Document K6QG9K3ypg2Gpd6ENvLM2xwoN

Six Becker Farm Road Roseland, New Jersey 07068-1743 Telephone: (201) 740-9400 y LIBERTY MUTUAL MARCH 30, 1992 SHERWIN WILLIAMS CO 101 Prospect Ave Newark. OH 44115 ^WORKERS' COMPENSATION APR - 2 1 REDACTED EMPLOYEE: INSURED: SHERWIN WILLIAMS CO CLAIM NUMBER: WC 324-508333 DATE OF ACCIDENT: 11/17/89 *1 WC001 R1 ROSELAND CLAIMS MARCH 17, 1992 DONALD GRUNSlhi . WAR 3 0199? ROSELAND CLAIMS ATTENTION: DON GRUNSTRA - ASSISTANT CLAIMS MANAGER REDACTED RE: vs. Sherwin Williams Co. File Ho: 324-508333 Date Of Injury: 11/17/89 APR - 2 fggg SETTLEMENT AUTHORIZATION REQUEST: This matter was last heard on January 28, 1992 before Judge Boyle in Newark Workers' Compensation Court. This matter concerns a denied accident of 11/17/89. The claimant alleges being exposed to chemicals while operating a forklift on 11/17/89. The claimant alleges loss of breath which resulted in him being transported to St. James Hospital for treatment. The claimant missed approximately 2 weeks of work and returned with no further problems. The claimant is markedly obese, has a history of a prior prostatectomy and hiatal hernia, also has a history of pneumonia and bronchitis. Liberty Mutual has not extended any payments of temporary disability or permanent disability. REDACTED The petitioner's attorney, Mortimer Wald of West Orange, N. J. has filed a Formal Claim Petition against our insured. This petition alleges permanent disability resulting from the alleged exposure on 11/17/89. Mr. Wald has also petitioned for the Second Injury Fund to be named as a correspondent. The petitioner's attorney has medical evaluations which states that is totally disabled. We have an exam from Dr. Edwin Rothfeld, dated February 13, 1990, and March 21, 1991, in which Dr. Rothfeld estimates permanent disability at 20% of partial total for chronic obstructive lung disease. Dr. Rothfeld however, does not relate this disability in any way to Mr. employment with our insured, however, he relates this disability to hypertension, obesity, varicose veins and non-insulin dependent diabetes mellitus. Based on the above issues of questionable liability and causal relation, I am requesting that Authorization be extended to dispose of this claim for up to $50,000 pursuant to N.J.S.A. 34:15-20. SPlease grant authorization to settle this claim for $50,000 pursuant th N.J.S.A. 34:15-20. ANDRE WYNOLDS SENIOR CLAIMS ADJUSTER AR/ rn N40348.01 0007-SWP-005800388 CONFIDENTIAL