Document N2vKr81v606Z9qLrDzrJBL52V
FILE NAME: Insulators Workers' Comp Claims (IWC) DATE: 1960 DOC#: IWC035 DOCUMENT DESCRIPTION: Claimant - Templeton, Dean [Templeton v. J-M]
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state or mewowi - ' ` ,
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APPUCATIOH FOR HEARING AND ADJUSTMENT OF CLAIM
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1. Tlmt tU* <*< rsintee to pernotml injury which eecwrTwd on or
/ij/ OK to disablement from occupational dlsnnse which occurred on or ahoutj
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a. That the Injury or disablement occurred t
D etro it
Wayne / / T''-' M& ic h ig a n ______ .anA in the toOorto
-- ........-- ~ ..............-- C^iinty ------------- 8toto
manner:
irritants
(Give details)
M A IL E D
AUG 3 1960
6/ 17/60 ...
(Lari day worked)
(Daily Wate at time of injury or disablement)
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C O M DEPT.
LANSING, MICH.
(W eekly earmnsr*)
In ju r y to lu n g s and c h e s t , P ? e ^ o c ^
S. Nature of disability.:................
..... (Deaeb'pnrt'''body'mjjrd'/'oooip atis^ diae, tat specific disease)
T ^ p n ^ t bo r a x , r e l a t e d c o n d it i on and th e
neurosis.
Dato of recovery......M 1 ..L .9S I .*. :*.....................................
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w0t returned.
to ^ ........... .................. ~ ......
4. If d ot* resulted, iv. d st. of death........................................- .............K aU tW dp of applicant to
............ W i f e , C h a r le n e ;
5. Karas of persona dependent upon injured employee on date of Injury ----....... -
...................
.................
Son, hark.
. If adjustment of attorney or medical teee or funeral expense is eou*ht, plsass stats which sad amount.............- .........................................-
A, . .
.. .
V . I. titled to under the Workmen'* Compensation Lew of Michigan and
'Wherefore applicant request, that t . betranted me* r M t l u \ he U
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tfeterminatioc of their rights under the Workmen's
that the Department set this matter for hserin* so that the parties hereto may nave s oeierm iua
Compennation Law.
Dated a t............... I ^ t r o i t ............................. ...........this........J . # k ----------- _ d .y of.......l j . _ . . 19..6 0
Clarence R. Const&n
A2t3t^o0r0neVyanfBorornPlRaoiandtiff 8i*n .......
Klchl"
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RECEIVED
JUL 19 I960 iw a a r s caetitann dot.
LAN* INO, M.CH1GAN
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STATE OF MICHIGAN
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Wo r k m e n 's Co m p e n s a t io n De p a r t m e n t
LANSING. MICHIGAN
PLAINTIFF
NOTICE OF HEARING DEFENDANTS
f
at.
i STATE OF MICHIGAN, '
County of Ingham
To the above named parties and each of them: PLEASE TAKE Nr ' 'OE that a hearing on this case will be held before a Representative of the
Workmen's Compensation Department on the matter indicated below:
( } application for hearing and adjustment of claim
( ) agreement to redeem liability
*
( ) application for a lump sum advance
( ) petition for additional medical benefits
( ) order or petition for additional testimony
( ) petition for determination of rights
( )
at the 18th FLOOR, CADILLAC SQUARE BUILDING, in the city of DETROIT, county of WAYNE, State of Michigan, on the____ , 1 . _ D A Y OF-----------M M * ------------ , 19 C om m encing at 9:00 o'clock in the forenoon, LOCAL time.
YOU ARE DIRECTED to be present at the time and place above mentioned and to be prepared to proceed with the hearing with such witnesses and proofs as are necessary.
If approval of attorney fees is required, the attorney must file a statement of the proposed fee on
or before the date of the hearing.
WORKMEN'S COMPENSATION DEPARTMENT
Dated at Lansing, Michigan, this.
.day o f ........ ............. ....................,
Johns-Renville Sales Corn. *32 Bisher Bldg. Detroit, Bich.
Travelers Ins. Co, 930 Blae Bldg. troit 26, Rieh.
Mansfield, BeVltt, Salsbech A Jenkins Attorneys at Lev 1912 Guardian Bldg. Detroit 26, Ri oh.
ABTS
Riehigan State Aocident Bund 1)2 Cadillac Tower Detroit 26, Riehigan
lens A Killian Oo. 176l V. Borest Detroit, Riehigan
A cldtot Assurance Corp. 1 5 W li. ReHiehols Detroit, Riehigan
Owena-Corning Blbreglas Corp. 15300 V. 8 Rile ad. Qak Bark, Rieh.
Aetna Casualty k Surety Co. 1000 Guardian Bldg. Detroit 26, Rieh.
Alexander, xehanan k Conklin Attorneys at Law 2217 Birst Sational Bldg. Detroit 26, Riehigan
Brown Insulation Co. 16200 Subhell Detroit, Rieh.
Riehigan Butual Liability Co. 23 V. Adens Detroit 26, Rieh.
DeVasseur and Berner Attorneys at Law 515 Bord Bldg. Detroit 26, Rieh.
ft* . Andersen, Ino. 20483 Woodlnghan Detroit, Rieh.
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PRAECIPE FOR HEARING
Workmen's Com pensation Department State of Michigan
MoOuirs, Taylor, Mich.__________
Sales C*rp.. at al (Se# attaahd Hat)
____________________ Pet of Injury, Jena 17, i960
P le in u ff Defendant
D irector Workmen's Com pensation Department 1800 Cadillac Square Building D etroit 26, Michigan
P le a s e place the above e n title d cau se for hearing on the ( ) F irs t H earing Docket or (
Regul ar T rial Docket.
I, counsel for . Plaintiff
this praecipe has been served upon all opposite parties.
.in the above cause, hereby certify that a copy of
I, counsel for the on the issu e s.
______________
have d isc u sse d this cause with counsel for Defendants
.an d we have d isc u sse d a ll p o s s ib ilitie s of am icable agreem ent and I am prepared for trial
I, counsel for d ie . Plaintiff
.certify that ( ) no m edical exam ination needed in th is
cau se or ( ) D efendant has com plied with Section 19 of P art II and has furnished m edical reports to the plaintiff.
'
/s/ David M. Roberts
---------------------------------------------Barid -3. -Sobartp-- _ Attorney tor P lain tif:
83*60 Church Bd., Oak Park 3T Mich.___________________________
A ddress
A ddress
&* attached list.
A ttorney for D efendant
Detroit 26, Michigan
F eb ru ary 17,
, isfil
This praecipe must be filed with the Workmen's Compensation Department, Detroit, Michigan
TO: WORKMEN'S COMPENSATION DEPARTMENT DETROIT 26, MICHIGAN'
STATE OF MICHIGAN COUNTY OF WAYNE
PROOF OF SERVICE
----- M i r y 3 1 atraask----------------- , being first duly sworn, d eposes and say s that on th e -X ^ ^ frd a y o f. Aboee naaed defendants and attorneys
F s b r a a r y ----------, a . d . i & L - , she cau sed to be served on ( f l S --a t t a c h e d --I l f t ) -------------------- . atto m ey (s) for the above named defendant, a copy of th is PR A EC IPE FOR HEARING by p lacing same in an
-'envelope addressed to (See attsehed list)-- A H eowyanies -and attorneys^------------------------
and depositing the same with postage duly prepaid in the United S tates mail
Subscribed and sworn to before me `fc is - T P th d a y f ^ P b , ------------ A.D., i f o -
Notary P u b lic, Wayne County, Michigan
My com m ission exp ires:
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STATE 07 KICHI&W W B K H SP S 0GHPEaSAlXC3 X3PAHXKSSTT
CSAH T2XPL270I, P3iaUff
R. X. A5DSR5C3, I3C. m d STATS ACCXE3BT IOSQ,
:ca to Disarm
S a t o o b m t h a M la h lg a n S t a t o A oeL dant f in d ta d n ow w t o d la n ls a o s
a & d a r t i t o a l f t h o A p p lic a t i o n f i l e d bgr t h a l a a t o n p ln g r r a n d i t s in o u r r a o o
u r e t e r an d A tto rn ey * i n o w m a c tla n i& th a n A p p lic a tio n f a r A p p o r tlc m m t
,
MHrtor 3 a c t i o n 9 * f t m l V IZ o f tfa a V o r iawm 1 C o n p c n o a tlc n A c t f o r t h o r o a o o n
t h a t t h o a b o w a nnaoart p l a i n t i f f , D m f t m p la t o n , m s -- p i g t a i l bgr t b a R* U*
A n d a m iu , Zoo o n A p r il 1 7 , 195 and A p r il IB * 1 9 5 8 -- a p e r io d o f tw o d ay* --
cm t d iie h d a t e * t h a S t a t e A o d d a u t f w A mm n e t t h a d o l y r a c o r d o d Wort n a n 's
O o n p e n c a tie n c a r r i e r t o r R . R . Aar ia r o a n , X a a .
F ^ r th a r , i n w p y ie r t o f t h i s M o tio n t o O LanLaa, th o M lafalgan 5 t a t
A e d d a n t fu n d ev e n s th a t t h a ir p o lic y b e a m e f f o o t lv o on J e ljr 1 5 , 1 9 ^
hHBaETOKK, tho Stato Aeddant Toad roapootfulljr noqpaata anriOdor !
f t t * th o Sapor ta o n t d ia d s a ia g th a n a o a Z h fn d o tt n o d o r th o A p p a rtio o n o n t
;
A p p lic a tio n .
ft t n a r y 22, 1961
VorioMB*s CoKpaasatlxsi O ^p utM st la n rin 13. efcJLgaa
VL tean Tavolato t s R . R. itodersoo, ^ .
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Bacloeed herew ith p lease fin d H atlon to DSjbbIss la the abavo e n title d otase.
H C R ihJb
Bad.
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es Jo ta -lte o e v llle Salae Carp. T rsve la re Xaa. Ce. B n s fU L d , S a H ltt, Sdabeeh A Ja n V iia , A tty s.
Oma-Cbndaf nbrau Carp. Aetna C asaelty A Sare te Ce. H exender, Baohaaan A Oon frU a, A ttya. Brenta la a d b t ia i Ce. HLettUn Bated liability Ce.
la T a a a a v A te n a r , M % .
G La A m ila n Oo. (teserai Aoddant Assurance Cozp. H r. David H. Roberts, A tty. H r. H. F . B rlgga
Workmen's Compensation Department
DGa . Tii-iFLATOK
--
NOTICE OF HEARING DATE
plaintiff
--iAh.iS vILhr. om-u2*lj CGtti
O 1' ^ -G --C G fvv.1, u r I < j ^ . i u L 'vS U i u
IK S u Li.T ii ( GO* K . 1 . aKu - u-ON IN C. ` . GLa&L A. E I L L I hh CO*
Defendant
TRAVELERS IK S . CO. ETK-. CASUALTY k SU.. STY CC. k i c k i -ja ;: mutual l i * i l i v y c o .
S T A T E AGClAtJTi FUND Insurance Company
G&it^JtAXi A C ^ i uwL
G ii C v^hP .
K . CONsTAK
<-. AD L _. i T
Attorney
.MAKSFIEL, Di*. ITT i. SUL*- -.CK
AhLl
. i C K . i K A l - o'. CCI, L 1 I.
LLV*u w Eli;. .
At to rney L i 'l i
RlCU-iiii/
, ATTY
Jhe above captioned matter will be heard on
M a r c h 20, 1961__
nr as soon thereafter as possible at 1800 Cadillac Square Building, in the
city of Detroit, Michigan, commencing at 9:00 o'clock in the forenoon, LOCAL
time.
You are directed to be present at the time and place above mentioned and to be prepared to proceed with the hearing with such witnesses and proofs as are necessary.
WORKMEN'S COMPENSATION DEPARTMENT
Dated March 6. 1961
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Workmen's Compensation Department
AMENDED NOTICE OP HEARING DATE
PSAN T34PLETQN___________ _
Plaintiff
CLARXNC3 R. CONSTAR DAVID M. ROBERTS___________
Attorney
JOHN-KAKSVILLE 5AL.%S CCEP.
WENS-CORNING FIBERGLAS CORP. BROW* INSULATING CO.
X . H . ANDERSON INC. QLANZ k KILLIAN c n ._________
.
Defendant
TRAVELERS INSUKABCE CO.
AETNA CASUALTY k SDRETT CO. -- MICH TGAK M i r r i i . l T.T aHTT.TTY r.D ,
STATE
Insurance Company^cci DENT FUP
GENERAL ACCIDENT ASSURANCE CORP.
MANSFIELD, DE1TT k SULZBAC.i ...ALEXANDER. BUCHANAN k CGNKT.TN
LEVASSEUR, VRKa t t o r n e y k HITSEFF
RICKARD ROGERS, ATTY.
The above captioned matter will be heard on April 12 1Q6I_____
or as soon thereafter as possible at 1800 Cadillac Square Building, in the
city of Detroit, Michigan, cossnenclng at 9:00 o'clock in the forenoon, LOCAL
time. T h is a t t a r h a s b a a n r a a a t b a c a u s a t h a a a d i c a l e x a m in a tio n s w i l l n o t be c o a p la te d u n t i l March 27, 1961.
You are directed to be present at the time and place above mentioned
and to be prepared to proceed with the hearing with such witnesses and proofs
as are necessary.
Dated ,,Kerch 9, 1961
,
V.
(
JtEDEMPTION ORDER
The agreement to red eem the employer's entire liability for an injury sustained by the plaintiff on
' '
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.
by a single payment in lieu of weekly payments having
been considered by a Hearing Referee of the Workmen's Compensation Department and it appearing
--
that said agreement should be: .SBBSSSifid; denied;
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THEREFORE, IT IS ORDERED that said agreement to redeem the employer's entire liability
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for weekly payments herein by the payment of
flnnrT'Yffi- denied;
\
TT Tfi ETTRTm r p n s m B T O that said .sum .he nati att.inUnwg.
'
JERED that defendant(s) shall also complete the payment of weekly com-
JY T T `lr M l j 1 .................. .................
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IT IS FURTHER ORDERED, that. of the transcript of the hearing herein.
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shall pay the cost JBtmrini Raieree
County
THE ABOVE ORDER IS ENTERED IN ACCORDANCE WITH THE PROVISIONS OF ACT NO.
10 PUBLIC ACTS FIRST EXTRA SESSION OF 1912, AS AM ENDED. IF A REQUEST BY ANY
OF
REVIEW BY TH E DIRECTOR. OR NOTICE
DIRECTOR ON H IS OWN MOTION, IS H O T FILED W ITHIN 15 DAYS FROM THE MAILING
O ^ ^ i T W A I J . C T A N p. AE TH E FINAL DECISION OF THE WORKMEN S
COMPENSATION DEPAKTMfeHT. Y
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AFFIDAVIT
STATE OF COLORADO ) ) ss :.
COUNTY OF JEFFERSON )
R. B. VON WALD being duly sworn according to law deposes and says he is Vice President and Corporate Counsel of JOHNSMANVILLE SALES CORPORATION, a defendant in this action, that he is authorized to make this Affidavit on its behalf and that the facts set forth in the foregoing pleading have been supplied to him by others upon whom he relies and are true and correct to the best of his knowledge, information and belief.
R. B. VON WALD
Sworn and subscribed, to
before me this jQ svu x day
of Q - " ^
1982.
My Commission Expires Jy Commission expires Oct. 15, 1984 P.O. Box 5723 Denver, CO 80217
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