORNIA
NOTICE AND REQUEST FOR ALLOWANCE OF LIEN
`Jtic*' ? A
__________________________ Date of Injury
STATE CF CALIFORNIA
Employment Development Department
.iarjorl* J*. --rl i
1Um of
li*n Clc mont
S/nO'O
545 -- jjX_
Case
___
P.O. sox ^37
its o*o A 95106
Addrn
1527 Votanm. *rm 3mm Jo-- Sa 35129 _
Addftst
-V -JL v t jJI
(mptayvr
Iflivranc* Corriir
Add'tu
Addrtti
OPENING LIEN
1. The undersigned hereby notifies the Workmen's Compensation Appeals Board that payments of unemployment compen sation disability benefiti are being made at the weekly rate of $_____________ commencing-----------------------------------end continuing. Payments will not exceed S___ _________ for daily indemnity and $ for additional hospital confinement benefits. Request is made that these payments be determined and allowed as a lien in the settlement of this cose. Upon cessation of payments or on j^ta^^gquest, an amended "Notice and Request far Allowance of Lien" will be filed to cover the totals paid.
AMENDED LIEN
2. The undersigned hereby requests the Workmen's Compensation Appeals Board to determine and allow as a lien, the sum stated below as "Total", which represents the amount of unemployment compensation disability benefits paid to date. Further benefits will be paid if the employee is found eligible and the Board notified of any resumption of payments. Upon cessation of these continued payments or on Board. request, a further amended lien wtll be filed.
Filed under Labor Code Section 4903(f);
Disability benefits at the weekly rate of
1. days at
per day. From .
2. days at $.
per day. From
3. days at $.
par day. From .
paid for the periods shown below: to inefushse to inclusive toL inclusive
Filed undet Labor CodSrSeetioo 4903(b);
J
Additional benefits for hospital confinement at the daily rate of %_____ -------------------------------
paid ___ :-------------------------------------------------------------------------------------:---------------------------------
for the period .to inclusive
Total
3. The undersigned declares he has delivered or mailed a copy of this document on
------,0
of the persons named above and listed below. it other persons should be served with this document, photo notify the
Employmoof Deve/opmedt Department at fho above address. Copies oSo-served* on Hie following representatives and
' attorneys ofrecM'd*
.
609
State of Cglifjprpia ___ Employment Development Department
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-cFGRE THE WORKMENS COMPENSATION APPEALS SOARD OF THE STATE OF CALIFORNIA
NOTICE AND REQUEST FOR ALLOWANCE OF LIEN
i>*L_____________________ 5TATE OF CAUFORNIA
Date of tn)ury
employment Development Department
P.O. BOX bit
Cose No.
, C*. 95129
Addnu
< tnnmiaMrEWMiM^^gaff
Caataaaatiat UnnM fiat Oaomom. n*ftmricmTif a
1. The undersigned hereby notifies the Workmen's Compensation Appeals Board that payment* of unemployment compen sation disability benefits are being made at the weekly rate of $, commencing-----------------------------------and continuing. Payments will not exceed $____ ________ for daily indemnity and S---------------------- for additional hospital confinement benefits. Request is made that these payments be determined and allowed as a lien in the settlement of this case. Upon cessation of payments or on Board request, an amended "Notice and Request for Allowance of Lien" will be filed to cover the totals paid.
AMENDED LIEN
2. The undersigned hereby requests the Workmen's Compensation Appeals Board to determine and allow as o lien, the sum stated below as "Total", which represents the amount of unemployment compensation disability benefits paid to date. Further benefits will be paid if the employee is found eligible and the Board notified of any resumption of payments. Upon cessation of these continued payments or on Board request, a further amended "er. will be Fled.
Filed under Labor Code Section 4903(f):
Disability benefits at the weekly rate of $_
_ paid ftor the periods snhoovwn below:
7. ^_ doys at $
per day. From . wim ,o turn inclusive
2. days at $per day. Front-.
Inclusive
3. _____ days at $per day. From .
inclusive
$_
Filed under Labor Code Section 4903(b):
Additional benefits for hospital confinement ot the daily rate of $_
paid to ----------------------------------------------------------------------.------
for the period
to
Inclusive $_ Total
3. The undersigned declares he has delivered or mailed a copy of this document on _JkaMaftat.Jll^^]9Sft-- to each
of the persons named above and listed below. If other person* should be served with this document, please notify tf
Employmont Development Department of the above address. Copies also served on the following representatives and
attorneys of record:
SmmSiIws*utm
*,tlJ>
State of California
Sat ftaMiaaafc Cite MM
Employment Development Department.
UK* It
DE 230! NKV. II l>7*
ft I
Lin CtaiiMni
* AiJMtM Co. IjO - r4 St.
-'n rsw:'.*^ Co. MU*
Arnatjrooo Cecil Co.
L Lbarrty ( ^Wlotta StA.
ijouaur, So. IMA)
Sochtal :leCM ftnoM Cecy*
601 *. j<* Su
Um .ji-! Co. 90000
Flbro Jotr4 Ccy 55 rnoiiM U
3o :'raacl*ca, Co. 94115
941 E. 2md St.
120 0. Liao Sc. Uacuto, So. 17004
..$ zaxck, ca* mas
*rwin laAaalty Co.
'50 uUifonla Sc. ^o Fraoaiaeo, Co. 94104
A*ua CtMaltf 4 fcwcy 600 HaztoC It*
Joo /nortiHi Co.
-* .
-.
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workmen's ccmpencaticn appeals board
A . STATE C? CALIFORNIA
NOTICE C? CONFERENCE PRE-TRIALS
APPLICANTS required to appear
You arc hereby notified that the bel w-entitlcd ca.ecs are set for ' hearing before the Workmen's Compcns, tion AoDcals Board of the State of California at 455 COLDER GA' 'E AVE.'/RCOM 2202^ SAN FRANCISCO CALIFORNIA.
FEBRUARY 7, 1975
1:30 P.M.
251-403) CARTWRIGHT, John
251-407)
(Scully)
vs.
247-811) LAURICELLA, Joseph E.
247-612)
(Steven S. Agosta)
vs.
245-800) 247-534)
247-535) 247-943)
247-5^9) 247-950)
247-951)
HEANEY, Frank J. (William T. Hays')
vs.
250-44-7) /bAUMANN, Earl. 250-054)1
250-443)'
(McCarthy-, Johnson & Miller)
250-578) 250-579) 250-530)
250-561)
KASSEM, Bassam F.
vs.
(Cartwright, Saroyan, et al)
252-049
McNEIL, Carlos A. (Donavon R. Marble)
vs.
Home Insurance Company Argonaut Insuranance Co.
(Hanna, Brophy, et al)
State Compensation Ins. Fund
State Compensation Ins. Fund Employers Commercial Union Co. Travelers Insurance Company ABMI Management Coporation
(Hanna, Brophy, et al) American Motorists Ins. Co.
IT IS IMPERATIVE THAT MEDICAL REPORTS BE FILED, AND COPY SERVED ON .OPPOSING PARTYj AS SOON AS POSSIBLE, If ADVANCE OF THE SCHEDULED CONFERENCE.
CONTINUANCES ARE NOT FAVORED AND WILL BE GRANTED ONLY UPON CLEAR ' SHOWING OF GOOD CAUSE.
NOTE TO INSURED EMPLOYERS: Your attendance at this hearing may not
be necessary. Ask your insurance company.
.
Served by mail on persons shoun on the official address record.
Date:
January 15, 1975
WORKMEN' S COMPENSATION APPEALS '
By:M. Kimoto
_ `Criculturc and Services Agency Department of Industrial Relations Division of Industrial Accidents
By EMILY B. JOHNSON Referee
STATE OP CALIFORNIA
DEPARTMENT OF INDUSTRiAL RELATIONS
DIVISION OF INDUSTRIAL ACCIDENTS
WORKMEN'S COMPENSATION APPEALS BOARD
EARL BAUMANN, vs.
Applicant
PLANT INSULATION COMPANY, and STATE COMPENSATION INSURANCE FUND,
Defendants
MINUTES OF HEARING CASE NO. 74 3F 250-447
EARL BAUMANN,
Applicant
vs. ARMSTRONG CONTRACTING & SUPPLY CO. and TRAVELERS INDEMNITY COMPANY,
_______________________ Defendants.
MARJORIE BAUMANN, Applicant (Earl Baumann, deceased)
CASE NO. 74 SF 250-443
CASE NO. 74 SF 250-054 AND DISMISSAL OF PARTIES DEFENDANT
vs.
PLANT INSULATION COMPANY, STATE COMPENSATION INSURANCE FUND, and COMMERCIAL UNION ASSURANCE COMPANIES,
Defendants.
KPMTMENT OF INDUSTRIAL RELATIONS DIVISION OF INDUSTRIAL ACCiC-tfS
! fcL' 101975
PLACE AND TIME: San Francisco - February 7, 1975 -: !.30
REFEREE: REPORTER:
ALBERT S. GATELY Robert A. Van Acker
APPEARANCES:
Applicant Marjorie Baumann not present; represented by McCarthy, Johnson * Miller. Attorneys. (Janies E. Miller apoearing).
State Compensation Insurance Fund represented by Ronald Stelnlnger, Attorney.
Travelers Indemnity Company represented by John R. Conway, Representative.
Commercial Union Assurance Companies represented by Goshkln, Pollatsek & Meredith, Attorneys.
(Charles F. Lee appearing).
(SF 250-054)
CONFERENCE PRETRIAL
IT APPEARING THAT THE APPLICANT ALLEGES EMPLOYMENT WITH PLANT INSULATION
COMPANY FROM NOVEMBER 1963 TO JUNE 17, 1974 THE DEFENDANTS
WESTERN ASBESTOS COMPANY; ARMSTRONG- CONTRACTING & SUPPLY; and
TRAVELERS INDEMNITY COMPANY AKFTDXSMISSED AS PARTIES DEFENDANTS HEREIN.
DISPOSITION
ALBERT E. GATELY, REFEREE.
These matters will be continued for regular hearing, one full day to be allowed.
Opp
CONFERENCE PRETRIAL - FEBRUARY 7, 1975
SERVED BY MAIL ON PERSONS SHOWN ON THE OFFICIAL ADDRESS RECORD.
P.R. 1017 (3/10/71) Date: February 10, 1975 By: E. Kanada
NOTICE C? CC
WORKMEN'S CCMPENC ATIC;: APPEALS BOARD
STATE OF CALIFORNIA
PENCE PRE-TRIALS
APPLICANTS REQUIRED TO APPEAR
You arc hereby notified that the belov/-ent itled cases are set for' hearing before the Workmen's Compensation AoDcals Board of the State of California at 455 GOLDEK GATE AVE .',~RCOM 2202., SAN FRANCISCO
CALIFORNIA.
FEBRUARY 7, 1975
1;30 P.M.
251-403) CARTWRIGHT, John
251-407)
(Scully)
vs.
247-811) LAURICELLA, Joseph E.
247-812)
(Steven S. Agosta)
vs.
245-800) 247-564)
247-585) 247-943)
247-949) 247-950)
247-951)
HEANEY, Frank J. (William T. Hays)
vs.
250-44-7) /
250-054)/'BAUMANN, Earl.
- vs.
250-446)'
(McCarthy", Johnson & Miller)
250-578) 250-579) 250-580) 250-561)
KASSEM, Bassam F.
vs.
(Cartwright, Saroyan, et al)
252-049 McNEIL, Carlos A. (Donavon R. Marble)
vs.
Home Insurance Company Argonaut Insuranance Co.
(Hanna, Brophy, et al)
State Compensation Ins. Fund
State Compensation Ins. Fund Employers Commercial Union Co. Travelers Insurance Company
ABMI Management Coporation (Hanna, Brophy, et al)
American Motorists Ins. Co.
IT IS IMPERATIVE THAT MEDICAL REPORTS BE FILED, AND COPY SERVED ON
.OPPOSED PARTY, AS SOON AS POSSIBLE, IN ADVANCE OF THE SCHEDULED
CONFERENCE.
'
CONTINUANCES ARE NOT FAVORED AND WILL BE GRANTED ONLY UPON CLEAR '
SHOWING OF GOOD CAUSE.
NOTE TO INSURED EMPLOYERS: Your attendance at this hearing may not
be necessary. Ask your insurance company.
.
/
Served by mail on persons shown on the official address record.
Natc:
January 15, 1975
WORKMEN'S COMPENSATION APPEALS '
By:______ M. Kimoto__
Agriculture and Services Agency Department ol* Industrial Relations
By EMILY B. JOHNSON' Referee
LIFE & CASUALTY
Casualty & Surety Division /Etna Life & Casualty Bunding Crocker Plaza, 600 Market Street San Francisco, California 94104
February 20, 1975
4.
A\ , v u3C *Ji
304 Shaw Rd. South 3an Francisco, CA
R23: CLAIM NO.: 3 5 CC 231784 MR - CLAIMANTi CARL BAUMANN (DECEASED) VS. VARIOUS EMPLOYERS
Gentlemen:
'/e are in receipt of advices that the above named claimant's widow has filed an application at the Worker's Compensation Appeala Board for permanent disability benefits. The claimant passed away an Sep tember 7, 1974 and the medical records show that his illness and death were caused by his exposure to asbestos.
We have been named as a co-party defendant in this case for your company. As we started insuring your company for Workmen's Compensation on I-I-63 we would appreciate if you could check your records and give us the erne date of the deceased claimant's employment with your company from that day until September 7 1974.
Thank you for your cooperation on the matter.
Very truly yours*
Uktlcfcfc.
Odette Aheme Claims B-Unit 445-8913
jab
V
/Etna Life insurance Company.'The /Etna Casualty and Surety Company.The Standard Fire Insurance Company
(PROOF OF SERVICE BY MAIL -- 1013*, 201J.J C. C P.)
thtI am * atiztn of the United Stout and a retidrnl of county of -- San__Pi'SnCl SCO
hntinttt oter the ate of eighteen yeart and not a forty to the tttitom ahote entitled action, my i<Udr*n it:
2160 Crocker Plaza, San Francisco, Calif.
/ am
a. May 1, 197 5
,,____ ,
NOTICE THAT ACTION HAS
--BEEN COMMENDED AGAINST-T-tHBD PSRSOti------------------------------------------------,,,, FOLLOWINGin said action, by placing a true copy thereof enclosed in n seeled em ehpt
u;;f postage thereon full) prepaid m the Untied States pott ofice mail base ai--. gan
nddretted at fallout
(by certified mail)
1 ff r> j
.-
Armstrong Contracting & Supply Co. 120 N. Lime Street Lancaster, PA.
Travelers Indemnity Company 550 California Street San Francisco, California
Agnes Stofka
fname must be typed or printed)
of perjury. that the foregoing tt true and correct
certify (or declare), under penalty
Executed ->n____ May__l_j__ 197 5 fdatei
San Francisco
(place)
Of
LtU&
Signature
l
mproof of tfruce b> mail forms, being ugned under penalty of perfut-t. do not require notarization
Calif ot ifia
Minting *f**c* *0*M no >
1 TION, a corporation, G.A.F. CORPORATION, OWENS--CORNING FXBERGLAS 2 CORPORATION, a corporation, STANDARD ASBESTOS MANUFACTURING AND 3 INSULATING COMPANY, a corporation, UNARCO INDUSTRIES, INC., a 4 corporation, EAGLE-PICHER INDUSTRIES, INC., a corporation, 5 COMBUSTION ENGINEERING, INC., a corporation, DOE ONE, a corporation, 6 DOE TWO, a corporation, DOE THREE, a corporation, DOE FOUR, a 7 corporation, DOE FIVE, a corporation, BLACK & WHITE COMPANY, a 8 co-partnership, DOE SIX and DOE SEVEN, partners associated in 9 business under the common name and style of BLACK & WHITE COMPANY, 10 DOE EIGHT, DOE NINE,DOE TEN, DOE ELEVEN, DOE TWELVE, DOE THIRTEEN,
( 11 DOE FOURTEEN, DOE FIFTEEN, DOE SIXTEEN, DOE SEVENTEEN, DOE EIGHTEEN, 12 DOE NINETEEN, and DOE TWENTY, in the Superior Court of the State 13 of California, City and County of San Francisco, the same being 14 Case No. 688-553, to recover monetary damages for wrongful death 15 based upon negligence in the manufacture and production of a 16 defective product, and strict liability in tort. 17 Dated: April 28, 1975. 18 19 HALLEY, CORNELL & LYNCH 20 |
211 By
22 | !
23 i
24 ! i
25 i
i
26 J
2.
1 J. KENNETH LYNCH HALLEY, CORNELL & LYNCH
2 2160 Crocker Plaza San Francisco, CA. 94104
3 982-2460
4 JAMES E. MILLER McCarthy, Johnson & miller
5 Suite 1300, 605 Market Street San Francisco, CA. 9410-5
6 362-0726
i Attorneys for Plaintiff
8
9 IN THE SUPERIOR COURT OF THE STATE OF CALIFORNIA
10 IN AND FOR THE CITY AND COUNTY OF SAN FRANCISCO
11
MARJORIE L. BAUMANN, as Adminis-
)
12 trator-of the Estate of EARL M.
)
BAUMANN, Deceased, 13
j NO. 688-553
14
Plaintiff, J NOTICE THAT ACTION HAS BEEN vs. 'COMMENCED AGAINST THIRD PERSON
15 )
FIBREBOARD PAPER PRODUCTS 16 CORPORATION, a corporation, et al.
) )
) 17 Defendants. )
) 18
19 TO: ARMSTRONG CONTRACTING & SUPPLY CO., and TRAVELERS INDEMNITY CO.J:
20 ;
21 < YOU ARE HEREBY NOTIFIED that on April 9, 1975, MARJORIE j
22 L. BAUMANN, as Administrator of the Estate of EARL M. baumann,
j
i
23 Deceased, commenced an action against FIBREBOARD PAPER PRODUCTS
24 CORPORATION, a corporation, PITTSBURGH CORNING CORPORATION, a 25 corporation, PHILIP CAREY CORPORATION, a corporation, ARMSTRONG
I
26 CORK CORPORATION, a corporation, JOHNS-MANVILLE PRODUCTS CORPORA-
1
I
\ J J
May 6. 1975
Ma. Odatta Aharna
Aatna Ufa I Casualty Crofckar Plasa 600 Markat Street Saa Prsaaisca, California
94104
Daar Hi. Abaraai
Subjact: Bari lanaama
la regards to your lattar af Pabruary 20, 197S, X hare andosad tha following inforaatlan.
Vary truly yaure.
VAG Enclosure
Mrs. Vicki A. Gaitar Iuoraaca Dapartaaat
V * if*
. /5 CO.v..33NiAf :m : r a r _r _
Nt.
3H,3 3C.-wi
Notice of Hearing
__ A : J.
^
:iZ3TC3 ojmpazy, 5- 21, -i.-
'AL L7i iC'I A JoViCZ
,n . jj ~
-
OvfpTufant.i
- | 1 1 !ui t aie.'id.if _i (7. iterence ( Ziiefuluf C] I'1 -a tingI.'ulendar _j Settlement f .'alendar [j .Standby Referee ; j Cross Examination
f9 1 viter {_"] Doctor
I | Change ot Time or Plate
n
Y(;a are hcrebv notified that rhe above entitled case is set for hearing before the Workmens Compensation
Appeals hoard of the State of California -it
Gcr_T}e\j rjATZ nVZ.v)UZ, ROOM 2202
"Ham framcizoo*, califop-'iia "
JULY 25, 1975
ALL DAY
9:00 an
(RZ?EREE Albert S. GItaly)
CONTINUANCES ARE NOT FAVORED AND WiLL BE CHANTED ONLY UPON CLEAR SHOWING
OF C::'n ;D CAUSE.
NOTE. TO IN'S (.'RED EMPLOYERS: Your attendance at this hearing imp. mit be necessary. \sk > or insurance (iriipai'v.
s; : I n.\ 'i.:i
[ 2:lti
By:
M : I 1 ins Si i< \ , i ' vi. .ii.i-'i.ss i ,o.ai Cay 13,375
7 L'i. .'a.".'., Jjl*.
acoicui.tu * * and r.zRvsces agency OE**A^T'*z*r OF IMOU T.T1AU RELATIONS Qivmp.N 3/ i.vji, T ill At, ACC"SNT3
n'A . . .'Or