Document OzqLJ060QxZ3bRg9doGeZR3ov
FILE NAME: Kentile (KEN) DATE: 2002 Dec 16 DOC#: KEN025 DOCUMENT DESCRIPTION: Workers Compensation Documents with Cover Letter
LLP
December 16, 2002
HARRIS BEACH
Attorneys at Law
805 T hird A venue N ew Y ork, N ew York (212) 687-0100
(212) 687-0659 Fax
10022
Lisa M. Pascareila, Esq. D irect: (212)212-313-5412 lpcsccrella@harrisbeach.com
Via FedEx (Tracking No. 8372 0197 6217)
Richard Meadow, Esq. Weitz & Luxenberg 180 Maiden Lane New York, New York 10038
Re:
Kentile Discovery
Jacques Weinstock
NYCAL Index No.: 110500-01
Our File No.: 187610
Dear Rick:
Enclosed please find redacted Workers Compensation records responsive to demands numbered 8 and 10 of vour firm's discovery and inspection letter dated October 29, 2002. Please be advised that these documents are being turned over to you over vehement objection. Please also be advised that Kentile Floors, Inc. reserves all objections as set forth in my correspondence of December 12, 2002. and reserves all rights to make the appropriate motions in limine and otherwise at the appropriate time.
Should you have any questions or concerns please do not hesitate to contact the undersigned.
Very truly ypurs.
LMP/amv Enel: cc: Special Master Laraine Pacheco (w/o end)
ifV K Q
LISA M. PASCARELLA
PLAINTIFF'S EXHIBIT
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NOTICE IS HEREBY GIVEN THAT AN APPLICATION FOR E* 7~ 2 F CLAIM WAS F1LEDWITH THE ILUNOIS
INDUSTRIAL COMMISSION
KENT IL F FLOORS 4S 3 2 S K C L tN C H IC A G O
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THIS IS A LEOAL DOCUMENT WHICH MUST BE
FORWARDED IMMEDIATELY TO YOUR INSUR
ANCE CARRIER OR ATTO RNEY. F A IL U R E . TO
RESPO N D ' MAY -RESULT *; I N '; A JUDGMENT
BEING ENTERED AGAINST YOU.
.
A S S IG N E D TO AP f 11 T fl A T O R A U * . H E P B E H T REPORT TO A S S IG N M E N T S IH N 1 3 0 3 1 F IR S T
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FURTHER TAKE NOTICE THAT THE ABOVE ENTITLED CAUSE IS SCHeOOLED FOR HEARtNO BEFORE THE ILUNOIS INDUSTRIAL COMMISSION AS STATED ABOVE AT WHICH TIME ALL PARTIES OR THEIR COUNSEL MUST APPEAR. ALL PERTINENT DOCUMENTS. RECORDS, OR OTHER INFORMATION
SHOULD BE AVAILABLE TO COUNSEL, PRIOR TO THE HEARING DATE
TO BE COMPLETED BY ATTORNEY FOR EMPLOYER. OO NOT DETACH.
ATTORNEY'S AFFIDAVIT RULE 2 -0L FILE ONE COPY WITH COMMISSION AT ONCE, i HEREBY CERTIFY THAT ! HAVE NOT DIRECTLY OR INOIRECTU SOLICITED EMPLOYMENT BY THE
ABOVE NAMED PARTY, ANO KNOW OF NO SOLICITATION OF SAIO PARTY BY ANY PERSONTHAT
- HAS RESULTED IN THE EMPLOYMENT OF MYSELF OR ANY MEMBER OF MT FI KM.
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T im m u r
k u m m i us:
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THE ABOVE SIGNED ENTERS HIS/HER APPEARANCE ON BEHALF OF THE AESPONOENT. SERVED TO:
M IC H A E L F J O R i r o / P S IE M A N 1 IS S L A S A LLE ST 1 4 5 5
SP363714
f o r m 45: ErrpSoyers First Report of Injury or Illness
P L E A S E T Y P E O R PR Ik
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D O IN G B U S IN E S S U N D E R T H E N A M E OF
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OATE OF REPORT I ` Y V + I _____________________
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CASE OR ;- li. f il s YEAR | NUMBER
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YES
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IF E M P L O Y E E D IE D AS A R E S U LT O F T H E IN JU R Y O R ILLN E S S , G IV E OATE O F D E A TH
MONTH DAY YEAR
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in d u s tria l C o m m issio n
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OR IN JU R Y O C C U R R ED ?
'iJ-.fc.: aehanle / lead Ian.
_ OEJECT OR SUBSTANCE S I R E S P O N S IB L E FO R IN J U R Y
O R IL L N E S S (S O U R C E !
1lor;ed vposuro to laLoatoa fib e r s ard i-o lite d m a te r ia ls ,
1 _ H O W D I D A C C I D E N T O R
T I IL L N E S S O C C U R (T Y P E )?
ill-.,'oil rcMLiT-o -o i bo x r.s i/iaera <i.-:d -Misted raterial s .
i W H A T H A Z A R D O U S C O N D IT IO N S .
'
U M E T H O D S OR L A C K O F P R O T E C T IV E 1
I D E V I C E S C O N T R I B U T E D ? _______________ .
W H AT U N S A F E A C T BY A PERSON .
V C A U S E D O R C O N T R IB U T E D TO
T H E IN J U R Y O R IL L N E S S ?
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i REPORT PREPAREO 8Y :
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SP363715
IS O R H A S T H E E M P L O Y E E B E E N H O S P I T A L I Z E D ?
/E S G
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C IT Y . STATE
S IG N A T U R E
C IT Y . STATE
: T IT L E A N O T E LE P H O N E N U M B E R
ilD E N T REPORTING DEPT., IL L IN O IS IN D U S T R IA L COMMISSION, 160 North LaSalle Street, Chicago, Illinois 6060 WITHOUT WRITTEN APPROVAL OF COMMISSION, THIS FORM MAY NOT BE REPRODUCED
NOTE: DISCLOSURE OF THIS INFORMATION TO THE INDUSTRIAL COMMISSION IS MANDATORY UNDER IL. REV. STAT. CH.
KENTILE FLOORS INC.
53 S eco n d A venue
Brooklyn, N.Y. 11215
/j
PULMONARY FUNCTION EVALUATION
____________________________________________
S e x ------------------
Date
/ l 0 / y ~j
/
/ ` ''
. Address____ /) ________________________________________
Smoking History____ L __ P a c k y / ^ Z l _ Years
A g e ____ _________
/ /
Height (inches) __
Weight (lbs.)U - - 1 - .
Additional History_________ f -V --f_ /" i l l i
Ventilation
F VC >
1 FEV1
FEVl/FVC
. PEF '
FEF 25-75
INTERPRETATION :
Predicted W' / V 3 0 ^
3.0f
Actual 'z -n
in
ZTT
v-
-- % Predicted 72-0
r -(*
ay- z
y iA J r c l ^
l a ; Q T-^O--1--
Nisar A. Ouraishi M.D
SP424587
doctor to establish a final diagnosis. Patient adviced that a copy of these reports would be sent to his doctor at his request.
M
SP424588
3P424588
/
;
J O S E P H N . S A V IN O , M . O ., p .c .
1 6 8 Clin to n St r ic t
B rooklyn, New Y ork 11201
M arch 3, 1977
Re :
D ear D r. Q u ra is h i:
.
RADIOGRAPHIC EXAMINATION: CHEST PA
There is no e v id en ce o f a c u te , re c e n t o r p ro g re s s iv e pulm onary
p a th o lo g y .
"
The c a r d i a c , h i l a r and m e d i a s t i n a l shadow s a re n o rm a l f o r th e p a tie n t's s ta te d age and h a b itu s.
The v is u a liz e d o sse o u s s t r u c t u r e s and s o f t tis s u e com ponents o f the th o rax are in ta c t.
IMPRESSION: N e g a tiv e r a d i o g r a p h i c e x a m in a tio n o f th e c h e s t .
S in cerely ,
JNS/ fs film s to
Qr. Q u ra is h i K en tile F loors
SP424589
`'. if.. :
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rr ,
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CENTERS)
B R O O K L Y N HEIGHTS C A R D I O - P U L M O N A R Y R E R a BILITATION ASSOCIATES 164 C LINTON S TREET
B R O O K L Y N , N E W Y O R K 11201
VENTILATION SCREENING
TELEPHONE (212) 237-2814 (212) 237-2815
D e a r D r. v ) d Q-uXjQ
Your p a tie n ts and th e fo llo w in g r e s u lts w ere o b ta in e d .
was exam ined on
FORCED VITAL CAPACITY IN LITERS
OBSERVED
o?- /
PREDICTED
3- r /
^ 0P NORMAL
Js %
FEV 1
. /y?.5
FEV 3
, J 7 j5
.
These fin d in g s in d ic a te :
.A JU iX h ^ tlirf -'O io ^
> %^
9/Z
4
.
/}L i
cPopoJ
Thank you fo r r e f e r r in g
,
to u s .
S in cerely , c Dr. S. C u tle r
SP424605
SM24605
H 'tia,.
w iy-y**-, rp
" '\ t ~.1;& y w . ^ jtar&Sv*:.x&isafe.
JOSEPH N. SAVINO, M. D ., p.c. I t a Cukton etrcit
Brddkuyn, New YDRK 11201
7 8 -7 7 *4
December 19, 1975
Re :
D ear Dr. G reco:
.
RADIOGRAPHIC EXAMINATION: CHEST PA
There is no ev id en ce o f a c u te , re c e n t o r p ro g re s s iv e pulm onary p a th o lo g y .
The c a r d i a c , h i l a r and m e d i a s t i n a l shadow s a r e n o rm al f o r th e p a tie n t's s ta te d age and h a b itu s .
The v i s u a l i z e d o s s e o u s s t r u c t u r e s and s o f t t i s s u e co m p o n en ts o f the th o rax are in ta c t.
IMPRESSION: N e g a tiv e r a d i o g r a p h i c e x a m in a tio n o f th e c h e s t .
JNS/ fs film s to D r. Greco
(12/23/75)
S in cerely ,
, . )VV i
l* '
"
Jojseph N. S a v in o , M . D. ,P . C.
SP424606
SP424606
... _T^ a_,l,, --____ astwsa!w*' jy^fHsss^s^as^ssa^dB^Tpsgs^SSS^wKyi^
^
' BROOKLYN TUBERCULOSIS AND RESPIRATORY DISEASE hJCIATION, INC. SP424607
2 *3 CMIHMIBHOBM IT B IIT
U O O U Y N , K. T. 11217
SP4245D7
RESPIRATORY DISEASE SCREENING REPORT
Date: / - / / - 7
H eiigghhtL --2 'Z.----- W eight.
_
Name: Last
Age j l Y ' Sex
Address:
2ip Code_
Occupation; Present .
^ 0
Personal Physician:
Address:
X-RAY FINDINGS:
Ko p a iio io c ic iii hadinjtn"
PULMONARY FUNCTION TEST FINDINGS: .
^
-/y
11 C
A - 1 - C - a L-<_
Pi
X
> - < . , A c V. / L v ^ v - t *
l l C-C X* -
i ' - C . Y W . / O v-------
SYMPTOMS: Do you cough every day?
QUESTIONNAIRE _______ What time of day?
AM.
Have you recently had a cough that lasted 3 weeks or more?
77
During the past two years, have you had a cough lasting 3 months or more?
Have you ever coughed up blood?_______ As &
How much?
-When?
Do you cough up phlegm?
How much in 24 hours? 1 tbsp____________ 2 tbsp.''____________ More
-Less.
Color: White ______ L X _ _ .YYeellow _-_____Green ___________________
Are you usually short of breath?
MA.
Are you short of breath after exercise or exertion?
-M -
Can you walk up two flights of stairs without shortness of breath?
X
Do you have a whistle or wheezing in your chest? _
X
ILLNESSES:
In the past have you ever had:
P A T iE in ADVISED o f THE F IN D IN G * OF T H IS EXAMINATION ^
Heart trouble?
VA
A chest disease?
What kind?
A chest operation?
What kind?
Has a physician told you that you have:
Bronchitis? Emphysema?
Hay Fever?
Pleurisy?__
A
-Other chest disease?-
-Specify
______
Asthma? ___
Tuberculosis?
SMOKING HISTORY:
Do you smoke? _
------W h a t?
X If cigarettes, how much: Less than 20 cigarettes'^ day?
Have you ever smoked? __________ at what ace did you begin sm oking?.
A l.
0 L . How many packs?
-When did you stop?
P.M.
S
> 01H i @
BROOKLYN TUBERCULOSIS & RESPIRATORY DISEASE ASSOCIATION, INC
293 SCHKHMEHHOIIN STREET. BROOKLYN. N. V. 11217
(212) 02-1-8531
MXS. OOHOlHT l . M'AUWN'j
H A IO lO A . LYONS. M.D.
MIS. ANNE M. NEWMAN JOHN W . SAPANbW W ILLIAM {. HOHENIATH
Sc>*l*>r Ttau<r A m i'a m TiaaUir
N tlS O N X. K X A M
D u e C lw
John J , Greco, M.D.
K entile Floors Inc. 58 - 2nd Avenue B rooklyn,!?.!. 11215
Jan . 3,197.
AGE: 53 16 - L e ffe rts Place
Dear Doctor:
The c h e s t X-ray which was ta k e n o f th e above named person on Dec. 27,1973 was read by a q u a lif ie d c h e st s p e c i a l i s t and showed:
no pathological fin d in g s.
Thank you fo r your r e f e r r a l
Sincerely yours,
AEG/an
CHRISTMAS SEALS FIGHT TUBERCULOSIS. EMPHYSEMA AND AIR POLLUTION
SP424616
SP424616 ~ *
:>
Jan. 22,1975.
John J. Greco, M.^. Xentile Floors Inc. 53 - 2nd Avenue Brooklyn,H.I. 11215
RE: 16 - Lefferts Place
Dear Doctor:
'
'i
The chest X-raya which were taken of the above named person on
Jan,. 14-,1975 were read by a q u a lifie d ch est s p e c ia lis t and showed:
PA V IS T -
DEPT LATERAL V IE jr-
RIGHT LATERAL VIEfT-
SO PATHOLOGICAL P a U B S . NO PATHOLOGICAL FINDINGS. NO PATHOLOGICAL FINDINGS.
Sincerely yours,
AEG/an
nea E. Gerding Program Director
M T ItH T ADVISED O f TH E FlNOtM GS OF
.
CHRISTMAS SEALS FIGHT TUBERCULOSIS. EMPHYSEMA ANO AIR POUUTlO'
SP424618
lllli
W UIA M K. U U . VM.S.
t
a *> A U o ^ rw i' M M ^
W tf. 0 0 1 0 TMT c . SF A lU M O
M A tO id A.' IVONS, M.0 . '
*
M U . AMMt M. M W MAM JOvtM W, J A lA M n WfcUAM | . HO M M A TH
IwM wf trm . n AylM A T w w
M UCH , U A lM li '
j BROOKLYNTUBERCULOSIS t RESPIRATORY DISEASE ASSOCIATION, INC.
S 293 SCHF.HMF.HHORN STHEET. BHOOtCl.YN. N. Y. I J2I 7
1212)621-8531
Jan. 27,1975-
16 - Lefferta Place
Saar Doctor] Attached is the Respiratory Disease Screening Report of tha shore .
named patient. Yon will hare already received this patient's X-ray report.
The pulmonary function screening test waa interpreted by a qualified pulmonary phy&iologlst. It indicates further examinations are needed to establish a final diagnosis.....
Sincerely yours,
AEG/an
Ml*0 * . ,
, "" r"
,- r 1
.
CHRISTMAS SEALS FIGHT TUBERCULOSIS. EMPHYSEMA AND AIR POLLUTION
D IH IIIIIl Ay:
.
SP424619
flu fr;j L f lw a a a te g g ^ s a g v ^ '
MMB*V 1 iOwOaOOnTmHVv iC. SPuAiUiAlOlOMfQI
MAMOLO *. LVONS. U . DOMALO ( . OK.LON
MMS. AWMt M. NI MMAA WILLIAM ( . HOMIMMATM
ALOIM M. MASttTT
BROOKLYN TUBERCULOSIS & RESPIRATORY DISEASE ASSOCIATION, INC.
293 SCIIER M ER H O R N STREET, BR O O K LY N , N. Y . 1 1 2 1 7
(212) 624-4331
ATE
n c l s o n m. kmacmco
1 / 27/ 75*
1 V M ^ rn M n ' 34 V
MimtVrutr,h iM i iii
TltM M Am h m Ti n m m
ow
TO: B rooklyn T u b e r c u l o s i s & R e s p i r a t o r y D ise a se A s s o c i a t i o n
FROH:
RE:
^
A G E : 5 4 16
____________ _
The t e s t f in d in g s o f th e above named p erso n i n d i c a t e a need f o r
fu rth e r study.
Your c o o p eratio n in r e tu rn in g t h is re p o rt w ill a id us in e v a lu a tin g our uork and enable us to give you b e tte r serv ice.
RSPORT
T he above named p a t i e n t h a s b een ex am in ed 'b y me a n d t h e f o llo w in g d i a g n o s is i n my i m p r e s s io n .
_ N egative fo r tu b ercu lo sis
_ T uberculosis - active
f T u b ercu lo sis - a c tiv ity undeterm ined
t T uberculosis - in activ e-receiv in g treatm ent
_T uberculosis - in activ e-n o t receiv in g treatm ent
C hronic B ronchitis
. Emphysema
Pujm onary F ib ro sis
P-talignancy
C ardiac A bnorm alities
,
'y
_________________ ____OUjua' a b n o rm al c o n d i t i o n s ( p l e a s e s p e c i f y )
{
%
'
Signed A d d i t i o n a l i n f o r m a t i o n may be r e p o r t e d On th e r e v e r s e s i d e .
90*
xrtcTM e r .ii f i r u t T iis c o H u r K ti rM O *^ r V n H i l p n tlllT riN
SP424620
BROOKLYN TUBERCULOSIS & RESPIRATORY DISEASE ASSOCIATION, INC.
293 s c u E n .'in n u o n N s t r e e t . Br o o k l y n , n . y . 1 1 21 7
(212) m i - 8531
M .lt.A M H
- -o
M IS . M lC H A a C. M A U O V,M * .* # *
M IS . D O IO IH T C. SPAULDING
*"
H AROLD A . IY 0 N$. M .O .
M IS . A N N t M. N iW M A N K9HH W . SAPANSU W IU IA M ( . M OHINIATH
Sm w m t t.MMMW A mi, IW I
naSON I, KlAlMlI
Mtn9>ng Oirvclw
Jan. 21,197A.
RE AGE: 53
DeaT Doctor:
"
Attached is the R espiratory Disease Screening Report of the p a tie n t
you r e f e r r e d to th e A s s o c ia tio n 's C hest X-Say C enter. You w i l l have already
received th is p a tie n t's chest X-ray re p o rt.
'
The pulmonary fu n c tio n sc re e n in g t e s t was in te r p r e te d by a q u a lif ie d pulmonary p h y s io lo g is t. I t in d ic a te s th a t fu rth e r exam inations a re needed to establish a fin a l diagnosis.
In form ation on your fin d in g s w i l l h e lp us ev alu ate our s e r v ic e s . We would ap p reciate your retu rn in g the enclosed form.
Sincerely yours,
AEG/an
A^nes E. G erding
/
Program D ire c to r
SP424621
SP424 621
BROOKLYN TUb.riCULOSIS AND RESPIRATORY DISEASE A...CIATION, INC.
391 1CHIRM11HORN I T I I t T
M OOKIYN , N. Y. 11317
43*4131
"\
RESPIRATORY DISEASE SCREENING REPORT
Date
______
Height / & >
Name: L a s t / _ 9 S B H i ^ t V ^ _________ .First ^ H M f t - I n l t i a l _________ Age
Address:
. Occupation: Present
Personal Physician:
.Referred by:
A dd ress:_________ X-RAY FINDINGS:
Wo pa th o lo g ica l finding
PULMONARY FUNCTION TEST FIND__IN__G_S:
'W p
c < J cL .
~T
SYMPTOMS: Do you cough every day?
^S
& C&
QUESTIONNAIRE _________ What time of day? ____
~zr _A.M.
Have you recently had a cough that lasted 3 weeks or m ore ?___ . j / During the past two years, have you had a cough lasting 3 months or m ore?___ Have you ever coughed up blood? / I S f ) _________ How much? _____________
V l- S
/
.When?
Do you cough up phlegm? .
How much in 24 hours? 1 tbsp____________ 2 tbsp_____________ More .
Color: W h ite ______________ Yellow
_______ G reen___________
Are you usually short of breath?
iB J .
-f
Are you short of breath after exercise or exertion? _____ /S J i__2 ____
y /jr''S Can you walk up two flights of stairs without shortness of breath?
Do you have a whistle or wheezing in your chest?
/
ILLNESSES:
m SS. ~ r~^--
In the past have you ever had:
-Less.
Heart trouble?_________ /] f
2 A chest disease? _
T A chest operation?.
_What kind? _What kind?
Has a physician told you that you,have:
Bronchitis?
_Hay Fever?_
.Other chest disease?.
Emphysema? ,
,,P le u risy? ____
.S p e c ify ____________
Asthm a?___
.Tuberculosis?
_P.M.
SMOKING HISTORY:
Do you smoke? . \L L d >
.What?
If cigarettes, how uch: Less than 20 cigarettes a day?_
Have you ever smoked?___________
At what age did you begin smoking? . T I L
3 M -4 /7 3
/ts
How many, packs?
.When did you stop?
SP424622
>0H2 @
BROOKLYN TUBERCULOSIS RESPIRATORY DISEASE ASSOCIATION, INC.
293 SCHERMKRHORN STREET, BROOKLYN. N. Y. 11217
(212 ) 624-8531
HABO LD A . LYONS. M.O, M IS . ANNE M. NEWMAN JOHN W . SAPANSK! W ILL IA M E. H O H EN IATH
N J L iO N R, RRa EMEI
T '* w rw A t m i t M 7(
M enegieg &tr*eter
DATE:
TO:
B r o o k l y n T u b e r c u l o s i s St R e s p i r a t o r y D i s e a s e A s s o c i a t i o n
FROM:
RE:
AGE: 53
The test findings of the above named person indicate a need for further study.
Y o u r cooperation in returning this report will a i d us in evaluating our work and enable us to give you better service.
'
REPORT
The above named patient has been examined by me and the following diag n o s i s is my i m p r ession.
_________ _________________________ n e g a t i v e f o r t u b e r c u l o s i s
___________________________ T u b e r c u l o s i s - a c t i v e
________________________________ T u b e r c u l o s i s - a c t i v i t y u n d e t e r m i n e d
_________ _________________________ T u b e r c u l o s i s - ina c t i v e - r e c e i v i n g tre a t m e n t
__________________________________ T u b e r c u l o s i s - in a c t i v e - n o t r e c e i v i n g t r e a t m e n t
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Chronic Bronchitis
_____________
'___________ E m p h y s e m a
_________ _
Pulmonary Fibrosis
________ _________________________ M a l i g n a n c y
__________________________________ C a r d i a c A b n o r m a l i t i e s
_________________________________ O t h e r a b n o r m a l c o n d i t i o n s ( p lease specify)
Signed:,
Additional information may be reported on the reverse side.
CHRISTMAS SEALS FIGHT TUBERCULOSIS. EMPHYSEMA AND AIR POLLUTION
SP424623
y>>-TviSe*
.V 1
iV 71^
(
BROOKLYN TUBERCULOSIS t RESPIRATORY DISEASE ASSOCIATION, INC.
MS jaiEKMKKHOKN JiTHKET. HH<K>kl.VN. .N. V. 11217
2* Mi-ttSI
tO U M A. f^W M O UP
'X rti& ih
MAS. MICHAEL O UALKO CiCU. A rtA aTtH , Ph, D
MPS WAtLAT A WH-." *
,(OHN A 3 *V*L*_IAM *. H ;iH t( .h A lil
PiM nt
S^rH jr* . lipaiuH"'
1 rf tM t
NCL5 0 N A* KAAfcWEft M m ig n tf O ntclO f
John J . Greco, li_D. Kentile Floors Inc. 58 - 2nd Avenue
Brooklyn,K.Y. 11215
Deo. ZL,]g72.
KE:
53
Dear Doctor :
The ch est X-ray rh ic h nas taken of the above naned person on Dec. 14., 1972, rr.s read by a q u a lifie d chest, s p e c ia lis t and shewed:
NO PATHOLOGIC AD FINDINGS.
Thank you fo r your r e f e r r a l .
AEG/an `
Sincerely yours,
Agnes E. Oerding ' Program D irector
SP424624
SP424624
Ch r is t m a s s e a l s fight t u b e r c u l o s is , em p h y se m a and a ir pollution
.
Deo. 21,1972.
John J . G reco, M.D.
K entile Floors Inc.
58 - 2nd Avenue
'
Brooklyn, H.Y. 11215
-,
Dear Doctor: Attached is the R espiratory Disease Screening Report of the p atien t
J you r e f e r r e d to th e A s s o c ia tio n 's C hest X-Ray C e n te r. You w i l l have alread y received th is p a tie n t's screening chest X-ray and re p o rt.
The pulmonary fu n c tio n screen in g t e s t was in te r p r e te d by a q u a lifie d
pulmonary p h y sio lo g ist. I t in d ic a te s th a t fu rth e r exam inations are needed
to establish a fin a l diagnosis.
In fo rm atio n on your fin d in g s w i l l help us e v a lu a te our s e rv ic e s . V7e
would a p p reciate your retu rn in g th e ecolosed^form.
Sincerely yours,
--
V** ft.
$jjties E . G erding Program D irecto r
end. 7.
SP424636
SP424636
.
BROOKLYN TUBERCULOSIS AND RESPIRATORY DISEASE . JOCIATION, INC.
J SCHERMIR H O R N S H IIIT
R R O O K IT N , N. T, 11117
<
RESPIRATORY DISEASE SCREENING REPORT
12-12?2 Date:. Name: Last
Address: 2.. L e f f e r t a P la ce Occupation: Present JLJ-*i6rS
Personal Physician: _
A dd ress:___________ X-RAY FINDINGS:
-First BKLYN
.In itia l
HeightS=6_
-Age S3
_2ip
168
-W eight
_Sex Code 11226
M ale
.Previous
t Ia.p*Ahci oy e o i f W f t w H,
.Referred
by: J O H N J. G R E C O , KENILf: FLCCRS
~~Mi 2 n d A V E ., l i . . . . . .
M .D.
INC. -1121!
PULMONARY FUNCTION TEST FINDINGS:
1 /A ' ~
ir, - /p tt- e & .'t C &
SYMPTOMS: Do you cough every day? r.O
QUESTIONNAIRE _________________What time of day?
s friO C A ic r_______
7^
-A .M -
Have you recently had a cough that lasted 3 weeks or m o re ? ____ ___ During the past two years, have you had a cough lasting 3 months or more? nO
Have you ever coughed up blood?
R0___________ How m u c h ? ___________
-When?
Do you cough up phlegm ?______ g 0_________
How much in 24 hours? 1 tbsp.____________ 2 tb s p .____________ More
-Less.
Color: W h ite ______________ Y e llo w ______________ G reen__________ Are you usually short of breath? NO
Are you short of breath after exercise or exertion?
-m -
Can you walk up two flights of stairs w ithout shortness of breath? .
T es
Do you have a whistle or wheering in your che st?_____ E2___________
-P.M.
ILLNESSES: In the past have you ever had:
Heart trouble?__ .
A chest disease?. -NCL A chest operation?. NO
Has a physician told you that you have:
Bronchitis?, Emphysema? Asthma?
_NDnO
nO
-What kind? _What kind?
.Hay Fever? nO
.Pleurisy? _ n Q -
-Tuberculosis?
H}0
SP424637
SP424S37
-Other chest disease?.S p e c ify ____________
SMOKING HISTORY: Do you smoke? -
T es
-What? 010
If cigarettes, how much: Less than 20 cigarettes a day?.
Have you ever smoked?___________________________
1--
--**n i / i i
16
20
How many packs?
-When did you stop?
S li WLK.
W ILLIAM H,
r \ . 0 . frmvmt
i-
' M ts . MICHAEL G. MAUCO V k .
f
.)
M *S . D O IO TH Y C. SPAULDING
'
H AtO LD A. LYONS, M.O.
M ts . ANNE M . N EW M A N JOHN W. AP AN iK I
W M IA M t. MOHLNtATH
S w e l.ry 7 > < ...
A u . il. n l Ti.v>l
NELSON t . K R A lM tR
Mngivg P ir c ic '
BROOKLYN TUBERCUL0S1S & RESPIRATORY DISEASE ASSOCIATION, INC.
293 SCHRMEHHOIIN STIIEF.T, UROOKI.YN, N. V. 11217
(2I2) 621-ar,3l
V"
; 12/2l/72.
. :&
TO: Brooklyn T u b e rc u lo sis & R e s p ira to ry D isease A sso ciatio n
FROM: RE:
A h n J . Greco, M.D. K e n tile F lo o rs Inc. AGE : 53
The t e s t fin d in g s o f th e above named person in d ic a te a need fo r fu rth er study.
Your cooperation in re tu rn in g th is re p o rt w ill a id us in ev a lu a tin g
our work and enable us to g iv e you b e t t e r s e rv ic e .
REPORT
The above named patient has been examined by me and the following
diagnosis is my impression.
.
___________________________________ N e g a t i v e for tuberculosis
___________________________________ T u b e r c u l o s i s - active
___________________________________ T u b e r c u l o s i s - a c t i v i t y u n d e t e r m i n e d
___________________________________ T u b e r c u l o s i s - i n active - r e c e i v i n g t r e a t m e n t
______________________________ T u b ercu lo sis - in a c tiv e - n o t re c e iv in g tre a tm e n t
_____________ ' '_________________ C h r o n i c Bronchitis
___________________________________ E m p h y s e m a
______________________________ Pulmonary F ib ro sis Malignancy
___________________________________ C a r d i a c Ab/iarmalities
___________________________________ O t h e r abn o r m a l conditions (p l e a s e specify)
Signed:
A d d itio n a l info rm atio n may be re p o rte d on the rev erse s id e . SP424638
. Qr0UP
^
LOST TIME
**>
a t '. i a j
~ >L
..
:
. i)
K E N T I L E , m e.
Brooklyn
Plant
NURSE'S REPORT Of-INJURY PC l.SirrCTTT '
. ?$r*i&t#se) ^1''-'
FORHSA :*
Date of Report:.. 7-8-6U Date of Injury.__1"--Ak
__ _____ ___ Time :.. 11.5.-&EU.
L.
..... ................. Time:...... ... 1.1;.3.9.....3..?B..*.................
N a m e :...
Address:
A gt:....... JR--
S (M) W
D
..D ept.:.... ErQ.duc.tiQn.......... ............ .,,Occupation:.... ..... .R.li..i...SUi...... . Supervisor:-------- R.-M angino............ (Irr-fLili)..................
How Long Employed:...!?.!?.!!........ .7'S...yrs_.......... ............ _...
Patient's Story of How Injury Occurred:__ Emp.l.gyeg....5.tat.es....tMt....h.e....i5....C.Q.Ughing....up....5.oro.e.,,.'blo.Qd......,,..........
.N o tic e d .X tx g t.^
._.... ...... __Ilan...Eixft5...nQ...bi5t.P.rx.
Nature of Tj<i,y As above along v i t h cow m ent.tb n t^l9 ad -> jO irlg b t^red ..in ...so .lQ rt. n o t d a rk .
Blj
'pricing on a ir .hamerJ.dnstyi _ TempgraJ.ur^.J.akgn.:--l2IigL_.Pul.sgi--itro n g j;.,,re g u la r.^..
Soutum re o u e stM ;__Ksti.erit...unable...t.o_prp.2id.e.,------------------------------------------------------------------ ----
Disposition:.. .To..s.?.g..p.wn..liD..,__ Rs.tiuest.e.d....dQ.c.tor_.no.ts....... ......
X-Ray: This has te e n ordered by own MD P t . w i l l advise u s.
Re-visits:.J7.r.iQr.6L___ P a tie n t brought d o c to r note...ng.L.to...x.^unL..Q....'WQrk...-...Dr.,. .has o rd e re d ......
X-ray.,......_.P.ati..er:t....4P2.e.sx5...3,BJ!reIi.en.si.Y.fi.;..ay_tliat...h.e...ba.s...iit.,,CQUgIied.._up...Any...jnore...blQod... .....
s.ince,.We,^es_day,._7..-8-k.....,,._.Px.B..XSSiueat.e:d_.spjatm...s.aiiple...T...pati.ent..unablfi..t.a..pr.Q.vids........ .........
__ .3 . 'yU A Jitts i*.
... > f^ U ^ d r.__________________ isecrfaiftssa.__ . ______________________ ____ ___
C 2-- no
vjg
C-104.
C-4--
,.C-l4_ ..C-ll...
SP424639
SP424639
^ 'W *kt-;i?au4
>
J D B E P H N . S A V IN O M . D ., 1 6 B CLINTON Street
B ro o klyn , New Y ork 11201
p.c.
*7 5 -7 5 *4
A ugust 19, 1976
D ear D r. Q u ra ish i:
Re: In ju ry D ate: 8 /1 8/76 E m ployer: K e n tile F lo o rs W /C058930
RADIOGRAPHIC EXAMINATION: CHEST PA AND''LATERAL: '
There is ' no ev id en ce o f a c u te , re c e n t or p ro g re s s iv e pulm onary p a th o lo g y .
The c a r d ia c , h i l a r and m e d ia s ti n a l shadows a re n o rm a l f o r the p a tie n t's s ta te d age and h a b itu s.
The v is u a liz e d o sse o u s s t r u c t u r e s and s o f t t i s s u e com ponents o f the th o rax are in ta c t.
IMPRESSION: N e g a tiv e r a d i o g r a p h i c e x a m in a tio n o f th e c h e s t .
JNS/ fs film s to
K e n tile F loors
S in cerely
t..
s f A..S t/ -f
""
t*
J b s e p h N.
kC S a v i n o , M . D . , P . C .
SP424600
1. Your name (Print)..
STATEMENT OF CLAIM FM
ACCIDENT AND SICKNESS WEEKLY BENEFITS
TO BE COMPLETED BY THE EMPLOYEE
(P/*a# o n iw tr a lt qvm ittm nil
' * * t ' ,o *e til n l i t * lnnraca Comtamj (' Mi) nM im I
V /c/SN
..Phone
2. Present address-
. .. Slate. *
GJ^M ale D Female Date ol birth./ ? /.!li/.^ .0 Single 0 " Married Socia^Security No
3. Date you were firstd isabled by this sickness or injury........................................................... 19..
4. If you were hospitalized, at o bed pahent. please answer the Allowing:
Cot Name and address of hospital t i f f ,!is m IJ [U \.
F fC ^X - ;
Cb) Date ad m itte d ....... Q.j..........................................................................................1 9 . & . i / . . . . a t . . 3 i . i . . J | ~ - IL L
V Date discharged
..
ta .m .
.
19 . . . . at
f t <{ j l & t J } >
.J ^ V . /
5. W as an accident involved Yes No It yes, please answer the following:
Cot When did the accident happen? Date..
,.19.................a t . . . .
. [ -m-
(Hour) jp . m .
Cb; Where did the accident happen? City........................ ...........................................................State..................................................... ...................
Cc| Where you at work when the accident happened? Yes ["] No
Cd1 Give a brief description of the accident..................................................................................................
...................................................
I authorize th P h ysician to raiease any inform ation raquestad w ith respoct to th is Claim . 1c e rtify that the inform ation i furnished to support th is claim is true and co rre ct. I KNOW IT IS A CRIM E TO FILL OUT THIS FORM WITH ACTS I KNOW A R E FALSE OR TO LEAVE OUT FACTS I KNOW ARE IMPORTANT.
Date. ...3Jj.fi..J .......is S .J
Signed /Insured pm p/oyee;
TO BE COMPLETED BT THE EMPLOYER
-
( P i m v i w # " / w r o /7 qumrtiontf
1. Employee's name.___________ '. ..................................................................... ...................................... - ............Employee's Identification No.
2. Amount of weekfy benefit, %................................................................
Effective date of employee's insurance
..
.19
3. If this coverage has been canceled, give the date and reason ....................
.. .....................................................................
t.
Date last w o r k e d .............................................
....
'9 .
-'.c-neo tc work
S. If salary continued, give date salary paid through
.. .
...................19
S. Is the employee claiming or receiving workers' compensation benefits? If Yes, what is the present status of the compensation c la im ? ............................
I Yes No
n of this claim..............
k e n t i l e FLOORS INC. BROOKLYN, N.Y.
Date ..........................................
.1 9
l:V- ! , "if(*
n 2 6 1 9 8 XX 0 0 1 0 ' 0 1 )1 (LOCAL 4 0 2 ) IAMAW ' 3 LOCAL 457 URW '05 (LOCAL 3) IBEW '07 SALARIED 0 8 ) CHICAGO-ATLANTA 1 0 ) (LOCAL 5 0 5 ) 1JKW By
Telephone numbei
' it* f.***`
SP424564
SP424564
fo n t Approved OMB N. 76 -R 0 11 B
REQUEST FOR AND CONSENT TO RELEASE OF I N F O R MA T I ON ______________________ FROM CLAIMANT'S RECORDS _______________________
Wt)TZ: The execution o f this form dot* not authorise the release of information other than that spe ci fic all y d escribed below. The infor
mation requested on this form it solic ite d under Title 2&, United Slate* Code, and will authorise release o f the information you specify.
The information may also te disclo se d outside the VA oj r e m i t t e d by law or a* state d tn Me "No ti ces o f S ys te ms of VA necords
Published in the Federal Register in accordance with the Privacy Act of I 3 7 i. Disclosure is volvnlory. However, if the information i.
nat furnished, we may not be able to comply with your request.
'*1
&
H a m AN O AD O RESS O F O R G A N IZ A T IO N . A G E N C Y . O n IN D IV ID U A L TO WHOM IN F O R M A T IO N IS TO B e R E L E A S E D
u =m l
VETERAN 'S REQUEST
1 hereby request and authorize the Veterans A d m in istra tio n to release the fo llo w in g in form ation, from the records id e n tifie d above to the
O rganization, agency, or in d ivid u a l named hereon!
________________^
____
n b o b m a T IO H R E Q U E 5 T E 0 I'i*'wW men lf m r+outAtnO t n O gt to Ih d ( M n f a r o u A u R dim* prrioO Iron* mnO r e c e * " * * l Of ***-)
w; SD 1 . DIAGNOSIS:
Q Jl
ward n r 1C I A N {&> - L lJ /
2. OPERATIONS OR OTHER K>-KETOSES,: (DATES)
3. Hffifijfor T O W O R K S T A T U S :
)---- ----------------------------
b'. R E M A R K S :
RETURN TO CL1KI I-: lATH:
/ > f f _ ? A T J E N T P7E: :raj" T.Y i O S P I T A U - '.ED
5 . CONVALESCE?.'T PERIOD.
U R R O S E S F O R W H IC H T H e IN F O R M A T IO N IS T O B E U S E O
rv m S E OF I N F O R M A T I O N ;
(T --
HQT E: Additional items of information debited moor be li ste d on the reverse hereof * S IG N A T U R E A H O A 0 0 R 8 S S o f C L A IM A N T . OR F ID U C IA R Y . If C L A I M A M X I S IN C O M P E T E N T
C 1*73 60-3288
E X IS T IN G S T O C K S 0 V A F O R M 0 7 -S IM . * C B 1?. W ILL & u s e o .
SP424565
SP424565
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i r E i n i E r r r > n E N r .n , m .d ., p . c . ]n o x m it j i h th f.k t
IlIfOOMI.Y.N*. N . T . U S U I
V I.KTKM r w S f i 2
H A S SEEN UN D ER M Y P R O FE S S IO N A L C A R E . A N D W AS: T O T A LLY IN C A P A C IT A T E D P A R T IA L L Y IN C A P A C ITA TE D
,,.n, P - / - W
..
REM ARKS-
t
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s. t d- //
., - 7 / - / V
SP424566
RP42456S
H E A R IN G L E V E L IN D E C IB E L S IdB )
M \ y on/ "3 ? R qc \L
AO
SO
60 70 80 90
100 1 10
1 I
r,7y~fr H L\ i
ct
? '
\\
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r
A U O IO G R A M K E Y
0 ----SC------- tg n t L e it
Unm asked
6T
10 MaAsCked
SC
20
M a sto id
U nm asked
] B C
3D
^ M a s to id
M asked
BC
30 r F o re h e a d
SO M a s k e d ______
1 : 6 0
BC
F o re h e a d
Unm asked
|
70
S ound F ie ld
T
1 \ 80 Lett Ear Right Ear
I \ 90
S .fl.T .
1 1 100 M.C.L-
1
11
T.O. 110
F R E Q U E N C Y IN H E R T Z (H i)
NORTHEASTERN INSTRU M EN TATIO N 6370 A 7Siti Su. Middle Viti*9*. New York 11379
1317) 894 -5675
Audiometer Sales & /Service
SP424567
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DO NOT DETACH
? JNQUSTXUl H IM fH IN C 1979
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SP424568
SP424568
SP424569
<
T IR E OF TEST
I- ] A "
S E R IA I HO.
j
;
HEARING T H R ES H O L D LEVEL IN DE CI B ELS
(
h e i u i x r t w i E t f E i t , i l d ., r . c .
in a s m it h s t r e e t tiH O O K iity , . t . a i s o t
u i .bttsu s . s n n s
.
U L itrsH s - n a is
DISABILITY CERTIFICATE
TO W HO M IT M AY CONCERN;
DATE / " ^ ^
H A S S EEN U N D E R M Y P R O FE S S IO N A L C A R E , A N D W AS: p , t o t a l l y in c a p a c it a t e d PARTIALLY in c a p a c it a t e d
r.n,, Z - S> <=- y / _ 1 O 9 - F -/
REM A RK S!.
/
h U M - ' i/ & ~ s s.
L^' 1
1
SIG N E D
/!i 1/ h ! ` l^ / Y ,;k . 'V A L j
oL; "i O ti.J <5'*'^ '?- \ L ' 'I '? I
SP424570
SP424570
I STATE OF CALIFORNIA
AGRICULTURE -,AND SERVICES AGENCY DEPARTMENT. OF INDUSTRIAL IEUTIONS
DIVISION OF INDUSTRIAL ACCIDENTSMYORKERS' COMPENSATION APPEALS BOARD
APPLICATION FOR ADJUDICATION OF CLAIM
CASE No.
SEE REVERSE SIDE FOR INSTRUCTIONS
M r. MCKXMOi Social Security No.
IIRUTII'l milMI
:'* *
* IAPPLICADT. IF I T I t * TDAD ID J U D II ID P L O T R I)
U F F U t t i r i A P M I U ADI IP O D D I)
XHJTTTJ: FTflORS
1' ' ....
>1
2929 California St. Torrance.'
'
|lllTiri ilHIII)
AETNA INS. CO_______________
. 3?(hA56S
I lF H I C it r i TURPI
_358Q W ilshire Blvd.__ L. A . c a l i f .
U H H U o r l a t v u i e i h i m . ip i h i
90Q1Q
.
. ... 1
IT IS CLAIMED THAT:
I I ; I
- - 'lli
...
'. .
'
; V
1. The injured,employee, born.:__ 8 /1 3 /3 8
:, while employed.as a-- TflhQJI-P ool_^___ !__________________
r {f
. ], 1
4 DA p i I I I T I ] | " > r
(DC S IPATM D AT T i l l DP IliD C T ) .
'
on 1970-1975____________________ at *Porrance._______________ _ CaT tf n m ia ____ by the employer
.' sustained injury arising out of and in the course of employment to ------luncrs. railrmnary gyst-cm imia m i m n wmh 1 1 w iiui
2. The injury occurred as follows:---- pxpnsnre t-n ashg'.tns-
I ( S P U M I VD AT I I N . O T I I V A I D IM AT T i l l DP IDAS I T A l l D F IA J M T V A I I I C I D I )
J 3. Actual earnings at time of injury were:____ per .hour/ $5f) hours per itfpeV_________ !___________
^
,
. .
. ( -
| < m V ^ I I L T S D IT N LT U U I T t l N IV IL T I A T I ADD I U D I K I IP D M 0 M l I I D P e l m i l
I O f TIPD, S I A L I . L O T I I D I V I O T j l l l A D V A I f A I U A t l W l A l l V A IC C IV ID )
4. The injury caused disability as follows:.
IRPCCJ;
o p A U N * O M I f f H I r TRIP lA J IR T )
5. Compensation was paid____ _x.,1
*
I T il)
EDO) .
ITDTAL PAID)
lU IIL T U T II
, i . .. 4M T IM U IT N IIU T I
:
8. Medical treatment was received-------
4DAT! DF LAIT T IIA T D IIT ) All treatment was furnished by the employer or
insurance company___ --x. other treatment was provided or paid for by_
tr ill
id d i
( A IR PIIAD D ID A IID C T 0 0 * 1 * 0 1 M f A T l H
IIN U l CRM) '
Doctors not provided or paid for by employer or insurance company, who treated or examined for this injury are ;
(mil u u u u MMUIUu tacn DOCTO* miiuu n 'm aw n Hinia `KinnIKJMBIB} ' ........
7. Unemployment Insurance or .Unemployment Compensation Disability benefits have been'received, since the date of
injury------ --x --
,
SP255845
,
4T I D )
lilt
` ,
'
________________ ________ ; . .
SP255845
8. Other cases have been filed for industrial injuries by this e-mployee as follows:------n---i-c-i-n--e-iit--i-i-i-B--ti-i-a--n--c-m---m--i-r-i--m--ir--i- .,---- .
F tiL w e e A e r^w s e ie u *
(
iw---wo Ma*cwl
IR A A . GOULD. M . D -
I t i CAST t STH STA C CT, S U IT E 9 A NEW YAK. NEW Y O *K 10009 S IS SES*0 4 7 0
October 17th, 1986
Johnson, Tannen et al Counselors at Lav 225 Broadway New York, NY 10007
ATTN: Joel B. Rubin, Esq.
DOB: 8/19/20
Emp: Kentile Floor, Inc.
58 Second Avenue
Brooklyn, NY 11215
Carrier: ?
C.C.# ?
.
WCB# ?
DOA: To be established.
Date of examination: 4/7/86
Gentlemen:
Thank you very much for asking me to report in the case f Mr..
4 H H B H | ^ ^ r a s referred to me by his physician, Dr. Paolo DiStefano, for a pulmonary evaluation. .
SYMPTOMS (related to present illness, in patient's own words):
1) Shortness of breath;
2) Chest pains when coughing;
3) Pain in upper back;
4) Difficulty breathing.
(continued)
SP082270
Johnson, T&nnen et al Octobe?^17th^^L98^^^
page 2
SIGNIFICANT MEDICAL AND OCCUPATIONAL HISTORY
o worked for Kentile Floor, Inc. for approximately 30 years as a welder and burner. During the first 17 years of his employment at Kentile, he worked in a warehouse in which asbestos bags were stored, opened, and closed, causing him'to be routinely exposed to quantities of asbestos dust; asbestos tiles were also stored in this warehouse, likewise emitting asbestos dust. The patient's duties since that time have also entailed abrading copper, welding aluminum and cast iron, and burning pipes and steel. These activities produced clouds of dust, smoke and various fumes to which the patient was continuously exposed during the course of his everyday employ ment. He was also exposed to the asbestos dust produced by asbestos tile processing and cleaning of machinery in his immediate working environment. The patient states that protec tive equipment was not worn and that there were no windows or ventilation system in his working e n v i r o n m e n t .
On 6/25/85, Mr
began experience the onset of. a
dry cough. He was seen by the company doctor on that date and
was then referred to his private physician, Dr. Joseph Florio.
Dr. Florio prescribed antibiotics and ordered chest X-rays. The
patient improved slightly and remained stable until 3/5/86, when
he started coughing violently and vomiting blood. The patient
was hospitalized at Victory Memorial Hospital on 3/1*2/86, where
he had a bronchoscopy qn 3/27/86 and was diagnosed with chronic
bronchitis and possible asbestosis.
was employment since 3/5/86 described symptoms.
forced to permanently discontinue his due to the persistence of the above
Medications (related to present illness): 1) Theodur-- 300 mg; .1 every 8 hours; 2) Alupent-- 10 mg; 1 every 8 hours;
Smoking History: The patient has never smoked.
Presently Working: No
Last Day of Work: 3/5/86
, (continued)
SP082271
Johnson, Tannen et al
T3T7
October 17th, 1 9 8 ^ ^ *
page 3
OTHER MEDICAL HISTORY
Marital Status: Married
Number of Children: 2
Alcohol Usage: None
Other Hospitalizations: 1) Victory Memorial Hospital-- 8 years ago; Removal of fatty tissue on left side
2) Traumatic amputation of part of the right fourth finger
other Symptoms: Ringing in right ear
Other Medical Conditions: None known
Allergies: None known
other Medications: None
Family Medical History: Mother-- Deceased; Pneumonia
Father-- Deceased; Stroke
(ages unknown)
'
SIGNIFICANT PHYSICAL FINDINGS
Age: 65 Sex: Kale Color: White
Height: 68 inches Weight: 210 1/2 pounds Blood pressure: 140/76 mmHg Temperature: 99.0 degrees F
Appeared short of breath on minimal exertion.
Bibasilar dry rales heard on auscultation of the lungs.
Absent middle and distal phalanges of 4th finger of right hand.
Borderline digital clubbing.
.
(continued)
SP082272
9P0B2272
Johnson, Tannen et al
RE:
BI
October 17th, 1986
page 4
SIGNIFICANT LABORATORY FINDINGS
WBC: 8,4 00/cubic sun Grans: 53% Lymphs/monos : 47% Platelets: 252,000/cubic sua
HCT: 54% Urinalysis: Within Normal Limits
pH: 6.0 Specific gravity: 1.020
Electrocardiogram: Normal Sinus Rhythm. Left Electrical Axis. Small Q waves in I and AVL.
Chest Roentgenograms taken in the standard postero-anterior and left lateral projections: Multiple bilateral pleural plagues. Coarse linear densities in moderate profusion in both lower lung fields. Loss of lung volume bilaterally. Borderline heart size.
PULMONARY FUNCTION STUDIES
* Before bronchodilator ** After bronchodilator
S ^ Hi hr)
Peak Flow (L/sec) Forced Vital
Capacity (L) FEV 0.5 sec (%) FEV 1 sec (%) FEV 3 sec (%) FEV 0.5 sec (L) FEV 1 sec (L) FEV 3 sec (L) M W (L/min)
Observed
*
* **
9.0 8.6 10.2
2.6 2.4 3.1 69 70 64 86 88 81
100 100 96 1.8 1.7. 2.0 2.2 2.1 2.4 2.6 2.4 2.9
40 55 104
Predicted 8.5 4.0
2.1 3.0 3.8 128
% of Predicted
*
*
* it
106 101 120
65 60
78
86 81
95
73 70
80
68 63
76
31 43
81
(continued)
SP082273
SP082273
Johnson, Tannen et al RE: October 17th, 1986
page 5
PULMONARY FUNCTION STUDIES (continued)
Interpretation: Moderate reduction of Forced Vital Capacity. Moderate reduction of Maximum Voluntary Ventilation. Slight airflow obstruction. Some improvement in all tests after bronchodilator administration.
CONCLUSIONS
In view of the above, I have the following opinions with a reasonable degree of medical certainty:
Diagnoses:
1) Pulmonary Asbestosis; 2) Pleural Asbestos-related Disease; 3) Chronic Irritative Bronchitis; 4) Chronic Obstructive Airway Disease.
Pulmonary Functional Impairment: Moderate, Partially-reversible
Pulmonary Restriction. Minimal, Partially-reversible Airway
Obstruction. Moderate, Partially-reversible Reduction of
Exertional Ventilation.
'
Causal Occupational Relationship: There is a clear causal relationship between the patient's" occupational exposures and his development of Diagnoses #1, 2, 3 and 4.
Degree of Occupationally-related Disability:
Total
and
Permanent.
Prognosis: Poor. The patient's pulmonary conditions are expected to worsen with time. In addition, the patient is at increased risk of developing a malignancy.
There is a need for continuing medical care, and authorization
for this should be requested.
,
(continued)
SP082274
3P0B2274
Johnson, Tannen eh al
page 6
Recommendations for Therapy:
1) Avoidance of all pulmonary-offending agents; 2) Should not return to his usual occupation; 3) Avoidance of crowded conditions such as public
transportation; 4} Avoidance of inclement weather and extremes of
temperature and humidity; 5) Pneumococcal and influenza vaccines; 6) High fluid intake and expectorant; 7) Continue present medications; 8} Periodic medical examination and chest X-rays; 9} Periodic sputum cytology studies; 10) Home oxygen therapy might be indicated in the future; 11) Prompt treatment of any respiratory infections.
Thank you very much once again for asking me to report on Mr. Catuogno. If 1 can be of any further assistance to you, please do not hesitate to call upon me. I am available for testimony on the first and fourth Tuesday afternoons of each month at the Workers' Compensation Board in Brooklyn, N.Y. only.
In keeping with Part 22 of the New York State Sanitary Code (August 1, 1982), I have sent a copy of this, report to; Division of Health Risk Control, New York State Department of Health.
Sincerely yours
Ira A. Gould, M.D. WCB Authorization #094552-7 WCB Rating Code: CIM-PD
cc: Employer: Kentiie Floor, Inc. Paolo DiStefano, M.D. Workers' Compensation Board New York State Dept, of Health
IAG/jae
SP082275
SP082275
APPLICATION
STATE OP CALIFORNIA AGRICULTURE AND SERVICES AGENCY DEPARTMENT OF INDUSTRIAI RELATIONS
DIVISION OF INDUSTRIAL ACCIDENTS--WORKERS', COMPENSATION APPEALS BOARD
; .1 in o r.l\
FOR ADJUDICATION, OF CLAIM
QASE No.
SEE REVERSE SIDE FOR INSTRUCTIONS
Mr." MCKXM Social'Security No..
1IUc3 J.O f
(A P P lIC A M T . IP OTHER T H A I IP J U R I I I P L O T t l l
lA p P L IC lR T ** M M I I I M | | | | CHOCK .
1. ^fepti.le Floors
_
1. ^'^^C^iforni*RRLRT)fflTFnci^~Caif"
2--550 ,5. Alameda.,--- Mexnon,-- Calif_____ 1. Aetna Ins B"*"* 2 .-- Libert y-Mutual-Ins-Ca.--- ------
.,ls
320-3298
IIP P U C A R T 'S YRLfHMORE I
3580 Wilshire Blvd. Los Angeles, CA finafi w i i g h i r p riuyt t, . a f ca grimi;
..
lA P O R ttR QF IR R U R A IC I C A R * . IF A I T I
IT IS CLAIMED THAT..
1. The injured employee, bom___ 8/13/34-
"j'hl ! '
; T ^ ( * * T t O f fla p i . .
o n -- 1976 -- present11 1
i i .j
1 g */ f ;
-Lat.;--
, while employed as a-- minl-onanro mor-Kanji- (OCC,.TIO T II.
iMarron .
- Cal i fornir! , by the employer
sustained injury arising out of and in the course of employment to lnwjg, pnlmonaT-y gygt-om
IR TATa w h a t H i n of foot v i a l l a j v a a .
2. The injury occurred as follows:
IF i w i l l s
-pypn.si.ire to.a siestas
I I I P L A I I WHAT l O t t O T H VAR D e l i a AT T I M o r IHJURT A l t N O V H U N IT V A * R IC IIT tB
3. Actual eam ings at time of injury w e re :_____$ 4 On p o r- h rm -r-/ 9 0 Vw-inr.g p u r- u n r V
' 1
1-a;-
___ i 11_Li-__:
... ; |fTlVl"*"".* ' '
s . .-. ]. . ----a---------o----r----- M R V O Rjf t,l :PaC I-V K I t )
IR A P R A T IL T A T I V A L * P C I t i l l 0 MONTH V T IP I. I K A L I. L O N I I I HR R fH fc t IPTAMTARAR HINULARLT H C C C I t |
4. The injury caused disability .as follows: .
. ___ ______
. : ,,, - _________ ____________
...... siapn.y ..-i ; i,:.ui'anci oar ;i i ) ,
! ...
.
. . .
( i P f C i r r LAST 3 * r o n O l i SRC TR TH1 IR iR lT IR R i l . l l . l M . B I M f t i l . D A T M R , A IA F lllo n
BUA TR T M ia 1 1 , B I T )
L- 5. Compensation was.paid
-XX.'Ai
(T IS I
'la
, - ,
J
L' :- 8. Medical!treatment.was received i___ y .^
L.|.'ij
... )( K I L T IA T I )
.
i zi
(.A T I.RF tURT FATICATI
i-vu 4.'*IrwthnepSy*s fugushedby^ft empii.
I.:|.C .\hi ... ! ,,
(IR| ~
I P A T I OP L A IT IR R A T ItR T
insurance com pany___ . other treatment was provided or paid for by_
I, .
I T I R I -< >
. .
...
I I A I I F U R O R OR AOCOCV pR O T lp IR OR PATIRR FOR H I M CA l CARA I
1 ..............
* L I . I
. i; h
. . L %. r . -j,
Doctors-not .provided or paid.for_.by psiplqy;>pr jrvsuramjecompany, who treated or examined'for this injury are
. {S IA T C A R R IS E R O A P P I IM C 1 CP SICH OOCTOBR A IO P A R IS PP HOSPITALS TO VNICR SUCH P O C T IIS A B R I T t t * I O J 0 1 I I ) ' T7I77TZ TXr"
7. Unemployment Insurance or Unemployment Compensation Disability benefitshavebeenreceivesinc^th'date of
m jury-------_ -je t-
(V I )
(HO
S. Other cases have been filed for industrial injuries by this employee as follows:. (IM C irV C R I RURRIR R R C ITf WHIRR VILRR)
9. This application is filed because of a disagreement regarding liability for: Temporary disability indemnity__y
Permanent disability indemnity___ x _ TteimKiarseineni fn^mdirai erpeiuu-. X ^
irv-aijT^TiF r . x v
Compensation at proper rate--X__ Other_____Specify:________ '
............... .
and applicant requests a hearing and award of the same, am^ipr all other appropriate benefits provided by law!.`/
Dated at_
Tnnrj Rpar-h ' i ; ' 1 I. IOITtI.) L.
i. I. y. .
FELISA R. NAYF/CK" '"
~ -- TOO -,
'
3fiBR rh v s rry Av p .__ T r t n g FWic h .
90907
, California, "1/24/79'
APPLICANTE* MOiI nmii yr
P ie n te file s ig n e d o rig in a l a n d s ix c o p ies
--F --*.* ... - --- -..J
'
*
S 6 2 3 W EST O t ' w *r B O *
SuiTC 6 0 3
LO S A N O fL T S C A LIF O R N IA *.3016
`'
PHONE 1 2 t 3* 3 8 I 3H ' I 3 8 S 1071
STEVEN O S fW *N ANTHONY J 0R A SS * ROBERT T CROTOOT
ROBERT C BANC EDWARD A V lL t.A l.0 8 a S COWARDS OACh ON FELISA R N A v P A f ANDREW M NASM STEVEN M BARR* JOHN M SHERMAN
'
LAW OFFICES
STEVEN ROSEMAN
ATTORNEYS AND COUNSELORS AT LAW
January 26, 1979
Workers' Compensation Appeals Board 6450 Garfield Ave Bell Gardens, Calif 90210
Re: V I M I I M M M F VS FLINT-KOTE & KENTILE FLOORS Liberty Mutual & Aetna Ins Date/ Inj: 1976 - present
3 6 8 8 CHERRY a v e n u e LO N G BEAC H C AU FO R N IA 8 0 8 0 ?
PHONE013)89S803t
o*eoiHUL ALFRE D BO RN STC IN
JCRROLO 5 FREED
O* COuNtCL
Gentlemen: '
Enclosed please find original and
six
copies of applica
tion filed on behalf of the above named applicant.
By copy of this letter, we are this day serving a copy of the application on the employer and/or the insurance carrier(s) named above. In accordance with the Rules of Practice and Procedure, request is made that said named parties serve their entire medical file upon this office within ten(10) days of the date of this letter.
Demand is made that this office be served with copies of any statements taken of this applicant.
PLEASE RETAIN THIS CASE OFF CALENDAR TO ALLOW APPLICANT'S COUNSEL AN OPPORTUNITY'TO INVESTIGATE THE CASE AND REVIEW MEDICAL REPORTS.
FRN/ra
enc: cc: LIBERTY MUTUAL INS.
6006 Wilshire Blvd. Los Angeles, Ca. 90036
Very truly yours,
m iiiiin iiiiiiiin ! SP255042
LAW OFFICES OF STEVEN ROSEMAN
*
.
BY FELISA R. NAYFACK
AETNA INS CO 3850 Wilshire Blvd . Los Angeles, Calif. 90010
jnfjfc 9 `1973
' v?? GLVi.iO
STATC OF ILLINOIS
INDUSTRIAL COMMISSION
160 NORTH LA SALLE STREET CHICAGO. ILNO' S 30601
r* i I AMEff^EO iPP..iAVotV-rtan a d j u s t m e n t of c l a im
"Britii -i 7Tri'B (Fite fa ir a i of this form)
M nk*t` C W " y'g (blUUGUO&H<Htf
/
MPLcr.:a -esTiTir-rjSRdAA)
8 3 CID 7 6 8
_Z_
{OFFICE USE ONLY)
/ KEMTILE FLOWS, INC.
S V 'u w V E fi - R K ' JN D iN T (3AAJ
i r-
lOF'C I USS ONUV1
The P e t it io n * '* '^ , t foH s-ring particulars re!.Y.rre to this A x ^ s s iio n under th e provision of die W orten*
Co.Tioerjnion c.~ Jecupatfgne: D jqm 4-:::
.
/ i o . K e n t i l e F l o o r s , I n c . / ,, ,532 s . K o l i n ________ / ' n , C h i c a g o , I l j / u , 6 0 6 3 2
M-UACO SM F L O ' S S 'S H A M i I! AA.JAA1
DEPENDENTS
NAME
AGE RELATIONSHIP
(Atraen separate i h m for more than (our)
Is Petitioner currently reenteing Temporary Total OiMbiltty Benefit In th e proper amount?
Y e a OC N o . . ............. Hat Petitioner Returned to Morte?
S Y O N o ..................
How did Accident or Ulne occur iTyoe)?_
Part u l Body A N e c ttd ? .
In ju r e d a t w o rk
Body -- Lunga
Natura o f the l n j u r y ? _
Hat a p r'or Application bi-en filed w iih the Industriai Comm iu io n bv elltioner or on Pniitionet'i iMhdf?
K ^es No
If yes.give number ndd;s|iOMon, if anv: - 8 3 OD 7 6 8
ClTi
or Lart Exposure
City
XlFeODK
TI 1In n i n Su m
Phone Number
/ ' 9.
.......
Social Security Sex
/a a.. M a la
pn S in a ia
Birthdate
Gross Weekly Wage (Exclude Overtime)
tn 0 m. 1
n S .
1-2
-
in e lfte s s 350. 00
29 o r
Date o f Accident, Last Exposure,
Disability or Death
728. 5 - ^ 2
Month
Day
- 81 Yaw
fa Petition for Immediate Hearing Attached?
Return to Work Date
V Ym
IS Ms
2/ a.
-
Month
Dry
Yaw
Commiuion Uie Only
_/29, _
_,30. _
How did Employer get / 3Z S Orally Motlea of Accident?
We Employee given <33- (3 Yes Industrial Commiuion Information Handbook?
Written
fJCTS TO f -: PFTIT^Itif R THIS is A L^rJAL tXJCUMCNT. ee SURE ALL, T H ABOVB SLMKS #RF FILLED IN 1 m e e n y an o tm /
YOU HAVE -TEa O A?Jl< U<0:RST&QD TW STATEMENTS BELOW BEFORE YOU SION.
0Te.j3<._JlQy.gb.a.!_lj^ lSj-,. 0 S E:Q l i X S lby' kot et n MtKliealU"
canity )M I new nrt cUrscr:* or InOiMeJy eliciWd wnflloyrnwit by tho Fvilnonar, m m r n .('o n e r U wiy o e n o n UM tu rw yj|*0 mi th e W o * n * "i ( myi jr in y nu m o w o1 my 11m. A a o e r A n d re
ReorpMAtMte A p .iy rr* '- - - . - i . t - m * Apoliceiion te r M m h w im e t Claim.
fa THOMAS R . ATTOHNEV IJAAI
W IC H TEN
fa K a tz , FIRM NAM
F rie d n ta n ,
S chur
6 E a g le
'f a C h ic a g o , C iv y
Illin o is STATE
_
,.J L ^
_
5<u<H<rYuxe
P</J
60603 Zie COOS
fa 7 S . D e a rb o rn S tr e e t
2 6 3 -6 3 3 0
C'JCi.wJ.uUfc .'f This INFORMAfiON TO THE INOUSTfilAL COMMISSION 13 C N * VOLUNTAfLT
UOSA IL.PEV.|T*T. CM.4B *^34f..JlFFROViD UV F0f\MSMAffAGEJUEN",
T .
SP051696
h-'
STATE OF ILLINOIS INDUSTRIAL COMMISSION
100 NORTH L> SALLE STREET CHICAGO. ILLINOIS 90001
AMENDED . y- f\ APPLlCATIOf^FOa D^|STiVnKyT OF CLAIM
(Sila four eoBin o f this forni) .
1. Work ara* Cam
QuMrtanti O
Siili 'a...,
^ -- :--
COMHlfy-"
Crnttartan
{OFFICE USE ONLY)
/`- ^ b i
EMFLOViS PETITIONER(lAAl
S3 VIC 039415;
KENTI.LE FLOORS, INC, ; sMPvoniR re*o.noent (Sani
to.
(OFFId USIONLY)
Tha Parltiontr M'epei ilia f.v'iowing oartlcciart raia-jvi to th h A-.-.'icatian unitor tn t prov ik.* o f tha Werkes*
Co.-npar-sMia^ nr Qgeuien.or.Bl D l t m A ft:___________________________
.
K e n tile rloo irs, Inc.
EKFl.O YEA'S NAME JAA
4532 S. K o lln
/,,.C h icg a o , i l . / n . 6063;
irU UA SO EM FtOV EE'S NAUE (IA A /3A A I
DEPENDENTS
NAME
AGE RELATIONSHIP
(Attach parata ihaat tor mora than four)
h Patitienar c u rrm ijy r e liv in g Tamporary Total Disability Banafla In t t propor amount?
3 H C N o .................. Ha Patliiopar, Ratumad to Work?
a y a t O N o ..................
How did Acsidant or Itlnau occur {Typa|?___
Part o f Body A H * ad?_
Injured at work Body
Natura oF tha
Hm a pr*or Application feaan filed w ith tha Industrial Com mission bu Patiti on*r or on P ttltlonsT i M nall?
B|Yn No
Ily a s , givi fwmbm ndHiiooilton. if anv: 9 3 MC 3 9 4 1 5 _
c ity
,
a
Locailon of Accidant via. Chicago/
or Last Expowra
City
.
zie coot Illlnola
Seta
Phono Numbar
Soda) Saeurity
Sox Marital Statut T o u t Drpondtna Birthdoto
Grow Waokly Waga (Exduda Ovartima) Dan of t L a it Exposuro. Disability or Daath
;>i Mala tn Single
;2io____
;24.!!__=_
29
In excess a l l
On o r bout iM- * - 30 - B I
Is Patltion for immadiata Haaring Attachai?
S No '
Actual or Anticipataci Ratum to Work Oata
Commlnion Usa Only
_ /2 9 ______________________
an
-`31`
- - _____
How did Employar gat 32. IS Orally W rittan Notica of Aocidanc?
Was Employt givan *33. S3 Ya*
indurtrisl Commission Information Handbook
O No
rts PETlTlONEF T his l i A LEGAL DOCUMENT. 88 SURE ALL THE ABOVE BLANKS /.RE FlLLED^IN CORRECTLY ANO TM
REAP ANO wMtitHSrOOO THE STATEMENT! BELOW BEFORE YOU SIGN.
.
/
November IB. 1983
<
~ ______________________
I hirM y n i l my udomm n m auomay lar Pklitiontr *na cortily iKai | ham not der* o t kndiracily He ft amdaymtat by tha Pofitkanar.
iwKm of no ikiisMan of ia-C Patriiaarr by any Parian tha bai rtMiiad in in i mpleymwit ei mywtl m f*y mwewef my^tW*. Aeepy of A n n
Raaratanmlbk Afraamam is tUMt a itn mi* Application lot Acjutimant of Claim.
>
Aa THOMAS R . LICHTEM
a t to r n ey ija a i
As C h i c a g o ,
CITY
I llin o is STATI .
60603 x ia eo n a
/je . K * tz , F r ie d m a n , S c h u r t E a g le FIRM IAMB
/ . jts * ~ * - *
'.
SlC N A T U M
/s7 , ? S . anom s
. I.C .itM ll
D e a rb c rn S tr e e t
/ 4 0 263-6330
Tatam toM E no.
r.tSCLCSCRf. O FTH ii INFORMATION TO THE INOUSTRtALCOMMISSION IS SORE VOLUNTARILY
UN0ER U. P6V.STAT.CH.4g.i38i, APPROVCO BY FORMS MANAGEMENT.
:
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W ORKERS' C O M PEN SA TIO N AT TEALS B O A R D
p tv ta to N o r iN O M m iiii a c c ic wt
D KPAflTM C M T O P IN O 'J fT N iA L H C U r iO M I
STATE OF CALIFORNIA
R e c e iv e d
JL/L2 9 7532 .
A\y OFF/CES O r
COMPROMISE AND RELEASE (Dependracy Claim) (Partial)
CASE f o E k ^ ^ ^ 6
(M r.)
'
x(Mr*)
( M lu)
SOCIAL SECURITY NO- '
BETHLEHEM S T E E L CORPORATIOM
c/o Associated Claims Management, Inc -BOX 939.6 . Walnut Creek. ca
-il
S E L E --IW S O R E D
T he parties hereto, fo r the p m :c n of fnm prn m ite only, a g ree a fa B w n :
1 T h e s b o v e - H u n e d a p p lic a n t__ c iirm S A j t - J W B f f B B B B M i _____ !___:______________ ___
S a n F r a n c i s c o . CA _______ 1 ................_
-- 3 /7 /4 2 tro u g h 1 /3 0 /4 2
-while e m p lo y e d t
by- B e t h l e t i e a S t e e l C o r p o r a t i o n
d n t a n n e d u to e t t f a i f c o e a p e a a tia n VmUBty
*>r- S e l f - I n s d r e ^
-- on* to e d injury aristaf n o t o f a n d to th e c o a c to e f .
e m p in y y ^ faiv .- e x p o s a r c t o a s b e s t o s - tn e x p t h e l i o m a
j . The d o th o f said - " f l r y
d -- F e b r a a r y 2 S
i fl 9 1 u r e m i t o f t h e d s i n d iafimy.. ' : -
1 T i e i e t a a l w e e k ly m a g a o f th e n f t o j u n 'n t t h e t t o e t i e ta rm e d w y u ry m a r 111 d i a U t C -----, n e e r r i m i r 1\1 j
maga (iu ia wqr}w
in fitta
;.
' '
.- . .
.
4 Taym aX t of unijwwtorto to &e tm pfm to U s B o t o t t o m a t o f the Afawifl ig f a q r n m ___ WP -- .
Waiter*'
.4 TSe p arta h e re b y tree to ettJe *m j and I A t o l of i o f aaU --a p la y e b y p a ym ent o th e a n a f t 3 , 0 0 0_ j.0 0 _
ap p ro v ed a tto r n e y fe e .
>accotait ef the rtohnrd tofn>7 w f the death , p iy sh k a i (bQows t
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7. T h e p a rtie r h ereb y e p e e (Si n d iteTM * ip w e b e d o m e d ) A a t M edicai, h o sp ital a d W d expeoae re q u ire d b y
-- .te a afiK u T l-g e d injury an d the dealh o f th e o p in ili A lti h e h o m e m fa llo se - H O t b y d e f e n d a n t B e t h l e h i
S te e l C o rp o ra tio n
__________________
' _________ 0 *-*''*'*
;
A. T h e n a m e a n d a d d re s s o f applicant*] a tto rn e y ( if any)* J o h n C . S m i t h y J r , 1 6 5 F e l l S t r e f c
San Francisco, CA 94162______ _________________ __________
w ho requests a fee of 1 4 0 0 . 0 0
, having been previously paid | M*?Ge
9 . R easo n fo r ennrpm n ..v . <tto ^ f - t a r h e d R eason f o r C o m p r o m i s e a n d E x h i b i t A
1CL The undersigned request that this compromise agreement and release be approved.
H . TXpoo a p p r o v a l o f th is co m p ro m ise a g re e m e n t a s p ro v id e d b y la w , a n d p a y m e n t m a c c o rd a n c e w ith th e p n'-f t ; .
said o rd e r o f approval, said applicants an d each of them d o hereby release and fo rev er discharge said em ployer ~ t ^
. f a n n a n c c c o m p a n y o f a n d from a ll rta im s . d e m a n d s , a ctio n s o r c au se s o f a c tio n , o f e v r s y k in d o r n a tu r e a i m m i m r-- acc o u n t of, o r b y r e w n o f the injury a n d d eath sustained as aforesaid by th e em p lo y ee, an d p articular o f any, a ll and
e v e r y d a m o r c a a s e o f a c tio n w h ic h th c r.a n d e n d g n e d . h c its , executors, re p re s e n ta tiv e s , o r a d a sm istra to ss m a y b a s e h a d ,
now h av e, o r sh all hereafter have against said em ployer, raid'insurance carrier, a n d e a c h o f them tinder. D i v a t e IV o f
Labor C o d e of the S tate o f California.
'
-
.
.
1 1 I t ia a g r e e d fay aD p e rrie s h e re to th a t th e B in g o f th is d o c u m e n t is th e filing o f m m r l f --i f i m tat h rli ilf o f I l a I q ifu l i t ^ . a n d t h a t 1 a w y b e a c t fo r b e a rin g a s a r e g u la r a p p lic a tio n , re serv in g to th e p a r tie s t h e r ig h t. to p o t i n i o n e a n y c f tfae facts a d m fttrri herein, s a d . th a t if b earin g is held .w ith this docum ent used as a n app&Lialioo the d e fe n d a n t s h a ll h av e . variable ta th e n all d e frm rt that were' available as o f th e date of flin g o f this d n r a n e n t, an d f la t II n ra y j s f f o w d . f e a pao u l. o r a 'd erision issu ed a fter a bearing bar been held and th e a iy ttc r regularly ;
X3L F o r t h e p a p t a t o f d e t er m in in g th e R en d a i m B e d b r i a fo r th e u n e m p lo y m e n t c o r o p m n r i o n d h a b f lity n a d / n
ploym etrC tian p iitarirai 'b en efits' w h ich h a v e b e e n p a id a n d e s o r p u rsu a n t to tir CiaE tre n ia UnemploynseTO h
o fj th e p e rrie s propose th e fo O o w ia g 'd irisio a o f th e so m a g re ed u p o n fo r settim a*mad td e a s e o f th is i
* . o n e ----------- ;------- f t * te m p o ra ry d is a b ility c o m i n g th e p e riod : -- .-- i - .
None
-fo r accrued m edical expense p aid o r incaired b y the e m p ic a n .
Bone
-fo r fatare m edical
one
-for permanent dinMSy.
f O n a b o v e s p v p t i n m u st b e fofo s a d rea so a a b la a d d a n * b e b ased o a th e rem i b e t s o f d m t to dep riv e th e ben claim an t o f a n a so n a b la recovery oondstrnt w ith aB d ie ansa
knehndL)
mN otary P ublic to m td fo r (Ac ta id C ounty mad Slate, redding therein, d u ty oonun lrr ion e d mad sw orn , pertoaoBy apprm m d
ig w v a to m e m h r the / em bteribed to the m f u r m * a n d ech u n d ed g ed fa m e that -- b e __ e x e c u te d the nem o.
I s W st m t s s W n r s o r , / have hereunto m t m y hand and afile d my o fic ia l teal the d a y <
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REASON FOR COMPROMISE
APPLICANT'S BLUE: Ruth Cape 11
WCAB NO: SPO 3S0286
The principle issues are injury arising out of and Incurring.in the
course and .scope' of employment; Statute of Limitations;
Jurisdiction of. the Workers' Compensation Appeals Board; nature,
extent, and duration of disability; liability for self-procured
treatment;, death as a .. r esul t ' of the alleged injuries;
apportionment-
The Applicant desires a lump sum certain and settlement. - Defendant desires to boy peace and parties wish to avoid the hazards, delays, uncertainties and expense- of further litigation. The parties expressly agree that the proposed-settlement is meant to cover all aspects 'of the -injury alleged herein as to Bethlehem Steel Corporation only. ' . ' - ; " ' '. .-I
I have been advised and fully understand that this Compromise and
Release agreement releases any and all claims t o 'death benefits
relating to. the injury -or injuries covered -by this Compromise
agreement. . <
'' . ;
X serious and good faith issue exists over AOE/COE end Labor Code-.
SP452754
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EXHIBIT "A"
APPLICANT'S HAKE: Ruth Caoell
-.
WCAB HO.: SFO 350286
.
Applicant has been fully informed of her rights in this Batter,
including the following:
. .'
. .
'
1,. The right to have a full hearing before a Workers*.
' , Compensation Judge, to determine 'rate of disability and
. - - benefits,' if any, if so ordered b y the Workers'
Compensation Judge. .
-
2. That there is a possibility that upon hearing of all/
. issues,! Applicant say be awarded ore or: .less than t h e 1
..
aaount in th e ;Coaprosis* and Release..--t ::'
.
.
. -
. .
. . `i
C'tr-;' '
.. ...3. Applicant,.by -signing this agreeaent, fully.realizes that
. `
. , ...
. 4.
defendant , will
expenses. >:.
- That Applicant
not be responsible for any further
\
' ; . .- '
<rr .. :
. . . .
understands that .this -CoBpraulse . and
Release is a final settlement of her clain against
'
Defendant.
That upon approval ' by the Workers'
Compensation Judge, She cannot fils a :furtAer'claim for
.
asbestos and noxious fuses related injuries against said
. . defendant. . . .
. ;
. ."
Applicant .by. bar signature below, acknowledges that she fully
understands the above and freely waives the rights enumerated h e n .
SP452755
007
W 222 hast 90th P la c e Chicago, Illinois GQ619
312/S7-1-5746
September 20, 197-1
State of Illinois Department of Labor
Ms. Harriet Pacini
Labor Standard - Labor Board
Boon 1400
ICO North La Salle Street
Chicago, Illinois G0601
Dear Ms. Pacini:
Enclosed please find for your inspection a copy of a letter from my former employer KENTILE FLOORS, INC., dated September 12, 1974, informing tze that I have been terminated.
My n,ama is Leon Stevens, social security number 352-18-4985.
I have been an employee of Kentile Floors, Inc operating out
of the Chicago Branch for twenty-four years anu ten months,
r.y date of hire was November 13, 1949. On August 2S, 1974, at
the doctor's instruction I entered Veterans Illinois Reserach
Hospital for treatment to a snail ulcer on my left ankle, 1
run still hospitalized. There is also still a question as to
v.hether this ulcer developed as a result of being in direct
contact with certain chemicals at Kentile.
.
I am writing to- you in the hopes of obtaining help - a recourse
of some kind with regards to ray lost employment. I can not
believe that' after so many years of service an employee can be
terminated with no more than a short note, and four weeks of
severance pay { hardly sufficient ) which I have not even
received as yet. There was not even any mention of my profit
sharing distribution.
/-- ^
\
I am more than willing and eager to take any steps that you
'
feel are necessary, obtaining counsel or whatever - in order
to secure ray future which at the age of forty-nine, married
with small children to support, seems quite bleak.
Thank you in advance for any and all help you can give me and
.
I will await your reply.
.
Sincerely, LEON STEVENS
//-//-// - O ri* H-f-s'Z - - `K-
l S Z J O t f y S <4/ 0
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- e-z.c>-7f- Ci/Om* r o*. C , ^ r i/a /2. -3:
cc: Mr. Loff - Kentile Floors, IncT
.
Personnel Department - Brooklyn, N. Y.
s g k/>cj f**y jLe -- y'A
S. E. Tallo, Sr. - Kentile Floors, Inc. Plant Manager - Chicago, Illinois
/ O - /' i*7 - *7/ -- -OLs - iste e7 7 , r /?a/aZ'^4.
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7 ~ o S- 7/ii.LO
& - Z o - 7 <t- - , C /? <-c/o e j e
. SP167859
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