Document OJJypKawM0VvGEvKbEYwbKqgL

FILE NAME: Insulators Workers' Comp Claims (IWC) DATE: 1964 DOC#: IWC060 DOCUMENT DESCRIPTION: Claimant - Rogers, Ollie [From J-M Archive] 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 SS * * *'-^.-.iSSiO N?, p r i.o- r <to* 196 6) APPLICANT OLLIE ROGERS CASE =LB 26 779 Ei'IPLOYER/INSURER B r e m e n 's Fund I n s , m , ^ ^ _ip?ludxng J-M P ro d u cts C o r p . /T ra v el OTHER NOTES _Asbestosis/pulm onary f i b r o s i s .Ap p lic a n t reopened c a se 1970 due t o d e t e r io r a t in g condition DATE OF RESOLUTION J u ly 11, 1966 RESOLUTION F in d in g s & Award $14,280 settlem en t Oct. 22, 1971 Compromise & R elea se CLAIMANT JILL _____________ ,_________ _ 34 C a lifo r n ia W orkers' Compensation Appeals Board ' CARRIERS INVOLVED: The AETNA C a su a lty & S u rety Co. oAmerican Automobile In s. Co. oAmerican Employers I n s . Co. oAmerican M otorists In s. Co. oArgonaut In s. Co. oA ssociated Indemnity Corp. C a lif rn ia C asualty Indemnity Exchange ^ J-^ -forn ia Compensation & F ir e Co oC asualty in s . Co. o f C a lifo rn ia ' oEraployers L ia b ilit y Assurance Corp.Ltd. S ?5i?yr* L ia b ility In s. Co. o f W isconsin oFide^Lity & C a su a lty Co. o f New York - F irem a n 's Fund I n s . Co. o S e aL S t T c o ! ire * L ife corp. ltd . oGuarantee Insurance Co. oGreat American In s. Co. " "i " 1 c a su a lty Co. (Sentry I n d u s tr ia l Indemnity Co. Industrial Indemnity Exchange olnsurance Co. o f North America oL ib erty Mutual In s. Co. Lumberman's Mutual C a su a lty Co. Maryland C asualty Co. oM ichigan Mutual L ia b ilit y Co. oM ission Insurance Co. Ins. C o .) o N a tio n a l A utom obile & C asu alty I n s . Co. oNew Amsterdam C a su a lty Co. ' oOcean A ccid en t & Guarantee Corp.Ltd. P a c i f ic Employers In s. Co. o P a c ific Indemnity Co. oR elian ce In s. Co. (Standard A ccid en t In s. Co.) oRoyal Indemnity ' S t a t e ComInpeSn*saCti*on IfnHsuarratnfocer dF. uiUnd.S . C a su a lty I n s . Co.) oTransport Indemnity Co. The T r a v eler s I n s . Co. oThe U n ited P a c if ic I n s . Co. oU .S. F id e l i t y & Guaranty Co. oZ enith N a tio n a l I n s . Co. oZ u rich I n s . Co. o________________ . o ---------- ------------------------------- --------------------------------------- - o -- --------------------------- -------------------------- -------------------------------- - o ~ ------------------------------------ ------------------------------ 5/81 <' I SCHEDULE OF CQNTRTRHTTnyq l *;9UI3 FIR3BRICK & INSULATION COMPANY* 1 -IFORNIA COMPENSATION & FIRE COMPANY ' JouNS-MANVILLE PRODUCTS CORPORATION* TME TRAVELERS INSURANCE COMPANY ' ROTHSCHILD OIL COMPANY: MARYLAND CASUALTY INSURANCE COMPANY BECHTEL CORPORATION; INDUSTRIAL INDEMNITY INSURANCE COMPANY MARINE ENGINEERING; PACIFIC EMPLOYERS INSURANCE COMPANY P OET CORPORATION; A ,IA CASUALTY & SURETY COMPANY GOLDEN BEAR OIL COMPANY; STATE COMPENSATION INSURANCE FUND . PIjkITAN ICE COMPANY; CALIFORNIA CASUALTY INDEMNITY COMPANY .034 .135 .003 .005 .220 .008 .013 .005 E TM * ENGINEERING & SUPPLY COMPANY; AETNA CASUALTY & SURETY COMPANY THORPE INSULATION COMPANY FIREMAN'S FUND INSURANCE COMPANY .006 .521 I AL CONTRIBUTIONS; OLLIE W. ROGERS - WCAB C ase No: 64 LB 26779 coNTRisurrnM $ 384.00 2,039.39 33.88 56.47 2,258.80 90.35 146.82 56.47 67.76 6,110.06 ir,m .o o ( c f 4 Re: Ollie Rogers Good S a m a r a foorr ccnh,,esstt xx --rraa v>ss. TT hheas, e ^w ere report^ed aHs fSopliltoawl s:f the "Chest: P o ste ro -a n te rio r and la te ra l views of v ., .0 u =m . . U1. th , ^ " l r r f 3; ; j h B * iihr s h' a r t " !' bleated m i there i . thickened pl , ut , . ^ ,, f h n t h ? 0' " " ` ' ` T " " 1" -- * * . Z i ; h' ' , m ore so on the right near the h eart border. There is a fihrotio ' ? sma11 cr ia the rig h t apex con sider aw V tieg ener aUve *change* of^the^dor s al coS S . overlying soft tissu e density on the low er two or three vertebral b M i.s w hich would su g g e st p a re n c h y m a l le sio n . W h eth er th is is acu te the f H' are not known as old film s are not available for com parison"" T / s / R. E. L evis. The diagnosis of this pulmonary condition is established by the lune biopsy which showed the findings of an asb estosis w . J g d isab ility bat a . this , i m . i , i , 8p. r ti^ ^ perform a light type of w ork. As regards lia b ility o f his m L - Tu > this m ust be apportioned by his various em ployers and this is d ^ d * of " s *m ploy" ' " - d by z As stated above he is physically able to do a light type of work and should be encouraged to do so . H owever, he should avoid an atm osphere of potentially harmful dusts since it might cause an aggravation of his present underlying condition. Very truly yours. 1 WORKERS' COMPENSATION APPEALS BOARD 2 STATE OF CALIFORNIA 3 OLLIE M. ROGERS, 4 j Case No. 64 LB 26779 5 Applicant I 6 vs' / . 7 FIBERGLASS ENGINEERING & ( SUPPLY COMPANY l 8 I I A I I 0E " 9 Defendant ' 1 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 a re tru e 12 and c o r r e c t c o p i e s o f th 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 ADEST 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 i f o r n i a . 16 17 18 19 20 s e r s ' Com pensation Judge W orkers' Com pensation A ppeals 21 22 23 24 B ated a t San F ra n c is c o , 25 C a l i f o r n i a , t h i s day 26 o f A p r il, 1981 27 m pa rtm iw t o r m o u r r a u u rruationr PIVUIQNor INOURTRIAVACCtQKMTt f ( 1 ' WORKMEN'S COMPENSATION APPEALS EOARD ;t I OLLIE M. ROGERS, STATE OP CALIFORNIA ) A pplicant ) vs. ' FIBERGLASS ENGINEERING & SUPPLY CO* ^ 3 AETNA CASUALTY & SURETY C O ., ' ) || m a rin eENCEINEERING C O ., ) |j PACIFIC EMPLOYERS INSURANCE C O ., CaSe No* 64 13 2677; J BALDWIN-EHRET HILL; ^ ' ;; aetjla casualty & su r ety c o . , ) THORPE INSULATION COMPANY; FIREMAN'S FUND INSURANCE C O ., JOHNS-MANVILLE PRODUCTS C O .; THE TRAVELERS INSURANCE C O ., I PURITAN IC E CO.; I CALIFORNIA CASUALTY INDEMNITY C O ., ' 1 GOLDEN BEAR OIL C O ., j! STATE COMPENSATION INSURANCE FUND, ;i ;i ST. LOUIS FIRE BRICK C O ., !i CALIFORNIA COMPENSATION & FIRE C O ., j! ROTHCHILD OIL C O ., | MARY LAND CASUALTY C O ., ) ORDER APPROVING COMPROMISE AND RELEASE ) ) ) ) ) ^ ) BECHTEL CORPORATION; ) , INDUSTRIAL INDEMNITY C O ., i1 ___________________ D e f e n d a n ts ) jj A p p l i c a n t r e c e i v e d a F i n d i n g s a n d Aw ard J u l y 1 1 , 1966 o f ; 68$ b a s e d on a l i m i t a t i o n t o l i g h t w ork w i th o u t d u s t e n v iro n m e n t and : f u r th e r m ed ical tre a tm e n t; th is has been p a id in f u l l in th e amount !j o f 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 ! 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 jj w o r s e n e d . D r, G o ld f a r b f i n d s him l i m i t e d t o s e d e n t a r y w o rk ; D r. ; 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 ta tio n , th e se 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 thereby. -1 - ( 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 ire m a n ', 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. E dw ard D i c k e t e i n , * > < * .00; E n d r ia a p h o to c o p y S e r v i c e , { 2 1 .0 0 - Levy & van B ourg. c o a ts {55.18; Levy van B ourg, fe e s { l.o o o .o o ! 5 The p a r tie s to th e above e n title d a c tio n have f ile d a 6 Com prom ise a n d B e le a s e h e r e i n , o n O c to b e r 2 0 , 1971 s e t t l i n g t h i s is 7 f o r 1 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 re v io c 8 and re q u e stin g th a t i t be approved; and th is Board having c o n sid e r, 9 th e e n t i r e r e c o r d , I n c lu d in g .s a id Compromise an d H e le a s e , now fin d s 10 t h a t i t s h o u ld be ap p ro v ed ; an d 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 olt.ttc w. ROGERS 13 A g a i n s t : AETNA CASUALTY & SURETY C O ., PA CIN G EMPLOYERS 14 INSURANCE C O ., INDUSTRIAL INDEMNITY C O ., MARYLAND CASUALTY INSURANC 15 C O ., CALIFORNIA CASUALTY & INDEMNITY C O ., STATE COMPENSATION INSURA 13 FUND, CALIFORNIA COMPENSATION & FIRE C O ., FIREMAN*S FUND INSURANCE 17 TRAVELERS INSURANCE CO. 18 P ay ab le a s fo llo w s: 19 By CALIFORNIA COMPENSATION & FIRE CO. 20 T o: O l l i e W. R o g e r s , a p p l i c a n t $ 384.0i 21 By THE TRAVELERS 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 22 By MARYLAND CASUALTY INSURANCE CO. 23 T o: O l l i e W. R o g e r s , a p p l i c a n t 2,089.3; 33.6c 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 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 5 6 .4 ' 2,258.8c 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 158.1: B y STATE COMPENSATION INSURANCE FUND To: O l l i e W. R o g e r, a p p l i c a n t 1 46.8: By CALIFORNIA CASUALTY INDEMNITY CO. To: O l l i e V/. R o g e r, a p p l i c a n t 56.47 'l 64 LB 26779 - 2- ( '( I By -/.1 FIREMAN'S FUND INSURANCE CO. f 701 D ick stein , lie n claim ant --- u c i v iv iS j X ie n LL eevvvy Sc vV=ann Bn 0oUu rrgs,' al ltet yn s c l a i m a n t . T otal lie n s ' 0 \ l i e W. R o g e r s , a p p l i c a n t A T o tal due $ 294 00 5 5 .1 8 1000.00 ?1'870.18 4 7 3 9 .8 8 7 S 9 >/ / 10 :| Long B e a c h , C a l i f o r n i a jj SERVED ON ALL PARTIES LISTED U |! ON OFFICIAL ADDRESS RECORD 12 |, D a te d : 1 0 /2 2 /7 1 B}L-A / , 13 ! ^ '7 ' 14 T\ /*6 j U C lC ie g ^ WORKMEN'S COMPENSATION APPEALS BCA 15 16 17 18 19 20 COT 2 2 197K ^/1 21 " vvrT - -^rl OFFICE 22 23 24 64 LB 20779 -3 - . instructions / n i . " '' 'm' m i s - > * * > *" " t e ' *" a m . >P.. , ,, . ,, a / . < : S . 1T s s z A is r s 's ... s a t* . * * * -- e* - > -- >* ((TO|! Biw M Mij!> ^ ,, UM. 1^ ..... . ^ M COMPROMISE AND RELEASE STATE OF CALIFORNIA HUMAN RELATION* A O EN Cr DEFARTMENT O F INDUSTRIAL RELATION* DIVISION OF IN DUSTRIAL ACCIDENTS W ORKM EN'S COM PENSATION APPEA LS SOARD CASE NO.i4_LB__26779__ ( Mr.) {Sm.:r ( S f S ^ _ 0 I L U W. ROGERS VS. ^VARIOUS EMPLOYERS__________ C O R A icr ham o r H kovR _ AIQUS CARRIERS 6 3 5 1 s I 3 K C$ i " iiira^.L .o^^J aJi^ornia g 17 j.2_ A tM lIi > j >> fO U e parties hereto, for the purpose of compromise only, hereby submit the following agreed statements oHact-.A 1. __Q ll-ie W. Rog e r s __; , ,, , \ c . - . 5* >5. ' 4. J H . H t H a A d . E --------------------------------------------------------------- _ T _ (OOCVRATIOH) workmen's compensation liability hv V a r i o u s C a r r i e w g 1 C*TA 1 MAM OF C A ttR I * OK WHKTMK 0 |,rP tM U N S S t he sustained an injury arising out of and in the course of his employment as follows- A l l e g e s _ to . ` ' ---aUnUd Uth1<a1t TnriTY f r h is a,,v a ii - t B . . ?. M r 9iftsH W Urn t*a .in t o M.* . . . i t . . ---------- `a re actual weekly wages of the employee at the time of injury were i tt U t a f f i R ______while the average weekly wages were $ ______________ _ 3. The employee's present disability is__yi d is p _ u te . .................. d the e m p lo y e e .^ ijn tu rn e d to work.... ( T A T I F H ta lM T l A I U r V RoaU CTlM O FROM TN CIM X JRV ) (IF M . TA T WHBNI 4. (a) Temporary disability indemnity has been paid to the employee in the sum of $.3.23iLJ).Qat S-Z0...0D___per week btgmnmg../? 9 /.64... t0 and Jnc]uding. 5 / 6 / 6 5 .....The amount due and unpaid to the employee is S.NflnS______ . < y1Aj 2 8 0 ,0 0 ( ) Permanent disability indemnity has been paid to the employee in the sum of $_U 1 L ..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 sl l . 2 9 4 .0 0 in addition to any sums heretofore paid by the employer or the insurer to the employee, said sum to be payable as follows: AU ..tQ...e PP.Uffian.fc s j.2 .9 4 ,.00... t o E d w a r d D i c k s t e i r ^ _le s . any. t.C;or.n.?;.y.'.s....feeg...a,s ,,a L lp w e ^ b y . t h e A p p e a ls B o a rd . V o n :r; -, ,,- V ' *1i l ** : ` ' "'-A! . n o >*'j A . ] C-" 7? Lfi.q t%' \ to*"* * c.a /,. ......... ' * v 6. Medical and hospital expenses have been paid 5S o i e ......... by the employee and $A L L - i l / b y * e employer or carrier. Unpaid bills amount to $... U o n e........ . Future medical and hospital expense is estimated at $____________ Unpaid and ' turc medical and hospital expense is to be assumed as follows: A ll...b .y _ .a p p lic a n t..im d _ n o n e ....b y .......... d e fe n d a n ts. ( ( a,d address of employees attorney, if a n y . . . B p u r g * Sa;d attorney requests a fee of $...1., 0 0 0 . 0 0 . ,. ~.............. . Amount f attorney fee previously paid, if any, neason for Compromise__ SEE PACE.J l i f O J ND ONE-HA LF ................. " _______ ____ 10. The undersigned request that this Compromise Agreement and Release be approved. Upon approval of this Compromise Agreement bv the Worlm' .. , oayment in accordance with the provisions hem o/said em nW . 1Compeasf ? n APP<*h Board or a Refree, and insurance earner from all claims and causes of a c tL w h ^ e TM ^ " " foreverj `^charges said employer and or develop as a result of said injury, including a n ^ d ^ U ^ t b m t T o f ^ 7 " O, * a * a * * * " * * * - X hereafter arise T ^ X t S ? h 2 ? `J S * * * * * Ixk*" f ft.m ploy, he right to put in issue any of the facts admitted herein, and th afif h rfgu3.ar aPPLca^on- reserving to the parties "* P M ", ` - i A" ^ i - h - biid 13. For the purpose of determining the lien claim filed a. , unemployment compensation benefits and extended d m d o n heTMfi^n eu? u>T entiCOmpensation benefits or California Unemployment Insurance " o d e ^ paid under or P" to the settlement and release of this case: P P P * the foIlowiDS * * * of the sum agreed upon for $ for temporary disability covering the period______ ____ 5. J S X f i i S T " '* > " "TM i v * - , . 7 . ^ ------------------ for permanent disability. aw SSH Egj W m u s!h t* g n a tu rth e m )ftk lt. . . 2 ! J . . d a g o f . ^ ____ l$ _ 7 / w iT N K itf i --------------------- S * r -------------- ----------------------- ATTORKEY.'TjOR a p p l ic a n t fj -- -------------ss j r . r * 1^ ^ -- _ ____ STATE OF CALIFORNIA \ t ) ~ . > jj. / -- ......................---County of -AllC^kSy,.Xrf_ ) ^ - T/^ . 1 / ' ( On this -----dayofpfirjdltlJ&d_____ __ JOSEPH El " / // bef NELSON hivtcn to me to be the person__whose name >j ..... - 1' ' N S o S W TM i M',lmT ' a^ ^ w l e 7 Se d i o ' ^ h ^ : ' h e..... e r e c u , ^ ^ . e, r F- 7 ftereU"f0 "* my hand and ^ ed official seal the day and year in this Certificate first C- ^ >Us.J } ___________ notary Public in end /or said County and State 0/ Califarms a : t:;a c-.: malty insurance c o m p a s ?a : : ? ic employers insurance company in d u s t r ia l in d em n ity insurance company I'SNDI/ S70CKVELlTcLEAqn\] < by.: ' : r 'P r r r .0* & n U- ROoERTS & THOMPSON gV; V ! s' / // MARYLAND CASUALTY INSURANCE COMPANY CALIFORNIA CASUALTY & INDEMNITY COMPANY STATE COMPENSATION INSURANCE FUND ZONNI, BY. . 7 & TAYLOR CALIFORNIA COMPENSATION AND FIRE COMPANY FIREMAN'S FUND INSURANCE COMPANY THE TRAVELERS INSURANCE COMPANY OLLI W. ROGERS - WCAB C ase No: 64 LB 26779 ro> t>>t. C_D . ^^ TsO on o. "2* /.ij i-c