Document N2Gn0LNbZ9kEnXEQENwLjXbyp

5 PLAINTIFF'S 2 EXHIBIT cnSTA -CO STATE OF CONNECTICUT) ) SS . Bridgeport COUNTY OF FAIRFIELD ) ( Exhibit # \9Z+ ------------------------- ---- V- * Case # ________ ! (J^DisTfiicTcounT-- EASTERN DISTRICT OF TENNESSEE C ERTIFICATION THIS IS TO CERTIFY that the attached is a true and accurate copy of the Agreement to Compromise, Petition to Compromise and Order from the records of the Office of Workmen's Compensation Commission, State of Connecticut, Fourth District, in the case of: Benjamin Crooks vs. Raybestos Company, now Raybestos-Manhattan, Inc. and The Travelers Insurance Company; The Hartford Accident and Indemnity Company; The American Surety Company; Given under my hand and seal this 1978. Cday of ^ O S J0HN A. ARCUDI, ^Wprkmen's Compensation Commissioner >urth District BENJAMIN CROOKS 22 Howard Place Bridgeport* Conn. 1 CLAIMANT1 V8 '- - ' ' - RAYBESTOS COMPANY now RAYBESTOS-MANHATTAN, INC. EMPLOYEE AND THF TRAVELERS INSURANCE CO. HARTFORD ACCIDENT AND INDEMNITY CO. AMERICAN SURETY COMPANY CORAllt * " COMPENSATION COMMISSIONER ' FOURTH CONGRESSIONAL DIST. BRIDGEPORT, CONNECTICUT OCTOBER AGREEMENT TO COMPROMISE PETITION TO COMPROMISE AND ORDER WN^REAS on or about the 16th day of April, 1938 and for a number of years prior thereto, the claimant, Benjamin Crooks, of Bridgeport, Connecticut, was an employe of the Raybestos Company now Raybestos-Manhattan, Inc., of Bridgeport, Conn.1, and WHEREAS the said employe and employer had accepted and were at all times herein mentioned subject to Part B of the Workmen's Compensation Act of the State of Connecticut, as amended, and the employer had insured Its liability thereunder for various periods during which the said claimant waa employed with The Travelera Insurance Company, The Hartford Accident and Indemnity Company and The American Surety Company,'all of which said companies exist and do business under the laws of this State and are duly authorized to take such risks In this State, and WHEREAS the claimant claims that on or about the l(5th day of April 1938, he suffered an occupational disease, to wit, asbestoais; and further claims that said occupational disease arose out of and In the course of his employment with the employer) and further claims that said diseass is compensable; and further claims that he has been disabled from all work since April 4, 1940; and further claims that he will be disabled In the future, all of which'said claims each and all of said respondents deny, and ` .t V WHEREAS a partial hearing of said claim was held on June 13, 1940 before the Compensation Commissioner of said Fourth Congressional Dlstrlot as will more fully appear In the flies of said office, and t *;HERKAS the said Benjamin Crooks has a wife, Dora, who la a potential dependent, and WHEREAS the said claimant was represented at the aforesaid hearing and Is now represented by counsel, and WHEREAS It Is the desire of the claimant and the said re spondents to reach an amicable adjustment of the above disputed claims to the end that further litigation be avoided and doubtful and disputed claims be rendered certain* THIS IS TO CERTIFY that I, the claimant, have agreed to re ceive from __ The Travelers Insurance Company the sum' of $200.00 The Hartford Accident and Indemnity Co. the sum of $700.00 ,The American Surety Company the sum /of $1200.00 making a total sum of Twenty One.Hundred and Ho/lOO Dollars ($2100.00 and we the Insurer respondents do agree to pay to the claimant the sum above specified, to wit: The Travelers Insurance Company, $200.00 The Hartford Accident and Indemnity Company, $700.00 The American Surety Company, $1200.00 In full accord and satisfaction of above disputed claims. AND TO FURTHER CERTIFY, that In consideration of said sums so paid, I, the claimant do hereby remise, release and forever discharge the employer and all the insurer respondents from all claims for compensation benefits whether for compensation In any form payable to me under said Act or for surgical, medical or hospital benefits payable on my behalf and whether said claims have already arisen or hereafter might arise by reason of afore said claim of occupational disease. AND TO FURTHER CERTIFY that I, Dora Crooks, wife of afore said claimant, Benjamin Crooks, agree that In consideration of said sums so paid, to remise, release and forever discharge each -2- and all the above named respondents from any and all olalms which I might hereafter have against any and all of them by reason of the alleged Incurring of an occupational disease by the aald Benjamin Crooks, while In the employ of the said em ployer -respondenta , AND TO FURTHER CERTIFY that we, the claimant and the respondent hereby submit the written agreement to the Compensation Commissionei of the Fourth Congressional District and respectfully ask that said agreement may be approved with the force of a full and final award. In witness thereof we hereunto set our hands the day and date first above written. Approved this ^ day of October. 1940 Compensation Commissioner Fourth Congesslonal District JCl 4 oomniiss;oi!->r