Document MJRyp01EDkgG18JL9jb9pX3Kj

FILE NAME: Contract Unit W orkers Comp Claims (WCC) DATE: 1964 DOC#: WCC060 DOCUMENT DESCRIPTION: W orkers Comp File - Rogers, Ollie File Name Contract Unit Claim File: OllieRogers Jun. 23/64 Scanned ? yes Source JMA: NS-JM Start Year 1964 Stop Year 1964 Contents claim Notes  WORKERS ' COMPEKSATICN APPEALS BOARD - CALIFORNIA (INDUSTRIAL ACCIDENT COMMISSION, prior to 1966) APPLICANT OLLIE ROGERS -__________________________ __ CASE =LB 26779 Insulation Mechanic__________ DATE CLAIM FILED June 23, 1964__________ .____________________________ _ INJURY ALLEGED Pulmonary Fibrosis____________ ALLEGED DATE OF INJURY 1942-1962_________ _ _ _ ________________________ EMPLOYER/INSURER Thorp Insulation Co./Firemen1s Fund Ins. Co., et. a] including J-M Products Corp./Travelers______________ OTHER NOTES No apparent Canadian carrier Asbestosis/pulmonary fibrosis r Applicant reopened case 1970 due to deteriorating condition DATE OF RESOLUTION RESOLUTION July 11, 1966 Findings & Award $14,280 settlement \ Oct. 22, 1971 Compromise & Release $11,294 settlement DOCUMENTS COPIED 1) Compromise & Release & Ord,er Approvi.ng r OF 7PAGI 2) May 26, 1966 Rpt of Dr. Urabec to Pacific p.4 E m p lo y ers CLAIMANT n i e ^ f o a t r s ______ 3 California Workers1 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 Indemnity Corp. California Casualty Indemnity Exchange California Compensation & Fire Co. oCasualty Ins. Co. of California oEmployers Liability Assurance Corp.Ltd. oEmployers Mutual Liability Ins. Co. of Wisconsin ,, oFide^Lity & Casualty Co. of New York Fireman's Fund Ins. Co. oGeneral Accident, Fire & Life Assurance oGlobe Indemnity Co. oGuarantee Insurance Co. Corp. Ltd. oGreat American Ins. Co. oHardware Mutual Casualty Co. (Sentry Industrial Indemnity Co. Industrial Indemnity Exchange olnsurance Co. of North America oLiberty Mutual Ins. Co. oLumbermanJs Mutual Casualty Co. Ins. Co.) Maryland Casualty Co. oMichigan Mutual Liability Co. oMission Insurance Co. oNational Automobile & Casualty Ins. Co. oNew Amsterdam Casualty Co. oOcean Accident & Guarantee Corp.Ltd. Pacific Employers Ins. Co. oPacific Indemnity Co. oReliance Ins. Co. (Standard Accident Ins. Co.) oRoyal Indemnity oSecurity Ins. Co. of Hartford (U.S. Casualty Ins. Co.) State Compensation Insurance Fund oTransport Indemnity Co. The Travelers Ins. Co. oThe United Pacific Ins. Co. oU.S. Fidelity & Guaranty Co. oZenith National Ins. Co. oZurich Ins. Co. o________________________________'_____________________ _ o_______________________________________________________ o_______________________________________________________ o ________________ ________________________________________________ ________________ o ________________ 5 /8 1  , # \ SCHEDULE OF CONTRIBUTIONS LCUI3 FIRE,ERICK & INSULATION COMPANY; l .IFORNIA COMPENSATION & FIRE COMPANY JouNS-MANVILLE PRODUCTS CORPORATION; THE TRAVELERS INSURANCE COMPANY .0 3 4 .135 ROTHSCHILD OIL COMPANY; MARYLAND CASUALTY INSURANCE COMPANY .0 0 3 BECHTEL CORPORATION; INDUSTRIAL INDEMNITY INSURANCE COMPANY .0 0 5 MARINE ENGINEERING; PACIFIC EMPLOYERS INSURANCE COMPANY .220 F OST CORPORATION; A ,IA CASUALTY & SURETY COMPANY .0 0 8 GOLDEN BEAR OIL COMPANY; STATE COMPENSATION INSURANCE FUND .0 1 3 PURITAN ICE COMPANY; CALIFORNIA CASUALTY INDEMNITY COMPANY .0 0 5 FIBERGLASS ENGINEERING & SUPPLY COMPANY; AETNA CASUALTY & SURETY COMPANY .0 0 6 THORPE INSULATION COMPANY FIREMAN'S FUND INSURANCE COMPANY .5 2 1 AL CONTRIBUTIONS: OLLIE W. ROGERS - WCAB C ase No: 64 LB 26779 CONTRIBUTION $ 384.00 2 ,0 3 0 .3 9 3 3 .8 8 56.47 2 ,2 5 8 .8 0 90.35 146.82 56.47 6 7 .7 6 6 ,1 1 0 .0 6 -- $TT ,m 3 OE ^55 ,c= =- ? r Z, V? ( c 4 Re: O llie R ogers The p a tie n t w as r e f e rre d to the x -r a y d e p a rtm e n t of the H o sp ital of th e Good S am aritan fo r ch e st x -ra y s . T h ese w ere re p o rte d as follow s: "C h est: P o s te ro -a n te rio r and la te ra l view s of the c h e st show the h e a rt to m e a s u r e 14 c m . w h ile th e c h e s t m e a s u r e s 31 c m . B o th c o s t o p h r e n i c angles a re blunted and th e re is thickened p le u ra along both la te ra l ch est w alls. The b ro n ch o v ascu lar m ark in g s a re p ro m in en t in both b ases, m o re so on the rig h t n e a r the h e a rt b o rd e r. T h e re is a fib ro tic a p p e a r an ce w ith the p o ssib ility of sm a ll c y sts in the rig h t ap ex w ith a c o n s id e r able p le u ra l cap. M inor fis s u re is d e p re s se d . A la te ra l film d em o n strates co n sid e ra b le d eg en erativ e change of the d o rs a l sp in e . T h e re is an o v erly in g so ft tis s u e d e n sity on th e lo w e r tw o o r th r e e v e r te b r a l b o d ies w hich w ould su g g e st p a re n c h y m a l le s io n . W h eth e r th is is a c u te , the findings a re n o t known as old film s a re not av ailab le fo r c o m p a riso n . " /s / R. E. L evis. The d iag n o sis of this p ulm onary condition is e sta b lish e d by the lung biopsy w hich show ed the findings of an a s b e s to s is . He h as a p erm an en t d is a b ility b u t a t th is tim e it is p a r tia l on ly . H e is p h y s ic a lly a b le to p e rfo rm a lig h t type of w o rk . A s re g a rd s lia b ility o f h is co n d itio n I b eliev e this m u st be app o rtio n ed by his v ario u s em p lo y ers and th is is dependent on the d u ratio n of his em ploym ent and by th e type of w o rk in w hich he was engaged. As sta te d above he is p h y sically able to do a lig h t ty p e of w ork and should be en co u rag ed to do s o . H o w ev er, he should av o id a n a tm o sp h e re of p o te n tia lly h a r m f u l d u s ts s in c e i t m ig h t c a u s e aui a g g r a v a t io n of h is p re se n t underlying condition. V ery tru ly y o u rs. JoHn H . U ra b e c , M . D 1 WORKERS' COMPENSATION APPEALS BOARD 2 STATE OF CALIFORNIA 3 OLLIE M. ROGERS 4 C ase No. 64 L3 26779 5 Applicant 6 vs. 7 FIBERGLASS ENGINEERING & SUPPLY COMPANY 8 CERTIFICATION 9 Defendant 10 11 I h ereb y c e r t i f y t h a t th e a tta c h e d docum ents are tru e 12 and c o r r e c t c o p i e s o f t h e o r i g i n a l d o cu m en ts f i l e d i n t h e r e c o r d s 13 o f t h i s o f f i c e i n th e a b o v e - e n t i t l e d m a t t e r . 14 ATTEST my h a n d and t h e S e a l o f th e W o rk e rs1 C o m p en satio n 15 A p p eals B oard o f th e S ta te o f C a l if o r n ia . 16 17 18 19 B ated a t San F ra n c isc o , C a l i f o r n i a , t h i s 3r d day A p ril, 1981 MPARTMIWT OP mOUmUAU RftATIONR OIVttlOMor IMOUtTMM.ACCiBtHT* ( ( WORKMEN'S COMPENSATION APPEALS EOARD STATE OP CALIFORNIA OLLIE M. ROGERS, ) A pplicant vs. FIBERGLASS ENGINEERING & SUPPLY CO; AETNA CASUALTY & SURETY C O ., i! MARINE ENGINEERING C O ., PACIFIC EMPLOYERS INSURANCE C O ., Case No. 64 L3 2677- BALDWIN-EHRET HILL; AETNA CASUALTY & SURETY C O ., 10 THORPE INSULATION COMPANY; FIREMAN'S FUND INSURANCE C O ., 11 JOHNS-MANVILLE PRODUCTS CO.) 12 THE TRAVELERS INSURANCE C O ., ORDER APPROVING COMPROMISE AND RELEASE 13 PURITAN IC E C O .' CALIFORNIA CASUALTY INDEMNITY C O ., 14 GOLDEN BEAR OIL C O ., 15 STATE COMPENSATION INSURANCE FUND, 16 ST. LOUIS FIRE BRICK C O ., CALIFORNIA COMPENSATION & FIRE CO ., 1" ROTHCHILD OIL C O ., IS MARY LAND CASUALTY C O ., 19 BECHTEL CORPORATION; INDUSTRIAL INDEMNITY C O ., 20 ) D efendants 21 A p p l i c a n t r e c e i v e d a F in d in g s a n d A w ard J u l y 1 1 , 1966 o f 22 68$ b ased on a lim ita tio n to l i g h t work w ith o u t d u s t environm ent and ? .s f u r th e r m ed ical tre a tm e n t; t h i s has been p a id in f u l l in th e amount 24 o f $ 1 4 ,2 8 0 .0 0 . A P e t i t i o n t o R eopen i s f i l e d a n d t h e p a r t i e s now 25 s e t t l e t h i s c a se f o r th e a d d i t i o n a l sum o f $ 1 1 ,2 9 4 .0 0 . A p p lic a n t ha w o rsen ed . D r. G o ld farb f in d s him lim ite d to se d e n ta ry w ork; Dr. D ic k s te in f in d s him t o t a l l y d is a b le d . B ased upon th e f a c t th a t d e a t b e n e fits cannot be aw arded in th e fu tu re due to ju r is d ic tio n a l lim i t a t io n , th e s e ttle m e n t i s adequate fo r life tim e b e n e fits and w ill perm it th e A pplicant to enjoy present- b e n e fits thereb y . -1- ( ( I I' 1 The .c o n trib u tio n s a r e i n acco rd an ce w ith th e ag reem en t. F irem an 's 2 Fund I n s u r a n c e Company s h a l l pay th e fo llo w in g l i e n s : D r. Edward D ic k s te in , $294.00; E n d riss Photocopy S e rv ic e , $21.00; Levy & Van 3 o u rg , c o s ts $ 5 3 .iS ; Levy & Van 3 o u rg , f e e s $ 1 ,0 0 0 .0 0 . 5 The p a r tie s to th e above e n title d a c tio n have f i l e d a 6 Com prom ise a n d R e le a s e h e r e i n , on O c to b e r 2 0 , 1971 s e t t l i n g t h i s ca 7 f o r $ 1 1 ,2 9 4 .0 0 i n a d d itio n to a l l sums w hich have b een p a id p rav io u 8 and re q u e stin g th a t i t be approved; and th is Board having considers 9 th e e n t i r e r e c o r d , in c lu d in g .s a id Compromise a n d R e le a s e , now f in d s 10 th a t i t should be approved; and 11 I T I S ORDERED t h a t s a i d C om prom ise a n d R e l e a s e i s a p p ro v e d 12 AWARD i s made i n f a v o r o f OLLIE W. ROGERS 13 A g a i n s t : AETNA CASUALTY & SURETY C O ., PACIFIC EMPLOYERS 14 INSURANCE C O ., INDUSTRIAL INDEMNITY C O ., MARYLAND CASUALTY INSURAHC 15 C O ., CALIFORNIA CASUALTY & INDEMNITY C O ., STATE COMPENSATION INSURA 16 FUND, CALIFORNIA COMPENSATION & FIRE C O ., FIREMAN' S FUND INSURANCE 17 TRAVELERS INSURANCE CO. 18 Payable as follow s: 19 By CALIFORNIA COMPENSATION & FIRE CO. T o: O l l i e W. R o g e r s , a p p l i c a n t 20 By THE TRAVELERS INSURANCE CO. 21 T o: O l l i e W. R o g e r s , a p p l i c a n t $ 384.0` 2 ,0 8 9 .3 ! 92 By MARYLAND CASUALTY INSURANCE CO. T o: O l l i e W. R o g e r s , a p p l i c a n t 23 By INDUSTRIAL INDEMNITY CO. 24 T o ; O l l i e W. R o g e r, a p p l i c a n t 3 3 . cc 5 6 .4 ' 25 By PACIFIC EMPLOYERS INSURANCE CO. ` T o: O l l i e W. R o g e r, a p p l i c a n t 26 By AETNA CASUALTY & SURETY CO. \ T o: O l l i e W. R o g e r, a p p l i c a n t 1 " B y STATE COMPENSATION INSURANCE FUND T o : O l l i e VI. R o g e r , a p p l i c a n t 2, 258. 8c 158. 1: 1 4 6 .8 : ' By CALIFORNIA CASUALTY INDEMNITY CO. T o : O l l i e VI. R o g e r , a p p l i c a n t 56.47 ,`L 64 LB 26779 - 2- ( 1 By / ..t FIREMAN'S FUND INSURANCE CO. To: D r. Edward D ic k s te in , l i e n c la im a n t E n d riss Photocopy S e rv ic e , lie n Levy & Van B ourg, l i e n c la im a n t L evy tc Van B o u rg , a t t y s T o tal lie n s ' $ 294.00 2 1 .0 0 55.18 1 0 0 0 .0 0 1 3 7 0 .1 8 Oi^Lie- W. R o g e r s , a p p l i c a n t T o tal due A 4 7 3 9 .8 3 7 S j / 9 / 10 Long B e a c h , C a l i f o r n i a 5 SERVED ON ALL PARTIES LISTED 11 *| j! ON OFFICIAL ADDRESS RECORD 12 || D a te d : 1 0 /2 2 /7 1 . , 13 'J r 14 t/(/ni/* ' "B oris Raynes, R eferee U WORKMEN'S COMPENSATION APPEALS BOA 15 io 17 i1 18 i1 19 20 I 21 22 23 24 -364 LB 25779 ( .. INSTRUCTIONS ( not use this form in death casts. Use Form IS. Do not use in third-party cases. Use 17. the injured employee be under 21 ytars of age and a guardian ad litem has not been previously appointed, a ce+ition for anointm ent / guardian ad litem and trustee must accompany this agreement " 3. the guardian must sign this agreement on behalf of an injured employee who is under 21 years c l age. It the minor Is above the - m>t of 14, such minor should also sign this agreement 4. sch all medical reports not heretofore submitted to the Workmen's Compensation Appeals Board and advise when other reports were filed. COMPROMISE AND RELEASE STATE OF CALIFORNIA H U M AN R E L A T IO N * a o c n c y DEPARTM ENT O F IN D U STR IAL. R E LA T IO N S D IV IS IO N O F IN D U S T R IA L AC C ID EN TS W O R K M E N 'S C O M P E N S A TIO N A P P E A LS SO AR D CASE n o .64 LB 2 6 779 ( Mr.) ( W . S 3 K S Ol L E W. ROGERS vs. VARIOUS EMPLOYERS ,,, ,, S O C I A L S E C U R I T Y N O ..5 5 5 - 0 1 - 3 8 9 $ ____ 6351- R id g ev isw Avatrue ?:iin!._iP!SaL C a l i f o r n i a 91752-- _ $2? IIOUS CARRIERS fi f t- The parties hereto, for the purpose of compromise only, hereby submit the following agreed statements of fact;-' \ V** si v ty<- I. __ 9 i-i.i _ H j_ S 9 S T S _______________________ , employee herein, bom on . J g f e g u a r y _13 1 ^ 0 5 ^ claims that he wasBeme"plo"yednon1t9he4.?/ I L U . day aa I n s u l a t i o n Worke r ________ by..V sLr.iaus..JnplayeT.s.. (* C U F* T IID (TAT) ..then insured as to workmen's compensation liability by-- (S T A T S M AM S OF C A IIIM M OB W H K T M t* t.P->IMUNUV .and that he sustained an injuiv arising out of and in the course of his employment as foUows:.AilgSS_il3dli3TY_.t.9....b.i.S a l ungs and c h e st and re s p ira to ry s y s te m as r e s u lt of exposure to asb esto s and o t h e r m a t e r i a l s . The C om prom ise a nd Re l e a s e i i n t e n d ed t o c o v e r a n y and a l l r - r t s o f th e body claim ed to have b e en in ju re ; .sxji_2^llt_fi_sa.i_.e.x.p.0..u.r.. 'a ;e actual weekly wages of the employee at the time of injury were _______ while the average weekly wages were 5 ---------------------- 3. The employee's present disability is_ .y i...^ ..isp u te------------ ------------------------------------- ------------------------------- (T A T S M I I M T O ISASIbITT H U U lT lH t FROM T M S IN X JS V ) d the employee..liiL5_Hih?ctumed to work...... ......... ................................. IIP M . STATS WMINI 4. (a) Temporary disability indemnity has been paid to the employee in the sum of $.3.^Z35.J3.Qat $_ZQ.,.Q)---- per week be-'innine^ /2 9 /6 4 t0 an(j includinz.i?./i?./..5......The amount due and unpaid to the employee is $.NanS--------- 6 ............... $1 4 ,2 8 0 .0 0 (b) Permanent disability indemnity has been paid to the employee in the sum of $-/-///--.covering 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 $ kl..2J4.,_00_ in addition to any sums heretofore paid by the employer or the insuier to the employee, said sum to be payable as follows: A U ..to....g.pp.l.ian,...l.e$s....$.2?400...t o E d w ard D ic k s t e i n , M. D . , ,, l i e n , c l a i m a n t : , ._j.es- any. ot.t;pr.n.3.y,..s....ae....a.s..allowed b y .the Appeal...BoardJ^ -l.C !.L s _ L ls j-_ .n i...? /o'l i; ' 'i. ! f> Z I' l -' rl sfi .''It ' t o e ; y S o r v i c e . 6. Medical and hospital expenses have been paid 5lio u e .........by the employee and $A l l - --by the employer or carrier. 1tnpaid bills amount to $... tlo n S ........ - Future medical and hospital expense is estimated at S------------ ------ Unpaid and -hire medical and hospital expense is to be assumed as follows: All...b.y_.flpplicaQ.t...iirtd_nnil9....b.jr........ ....... (' N-rrw r.r.d address of employee's attorney, if anv.. ( 110 W. O cean B o u le v a rd j?g.n..Bourg Long Bea c h . C a li f . 9 0 3 0 7 * Sa;d attorney requests a fee of .$...ij.Q.QP.?..Q.Q------Amount of attorney fee previously paid, if any, $________________ Reason for Compromise___5 PAGc. ..TyiQ _AiyD_..OKc.--HALFj,____________________________________________ 10. The undersigned request that this Compromise Agreement and Release be approved. Upon approval of this Compromise Agreement by the Workmen's Compensation Appeals Board or a Refree, and oayment in accordance with the provisions hereof, said employee releases and forever discharges said employer and insurance earner from all claims and causes of action, whether now known or ascertained, or which may hereafter arise or develop as a result of said injury, including any and all liability of said employer and said insurance carrier and each of them to the dependents, heirs, executors, representatives, administrators or assigns of said employee. 12. It is agreed by all parties hereto that the filing of this document is the filing of an application on behalf of the employee, and that the W.C.A.B. may in. its discretion set the matter for hearing as a regular application, reserving to the parties h e right to put in issue any of the facts admitted herein, and that if hearing is held with this document used as an application the defendants shall have available to them all defenses that were available as of the date of filing of this document, and that the W.C.A.B. may thereafter either approve said Compromise Agreement and Release or disapprove the same and issue Findings and Award after hearing has been held and the matter regularly submitted for decision. 13. For the purpose of determining the lien claim filed herein for the unemployment compensation disability benefits or unemployment compensation benefits and extended duration benefits which have been paid under or pursuant to the California Unemployment Insurance Code, the parties propose the following division of the sum agreed upon for settlement and release of this case: $ --------------------- for temporary disability covering the period----------------------------------- to_______________________ S --------------------- for accrued medical expense paid or incurred by the employee. S -------------------- for future medical care. $ ___ _________ for permanent disability. (The above segregation must be fair and reasonable and must be based on the real facts of the case. There should be no attempt made to deprive the lien claimant of a reasonable recovery consistent with all the amounts involved. W.C.A.B. Rule 10SS6 requires proof of service of a?copy of this agreement on such Lien Claimant.) W itness the signature hereof t h i s ------day of.------- ^ 19.7./.., at. plgt^TKaKATKSUMNI O R NITON*AMOTANTPVOUC. STATE OF CAiLLIFFOOFRNIA I ........County' (of ) WICaARD jl/CANTRELL " ATTORNEY.'XOR APPLICANT , ____ day off~&:i&}:L .......... ................ , A.D. 1 9 . / / . . , before n tonj Public in and for\tne saidLCouatu and State, residing therein, duly commissioned and sworn, personally appeared : ...........: j S u L L t i i r ^ t = = = - : Ictivwn to me to be the person__ whose name__ z .i.J............................................................................................................ .-- - subscripted to the within Instrument, and acknowledzed to me that . ha executed the same. I s Witness Whereof, I have hereunto set my hand and affixed my official seal the day and year in this Certificate first i-` c (critten ______ ........................r i---------------Notary Pubhc in end for said County and State of Cdhfotnia a i t :;a c -m h a lty in su r a n c e c o m p a s /KENDIC/, S70CKVZLL,GLEASON & AI BY; ^ ___ ?A ZTFIC EMPLOYERS INSURANCE COMPANY INDUSTRIAL INDEMNITY INSURANCE COMPANY ROBERTS & THOMASON BY: -"/ / // UANSE,LLlL"& BY': ''A - MARYLAND CASUALTY INSURANCE COMPANY CALIFORNIA CASUALTY & INDEMNITY COMPANY STATE COMPENSATION INSURANCE FUND r^ v F CALIFORNIA COMPENSATION AND FIRE COMPANY ZONNI, GINOCraiO & TAYLOR BY: / / t - L 7 BY: / j ti^ --------- 3IE7-TTPT5!Tr"---- FIREMAN'S FUND INSURANCE COMPANY * THE TRAVELERS INSURANCE COMPANY "7 O L L W. ROGERS - WCAB C ase No: 64 LB 26779 o o ? >3: o ? HI 3 O - to l = ='