Document MJ41pmo86vy0dD4mjQ3MQOyOM

FILE NAME: Contract Unit Workers Comp Claims (WCC) DATE: 1960 DOC#: WCC023 DOCUMENT DESCRIPTION: Workers Comp File - Reed, Clarence H Contains all documents found in the Claimant's file, with one blank page between each separate document J BALTIMORE NEW YORK J CLARKSBURG t TULSA l ST. LOUIS CHICAGO Y LOS ANGELES ATLANTA V PITTSBURGH SAN FRANCISCO NEW ORLEANS MIAMI PHILADELPHIA AlJEXANDER & AUEXAIVIDIEIR INCORPORATED r-/ INSURANCE / AVERAGE ADJUSTERS CONSULTING ACTUARIES 2 2 2 5 NORTH CHARLES STREET, BALTI MORE 18, MD. June 7, 1960. Hr. William L. Hughes, Manager Insurance Department Armstrong Cork Company Lancaster, Pennsylvania Travelers Policy No. r h r -6220500 Dear Sir: Please note disposition made of the following claim: Date of Accident: Claimant: Location: August, 1957 Clarence H. Reed San Antonio, Texas Claim No. : B-8742139 Disposition: $500.00 Fatal $1052.23 Expense Remarks ; cm. Indicate Whether: Workmen's Comp.____ X _ Auto Liability B.I.___ P.D.___ General Liability B.I. P.D. Very truly yours, ALEXANDER & ALEXANDER, INC. yS S'-/ LOSS DEPARTMENT /J \ TELEPHONE TUXEDO 9-4304 BELL SYSTEM TELETYPE BA 582 CABLE ADDRESS "ALEXBLUE" BALTIMORE NEW YORK CLARKSBURG TULSA ST. LOUIS CHICAGO LOS ANGELES ATLANTA PITTSBURGH SAN FRANCISCO NEW ORLEANS MIAMI PHILADELPHIA A l J E X A N I i n S l R S& < A X .] E X A T t f lD I E I R INCORPORATED INSURANCE AVERAGE ADJUSTERS CONSULTING ACTUARIES 2 2 2 5 NORTH CHARLES STREET, BALTI MORE 18, MD. February 19th, 1960 TELEPHONE TUXEDO 9-4304 BELL SYSTEM TELETYPE BA 5 8 2 CA8LE ADDRESS "A LE X 8 L U E " it* vl Mr. R. C. Schiedt, Jr. Insurance Department Armstrong Cork Company Lancaster, Pennsylvania Dear Mr. Schiedt: B 8742139 re: Clarence H . Reed D/L August, 1957TM**""* _____ Workmen's Compensation We recently inquired of the Travelers Insurance Company in respect to the status of this old case, and for your information and file, we attach hereto copy of letter from their San Antonio, Texas Office, which will be found self explanatory. Sincerely ALEXANDER & ALEXANDER, INC. LOSS DEPARTMENT R j a anavsp to 'y o a r re q tfa t o f February'.8 , 19&~Sye y m ld 11?' -~,J -..i : i- '~$'r*& Tis 't h a t this^abcve c a p tio n e d 'c la im ?la fp re a n tly ''i n jrv d t Coquet,; Bexar County,'San.'^ to r ^ o /iT e o a s ^ 'j^W hicJf p l i i n t i f f *^ a tio r a a y . l i ', i ^ g i . n B ^ a s t M t o i i i ^ c a a a ^ . t h e C" "` t ""iC3r ~;,1'a' :Wo'o4'her defepdanta`in 'th is ' I^vf; >; ?p *WLng''. i m a M j ripeiica t io rf ca r r l e ra . o f "other 'jw rix ras r/T`V-. 2r'f` o f ' th e deceased^-' CCLaronco" Hf 'Bead. ', Tbe2decM $ed.,wr^ed 'fo r - f \ .'cosple""sat'sequiei jtd V cfk in g . for'.iroajtofongl'. .,r-";i..To x m J C ^ j ^ e 't t o i T A c t ^ H w i d e s ^ ^ -';'-:'-'';;/-V' ' > ; -.; ,1;1' - V - - ; * ar 1 ; ' - l f e gS 'o t ^ i v : t^ y*a ,, \-r''f-&\S.-- '' ^ * ' ` !'J -" ;' y fir ri t b a t V ew ould h e tl ^ Ia 8 ^ ''c A iT ie rV /|^ ^ 'iV n i< 2 ^ :^ '::;2 'r ^ .* 4 ,, .:"1'V- '. i;'>'-_-. ,*:.$- y^.-i:.cr-V r'.-t'* - , *!&'.*'.}?-*-v'->>' ' V-.r-.A.u.'i* S*-!*!") ^ - / * - S f r 1 s > i --:`-r''t,':--' .V - : 1A1L"$> `--,-i V'i, ;v> '^ :<-^V *^fti# p i# # h i* bp$a s p e c ia lly e * tJ fc f. tK# 23rd day of^Februsyy, l$6?j> ;'-:'2 '-.^ fiH b s mtI c u '"trtiSrt ' `t i . s s i 1&fcV' '**- i VLtly^SS'^l U~. f o r p 26G0 for fatality, $1000 nedical ei^ P le ase 'e d rla a i f you ed e s ire any ^y^r^XkS^2 '\ '\ 2 2 lnform tion. . ?ery truly yourrJ BiBircw C. A. Karel S u p e rria ir H O M E O f M C E . 700 M A^I N ''S T f-c E i T-. -H A 1E O* t > iSNit&irlrf. 9 % J u ly '1 0 ,,iW l~ > .',': 7^* . " . . . w, - >- - ` ` *' ~b~' ^ i / * ' ; , * ' * ,-.>o i j s *' . ~ 1 'i > ' ^ *; \ - , ", i yv- '- v ~ 7 -'1 ^ > *1 .*v *'' ' ' b ~ ^ * -. "-' b i" b ^ V * '" ' i v '^ v > 4 .\ . \fb-..*rvb - *'; rit 7 *'. -'f /' .-1 .= i . ',' * ' 3 ..r-iri* -V" ~J ^ * / \- ' '.* o.. ' _*'* */. ., 'V. ^ ' ' ''"'v ''* 4 "'' ' ' **-- - * -. ^ T 1-' ~ . .,* r * '^. 3* * , ,, , . -c"^ ^f-f"''^ t'*_.*:- J -f , _.'_~ . . / . '*v.^ ^j f* ^4,- - _'jc' *vl- ??" "'^, J "'V""-''.- ' i `tr V .~ J u ? v**- - 1 < - ,'. b Vb'- -* / ****-?,JLi t v T&a Travelers Insurance Company^y,h> V 7 i v b ;- 4 f ' b --- - 4 >r- --- ^.v. / : l -.. ' V r^ > ^ C :y -V? ;-i,,- , r v: ^^ 7 <:". 'V ': ..y > .^7*- -' SubJect vifr, C l g ^ O t | e ^ i D e c e a s e d ;. ^-\.-' ,;'' V-"^ ;:V-V`:' - bV-^-'-y >-/?.. ' ;''JC't/'` '"' ..I rpiy to your July 3, 959 retjueet for, vage lnb,raitl<(i',. we mdLoBe:,'?. tb^-7/i ": +;, s/.v&PT o f our Jun* 30 le tte r vilch reflects R e la te Hr*. Heed^s HfetiM-:,;;?^! ': ^ v. '- :eaployuent idth Anastrong Coxic 'Cwpatgrr The original vags^ reqqiesi a.'.; : froa your geo Antonio o ffic e , , end in e ll probability, pur/replj'^end '^\xr^;^-i *;'.b r : la t e s t le tte r passed^ eadx^otber on f^v**; ' - '^ ' -V: -V `f-^- ; :;AU:; Our records indicate Ms;.tenain&tl'on yes due. to^lacfe o f .yoxtc*. . S i n c e . h e ^ ;' *'i;' did j^ot. report,an 'iiijttxy''b^g'M s;'e^^^ent^vye^ of ,^urse, had no >:>>. t- ' jreheon [to ^xbait'an ihjdoyer* s ,y |r s i. Report o f - . 7hecking'his four.Veeik" of'aployaeat .vith^^JUastrong/'.ye did .find 7 i , \ 7 ' '.-. b ^ ;> b jb i7that the group ^e.'w xied y ith ordinarily pat in a fiv e dsy yeek.^ Hou": : t /-; b - . b>.:vr ' , ; ;;:^7signiileant that aight be, .ve cannot say. ' PerhsspS ^ e o a e la the Dallas. , H: - ; l ' 1 o ffic e o f Jtnastrong.. Contracting' md Supper.^Corporation might have ths " t * -v.-^v..answers* ; Mr*, E. i * gtexa d is tr ic t amagef^fwuld be the nan to c o n t a c t s v,>.:': ery `trcdy yours,' ` :^ y 'ABMSTIOHO w'oOHPAHI'f. "* ' ^ " ` . ' 'r. *A-. \t - *"* _ ' 1 ? " -. ' ` " Z"1*. " --' ^ :'-,- r . _ _ l' JE2 ;;;,;;, '* i. "* * . ^ ~ ** * JEhcloeure' _; b; - ." ? v. , r .7 '-- He Co S ( ^ l io d t | ^Tp# . 5 Insurance C h a r t a esat ? i' -<-> .* '- ` v" >**.. * E. J. Stern, AC&S, Dallas ' .J, E. Zeller, AC&S, Lancaster; ;-- yv-vF* YVAUC OlAiCMtrSl O ^ PLOY^ C t A R t K C C H / f f c t P , ' ' M a s . W i l m a L s t h c s K c e 5 Vf d * O R S C R T r S A f l K R G 3 AMS J i R R Y WA i M i k o r s , 23O .S3EX S t r e e t S am A n t o n i o * T e x a s Reto, date: Noncn MAIL!!!) CLAIMANT DATE OF HEARING -3-59 INSURANCE CO. NO. 7-23-59 BOARD NUMBER s 60^73 O INDUSTRIAL ACCIDENT BOARD .f* WALTON BUILDING O Hn Rot R i e t , Attormet vw AUSTIN 14, TEXAS 417 S outh Maim S am Amtohio 5 a Texas "' t&> Claim for compensation from the employee named at left will be heard on "Date of Hearing" shown above. Below O Ct " are requests for Employer's First Report VS AVN- of Injury and wage information. Only those 7/ EMpL-OY^ ^ S H S T R O M S s t i x C O F A * O Y N. IHOUSTRIAL LVD. Da l l a s , / T exas checked are being requested. O INSURANC carrier E .Thc travelers I ksurahce C, qmfamv 7 I S c A a o a u cM B t o o . O Au s t i n , Texas CC: H . J O r 5 T ~ D ATE O F I N J U H ^ ' / * ames crcem / NATURE OF IN JU RY W H EN W R IT IN G TO TH E BOARD CONCERNING T H IS CLAIM ALWAYS GIV E T H E BOARD'S NUM BER AND STYLE OF TH E CASE. COUNTY WHERE IN JU RY OCCURRED SCXA* o 1Q-T-57 / P H REQUEST FOR EMPLOYER'S FIRST REPORT OF INJURY O No report of this injury has been received by the Industrial Accident Board. We call your attention to Section 7, Article 8307, Texas Civil Statutes, requiring every employer carrying Compensation Insurance to keep a record of all injuries sustained by t his employees in the course of their employment, and to report same to the Board within 8 days, if the employee loses more than -- 1 day's time from his work on account of the injury.'A severe penalty of not exceeding $1,000 is provided for failure to make Q such injury report. You should also furnish a copy of this First Report of Injury to your insurance carrier, if you have not already done so. Q C 3 REQUEST FOR WAGE INFORMATION On the reverse side is Employer's Wage Statement which the Board requires that you complete and return to this office prior -- to "Date of Hearing" shown above. This information is requested for the 12-month period immediately preceding "Date of Injury" given above. If this employee has worked for you less than one year, you should submit a summary of wages for an employee of the same class, working substantially the whole of the immediately preceding year in the same or a similar employ ment. If you furnish an employee board, lodging, laundry, fuel or other advantages in addition to regular wages, or if the O employee received tips or other gratuities for services, BE SURE TO GIVE THE ESTIMATED VALUE OF THE ITEM OR ITEMS. If you fail to do so, the Board will assign an estimated value. 3 O This statement will benefit you, because it will be used to prevent an excessive compensation rate, and will insure the payment of compensation at the correct rate in this claim. o o C L c J jf . jT t a v if; Lr. e x e c u t iv e d ir e c t o r o Return To: INDUSTRIAL ACCIDENT BOARD o WALTON BUILDING AUSTIN, TEXAS o CAUTION: BE SURE TO COMPLETE REVERSE SIDE OF THIS FORM Y V /A V JL . O IM I C m C iN I EyPLOY.EE > - C uAUCKU H. Ccc*6 Hai* Wjl*# L9THCS RttD* VlDO* . DATE NOTICE M AILED CLAIM ANT DATE 0 7 H E A R IN G BOARD NUMBER 1230 R o b e r t F a * * R e a m J c k t Wa t h c R i e # # Mi n o r s , esse* Stectt -3-59 7-23-53 3 60*173 Sa# Auro*## Tcaa# 9 IN SU R A N C E CO. NO. INDUSTRIAL ACCIDENT BOARD 9 H i , Ru? R # A ttouiict 417 S outh H * * ^ Sa# Automi# 5# ***** e VS EMPLOYER A omstmom# C o# C ohfam t o 12H H . I M0U9TIA L 0AVO. Dalla# Tcxa* WALTON BUILDING AUSTIN U, TEXAS Claim for compensation from the employee named at left will be heard on "Date^of^ Hearing" shown above. Below ,,ane^requests for Employer's First Report ^^Q-"f, 'o f Injury and wage information. Only those ''/cKeckd are being requested. f#5 9 INSURANCE carrier . T*Avtit I nsurance Comfamt ZIO SCAABMeUOM u$riM# TeiAS Stoa* CC: 9 __________ MM jA H t> SEOCM DATE OF IN JU R ^ * 7 * * * j" jJ NATURE 0 7 IN JU RY 10-7-57 W H EN W R IT IN G TO T H E BOARD CONCERNING T H IS CLAIM ALWAYS GIV E T H E B O ARD'S NUM BER AND STYLE 0 7 TH E CASE. COUN TY WHERE IN JU RY OCCURRED @CXAft r^TRREECQUEST FOR EMPLOYER'S FIRST REPORT OF INJURY - No report of this injury has been received by the Industrial Accident Board. We call your attention to Section 7, Article 8307, 9 Texas Civil Statutes, requiring every employer carrying Compensation Insurance to keep a record of all injuries sustained by his employees in the course of their employment, and to report same to the Board within 8 days, if the employee loses more than -- 1 day's time from his work on account of the injury^A severe penalty of not exceeding $1,000 is provided for failure to make ^ such injury report. You should also furnish a copy if this First Report of Injury to your insurance carrier, if you have not already done so. REQUEST FOR WAGE INFORMATION On the reverse side is Employer's W age Statement which the Board requires that you complete and return to this office prior -- to "Date of Hearing" shown above. This information is requested for the 12-month period immediately preceding "Date of 9 Injury" given above. If this employee has worked for you less than one year, you should submit a summary of wages for an employee of the same. class, working substantially the whole of the immediately preceding year in the same or a similar employ ment. If you furnish an employee board, lodging, laundry, fuel or other advantages in addition to regular wages, or if the 9 employee received tips or other gratuities for services, BE SURE TO GIVE THE ESTIMATED VALUE OF THE ITEM OR ITEMS. If you fail to do so, the Board will assign an estimated value. 9 This statement will benefit you, because it will be used to prevent an excessive compensation rate, and will insure the payment of compensation at the correct rate in this claim. 9 EX ECUTIVE D IRECTOR Return To: INDUSTRIAL ACCIDENT BOARD 9 WALTON BUILDING AUSTIN, TEXAS 9 CAUTION: BE SURE TO COMPLETE REVERSE SIDE OF THIS FORM -- * -- -- --* * ^ . w xr.% a w o- k n r n r n n e n i n w i /*^k i c r P i D V T O D H A D H ' AIR MAIL - v. In connection with the subject claim, please find Wate Statement received today from the Industrial Accident Board at Austin, Texas.' You will note that the date of hearing is 7-28-59, therefore, all papers _in connection .. ' with ttis case must;.be processJd " s soon as possible. . . ' - ' ' , ' Enclosure v ' H. T. Miller, San Antonio June *>, 1959 The Travelers la earanee Coapany 201 H. St. Mazy1 Street 8an Antonio 5$ Taxes Gentleaan*| Attention Mr. B. V. B ill / V.' Subject v Clarenoe B. Bead Ci aim #B--8742139 The following figures indicate the entire employment in Texas by Arastrong Cork Company of Clarence B. Bead, 8 .8 . # 216-10-7857. f . y Ai^ u i 8/ 25/57 9/1/51 9/ U /5 7 9/ 22/57 Vases 8 77. 7 7 .2 8 7 7 .2 8 7 7 .2 8 8 3 0 9 .1 2 Peers 3 3 3 -1 12 goujCI 24 24 24 2k 98 Boring the above oaployaent, ve did not submit an accident report, id our records indicate both terminations vere doe to lad; of voric. Tory truly yours, ARMSTRONG CORK COMPAHX B. C. Schiedt, Jr. Insurance Department JBZ E. J. Stem, AC&S, Dallas J. E. Zeller, AC&S, Dancaster ( ^ jo A j ^ jL ?-/'s 7 ? -!S s 7 ?~*?J~s7 1^ trd * ' R -JU L cQ LO cy^ 71 A S' I l i AS f ! Il A? 11 A S t 3 9 JA S.S. ^ o? / > -/ ?Ss? .3 vS JA S -JU -7 iJ-b-tlA saS' \A i i H H ! . % > Cec^ X -jr-s r? ? / f - * 7 ^ jt JX - Uj -& \ j 7^yy^uo^ i i ' i Jii .' <3)r S l id INTERj 'OFFICE COMMUNICATION To From Subject J. E. Zeller, Lancaster E. J. Stern, Dallas Claim for Compensation for Death Clarence H. Reed Social Security #216-10-7857 (A rm stro n g AIR MAIL On June 19, we wrote to you with reference to the above claim. Attached please find letter from The Travelers requesting further information in this regard. We have checked our records again and herewith is a tabulation of our records of his employment: Week of 1957 8/19-8/25 8/26-9/1 9/9-9/15 9/16-9/22 Dates Worked 21 22 23 26 27 28 11 12 .13 16 17 18 Total Hours 24 24 24 24 Rate $ 3.22 3.22 3.22 3.22 Gross $ 77.28 77.28 77.28 77.28 You will find copy of Employer's Wage Statement enclosed and no doubt, you will want to check your Lancaster records before completing the Statement. We-have searched our files and cannot find that a First Report of Injury was ever reported to us or filed with the Industrial Accident Board in Austin, Texas. Please advise us of anything further that we can do in this connection. LB Enclosure H. T. Miller, San Antonio e */ CLAIM DEPARTMENT PAUL W. BOGUSCH, Clolni M onog.r Armstrong Cork Company Plantation Road> Dallas, Texas - June 22, 1 9 ^ ^ ' s V ^ C ^ BRANCH OFFICE .-Petroleum Commerce Building 201 North St. Mary's Street SAN ANTONIO 5, TEXAS Telephones Cpttol 5-7661 3$ jtSH B-87h2139 Armstrong Cork Company Re: Clarnce H. Reed D/L: 8 - 5 7 B-87l|2076 B & B Supply Company Re: Clarence H. Reed D/L: 5-1-59 Gentlemen: We have been advised of a claim for compensation of beneficiaries of Clarence H. Reed through their attorney, Mr. Rudy Ribe, of San Antonio, Texas. Such claim is for death benefits under Workmen*s Compensation A.ct, death caused by asbestosis. The claimant allegedly worked for you during the months of August and September, 1957, in San Antonio, Texas, at the jobsite of the National Bank of Commerce "Building. ,It is alleged that Clarence H. Reed breathed asbestos dust and became infected with asbestosis and subsequently died on December 29, 1958. Would you please forward to us the employment dates of Clarence H. Reed and also forward a first report of injury - compensation, if Clarence H. Reed ever advised you of such an injury. ' We are also forwarding for your attention Employer's Wage Statement for completion for the weekly wages of Clarence H. Reed for the period of time that he was employed by you. VJe would appreciate a prompt reply to this letter as we anticipate ,n early hearing before The Industrial Accident Board and the possibility of suit being filed if such claim is denied by The Industrial Accident Board. Thank you for your attention in this matter. Very truly yours, HWH:rcw HOME OFFICE: W . Hill,Adjuster 700 MAIN S T R EE T , HARTFORD 15, C O N N E C T I C U T  "j,'*,'yt J-gS^Ci;~-&gjgyiegaTOix e is sia is isi t ssh ia ^ m MUMMKttiillfilUWyilUiuMiMittM EMPLOYER^, WAGE STATEMENT NOTE: A Shnw number of days worked cnd amount r orLed. S T A T E M E N T OF T O T A L E A R N IN G S OF Please complete this Statement in detail in duplicate. Return original to this office promptly. Send duplicate to your insurance carrier. IN D U STRIA L ACCIDENT BOAR AUSTIN, TEXAS I I PERIOD COVERED BY EACH PAYMENT FROM TO MONTH DAY MONTH DAY o tn u i ><- *<r o o5 OCCUPATION (Type of Work) WAGE RATE (By Hour, Day, ft'e e i, o r Months AMOUNT EARNED 1 2 3 4 5 FROM 6 7 TO 8 9 <' ' A 1 . STATE MAXIMUM NUMBER OF HOURS 10 - WHICH EMPLOYEE WAS PERM ITTED TO WORK PER WEEK OR MONTH UNDER THE II PRO VISIO N S OF ANY S T A T U T E. REGULA- 12 TION OR AGREEMENT L IM IT IN G HOURS OF WORK. 13 HOURS PER UNOER 1 4 15 2 . HOW MANY DAYS CONSTITUTED A W EEK'S WORK? 3 . HOW MANY HOURS CONSTITUTED A DAY' S WORK? 4 . IF EMPLOYEE WAS FURNISHED BOARD. LODGING. LAUNDRY. FUEL. OR OTHER AD VANTAGES HAVING A VALUE WHICH CAN BE ESTIMATED IN MONEY (e x c lu d in g , how e v e r , any sum p aid to employee to cover any special expenses entailed on him by acts of his employment). STATE ESTIMATED VALUE PER MONTH OF EACH ITEM FURNISHED. 1TEM FURNISHED e s t im a t e d value 16 17 . t 18 19 20 21 22 23 24 25 26 27 28 29 30 ITEM FURNISHED < 31 32 e s t im a t e d value 33 $ 34 35 36 1 C ER TIFY THAT TH IS STATEMENT 37 IS TRUE AND CORRECT 38 39 DATE 40 41 42 C IT Y STATE 43 4 44 45 SIGNATURE 46 47 48 O F F IC IA L CAPACITY 49 50 EMPLOYER 51 52 , TOTAL DAYS WORKED TOTAL AMOUNT. EARNED BALTIMORE NEW YORK CLARKSBURG TULSA ST. LO U IS CHICAGO LOS ANGELES ATLANTA PITTSBURGH SAN FRANCISCO NEW ORLEANS MIAMI PHILADELPHIA A lexander & A lexander INCORPORATED INSURANCE AVERAGE ADJUSTERS CONSULTING ACTUARIES 2 2 2 5 NORTH CHARLES STREET, BALTI MORE 18, MD. June 25, 1959 TELEPHONE TUXEDO 9-4304 BELL SYSTEM TELETYPE BA 562 CABLE ADDRESS "ALEXBLUE" Mr. Wallace B. Hofferth, Asst. Insurance Department / Armstrong Cork Company / Lancaster, Pennsylvania General Manager Re: CLAIM FOR COMPENSATION FOR DEATH \^31arence H. Reed _____ Social Security #216-10-7857____ Dear Wally: Thank you for your letter of June 24th and enclosures. We note that the Attorney has forwarded a copy of his letter with a copy of the claim to the Travelers Office in San Antonio, Texas. We are sending the original of the Attorney's letter and a copy of the claim to the Baltimore Branch with the request that they follow through and advise us of the developments together with any reserves set up for this him. Yours verv^tmily, ALEXANDE 'ALEXANDER, INC. JEF/be J. E. Fannon Vi^e President - Casualty -* **: - - v i * K _ *- June 24/ I9 59 .-> X * i *v;v; . . v -J k v *K i?m k cr - "* r Pannoa __ ' \ T> "r -: . " : - : ." ?. ' ! / * ` - ... - L. ~ AlexauderA Alexandsr, 2225 5 . Charles Street Baltiaore^ lB,Md* Dear Enclosed are a letter from the law offloesof Rudy Rice, 417 South Main, San Antonio 5, Texas,~ and a Claim for Compensation for Death in behalf of the widow, Mrs/ Wilaa Esther Reed, .12^ Essex. Street, Saa_ Antonio/ 'Texas.;v> .......... '? v .* Claroacs H. Reed was employed in our Contract Operations daring the follow* . ing p e x lo d s iX p -^ j/^ i-.^ 'v ^ > V \ - /X\. v; - B / 2 5 / 5 7 to 8/ 2 8 / 5 7 r Q u it Voluntarily , - X V-; r . '\9A o/ 5 7 > 9/l?/?T, r Quit Voliwtail^;/.;:^-- X Please forward one copy, of the enclosed.material to^the proper office of The Travelers so that our intereste a s y be fully protected* .* ' *.-->* // Sincerely yours, m- Enclosures- Wallace B. Hofferth Assistent General Manager Insurance Department To From Subject J. E, Zeller, Lancaster e * J. Stern, Dallas IN 2 3 Claim for Compensation for Death Clarence H. Reed Social Security #216-10-7857 WLH June 19, 1959 Please find attached letter and Claim for Compensation for Death from the law office of Mr, Rudy Rice, Our record of employment on this man is as follows: Hired Terminated Reason Terminated V . *V v t' Claim for Compensation for Death . INDUSTRIAL ACCIDENT BOARD . ; V . V / . , V :, W AUSTIN, TEXAS i V .* V : M OTS:--T hle claim aboold be m ad* o a t In d u p lic a te ;' on* copy th e re o f should b* m ailed to th e In d u stria l A eoldaat B oard and th * e th a r copy should b* dllT*r*d to th# E m p lo y ar o r th * In su ra n c e C om pany o r A ssociation c a rrjln R bla lasttraoe*. This is to notify rTM t o a t g o o y C ogk Cca p in r * F i t a t t l o a B4 S e l l s , Vf ; V - " : : - V * f . Nan o f i m p l o r e ? 0 m ocU U or o r o o sn p a a x w l f c f c w h l c k i m p t o r o r So i n m ^ L iT ''*y ' . r ~- : V'V- ,> v \ _ V ' V V V 'W , i ; ? ;* ' v ^ * ' ^ ,, -V'-V I - ~ V V^vvV^V3^ V^-'V ^.V-VV - that I claim compensation from you under the Employers'Liability Act of Texas on account of the death of .--Cl o r a a e o . 5 Eo o d K am a o f dceased *ro p lo y **. which resulted V*^ on the 2 3 t h .j. day of D ftg g & a r y ' ~ ` ' ia 5 3 , ; v; f^ xSk- c` .V-* r while in the e , ". m p J o y ` -.-rv-; _>- ,,x .... ... K a a i o r* m p lo y *iC Tasa C ity or to w n .. The place o f in ju r y w a iV IjIg h ilO OT. <*>? t boudin or iav T esa# In . - ...S M i - A a t g a O t ^ '; ^.v.vt ; v ;" The cause* of VVVv-i--- ;te lry a iea i o f ..iuag dwst t o I n h a l t l e a o f a s h e a t *- 5 *. - - - 1 ..'`J d - i f e v r ^ V ,i .r * 4i ,H '.*V *;$?>?'<' *- .-S v > P M c r lb o u n o f I n ju r y . -v~;; ' h i l a f^rplayad b y A r m s tr a a g C ^ k -Coaipony apyrQ rL nsgl y . t 5 9 a n te e o f A ugust M d g * p t d > , n $ ^ :g i f ^ : ' Name and P. 0. address of ^biesses in support of claim: gfcgft& fet S a n A s t c m iQ . T e x s A MrAm Wilma getfeiar Ready 12S0 Egeat Give names and P. 0 . address of the BteficiaHes of ttie deceased {stating^^^the Wnship" of each such Benefi- clary to the deceased) _ J te go...H12ffle--S al :ligX -JL A--M iX aL < ^ t e ^ C - y a - ^ - g ^ d y - x s a -7 ----------------------------- :-------- .. _ 1--/ ,,. -- 7 . v-' '.* -' ` *'- '7';- phort ftaak Bttd, as ! which of the legal Beneflciaries above named are minors? State s g e 3 h c r a -2 )i.S w -I ly - 1 9 4 3 r . AT^l J e r ^ L e i ^ : t ^ S P t i & ^ e m ^ l < ^ ^ i i 7 ^ injury^a^pgosirm tgly., teSLjaaiiShf U .. " ' jl ' jl. * .X s . : , - .- T a a n . m eatha o r d a ra . j ' ' -- V *.?. - T ' ' 'r - ,, -.' - Wages of deceased employee on date of injury were * * -- '-'-..vi**' t' ' V'y-''r-*> 5 v.- - '-- ' 4 5 p^ -- t a .* *D^a*jr. w k or m onth. p ' * ' 'V-,f V7":;7- : 7 i A . K , V : r . , , , Deceased was e m p lo y ed 7 lV .5 J ^ p er w e e k . " - ; : i V v V V ' - ^ ^ f '-V i'V \ . 3 ta t* w h e th e r o r f d ay. : * . '* ` -r 7 This claim for compensation, with respect to such injury and because of the death of deceased, is made *n behalf of and for each and ail of the legal Beneficiaries of the deceased, as well as by and for the under signed, he herein acting for himself and such legal Beneficiaries. Social Security No. S tynatur* o( Claim ant. of Deceased--2-X^2.C-**?c>S -- this. . day of_ ^-JL23flLtog&JfegftaiL Str**t an4 nuca bar. &Ea a So a io T e x a s C ity or tow n. 19-JSt F I i --J I It ta e la ia ic 4 t h a t t h * r I U t l b b y th * a a n p lo y cr, o f a n y t a t u t e c a r t< 4 f a r t h e s a f e t y o f e**p 1*7*ra, w a t r f t t t r t < t h * S a js r r m d e a t h * f th la e a p l e y e . It 1* K t a t i U d t h a t th l* b* *o ><atc4 l a t h i s e l a i a i f a r e o a t p e s M t la a . C E :--Sactlon ta , Ibart n . Employer* L iab ility A ct-- U nits* th e ;m *oclation or tub*crib*r hav* notlc* of th* Injury, no pro- to r com pensation for Injury u n d er th is A ct sh a ll b* m ain tain ed u n less a notlco of th e In ju n r sh all hav* bean * lven to th* ft o r a a b i c r l b a r w ith in t h i r t y (30) day* a f t e r th * h a p p e n in g t h e r e o f : end u n ln aa a c la im fo r c o m p e n s a tio n w ith re e p e e t i o1 ntr a sail bar* physical bean o r m< mad* w tth la *Ix (S) ntal Incapacity w ith m in onth a alx (*) fta r th* m onth* occurrence of tam e; afte r the death or or. th e In caa* of d e ath of th* *ms!ciy*e or In rem oval of auch physical or m ental {. ' P ro v id e d , t h a t fo r Rood c a u s e th e - -- V * la I* board mtiaty* KInoimmeLr ito r io u s cases w aive th e strict com pliance w ith the fortR olpR lim its- BALTIMORE NEW YORK CLARKSBURG TULSA ST. LO UIS CHICAGO LOS ANGELES ATLANTA PITTSBURGH SAN FRANCISCO NEW ORLEANS MIAMI PHILADELPHIA Alexander & ixawudieir, INCORPORATED d INSURANCE / AVERAGE ADJUSTERS CONSULTING ACTUARIES 2 2 2 5 NORTH CHARLES STREET, BALTI MORE 18, MD. June 7, I960. Mr. William L. Hughes, Manager Insurance Department Armstrong Cork Company Lancaster, Pennsylvania Travelers Policy No. RTTB-622050n Dear Sir: Please note disposition made of the following claim: Date of Accident: Claimant: Location: Claim No. : Disposition : August, 1957 Clarence H. Reed San Antonio, Texas B-8742139 $500.00 Fatal $1052.23 Expense i* ft 3' Remarks : Very truly yours, cm. ALEXANDER & ALEXANDER, INC. Indicate Whether: Workmen's Comp.____ X Auto Liability B.I.___ P.D.__ General Liability B.I. P.D. LOSS DEPARTMENT \ TELEPHONE TUXEDO 9-4304 BELL SYSTEM TELETYPE BA 582 CABLE ADDRESS "ALEXBLUE" BALTIMORE N&W YORK CLARKSBURG TULSA ST. LOUIS CHICAGO LOS ANGELES ATLANTA PITTSBURGH SAN FRANCISCO NEW ORLEANS MIAMI PHILADELPHIA A l i b x a n d e r S s A B U E X A s r a iE iR INCORPORATED INSURANCE AVERAGE ADJUSTERS CONSULTING ACTUARIES 2 2 2 5 NORTH CHARLES STREET, BALTI MORE Ifl, MD. February 19th, 1960 l^ TELEPHONE TUXEDO 9.A3D4 BELL SYSTEM TELETYPE BA 582 CABLE ADDRESS "ALEXBLUE" Mr. R. C. Schiedt, Jr. Insurance Department Armstrong Cork Company Lancaster, Pennsylvania Dear Mr. Schiedt: B 8742139 re: Clarence H. Reed D/L August, 1957"" ____ Workmen^ Compensation We recently inquired of the Travelers Insurance Company in respect to the status of this old case, and for your information and file, we attach hereto copy of letter from their San Antonio, Texas Office, which will be found self explanatory. Sincerely ALEXANDER & ALEXANDER, INC. LOSS DEPARTMENT R .v C UUi* Df?AST*D<T t H A W. lO O W O t, O M w g r * tsf 2 * " ... , _ iv- :> j f. J & If/w c/er* ,% iSu rttiu r\ fr / n / *" '% r ijh riu & tt .jT tfim tu Y u y 'm / m k ? iW: %' IUNCM "Of?iCt`U! " fT S S t^V ^v Ar-?-''' Ptfha Con*rca B*'Wfc^risC.r^.;;'-.-., 2ot N e n h -' : Sam; antono ,;,------- --------- . ----------captioned claim i s ' presently- . ._ r. . ~ r. . D is t r ic t Court, Sexar County, San Antonio..TeX** in which tbs I:. p la in t if f ' a ^attorney is Ja lle g irg ssb e atcais. vnich caused .the d e a t h ^ ^ ^ t `*;V 1 of Clarence H.' fteed. ' There' a re ..a lso other, defendant* in. th is stdii^ '5^ ;^ \ ;r_ being .the,insurance coitpensation c a r r ie r s o f .o th er1previous e ^ Ib y e rf r.; of^the; deceased, Clarence H Reed. 1Tbs.deceased forked for two other'. `^'dwipaniet subsequecii to working for' Anastrorig, Cork: Company e n d , t b s . ;41^xM .lCo^M satton ^Act jp i^ id e s jt t o ^ ,,*11 .deaot^ - -\ v > t ^ e ? . c a r r i e r * ^ . u r r i e r .Wo^ -,.HcweVerZ-i;^; r ; i^ cessa^ 'fcr^ ua' aintjiin^an,restS aat# aa^nt' o f y , .. V f a t a lit y c la i > in e e i t i s 1c o n c e i v a b i s ^ p i o s s ^ l e ' t h s V J i a r y v c - o ? \zaay find th at we .'would b e t h a la s t c a r rie r : *"' -.vv *:*-li'-'K *> v r7~C-- - ' / `tx ' *' fb s'c csa has bees s p e c iaillly set- f?*o''*r*' t-h>e"23rd ,,s? eff.'Febbrrucasrryy. ^1l5&6?9,. s^u z^-^-p S - w ill be trie d at that tiz Tbs e etin ates are se t up.for $12600 for fa ta lity * $1000 medical and $1250 fo r expense*; ^ .-*?/-.; n T ' ; ' - *, --: ' ` >.' ?:' ' -V .'-. - - ' Fleaso c d rise i f you d e sire any furth e r in fcr*-*ti.o n . -' ' *:.:' .-, ` i - ir/T^-&** ;4. T ^ r y i r u y y o t j u r e ^ f ^ s ^ ^ ^ t -r^ ; : ': '. 5 ' i-yEtrsw ' - - - - C~ A . K o r e lj^ t '"" S3?e r r i s i -'rr /* J aP , ,v HOM O ffic e . 709 u t l r t ST*fT. A,\ir H A I T f O t O- u'.t- Jf.. \ r* t ***,' "iv-rv - -T - ^ * ` <*Sj ' ; i - i-v r ' *"".* -`5. V ' >* v,*- '. - v-^-, . ." ' *. ' ~ --' ,, ' j V 7 V- v---^ ; , v " - I .??-''<>t r- -<... *3" r`S i ^ ^ /,=t rv_^ ' . * '; -. *w _r x' *' - - r-`*' - '' * ' . ^ r 1 ^ V; ` '7:,''> ^VvCv-. /;' .*. r'-"'v-' .'-r- ?' , /". i ' '\'r- V " .-.`"''"`-''rif.--^ !`'r -rv ^ v , >-v.--t -.? -'-v/' rI ^ ' Vf ':"; :' - 7.; .T i'.}. 'SV- f-^., V 'r_A, - :- .' -. v** ** >,,f' i>.w.v*' ' .' ? *4s ' *r*l"s t >*.-- '/?rv.- ~ V*i The Trav^ers Insurance *Company Z 710. Scarborough Building '. -, V-i Austin, Te: July 10, 1959 -Ij< > . Gentleman* Subject* s k r , & e ^ p 9 j l j ^ ^ & w i i d ': ,vClalm #8-8742139 ; !? ~n In reply to your July 3, 1959 r e v e s t for wage information, ve `enclose a v copy o f our June 30 le tte r which reflects the la te Mr Reed* life tim e . r' employment with Armstrong Cork Company- the original wage request cme>.f^".V from your San Antonio o ffic e , end in e ll probability, our reply and your,- la t e s t le tt e r passed each.other on t h e . v a y i t ;, 4? .-...4T;. ^ , Our records indicate h is termination y&s due to,lack o f work. Since h e w:i ` j , did not report' an injury daring his employment,' we, of course, had no ^ . reason to submit en Employer' s First. Report o f Injury, / v- '^-y.-. . ; > ;' r ; r . la checking h is four weeks o f eaployaeat with Armstrong, we did find that the group he'worked with ordinarily put in a fiv e day weak.; . How sign ificen t that jaight be, .ve cannot asy. Perhaps someone in the Dallas o ffic e o f Armstrong. Contracting'' ai4 Supply Corporation might have the ensvers. Mr,. 2 J , Stem , d istr ic t iasnagery wuld be~ the aa to contact. * 1" 'M t r iu y yw u f8 j*i;.--.vv ABMSIKJJIG COES COMPAST JESr \ i: **. ' . - * R. C* Sdiiedt, J r . .. ; . , : ' Insurance Department Enclosure '';`\r ;.; .."V V: :r\ -v ; ' ' 2. J. Stern, AC&S, Dallas'* ,V . , J. E. Zeller, AC&S, Lancaster AIR MAIL In connection with the subject claim, please find Wate Statement received today from the Industrial Accident Board at.Austin, Texas. You will note that the date of hearing is 7-28-59, therefore, all papers in connection with' this case must, b e "processStl'as soon as possible. LB ` Enclosure H. T. Miller, San Antonio WACifc 51 AT EMENT o EMPLOVPE rVt A'L ri Ci K # |v. fci?, D E C 1 Mas. Wilma lst lies Re e , o R SCRT piTAfitt fvir a n o J e M i n o r s , 1 2 3 O E s s t * i>TSiC 1>ATK .V O / I C r M AII,m> CLA IM A NT 7-3-yj l>A T E O f I F AILING 7- 20-59 & O A lll> N LCNTBEH s 60473 S am A n t o n i o . T e x a s o IN.SUUANCK CO NO. fr /"v^ $> 1 o 14ft* k)J S am Rwot R i c e , S outh Ha i m Automio A ttorney Texas ' ,.,-v '\j ^ *'> r> ,L > tvv lv>-';'.) 0 Ca vs ^ EMPLOYE! A r m s t r o n g -COMBAJiY o 1 / 1 6 2 4 N . I h d u s t r i a l B e v o Da l l a s , / T ex a s in d u stria l a c c id e n t bo ard WALTON BUILDING AUSTIN 14, TEXAS Claim for compensation from the employee named at left will be heard on "Date of Hearing" shown above. Below are requests for Employer's First Report of Injury and wage information. Only those checked are being requested. 77 o INSURANCE CARRIER T he Tr a v e l e r s I n s u r a n c e 7 1 0 SCAR&RGUOH B l d o . O l} A u s t i n , Texas Ms. James DATE OF IN JU R ^ i ** / K 7 ______ 1 0 - ? - 5 7 B esceh / T NATURE OP INJURY W HEN W H ITIN G TO TH E BOARD CONCERNING T H IS CLAIM ALWAYS GIVE THE BOARD'S NUM BER AND STYLE OP THE CASE. COUNTY WHERE IN JU RY OCCURRED B exar O F H REQUEST FOR EMPLOYER'S FIRST REPORT OF INJURY No report of this injury has been received by the Industrial Accident Board. We call your attention to Section 7, Article 8307, v Texas Civil Statutes, requiring every employer carrying Compensation Insurance to keep a record of all injuries sustained by his employees in the course of their employment, and to report same to the Board within 8 days, if the employee loses more than -- 1 day's time from his work on account of the injury. A severe penalty of not exceeding $1,000 is provided for failure to make Q such injury report. You should also furnish a copy of this First Report of Injury to your insurance carrier, if you have not already done so. f / o REQUEST FOR WAGE INFORMATION On the reverse side is Employer's Wage Statement which the Board requires that you complete and return to this office prior -- to "Date of Hearing" shown above. This information is requested for the 12-month period immediately preceding "Date of Injury" given above. If this employee has worked for you less than one year, you should submit a summary of wages for an employee of the same class, working substantially the whole of the immediately preceding year in the same or a similar employ ment. If you furnish an employee board, lodging, laundry, fuel or other advantages in addition to regular wages, or if the Q employee received tips or other gratuities for services, BE SURE TO GIVE THE ESTIMATED VALUE OF THE ITEM OR ITEMS. If you fail to do so, the Board will assign an estimated value. 3 O This statement will benefit you, because if will be used to prevent an excessive compensation rate, and will insure the payment of compensation at the correct rate in this claim. o o o Return To: INDUSTRIAL ACCIDENT BOARD o WALTON BUILDING AUSTIN, TEXAS o CAUTION: BE SURE TO COMPLETE REVERSE SIDE OF THIS FORM - -- -- -- -- -- < -- v y*y n \ / t / * \ n A HO 9 EyPLOY.EE C k R E H t i H r u C &* ^ C C * 9 N '8$* W l t H A 5 f K 9 R e t , V i O * . * DATE NOTICE M AILED CLAIMANT DATE OF H E A IIIN G BOARD NUMBER R o s e s ? r * H * RC> JERST WATMC R U b Mi k o b s , 1 2 3 0 e s s i * S tscct 7-3-59 7-23-55 3 S0H73 0 Sa Automi Te*** IN SU R A N C E CO. NO. INDUSTRIAL ACCIDENT BOARD WALTON BUILDING S O I* RuOT R iCE AfTO*tT 17 SOUTH HAI* Sam Amtoni9 5 Tc*Af AUSTIN 14, TEXAS Claim for compensalion from the employee named at left will be heard on "Date Hearing" shown above. Below 0 ,,jP^ G W uests for Employer's First Report VS employer A t M i t i o Cor C o h R m y jFlnjury and wage information.Only those --g 0 '1' ; checked are being requested. O. 1 0 2 ^ H . iMOUATRIAt tYO* Dallas Texas 0 c a r r i e r wyK C T f t V t t t * * I m s u h a m c c C e * 1* * * 7 1 0 SCARBR0U6M LOC* U 3TIM T e x a s v$ > 2 * CC: 0 HR DATE OF INJUR: JA M ES SCHOCK NATURE OF IN JU RY 107-57 W H EN W R IT IN G TO T H E BOARD CONCERNING T H IS CLAIM ALW AYS G IVE T H E BOA R D 'S NUM BER AND STYLE OF TH E CASE. COUNTY WHERE IN JU RY OCCURRED 0 CXAR HETRrEkQUEST FOR EMPLOYER'S FIRST REPORT OF INJURY No report of this injury has been received by the Industrial Accident Board. We call your attention to Section 7, Article 8307, TM Texas Civil Statutes, requiring every employer carrying Compensation insurance to keep a record of all injuries sustained by his employees in the course of their employment, and to report same to the Board within 8 days, if the employee loses more than -- 1 day's time from his work on account of the injury^A severe penalty of not exceeding $1,000 is provided for failure to make Q such injury report. You should also furnish a copy af this First Report of Injury to your insurance carrier, if you have not already done so. 0 REQUEST FOR WAGE INFORMATION On the reverse side is Employer's Wage Statement which the Board requires that you complete and return to this office prior -- to "Date of Hearing" shown above. This information is requested for the 12-month period immediately preceding "Date of TM Injury" given above. If this employee has worked for you less than one year, you should submit a summary of wages for an employee of the sameL class, working substantially the whole of the immediately preceding year in the same or a similar employ ment. If you furnish an employee board, lodging, laundry, fuel or other advantages in addition to regular wages, or if the @ employee received tips or other gratuities for services, BE SURE TO GIVE THE ESTIMATED VALUE OF THE ITEM OR ITEMS. If you fail to do so, the Board will assign an estimated value. 0 This statement will benefit you, because it will be used to prevent an excessive compensation rate, and will insure the payment of compensation at the correct rate in this claim. 0 0 /A EXECUTIVE DIRECTOR O R eturn To: INDUSTRIAL ACCIDENT BOARD 0 WALTON BUILDING AUSTIN, TEXAS CAUTION: BE SURE TO COMPLETE REVERSE SIDE OF THIS FORM -SFMn d n f COPY TO YOUR INSURANCE CARRIER; RETURN ONE COPY TO BOARD June 30, 1959 The Travelers Insurance Company 201 S. S t, Mazy's S tre e t 8 Antonio 5 Texas Gentlemens Attentions Hr. H. H ill Subj s e ts NClareaoe H. Reed G la ia # -8 7 4 2 1 3 9 The fallowing fig u res in d ic ate the e n tire employment in Texas by Armstrong CoA Company o f Clarence H. Reed, S.3. #216-10-7857 ?,ar.3h4in& i 8/25/57 9A /57 9A 5/57 9/25/57 S sm $ 77.28 77.28 77.28 77.28 $309*12 Days, 3 3 3 -1 12 Hom 24 24 24 24 96 During the shore employment, ve did not submit an accident rep o rt, and our records in d icate both term inations were due to lack o f work. Yery tru ly yours, ARMSTRONG CORK COMPANY R. C. Schiedt, Jr* Insurance Department JBZ E. J . S te rn , AC&S, D allas J . E* Z e lle r, AC&S, L an caster C ^ j>Aj ^ (u l PiX>^ (C'> \ J^v^^ i ? V ^ "7 < A / -JUL<$ UJ a y u s 77A f ? -IS -s 7 < ? 1 ` 1 772$ j ' i : 77 2 ? ** : i - : 9 -JJ.s? 'ScrtJ^y> t 772f ; --" ' i f j 3 69JA i t 1 i * i t i { 1 j : .:.i i i ' j ! ; i i ! j i 1 f . i i1 : { ! \\ i i\ ! 1 , 1I ; j i i ! j 1i ! ?fs? 3 3 3 ! I 2 -At -J? }4-&-<*As6S Ut ! ; % O ^V) i M-->\rS7jt^ X-A*-*? ?-/J>- s'? ! ! / 6 - .J, /. ^ 6: INTER 'OFFICE COMMUNICATION To From Subject J. E. Zeller, Lancaster E. J. Stem, Dallas Claim for Compensation for Death Clarence H. Reed Social Security #216-10-7857 (\V m stro n g AIR MAIL On June 19, we wrote to you with reference to the above claim. Attached please find letter from The Travelers requesting further information in this regard. We have checked our records again and herewith is a tabulation of our records of his employment: Week of 1957 8/19-8/25 8/26-9/1 9/9-9/15 9/16-9/22 Dates Worked 21 22 23 26 27 28 11 12 13 16 17 18 Total Hours 24 24 24 24 Rate $ 3.22 3.22 3.22 3.22 Gross $ 77.28 77.28 77.28 77.28 You will find copy of Employer's Wage Statement enclosed and no doubt, you will want to check your Lancaster records before completing the Statement. We- have searched our files and cannot find that a First Report of Injury was ever reported to us or filed with the Industrial Accident Board in Austin, Texas. Please advise us of anything further that we can do in this connection. LB Enclosure H. T. Miller, San Antonio CLAIM DEPARTMENT PAUL W. BOGUSCH, Claim Manager June 22, 1 B R A N C H O F F IC E ^/-Petroleum Commerce Building ' 01 Norths. Mary's Street SAN ANTONIO 5, TEXAS Telephone Cpitol 5*7661 Armstrong Cork Company Plantation Road' Dallas, Texas jU H ao B-87li2139 Armstrong Cork Company Re: Clarnce H. Reed D/L: 8 - 5 7 B-8 7^2076 B & B Supply Company Re: Clarence H. Reed D/L: 5-1-59 Gentlemen : We have been advised of a claim for compensation of beneficiaries of Clarence H. Reed through their attorney, Mr. Rudy Ride, of San Antonio, Texas. Such claim is for death benefits under Workmen's Compensation Act, death caused by asbestosis. The claimant allegedly worked for you during the months of August and September, 1957, in San Antonio, Texas, at the jobsite of the National Bank of Commerce "Building. It is alleged that Clarence H. Reed breathed asbestos dust and became infected with asbestosis and subsequently died on December 29, 1958. Would you please forward to us the employment dates of Clarence H. Reed and also forward a first report of injury - compensation, if Clarence H. Reed ever advised you of such an injury. We are also forwarding for your attention Employer's Wage Statement for completion for the weekly wages of Clarence H. Reed for the period of time that he was employed by you. We would appreciate a prompt reply to this letter as we antucipatean early hearing before The Industrial Accident Board and the possibility of suit being filed if such claim is denied by The Industrial Accident Board. Thank you for your attention in this matter. Very truly yours, HWH:rcw HOME OFFICE, W. Hill,Adjuster 700 M A I N S T R E E T , HA R T F OR D 15, C O N N E C T I C U T E H P t f m ' S , WAGE STATEMENT , NOTE: ** . A Please complete this Statement in detail in duplicate. Return original to this o ffice promptly. Send duplicate to your insurance carrier. INDUSTRIAL ACCIDENT BOAR! AUSTIN. TEXAS number of days worked and amount worked. S T A T E M E N T OF T O T A L E A R N IN G S OF PERIOD COVERED BY EACH PAYMENT (S) LQ 1 FROM TO li MONTH DAY MONTH 0 AY 1 2 3 OCCUPATION (Type o f Work) WAGE RATE (By Hour, Day, B e e t, o r Month) AMOUNT EARNED 4 5 FROM 6 7 TO 8 9 1 . T A T E MAXIMUM NUMBER O F HOURS 10 WHICH E M P L O Y E E WAS P E R M IT T E D TO WORK P E R W EEK OR MONTH UN DER TH E 11 P R O V IS IO N S OF ANY S T A T U T E . REG U LA- 12 TIO N OR AG REEM EN T L IM IT I N G HOURS OF WORK. 13 HOURS PER UNDER 1 4 15 - 16 2 . HOW MANY D A Y S C O N S T IT U T E D A W E E K 'S WORK? 17 18 . * 19 3 . HOW MANY HOURS C O N S T IT U T E D A D A Y ' S 20 WORK? 21 22 4 . I F EMPLOYEE WAS FU RN ISH ED BOARD. 23 LO D G IN G . LAUNDRY. F U E L . OR OTHER AD 24 VANTAGES HAVING A VALUE WHICH CAN BE ES T IM A TED IN MONEY (e x c l u d i n g , h o w 25 ever, an y sum paid to employee to 26 cover any special expenses entailed on him by acts of his employment), 27 STA TE ESTIM A TED VALUE P E R MONTH OF 28 EACH ITEM FU R N IS H ED . 29 ITEM FURNISHED E S TIM A T E D VALUE 30 $ 31 32 ITEM FURNISHED E S TIM A T E D VALUE 33 $ 34 35 36 <' > 1 C ER T IFY THAT TH IS STATEMENT 37 IS TRUE AND CORRECT 38 39 DATE 40 41 42 C IT Y STATE 43 - A 44 45 SIGNATURE 46 47 48 O FFIC IA I. CAPACITY 49 50 EMPLOYER 51 52 , TOTAL DAYS WORKED T O T A L AM OUNT, EARNED v.r-'j-'.rT- . ." 7-?/%;'.a'.ooci4 oecurxxy j^o-Au-Yopf c--^ 7v7;.V* ` Enclosed are a l e t t e r f r o a t h e l a v o ffic e s o f Bac^y Bice, 4 l 7 . ^ a t h ^ a i n ^ 7 7 K in td n lo '5*7****j ` id a Claim for;Compensation fo r D eath'la * 7 7 v;l' ::T'V^ o f the Adow# Mrs* .Wilma Esther Bead, .1230 Essex. S tre e t, Sea. Antonio,"i7 7* s&77*'C-7 ,- -- %' "i .:- T ^ X fta i -.J r V u-,, f7-.' - ---` --- -*vv*v' * -'-v* *-fir -w- * <-. %,;,,/<>{ iT. ,7^,,V;7' r 7 ;;vi;. ;-C ^ ^ c * V ^ y ---*&-'7 -7 7 ;. ,,Clarenoe H /R eedvas employed in our ContractQperationa^during t^e fo^w^V^..'. ^ 3it- P lease forward one copy o f the enolosed m aterial to the proper o ffic e of 7 jfh e . Travelers so th a t i n t e r o p f ^ y p^tected^ 7 7 7 7 ;7 7 yours, 7;-;:. .?^:' v- ^ 7 > 7 -' V ^ 7 7 7 7 : '7 7 : 7 ^ 7 V v 7 7 7 7 -7 y Hofferth - f .-7* Assistaat Qmeral M a n a g e r }. -:;-;7-';''7 7 :a;7 : :'. ; 7 | - 7 7 :'-srVr 7.:7*7,v-v- '-r%^rf:'t-7 ^'H':: Insorance'DDeepartmmeenntt` ' --*" Enclosures^ - -y $ : V'*..'<? 1' : I : '. >-* 'y!-^ r~ ;*v v ^ S <i r r JLo- . ^r ' " `.5 . ^ '^"v`*;-.r '/'.' "' \ : ^ Q P P X l Q K ' ` `" y , . / ' . * i ? S C Tl` M a > " . - ^ r X . t . ' 1 - ': ' T \ - ^ r l Z f r ' 1; S a T i ^ o x o *t , T exa m s'. T; : >^.--';J.-> > .---..^ ~= ** i/> ' ''V` 's - '``'-' -'.'T : >; '-l y iv -V . .'. y " y y J : / .. r.--;*`, i . * / .J -`- w- i /^ C h'- ' " ^ :^ - . ..V '^ -'si1y : y `J 'K 'l .l ^ ' 7J r y - < j i{T|; #$ ^ ' y ^ / r ^ V y . : t . -V /.-:; . Hy p V_ J R J CS ? ^ y * l '1, :* X : > ; : ^ i t . 0 ^ 0 j f : .}>!"-;-,*$; j;..'-*."; - ?-- , *V. *'- --. . vT;. $ - V-," r 'TvvvttVv ;'*;p iti*'' ' ;-* ;' V.;-- :} y ^ : -;':' ^ v u ^ i :v v . v A . ; ; r ' : ; - : M ^ i : -; " - ,. >t - t . " s f t rr a c t . a. * Claim for Compensation for Death INDUSTRIAL ACCIDENT BOARD ; AUSTIN, TEXAS . . _ ` ' ` MOTS:--T hts d a im should b* m ade o n t In du p licate; on* copy th ereo f should b* m ailed to th e In d u s tria l A celdent Heard end th e o th er copy should b* delivered to the E m ployer or th Insurance Company or A asoclatlon c a rry tn x hi* lu* a r t ace. This is to notify > ., & g U s ' ?*&&* N am e o f e m p lo y o* a sso c ia tio n o r ootnpany w ith w h ich e m p lo y er U Insure*. that I claim compensation from you under the Employers'. Liability Act of Texas on account of the death of f - ^. -i- " Ft : _r . N am * o f d eceased em ploy*. "on th e -2 S th _ _ day which suited ` irC.` 4~ . the employ 6: * _--t-.__.while in City or to w n .. The place of i ^ r y ^ ' ^ v . ' ' * Ant o n i a , "Y iM m * & & * * * -r A ' 4w lpU ^i o f buUdlPX o r placa. , v .._ jv - - - - - - The cause* of death'w a t - I g i l s ^ i a L ^ ^ ^ a p ^ g e a a o f t o & - d u a ^ . . l s l i a l ^ l C 5 1 - p l ^ A h 3 1< ^ ,, Describe causa of. Injury. ^ . ^ la .e s y t o y t M l ' b y " t k ^ . 4 ^ ^ L o i . A ^ S M * -- - : -": -y r *4% 4 s4 i- 4 4 i;`t } ' ,4 4 -y ':' - %i 5V>.C- `<--s " - ' Name and P. 0 . address of witnesses in support of claim: . Mr VflL--at E afch^r R a a 4 t 1 2 3 0 Z * n e x g t g * a f u . S t i a f e a z t l a >_ .T & ia i-- ;---------------- -- ------------ -----------:----------- !-- -i;;..^-- _ _ Give names and P. 0 . address of the Beneficiaries of the deceased (stating the kinship of each such Benefl- clary to the deceased) i_--M ga^-jgLlina--S A th ftg .SA&de--t e if ftl R Qh.3X fcJfo.ffa k I&S-3 4 12 r -^g~-7- r - j v%T ' ^ r *;>:** *<*?* - .& y-y, l . ; -,*(-} "v . ' . r S p b r t 'S t i r a f e S i i T - * ! * 1 5 Which of the legal'Benefidaries above named are' minors? State ages^ cxa--B g-aw --lIr --X9^3t -- g r j i. J e r r ; pr1vTou l i e of in ju r y ^ p p M x L n is L ? ,l3 -.te l_ m ii 2 i3 ' d vviS jfr . T~ ~ ^ -JTM . Wages of deceased employee on date of injury were 5p er_JiO lir- Day, w eek or month. 'j) (Deceased was employed------- 3-U?Z~per week. v State w hether * or t days. <; This Haim for compensation, with respect to such injury and because of the death of deceased, is made in behalf of and for each and all of the legal Beneficiaries of the deceased, as well as by and for the under signed, he herein acting for himself and such legal Beneficiaries. Social Security No. y S lrn atu re o( Claim ant. o f Deceased. 2 U - 4 Q *n$7~ .1 2 3 0 .S a ita x - fitg g a fc . Street and number. sp a to a i o , T e x a s ' ' this.--_____ day of. W SS. City or town. y 3 i _ l j tt U e la ia ir d th a t th e v io la tt * , h y th * e n p te y e r , e t a y a ta tu te c a a r te d fa r th a s a f e t y o f e a ip la y eca , eenatrVbated t* 1 th * laS ory * r d e a th a f th ia e ia y la y e e . i t ta r e e a u t e f th a t thta he * s ta te d !a tfcla r i a l fo r c o m p e n sa tio n . v E :--Section 4a. P a rt IL Ehuployere* L ia b ility Act-- U nless th e ssao c latlo n or a u b ac rib a r h av e n o tic e of th * In ju ry , no pro fu r e o ap * n * a t!o n fo r in ju ry u n d e r t h ii A ct sh a ll be m a in ta in e d u n less a r.atlco o f th e '.nJurT s h a ll h a v e been s i r e n to th s i n or subscriber w ithin th irty dfl) days a fte r the h ap p en ln s thereof; and unlete a claim for com pensation w ith rearect !' Ju ry sh'all h er* been m ade w ith in s i s i f ) m onths a fte r th# occurrence of Sam; or. in case of d eath of th e employe or la I of ht* physical o r m ental In cap acity w ith in e ls (f) m onth* a fte r th e death or th# rem oval of such p hysical or m ental 1 P rovided, th a t fo r good cause th e b o ard m ay In m e rito rio u s case# waive th e s tr ic t com pliance w ith th* fo re c o tp c lim lta - l '.notice and the filin f of th* claim b efo re th e board.