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FILE NAME: Contract Unit Workers Comp Claims (WCC) DATE: 1962 DOC#: WCC002 DOCUMENT DESCRIPTION: Workers Comp File - Harding, Clifford P Contains all documents found in the Claimant's file, with one blank page between each separate document i r tt BALTIMORE NE^jf' YORK t ' CLARKSBURG TULSA STI LOUIS. CHICAGO Lt)S ANGELES TLANTA PITTSBURGH SAN FRANCISCO NEW ORLEANS MIAMI PHILADELPPffA AU2XATCJD92IR A uexaxdiei INCORPORATED INSURANCE ' AVERAGE ADJUSTERS (CONSULTING ACTUARIES 2225 NORTH CHARLES STREET, BALTIMORE 18, MD. February 27, 1962 Mr. William L. Hughes, Manager Insurance Department Armstrong. Cork Company Lancaster, Pennsylvania. Travelers Policy No. HUB-4490459 Dear Sir:- Please note disposition made of the following claim: Date of Accident: January 9, 1955 ,, Claimant : Clifford P. Harding Location; Sacramento, California Claim No.: B 9527634 Disposition: 50.57 Perm. Partial Remarks : v\^ J TELEPHONE TUXEDO 9-A3CA BELL SYSTEM TELETYPE BA 582 CABLE ADDRESS "ALEXBLUE" Indicate Whether: Workmen's Comp. x__________ Auto Liability B. I._____________ P.D._________ General Liability B.I.________ P.D.______ sg Very truly yours, ALEXANDER & ALEXANDER INC. LOSS DEPARTMENT INTE OFFICE COMMUNICATION To J. E. Zeller, Lancaster From A. L. Stokely, San Francisco Subject Clifford P. Harding Claim No. 60 SF 193-854 CONTRACTIN September 29> 19^1 Attached for your information is the order approving compromise and release on the above subject man who had made a claim for Asbestosis. FORM ISO! Printed In U.S.A. Re : CLIFFORD P. HARDING - Claim No. 60 SF 193-854 By AMERICAN MOTORISTS INSURANCE COMPANY $ 84.28 By AETNA CASUALTY & SURETY COMPANY 370.81 By GUARANTEE INSURANCE COMPANY 286.54 By ZENITH NATIONAL INSURANCE COMPANY 33.71 By PACIFIC EMPLOYERS INSURANCE COMPANY 101.13 By ASSOCIATED INDEMNITY CORPORATION 33-71 By STATE COMPENSATION INSURANCE FUND 1934.72 $3300.00 IT IS FURTHER ORDERED that STATE COMPENSATION INSURANCE FUND deduct the sum of $352.00 from its contribution to be paid directly as follows: $300.00 to Smith, Parrish, Paduck & Clancy as an attorneys' fee; $22.00 to Smith, Parrish, Paduck & Clancy for transcript of the deposition; $30.00 to Norbert Frey, M.D. A H N :mlm A. H. NELSON, Referee INDUSTRIAL ACCIDENT COMMISSION Filed and served on: Clifford P. Harding, 1407 Howe Ave., Sacramento 25 Plant Asbestos Co., 1300 - 64th St., Emeryville J. T. Thorp & Sons, Inc., 1351 Ocean Ave., Emeryville Metalclad Insulation Co., Inc., P.0. Box 178, Torrance Caw Insulation, 3600 - 20th Ave., Sacramento 20 Dutton Asbestos & Supply Co., 532 Natoma St., SF Armstrong Cork Co., I8l4 Ogden Drive, Burlingame Coast Insulating Products Corp., 2684 Lacy Street, Los Angeles 31 C. F. Braun & Co., 1000 South Fremont Ave., Alhambra .Owens-Corning Fiberglas Corp., P.0. Box 89, Sacramento Jackson & Hopkins Co., Inc., P.0. Box 490, Bakersfield Marine Engineering & Supply Co., 941 East Second St., Los Angeles Fluor Maintenance, Inc., 2500 South Atlantic Blvd., Los Angeles 22 M. R. Carpenter, Inc., 907 Front St., Sacramento 7 Western Asbestos Co., 675 Townsend St., SF 3 Industrial Indemnity Co., 350 Sansome St., SF California Casualty IndemnityiExchange, 550 Kearny St., SF Standard Accident Ins. Co., 840 West San Bruno Ave., San Bruno Travelers Ins. Co., 550 California St., SF Argonaut Ins. Co., 550 California St., SF American Motorists Ins. Co., 417 Montgomery St., SF Aetna Casualty & Surety Co., 220 Montgomery St., SF Guarantee Ins. Co., 550 Kearny St., SF Zenith National Ins. Co., 582 Market St., SF Pacific Employers Ins. Co., 244 Pine St., SF Associated Indemnity Corp., 332 Pine St., SF State Compensation Ins. Fund - Personal Service -2- Re: CLIFFORD P. HARDING - Claim No. 60 SF 193-85^ Filed and served on: continued Smith, Parrish, Paduck & Clancy, 501 Financial Center Bldg. , Oakland Hanna & Brophy, 15^0 San Pablo Ave., Oakland Sedgwick, Detert, Moran & Arnold, 100 Bush St., SF - Attn: Gordon Keith Mullen & Filippi, 315 Montgomery St., SF J. Patrick Goodwin, 4l Sutter St., SF -3- CLIFFORD P. HARDING A. H. NELSON, Referee September 21, 1 9 6 1 vs. PLANT ASBESTOS CO., J. T. THORP & SONS, INC., et al Claim No. 60 SF 193-85^ Inj: Asbestosis REPORT OF REFEREE ON ORDER APPROVING COMPROMISE AND RELEASE Asbestos worker, born February 28, 1 8 9 6 , claims asbestosis as the result of industrial exposure in employments for numerous employers going back some 15 years. Overall, including his employments in the industry in various out-of-State localities, he has a history of approximately 3 0 years of intermittent exposure to asbestos dust. The record shows that applicant continued working until May, 1959* when he was seized with sudden severe chest pains. He was hospitalized on a diagnosis of coronary occlusion. Chest X-rays taken at that time were interpreted as showing evidence of asbestosis. It is now proposed to settle the case by the payment of $3 3 0 0 .0 0 , nothing having been paid heretofore. Concerning the present cause of disability, Dr. Horton C. Hinshaw, Jr., states as follows: "The degree of asbestosis evident on X-ray here would not be expected to lead to heart disease, and also the type of heart disease produced by lung disease is quite different from disease which leads to coronary occlusion, which this patient apparently has had. Consequently, it would be my opinion that his heart disease is a separate condition and not directly related to his asbestosis". On the basis of pulmonary function tests, the doctor concluded in his final report that the patient's symptoms were to a large degree due to his heart disease and not to asbestosis. Indeed, on the basis of diffusion capacity test, it was his judgment that the asbestosis was so mild as not to be disabling or productive of any symptoms. In an earlier report, Dr. Norbert Frey, on behalf of the applicant, had concluded that the patient had a moderate degree of pulmonary fibrosis, which was productive of some shortness of breath. He expressed no opinion concerning the industrial contribution to the over-all disability. On the record, the settlement is fair and adequate. DISPOSITION: Order Approving Compromise and Release to be paid to said applicant, less $30.00 to Norbert Frey, M.D., and less attorneys' fee of $300.00 and reimbursement costs of $22.00 to be paid to applicant's attorneys out of the amount- payable by State Compensation Insurance Fund. AHN :mlm A. H. NELSON, Referee INTE OFF!C COMMUNICATION To J. E. Zeller, Lancaster From A. L. Stokely, San Francisco Subject Industrial Accident Commission State of California Case 6o s f 193-51* Attached is a notice of time and place of further hearing in the above subject case for Clifford P. Harding. I note that we have been served as Armstrong Cork Company, l8lU Ogden Drive, Burlingame. I also note that the Travelers Insurance Company has been served. DJM Form 33377 6-59 Before the Industrial Accident Commission of the State of California CLIFFORD P* HARDING, 6o s f 193-854 Case N o.______________ Applicant_ V vs. / WESTERN ASBESTOS COMPAN?, et 1 and STATE COMPENSATION INSURANCE FUND, et el. Notice of Time and Place of Further Hearing D e fe n d a n t__ 3 NOTICE TO ALL PARTIES You are hereby notified that further hearing will be held in the above-entitled action at 631 J Street - Rooa 507 Sacramento JUNE 27, I96I 9:00 .M. - ALL DAY Dated at: San Francisco, Calif May 1 8 , 1961 ALSO TO COMPLETE CASE JUNE 28, 1961 9*00 JJ! -- ALL DAY INDUSTRIAL ACCIDENT COMMISSION NOTE: CONTINUANCES AND FURTHER HEARINGS ARE NOT FAVORED. SERVICE UPON: Served all parties as per attached list- 5-18-61 AM F o r m 4 0 0 <r e v . n - a e ) II1K 4-60 40M i93-->5^ - Ci.pi t'.-H!) K lABDw KAMI'S OF PARTIES 3KRVEBs PATE GF SERVIC Cliff era P, H&rding* 1407 How? Ave* Sacramento* 25 5 " l2-6l Smithy Parris-h, Padduck & Clancy* 501 Financial Center " Bitig,,, OaklendL* Jf, Af-tn.5 Kr. Lewie K,, R, Carpenter.; Ire, 90/ Front- 3t0., Sasrais&nto* ? " Fiberglaa Engineering & Supply Di v, 10-41 Fee-Dr* Saeto " Fibcrglas Engineering & Supply Di'-r,1200 - i?th St ** Sf-7 " D-n Caw Insulnticn* 3,600 - 20tn Ave, Sacrar'yer.te, " Jackson & Kopkirun* 115 Cak St* Bakersfield* !t Western Asbestos Co. 675 Twnsstri St* SF--3 r! Button Aebei'to?, it Supply Co** 532 Matcr&a St,,, SF-3 " Armstrong Cork Co,.. ;i8i4 Ogden Dr,,t Rurllngscss, __ " A , 1, Thorps k Son,, Sncf 1351 Ocean Ave* Eiceryville* 8 " Plant Asceston Co, 1300 - 64th St-, Emsryvilie, 8 P.c-talolad Insulstlon Co* P.,0,. Bc;t 178* Terrance* " C.. Tc Braun A Co, 1000 So Fremont Ave*. Alhambra* " Coast Insulating Products* % Argonaut Ins Co* 55 California " St,,* SF-4 Fluor Maintenance, Yxc* -% Arseelated. Indemnity Co,., " 332 Pine St * SF--4 Stile Ccmpensction Insurance Fund,, Personal Service Irnas-trisl nsssnity Co* 350 S^nsciae St, SP-6 " Ac"S1 Casualty is Sursty Co,, 220 Ainuneemery St* Sf=6 s: Attn| R E., Lhie;- t Supt:, Arrerican Motorists Ins vo * -07 lic-ntgomsry St, SP-4 " Pacific Employer Fr.-?. Ce , 44 Pine St* SK-4 Attn; S< K Hays " Anucdated Indemnity Cerf.* 32 fine St.,, SF-4 " St i-rnar.rd Accident Ins Cx f. 840 W San Brune Ave * San Bruno* " Travelers Ins Co, 550 Cal lierais* St* SF~4 Attnj Claims Dspt " Argra-.ut Insurance Co* 550 California St* SF-4 " H?nra & Brcphy* 15^0 San Pablo Ave * Oakland* AttmT Richardson'1 Ssid5 ick* Betert,, Horan & Arnold* 100 Bush St* SF-4 Attni " Ocrcen Keith Mi i1er & Filip pi, 315 Ka.tgomary St,, SF-4 Attnf Huit Mires 0 l-tir ist-e-r? nsurste*.- Co * 550 M&rrjr St* S?-8 " C,.iif,-rni3 ;a Ca.unity indemnity 1&.change* 550 Kearny St* SF~S " 2~niuh National lm-a Ce, 5-82 t St * SP-4 Attnj Don Kacrl Henry F 0 `Ccnnc.il c St. ta Ccr;p. Ins .Fund* 525 GG Ave* SF-1M Yx\- GctdwiR*, 41 Sutter Si* SF-4 " Jenesi Aura* # Calif Css-^lty l.nd`2r5Bity Exchange* " 550 Kenrr.y Si SF-8 Len Mhcri* % 2-enitn Katier3 l Ir,s, Co* 5 8 2 Market St* SF-4 " R S,, Bockaraith* % Guarar.t^e 1rs-Co* 550 Kearny St* SF- 8 " INTF OFFICI COMMUNICATION To J. E. Zeller, Lancaster From A. L. Stokely, San Francisco Subject Clifford P. Harding Industrial Accident Commission State of California Claim 60 SF 193-85^ CONTRACTING Attached is a copy of a letter from State Compensation Insurance Fund to the Industrial Accident Commission of the State of California enclosing earning record from the Social Security Administration on the above subject man. DJM I \-s i Q > `I 5 1 T l 3 ^ FORM 1501 Print!In U.S.A. STATE COMPENSATION INSURANCE FUND EXECUTIVE O F F IC E S 5 2 5 G O LD EN GATE A V EN U E SA N F R A N C ISC O 1 EARL R. HOWARD R. A. YOUNG H . C . M ILLER T. GROEZINGER J . H. LEIM BA CH . M G EN ER A L MANAGER As s t . C e n t ., m q r . COM PTROLLER C H IE F C O U N SEL M E D IC A L D IR E C T O R March 21, I96I LOS ANGELES C H IC O EUREKA FRESNO Lo n g b e a c h OAKLAND R E D O IN G SACRAM EN TO SAN BERN A RD IN O SAN DIEGO SAN JO SE STOCKTON VENTURA Industrial Accident Commission 3000 State Building 1111 Jackson Street Oakland 7, California IN R E P L Y R E F E R TO 34086l Clifford P. Harding Re: X.A.C. Claim No. 60 SP 193-854 Gentlemen: We are enclosing earnings record from the Department of Health, Education and Welfare, Social Security Administration, dated February 27* 1951. Copies of this earnings record have been mailed to the persons and addresses shown below. Very truly yours, HENRY F. O 'CONNELL Attorney HFO:fr Enc. c - Mr. Clifford p. Harding, 1407 Howe Ave., Sacramento 25, Calif, c - Smith, Parrish, Baduek & Clancy, Attorneys at Law, 501 Financial Center Building, Oakland 12, California c - M.R.-Carpenter, Inc. 907 Front St., Sacramento 7* Calif, c - Fiberglass Engineer & Supply Div., 1041 Fee Dr., Sacramento c - Fiberglass Engineer & Supply Div., 1200-17th-St., S.F. 7 c - Dan Caw Insulation, 3600-20th Ave., Sacramento, Calif, c - Jackson & Hopkins, 115 Oak St., Bakersfield, California c - Western Asbestos Co., 675 Townsend St., San Francisco 3 c - Dutton Asbestos & Supnlv, 532 Natoma St., San Francisco 3 " c - Armstrong Cork Co., lol4 Ogden Dr., Burlingame, Calif, c - J.T, Thorpe & Son, Inc., 1351 Ocean Ave., fineryville, Calif, c - Plant Asbestos Co., 1300-64th St., Emeryville 8, California c - Metalclad Insulation C0i.# P.0. Box 178, Torrance, California c - C.F. Brun & Co., 1000 So. Fremont Ave., Alhambra, California C r e a t e d by t h e S t a t e o f C a l if o r n ia t o f u r n is h p r o t e c t io n t o e m p l o y e r s at t h e l o w e s t p o s s ib l e c o s t a n d T O G U A R A N T E E T O T H E IR E M P L O Y E E S T H E B E N E F IT S o f T H E W O R K M E N 'S C O M P E N S A T IO N L A W S Industriai Acaidsnt Cennisoion Set I*A.C. Claia Ko* 60 F 193-&54 2 March si, 1931 e Ceast Izisalatioa Froduafcs, c/o Argonaut Insurance Cca^&ny 530 California treet, an Francisco 4, California c * Fluor fckttntenance, Ine*, c/o Associated Indossaity Cocjpany 332 Fina S tr e e t, an F ran cisco 4 , c s U f c m la c - Industriai Xndsaalty Co*, 350 Csnecsa et*, Csn Francisco 6 c - Aetna C&su&ltjr & surety Co*, 220 fccat^oraextr ft*, 2.F. 6 e - Asericsn Motorista Ina* Oc-*, 41? Mcnt_josery et.* 2.F. 4 - Pacific Ssplosrers Ina* Co*, 244 Fine et* es Fransiaco 4 c - Associated Xndessnity Corp*, 332 Fina et., ~ar* Francisco 4 c standard Aooident & &i8 co*, 433 v a U F o m i a *-t., F* 4 e - Sreveler X&eureace Co*, 550 California et., Can Francisco 4 c - Arsonatwt Insurance Co., ?5 California et*, San Francisco 4 c - % n n a & Brophy, lOOEoah et*, iam Francisco 4, California c edgwlck, Satert, BSraa & Arnold, 100 Eush et*, .?, 4 - Vallea -2? Filippi, 315 Montgcsaary St*, San Francisco 4 c - Guarani xauranoo Co., 550 Kasroy st*, ian Francisco 8 c - California Casualty Xcdessnity Sxehang, 550 K o a m y et*, F.E c * lesiith Ssticnal m a * Co*, $S2 Market et., ian Francisco 4 . c - Claiias Dcpartaanfc rcAorOlo-AgEan^ s^ v R V ivoR s In s u r a n c e -?r; i- -- * \ ^PA.YQMrErNATLtCSWE NA-TrE.R -//. .TIM O RE 2 , MARYLAND % February?27?196l-Vf';, ;.%State' Compensation;Insurance Fund *,4*525 Golden Gate Avenue - `, .. San:Franciscol/~California. .: ! JBefer_>to:`3?3l086iL&ft ^Attention:':*',Mr. .B*.J. Vali .' , L ,'^ s$ Claims Adjuster / 7 -> **, -- i-: *. , . . ' J> 2 '< i - ' ,* t .'te^*Gentlemen *i'' ***B"- *y'..<> ^:^pi'^ThiBlrefer8'to'yourirecentYletterjaboutJthe?polai; security kaccount 'of-Mr."Clifford PHardlng. 'a* / / ' YJ.t `'vtrTlie^followlngilnfonnatlonilaffurnlshed.as requested. : 1'&PeriodfEnded Amount Standard Sanitary Mfg;'Co. r ^ . i r 6/30/37- v p ,, 0.` Box 1226 ^ Pittsburgh;, P a . 1 . ' I ' I ,^.1 2 /31/37 / { ^^$225.01^ ' ' ;,,*-45 2 8 .ll" ' Standard Sanitary; Mfg.> CoY .`.} - 3/31/38 J ? - , '/133.1 3 '- ` . 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M.ltfi^Keliogg- Co. ?<}> ^,^3/3l/51rC 5 ;v^ }-^r^ij'o'ot^olf;l)anforthiATe.je*fo-vi^f6/30/51 U , : jffc1^Jerseyjitys3^Hii/Jggfe^#^9/30/51' iy^:&32/3L/p/f> k ^-*< 3 - - ^Western'Asfcestos Co.; % - 'V : te3 /3l / 5 ' ; , :/' ' . -675 ToWasend St.'. ", i ; . ^6/30/517 :r; .. ' ;^ S an Ti^BiciscOy,3 , i C alli - 4 9 /30/51 CK - Z. |.sss-J ,i|Cj C`ft;':kHone \ -Tr^^r " fI*'*' ` 5.`s^T^Ione - - ztfVone -/-J. 1.56 vU.'VJi _it*Lros*AngeleJs^22',JC*at3r - '/- V t i .^'r, f- r"12/31/52/ ' , . > - ' . . \ ,- ./.'Hone; ; _n- t/?V " . *i - a - , *r"% * , r * j k f e t ' - ' J < . . 1 * J -Ur-TXl'! fr\\ f '- - J'+ : ,,_. 's**.. - , , 4 -Vf \ * r * k. >- ,. " ^ `z~ U" f" "ksr*` t J1 . . y '-'n y 4^ y :^-1 y y m '. T V " > ', . '^ - . 4 ' ,'J i .- - f i- iv i' f f - i a * ''$*" a*;nv>7 Wfi- lod'Ended- S.Oyyf'?:>T *:' *Wtaiam^^ y ,7 'i.M. Hi? Carpenter JU- `ji907 Eront,St. f 7.,;.Sacramento,! Calif g^33/55p IS v* rv < f :/ l-i!!9/30/55 1 1 .-7,' r J <r ** > ^ it5S12/3l/55 ? ** (,y ' r . t . .I. >(. e - > : n 4 6 .6 o y 5 0 .4 0 % Hone - Hone , ..->* i* vOawceunsa w--* C *oi*n*i*nog F*' ib e rog*laMWs " Corp. .3/31/55 '. i ''sy :;j i -i p.' 0.-.BOX 89 , $ 6/30/55 : f 7 - Hone KHone ' J~ /-v '.Santa Clara,*iCalif. ' - y 'w . i % , , / ;= l_r % 9/30/55 V|;JX12/3l/55 t V*' ' 7 9 0 .6 5 ,, - i O . 0 3 3 . 2 0 ', /:'".Co.i'llne-'.^/''. .Si208.r3rd-Ave.y.S. -'' ..Seattle;4?:Wash v; ' >!; =N- ' * ^V ~' " 6 30/55 ^;:j f > # / ;v vV *i - * - &.-. .' T <. - * f I - Hone * * Hone - > , ,.- , ,6 2 4 .2 5 ' f 412/31/55 : ^ t Hone J J ~'f. ~ ..vvv*.'''.* Coast,JCnBnlatlng'Prodncta .Corp. .#3/31/56 i <#2684 lacey St. > - v ,<?:-],, <.. n/^6/30/56 :;.. - r ..^loa;Angeles .31,1 Calif. * - 1^9/30/56; ' . . ' - \ y . ^ #32/31/56 Ir s . . * 1 * > < 11 *r .^^.Owens -lCOrning"FiberglaaiCorp.|3/3l/56t-^.7 . ' i^ ... v .|y w . ,y, ' ;; f *6/30/56 ' ....< o -- r . > f t f t 9/30/5 6 : ` " i * JF ' - i ~ ,- ^ 4 2 9 .0 0 ' 3 Hone 'i' 4 * S Hone ~ % Hone * I ^ J t t . -jjsfHone :Tv Hone * y J S . 1 9 3 . 6 8 , ^<4 ' i - Hone 4 !*v.j- ' .* ' ' '1, ' 1 j J*:-. --' n-C ^ F r e d ' S h a i r &' Harry Hansell . /< J 3/31/56 - `Industrial Insulation Service,,4.6/30/56 "1717 Wells Ave. # 9/30/56 ' -jP. o.;Box 554 *12/31/56 AlBeno/ Hev* / y Hone ' ^671.73 5; 66.00 * **Hone , .- .4/.? ' 1 w ( r Mi w * tf %%j4k* '* - -iTirc s--`.'^ l^fvan,fxv, ',,j.^.^).- . ? - ***-jfcnuue '1 - **'- +^i' -, - ' -' '- Caw Insulations r;,' f ,`| l --.--'*' ' 0' ;.'V-t0'*{;>~- 3600T,M2W0MthM..A,vwe-..,-.-sl*t . . ;. 'v ;. " , - # 9/ 30/56 - ' - I r H o n e . 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Z,;-.... .-w,i'2--' ^Vacatian,3ltust.Jund;.iOc.[Ho.|'j;9/30/57 Y ,-.vo *{ v ^ " t%^ 2000'Guerrrreerrool'SStt..'i,j,j, . <T i;>:-,^U' ^1122//33l /15/5T7^ V'v^ ^ X ^ - ^ H t o n ^ -, " >4 ` CSan`tFranciscoi3*'iCalif. *f t . 5/i<^, iJ'j.V-x ~.1^"' k ,'^/'7^*v* S J4 1 r d V 7 7-^v A r -` ; -, The.'Jackson H opkins.C o.iilnc. ' ^ 3/31/58 ' ,` , r -'::i . n ? 6/30/58...... ^ H o n e ^ ^ jWs^^ lV A^ ^ r ^ ,'if9/^3l0l/^5S8 7,:^'^Honej'''%-'.i.:vv.i;, ,. / f r .-^Xg. V a. i C- y. ' a * # ; i g * s g a p ^ i w : --M' V:li.^' Si% ffii4:^7 H i " ; -I* 'V,S.vtfr''?<; - Jl" V- -. . - *7 > ^ ''r/'V'- -r, .-.* ,': ; . ; v ^v0Xn^7'~%-fiC7 !f -, - ,- -=. - t(_-,- - ;jjV r>;;r-| '.= /.- it': ^ "jc. ^ ?\^n.'g* i.1 "/h S' ;U Ul<')" 'i'} 1 5 . 4-; \#\&b lU $4 3 fc ;M Ble 4 ^ *T 6 . 6 ' 4 I 5 50 .5 *1 41. i 4! 1 5 , 4 1 b S 4 & T 1 $ $. ' 44 4 * 4^ % \ S '\ ^ % i f n , 6 - 4 "> -- T il T i' 1 ^ e 3 , r i s v /^ < v ,'V t*\ ' ^T) V b 8 j i 6-1 w'--* r> 4 (i 5 . V 1) ( t +; ') M 'fe. i' ' x fcT-r^ i{ `il,*) i n 1 ><ii 5T',^l . I N 2 4* H 'v ^ r- INTER OFFICE COMMUNICATION To J. E. Zeller, Lancaster From A. L. Stokely, San Francisco Subject Clifford P. Harding Industrial Accident Commission State of California Case No. 60 SF 193-85^ ( A r m s t r o n g Cc oOnN T R A C T I N G March l6, 1961 ti-" J Attached to this communication is a notice of hearing before the Industrial Accident Commission of the State of California for actions by Clifford P. Harding. I note that this notice of time and place of further hearing was also served on Travelers Insurance Company. DJM FORM 1501 P rin t'd In U.S.A. Before the Industrial Accident Commission of the State of California Case No. 60 SP Notice of Time Applicant. and Place of vs. Further Hearing n* 33C*# * al* Defendant_ NOTICE TO ALL PARTIES You are hereby notified that further hearing will be held in the above-entitled action at 1,^11 x:-> i&a Dated at: '"-a&nti., 3000 t#wi 3.111 .lessen c&telssitit =-aliitsmxa fSKi, IS* 2&L fil- 9.-? fdXit&st* 1 1 sj- INDUSTRIAL ACCIDENT COMMISSION NOTE: CONTINUANCES AND FURTHER HEARINGS ARE NOT FAVORED. SERVICE UPON: 10, 19U1 ^V-sS: I=?Va*- ,, ,3>JU? *- *jr 1^07 fett* TO* Sb* Cslif. *W 4$ ^ -.1805^ 34 rinaaclal v**3**r t e ^ I *2 jUis4*# issavo V - * rixr^Xa uvXa*ss* * .-Iv# ltl ftre iri-e laoo i m * tri# ? ? ; insolation# 3 6 0 0 & W . :j3-fc 3 -.-SKiesra AjfeehtxM 11 sl # LsisES'Sfti^Iiffc U f . 33> -Itesstea 3 &zss* t t o a *\?3s*rfitoa ^ v s l v * in%&m -3 t* * L.-' & X If # /rsactrsesu. -crii 1.^1* vfl? -* T.v.sesver i. .xav!*.'*# iy>l 4*M3 -a-- ilis*Jf -'vllf* la r,:- *~e*# l,,--00 i A t i i i^ r^ vlX X ' L XT i-S-J XrSS^ iS-Liiif >i3* l v X ?>'# *X3f,3?&`-4?* ..-itA *** . . ** r-ts^n w a** i-OO c * . T ix s a x fr. fcv** itsasfer . o&st te iso la ii s v voJ-uetfi V 1 J'iicr^y X&&* <-* 3&0 -'mrurul t## f-liis** & k -#* / AMNMl>ta xa&oestsr o*# 33-2 i i* 'lltc OKwSSliOS Ii*4S-* XiSo Celi* CSt V?* :/ in d u s tr ia l 3 ca n ity Co*# 3S& t e s a s s e it * # 3 " b A'ii-rs C^^tslUf > .o CO tif2*if et# A e e r t t f i s j d i a r i s t I t i c o . # * X f f ^ t ;- j3 3 2 T ? t i t , e ? X s: Ufi-.' U v `rf*'5*9 5ns# Co* ^*4 tirs ..t## --'T ^ fisico'iatev tn^z'J.tz Po.m3S-(R^ : 88^ cc^ - ti: it- s? V*# ^33. i et i P 1 tra cd*1*3 't o * # 3 U :C X '/>,, Vv} #il1 C.-ymA iti;.. X 18110'4-4Q40M(*),$rO usfica M i STACK TriO m b > w & s v? iwsasssai ua4jas2fi con& lf&j& ilen d f .* rti* B s^ rveti n &4i*si& IQ* X3&X 4* 119 ^ k XQO xxsh S t . , sSF 4 a&defc i-'trt, & ArsaJUi, 3.03 &**& t., t& k H&Sesi & Ftilppi, 1% St., c o a r K ii t e * Xijs&iam si C e , , S S O S^stsnw^ '4.* J F e 4U U $ & n ii* A*JJNftl*ie ^ASiSSSpS, 5 3 0 m & Sm $ S t . P SBtnltd ifct&ocMd Xnaucttae *, 3 imjrksfc St., .? o*;t<a ess lre one i s . . ^ w s ' X m v m m x & + , 0 ia U /e m d * ft- January 24 1961 AIR HAIL T ravelers Insurance Company 550 C a lifo r n ia S tr e e t San F rancisco 4 C a lifo r n ia Gentlemen: / Tour January 12 l e t t e r to AC&S' a San F rancisco O ffic e regarding C liffo r d / Harding has "been r e fer re d to th e w r ite r . His wages w ith corresponding hours worked are as follow s: Week Endine Wages Hour 10-12-51 $ 38.78 15 10-19-51 103.40 40 10-26-51 62.04 24 12-5-54 12-12-54 12-19-54 12-26-54 201.60 32 126.00 s 40 226.80 (uK` 40 126.00 ^ 40 1-2-55 1-9-55 226.80 56 126.00 40 In view o f h is lim ite d employment w ith Armstrong Cork Company our c o s t under apportionment procedure in th e case o f an a s b e s to s is claim would be n e g lig ib le . Standard A ccident Insurance Company has a lrea d y requested lim ite d inform ation regarding C liffo rd Harding. Very tru ly yours, R. C. S ch ied t, J r . Insurance Department MLT 'O $ I i <x I \ ^ v> * <5 X I 1i: N i> *^ rJ < <1 ^ * t) 5^> V> * w .' o% V ^ <a *0 \ 6-' N 3 < Na o O C*> O <i v3 >9 N3 Q t Y < % X <T o $ *Y \ 5 'o V> v> > > 4 *o is !$ vo vS r <s^ o -^ * nc n n 1 X X^ X P CLAIM DEPARTMENT A. C WELSH, Clolni Monogor {ffif &rtii>e/xP January 12, 1961 BRANCH OFFICE 550 Californio Street SAN FRANCISCO 4, CALIFORNIA Telephone: OOogla* 2-3600 Armstrong Contracting Company 30A Shaw Road South San Francisco, California Re: B~ Armstrong Contracting Company Clifford Harding - Injured D/A ? Gentlemen: The question I am about to ask you will probably involve getting records of this man's employment from your Eastern office. We have an Application filed before the Industrial Accident Commission by Mr. Harding allegihg over the years he has contracted asbestosis and is seeking compensation benefits therefor. I do not have the exact dates of employment, but it will undoubtedly in volve the previous carrier, The Standard Accident Insurance Company also. To the best of our ability to learn, he was employed by you during 1953, and 55, and his present address is 14-07 Howe Avenue, Sacramento 5. We do not have his social security number, but his date of birth is given as February 28th, 1896. Would you kindly set in motion the machinggy^to secure for us the exact datajof his working for you and his exact weekly earnings, so that we will know what policy year to charge this loss to. I am sending this letter to you in duplicate in the event you wish to refer it to the Standard Accident Insurance Company. Thank you. Very truly yours, AJSickr Enel. A. J. Schaefer Supervising Adjuster HOME OFFICE! 700 MAIN STREET, HARTFORD 15, C O N N E C T I C U T EMPLOYER'S REPORT OF INDUSTRIAL INJURY STATE OF CALIFO RN IA &-952734 DEPARTMENT OF INDUSTRIAL RELATIONS DIVISION OF LABOR STA TISTIC S AND RESEARCH Claim Department THE TRAVELERS INSURANCE COMPANY 1956 Webster Street, Oakland 12, Calif. - 'Every question must be answered fully to avoid further correspond ence. FAILURE TO FILE IS A MISDEMEANOR SUBJECT TO MAXIMUM FINE OF $100. (Labor Code. Section* 6407-6413) Pleas make this report In D U P L IC A T E so that we can file copies with Division of Labor Statistics and Research In your behalf. Every work injury to an employee which causes disability lasting longer than the day of the injury or which requires medical services other than first aid treatment must be reported within five days after the injury- If the injury results in death, a report must be made by telephone or telegraph directly to the Division of Labor Statistics and Research not later than 24 hours after death. EMPLOYER (Give nam e under which DO NOT WRITE IN TH IS COLUMN ' (No. and C ^ty or Case No. (M anufacturing shoes, retailing m ea INJURED EMPLOYEE , Kjom. (No. and - ...Soc. Sec. No. and Employer No. Industry . c peer hmr nr 1 nar dav. or S-- oer week. (If earning at Irreffular rate, such ms piece work or on commission basis, e n te r a ctu al av erag e w eekly earnings for convenient period n o t to exceed one year.) 11. If board, lodging, or other ad v an tag es furnished in a d d itio n to w ages, give estim ated value $---------------------- per day. or t ACCIDENT (No. and (City or . -- - (Yea or -----------------------------per week IS D ate of accident______ (y w nr Mn\ (Yea or 16. H o u r of d a y _____________ A .M ./P.M . IS. If ves. srive d a te last w o rk e d . 17. D id Injury result In disability beyond day of 19. W as in lured oaid in full for CAUSE OF ACCIDENT 21. O ccupation (job title)_____________________________________________________________________________________ 22. H ow long em ployed b y you a t this occupation? Check (vO Leas th a n 6 m onths__ 6 m onths to 2 years. (Describe briefly, such as: loading truck, operating i over 2 years---------- 23. W h at was em ployee doing w hen accident Age Sex and M arital Status Weekly Wage County Accident Date Occupation (D escribe fully, sta tin g w h eth er th e injured person fell, w as struck, etc.*, give all Accident Type 3S. W hat t p v H t**, (N am e the specific machine, tool, appliance, nhiitenre, nr nhject was m ost cioaelv connected w ith th e accident? gas. liquid, etc., involved) ..... (State if gears, pulley, (Yes or (Yes or 29. W hat do you recommend for preventing this type of accident? (S tate the specific preventive measures th a t can be taken by em ployer and workers. Do not say, " By being more careful." Specify w hat should or should not be done) NATURE OF INJURY AND PART OF BODY AFFECTED (Describe in detail the nature of th e injury and th e p a rt of th e body affected For example: am putation (Yes or - J (Yea or Agency Agency P art Meek. Defect Unsafe Act Personal Defect N ature of Injury Location E xtent of Injury Insurance Carrier C-4587 Rev. 7-53 rs iN tto u.s.,,. Signature Filing of this report is not an admission of liability. " . . . No report of injury required to be filed by an employer or an insurer by this chapter shall be admissible as evidence in any adversary proceeding before the Industrial Accident Commission." Labor Code, Section 6413. Report Lag Coded by EMPLOYER'S REPORT OF INDUSTRIAL INJURY T0 STATE OF CALIFORNIA , B-9527634 DEPARTMENT OF INDUSTRIAL RELATIONS DIVISION OF LABOR STA TISTIC S AND RESEARCH Claim Department THE TRAVELERS INSURANCE COMPANY 1956 Webster Street, Oakland 12, Calif. Every question must be answered fully to avoid further correspond ence. FAILURE TO FILE IS A MISDEMEANOR SUBJECT TO MAXIMUM FINE OF $100. (Labor Code. Section* 6407-6413) Please make this report in D U P L IC A T E so that we can file copies with Division of Labor Statistics and Research in your behalf. Every work injury to an employee which causes disability lasting longer than the day of the injury or which requires medical services other than first aid treatment must be reported within five days after the injury. If the Injury results in death, a report must be made by telephone or telegraph directly to the Division of Labor Statistics and Research not later than 24 hours after death. ____________ EMPLOYER (Give nam e under which 1. N am e concern does business) (No. and 2. Office address SotirTeCeti); -- .................. ---- -------------- (M anufacturing shoes, retailing men s 3. N a tu re of business clothes, tru ck in g for hire, etc.) ....... INJTJKED EMPLOYEE 4. N ame........................-----(No. and 5. A ddress S tr e e t)_____ -(TCoitwyno)--r . (City and - SSutattee)) M ..Soc* Sec. No.. DO NOT WRITS IN TH IS COLDMN C u , No. Employer No. Industry 6. Age.. 7. Sex: Check (yO Ma Female-- 8. Check ( V) M arried- Single 9. N um ber of hours w orked per d ay 10. W ages: S_____________________________ per hour, or $ per week- Num ber of days worked per week- Age - p e r day. or * --------- week. (If earnings a t irregular rate, such as piece work or on commission basis, enter actual average weekly earnings for convenient period not to exceed one year.) 11. If board, lodging, or other ad v an tag es furnished in addition to wages, give estim ated value $ - - per day, or %. ACCIDENT (No. and 12. Piace of accident Street).. (Yes or 13. On em ployer's premises N o)------ (City or -T o w n )__ 14. D ep artm ent-- -(C o u n ty )- -p e r week Sex and M arital Status W eekly W age IS. D ate of accident(Yes or accident? No).... (Yes or this day? No) .... CAUSE OP ACCIDENT 21. Occupation (job title)-- 16. H our of day_ -A .M ./P .M . 17. D id Injury result In disability beyond day of 18. If yes, give date last w orked- , , -- .... 19. W as injured paid in full for 20. If Injured in a mine, check ( y 0 accident location: S u rface- . , --. M ill..,.. ...__U nderground________ S h a f t_____ _____ 22. H ow long employed b y you a t this County Accident D ate occupation? C heck (vO Less th a n 6 m o n th s-------------; 6 m onths to 2 y e a rs- (Describe briefly, such as: loading truck, operating occurred? drill press, shoveling d irt, w alking down stairs, etc.)---- ----- ------ ; over 2 y ears- 23. W hat was employee doing when accident Occupation (D escribe fully, statin g w h eth er the injured person fell, was struck, etc.; give aii 24. How did th e accident happen? facto rs co n trib u tin g to accident. Use other side of report for additional space) Accident Type (N am e the specific machine, toot, appliance. 25. W h at m achine, tool, substance, o r o bject was m ost closely connected w ith the accident? gas, liquid, etc., involved) _ (State if gears, pulley, 26. If mechanical apparatus or vehicle, w hat p art of it? motor, etc.) (Yes or 27. Were mechanical guards, or other safeguards provided? No) (Yes or 28. W as injured using them ? No) 29. W h at do you recommend for p rev en tin g th is ty p e of accident? (State th e specific preventive measures th a t can be taken by employer and workers. Do not say, " By being more careful." Specify w hat should or should not be done) Agency Agency Part Meeh. Defect Unsafe Act NATURE OF INJURY AND PART OF BODY AFFECTED (D escribe in detail the n atu re o f th e in ju ry an d th e p a n o f th e body affected F or exam ple: a m p utation 30. of right index finger a t second jo in t, fractu re of ribs, lead poisoning, d erm atitis of left hand, etc.) ____ -- 31. N am e and address of physician, 32. N am e and address of h o sp ita l.. (Yes oi 33. Has employee returned to work? No)... (Yes or 36. Did injury result in death? N o )--- ------- __ 34. If yes. give date.. 37. If yes, give date.-- ----- 38. In case of death, give name and address of nearest relative.. 35. A t what wage? $_ 39. Names and addresses of w itnesses.- 40. Is injured related to Em ployer?.. Signed by.. If so how?_ Date of this report- Signature -O fficial positlon- Filing of this report is not an adm ission of liability. . . No report of injury required to be filed by an em ployer or an insurer by this ch ap te r shall be admissible as evidence in any adversary pro ceeding before the Industrial A ccident Com m ission." Labor Code, Section 6413. Personal Defect N ature of Injury Location Extent of Injury Insurance Carrier Report Lag Coded by TO STATE OF CALIFO RN IA DEPARTMENT OF INDUSTRIAL RELATIONS DIVISION OF LABOR STA TISTIC S AND RESEARCH Claim Department THE TRAVELERS INSURANCE COMPANY 1956 Webster Street, Oakland 12, Calif. enee. FAILURE TO FILE IS A MISDEMEANOR SUBJECT TO MAXIMUM FINE OF $100. (Labor Code, Section* 6407-6413) B-9 52 76 3 4 Pleas make this report in D U P LIC A T E so that we can file copies with Division of Labor Statistics and Research In your behalf. Fverv work iniury to an employee which causes disability lasting longer than the day of the injury or which requires medical services other than first aid'treatment must be reported within five days after the injury. If the injury results in death, a report must be made by telephone or telegraph directly to the Division of Labor Statistics and Research not later than 24 hours after death. ____________________________ EMPLOYER (Give nam e under which 1. N am e concern does business) 2. Office address Sa(Nitrroeee.e,twa)n-d- ----- ------------------ - -- (M anufacturing shoes, retailing men s 3. N atu re of business clothes, trucking for hire, etc.) ....... (C ity or _Tow n)__ DO NOT WRITS IN TH IS COLUMN Casa No, Em ployer No. in ju red em plo y ee i N am e.. 5. A ddress (No. and S treet) .... (City and - S ta te ) ___ _ __ Soc. Sec. N o.. Industry 6. Age------------------------ 7. Sex: Check. (vO M ale Female^ 8. Check ( V) M arried. Single. 9. N um ber of hours worked per day.. 10. W ages: *_____________________ Pr hour, or $ per w eek- N um ber of days w orked per week.. Age _ p e r day or L --per week. (I f earnings a t irregular rate, such as piece work or on commission basis, enter actual average weekly earnings for convenient period not to exceed one year.) 11. If board, lodging, or other advantages furnished in ad d itio n to wages, give estim ated value $ , .- -------- per day, or %. ACCIDENT (No. and 12. Place of accident Street).. (Yes or 13. On em ployer's prem ises N o ) - . - _ 1 14. D e p artm e n t. -(C o u n ty ) -.per week Sex and M arital Statue W eekly Wage 15. D ate of accid en t(Yes or accident? No).. (Yes or this day? No) ..... CAUSE OF ACCIDENT 21. Occupation (job title)--. 16. H our of day -- A M /P .M . 17, D id injury result In disability beyond d ay of 18. If yes, give d a te last w ork ed- ______ -- .. _ - - 19. W as Injured paid in full for 20. If injured in a mine, check (y*) accident location: Surface ...............M i l l --------..U nderground__ --__ - S h a f t..- .-- ..___ - 22. How long employed by you a t this County Accident D ate occupation? C heck (vO Less th a n 6 m onths.. 6 m onths to 2 years. (Describe briefly, such as: loading truck, operating occurred? drill press, shoveling dirt, walking down stairs. etc.)- over 2 years 23. W hat was employee doing when accident O ccupation (D escribe fully, sta tin g w h eth er th e injured person fell, was struck, etc.; give all 24. How did th e accident happen? factors co n trib u tin g to accident. Use o th e r tid e of rep o rt for additional space) Accident Type (N am e the specific machine, tool, appliance, 25. W h at m achine, tool, substance, or o b ject was m ost closely connected w ith the accident? gas, liquid, etc.. Involved) (S tate If gears, pulley, 26. If mechanical apparatus or vehicle, w hat part oi it? m otor, etc.) (Yes or (Yes or 27. W ere mechanical guards, or other safeguards provided? No) 28. W as injured using them ? No} (S tate the specific preventive measures th a t can be taken by em ployer and workers. 29. W h at do you recom m end for p reventing th is ty p e of accident? D o n o t say. " By being m ore careful." Specify w hat should or should not be done) Agency Agency Part Mech. Defect Unsafe Act NATURE OF INJURY AND PART OF BODY AFFECTED (Describe in detail the nature of the injury and the p art of the body affected. For exam ple: am putation 30. of right index fnger a t second jo in t, fracture of ribs, lead poisoning, derm atitis of left hand, etc.) - ______ 31. N am e an d address of physician-- 32. N am e a n d address of hospital.__ (Yes or 33. H as em ployee retu rn ed to work? * N o)----(Yes or 36. Did in ju ry result in death? No)..----------- __ - 34. If yes, give d a te 37. If yes, give d a te - 38. In case of death, give name and address of nearest relative.. 33. A t w hat wage? $~ 39. Names and addresses of witnesses. 40. Is injured related to Em ployer?signed by.. C-4587 R ev. 7-53 p r i h t c o i m u . s . a. If so how?_ Date of this report- Signature -O fficia l position.- Filing of th is report is not an adm ission of liability. " . . . No report of injury required to be filed by an em ployer or an insurer by this chapter shall be admissible as evidence in any adversary pro ceeding before the Industrial Accident Comm ission." Labor Code, Section 6413. Personal Defect N ature of Injury Extent of Injury Insurance Carrier Report Lag Coded by EMPLOYER'S REPORT OF INDUSTRIAL INJURY TO STATE OF C ALIFO RN IA DEPARTMENT OF INDUSTRIAL RELATIONS DIVISION OF LABOR ST A TISTIC S AND RESEARCH Claim Department THE TRAVELERS INSURANCE COMPANY 1956 Webster Street, Oakland 12, Calif. Every question mu6t be answered fully to avoid further correspond ence. FAILURE TO FILE IS A MISDEMEANOR SUBJECT TO MAXIMUM FINE OF $100. (Labor Code, Section* 6407-6413) B-9527634 Please make this report in D U P LIC A T E so that we can file copies with Division of Labor Statistics and Research in your behalf. Every work injury to an employee which causes disability lasting longer than the day of the injury or which requires medical services other than first aid treatment must be reported within five days after the injury. If the injury results in death, a report must be made by telephone or telegraph directly to the Division of Labor Statistics and Research not later than 24 hours after death. EMPLOYER (Give nam e under which 1. Nam e concern does business) (No. and 2. Office address Street) (M anufacturing shoes, retailing men's 3. N a tu re of business clothes, trucking for hire, etc.) ....... INJURED EMPLOYEE (C ity or ._Tow n)__ DO NOT WRITS IN TH IS COLUMN Case No. Em ployer No. 4. N am e.5, Address (No. and Street) (City and _ s ttaate ') - ..Soc. Sec. N o.. Industry 6. Age.___ __ 7. Sex: C heck ( vO M ale-- F em ale-. 8. Check ( v0 M arried- Single 9. N um ber of hour* w orked per d a y - per week-- N um ber of days worked per week. Ago 10. W ages: g - ..per hour, or V. -per day, or S- _____ _______ per week. (If earnings a t irregular rate, such as piece work or on commission basis, enter actual average weekly earnings for convenient period not to exceed one year.) 11. If board, lodging, or o th e r advantages furnished in add itio n to wages, give estim ated value $---------------------- per day, or $ . ACCIDENT (No. and 12. Place of accident Street).. (Yes or 13. On em ployer's premises N o)------ _&L 14. D e p a rtm e n t- -(C o u n ty )- -p er week Sox and M arital Statua W eekly Wage IS. D ate of accident(Yes or accident? N o)__ (Yes or this day? No) ___ 16. H o u r of d a y - -A .M ./P .M . 17. D id injury result In disability beyond d a y of -- 18. If yes, give d a te last worked-- -- ... ............. 19. W as Injured paid In full for 20. If injured in a mine, check (V ) accident location: Surfacg- M ill-- - U n d e rg ro u n d .-___- --.S haft___ __ CAUSE OF ACCIDENT 21. Occupation (job title)-- -------- 22. How long em ployed by you a t this County Accident Date occupation? C heck (v 0 Leas th a n 6 m onths________ ; 6 m onths to 2 year s-- (Describe briefly, such as: loading truck, operating over 2 years- occurred? drill press, shoveling d irt, walking down stairs, etc.)__________________________________ 23. W hat was employee doing when accident Occupation (D escribe fully, statin g w h eth er the injured person fell, was struck, etc.; give all 24. How did th e accident happen? factors contributing to accident. Use other aide of report for additional space) Accident Typo (N am e th e specific machine, tool, appliance, 25. W h at machine, tool, substance, or object was m ost closely connected w ith the accident? gas, liquid, etc., involved) -- (S tate if gears, pulley, 26. If m echanical ap p aratu s or vehicle, w hat p a rt of It? motor, etc.) (Yes or 27. Were mechanical guards, or other safeguards provided? No) (Yes or 28. W as injured using them? No) 29. W hat do you recommend for preventing this type of accident? S t )o ate not the say s , pecific "By b preventiv eing more e c measur areful." e s that can be taken Specify w hat shou by employe ld or should r an not d b worker e done) . Agency Agency Part Meeh. Defect Unsafe Act NATURE OF INJURY AND PART OF BODY AFFECTED (Describe in detail the nature of the injury and the p art of the body affected For exim ple: am putation 30. of right index finger a t second jo in t, fracture of ribs, lead poisoning, derm atitis of left hand, etc.) ________ 31. N am e and address of physician-- 32. N am e and address of hospital.--> (Yes or 33. H as em ployee retu rn ed to work? N o)....... (Yes or 36. Did in ju ry resu lt in death? N o )------------ 34. If yes, give date.. 37. If yes. give d ate.. 38. la case of death, give name and address of nearest relative.- 35. At w hat wage? $ - 39. Names and addresses of witnesses. 40. Is Injured related to Em ployer?... If so how?_ Date of this report- Signed b y,, S ig n a tu re -O fficial position-- C-4587 Rev. 7-S3 p r i n t e d in u .s a . Filing of th is report is not an adm ission of liability. . . No report of injury required to be filed by an em ployer or an insurer by this ch ap te r shall be admissible as evidence in an y adversary pro ceeding before the Industrial A ccident C om m ission/' Labor Code, Section 6413. Personal Defect N ature of Injury Location E xtent of Injury Insurance Carrier Report Lag Coded by s HOME OFFICE AT HARTFORD, C O N N ECTICU T THE TRAVELERS INSURANCE COMPANY THE TRAVELERS INDEMNITY COMPANY THE TRAVELERS FIRE INSURANCE COMPANY W e are in receipt of advices of an injury to the person named below. If this injury was the result of an accident which occurred while this person was working for you, please furnish us with full report on the attached forms as required by the Compensation Law. It is necessary that you make this report in duplicate so that we can file copy with the administrative authorities in your behalf as required by law. Your cooperation in promptly com pleting and returning these reports will be appreciated. DATE RE 1-11-61 Clifford P, Harding d/a 1-1-56 B-9527634 r Armstrong Cork Co. "I 304 Shaw Rd. S. San Francisco, Calif. L J C-1659 REV. 3-52 PRiN te o in u .s .*. A d d rtn a ll re p litt lo i Claim Department, The Travelers T?56 Webster Street,Oakland 12, Calif. / YivUra/i't S HOME OFFICE AT HARTFORD, CO N N EC TIC U T THE TRAVELERS INSURANCE COMPANY THE TRAVELERS INDEMNITY COMPANY THE TRAVELERS FIRE INSURANCE COMPANY W e ore in receipt of advices of an injury to the person named below. If this injury was the result of an accident which occurred while this person was working for you, please furnish us with full report on the attached forms as required by the Compensation Law. It is necessary fhaf you make this report in duplicate so that we can file copy with the administrative authorities in your behalf as required b y law. Your cooperation in promptly completing and returning these reports will be appreciated. DATE RE 1-11-61 Clifford P. Harding B-9527634 r Armstrong Cork Co. ~1 Lancaster, Pennsylvanie L J 0*1659 REV. 3*52 p r i n t e d in u .s .a . ' A ddrett a ll rp//s fo: Claim Department, The Travelers 1956 Webster Street, Oakland 12, Calif. / January 13, 1961 Standard A ccident Insurance Company &40 V est San Bruno Arenue San Bruno, C a lifo r n ia Gentlemen! A ttention! Vera E. Dowling \ R eplying to your January 10th l e t t e r , C liffo r d P . Harding was employed by Armstrong Cork Company during th e fo llo w in g p erio d s in C a lifo rn ia ! October 11, 1951 to October 24,. 1951 Horember 30, 1954 to January 9 , 1955 Very tr u ly yours, R. C* S c h ie d t, Jr# Insurance Department MLT O M F E R R Y J R , C h a i r m a n o fh 0 o * r d U K KIRK rcj> Prtsidtnt Standard A ccid e n t In su ran ce Com pany m eoiooM T to m ROY W. SM ITH Ma n a g e r CASUALTY FIRE MARINE FIDELITY SURETY No r t h e r n Ca lifo r n ia B ra n ch O ffice 840 W EST SAN BRUN O AVENUE San Bruno, Ca l if , PHONE JUNO 3-4000 January 10, 1961 Armstrong Cork Company Lancaster, Pennsylvania Rej S-309^ Clifford p. Harding vs ARMSTRONG CORK CO. Attn: R . C . Schiedt, Jr. Insurance Dept. Gentlemen: W e WILL APPRECIATE IT IF YOU WILL CHECK YOUR PAST EMPLOYMENT RECORDS AND ADVISE IF CLIFFORD P. HARDING WAS ON YOUR PAYROLL DURING THE PERIOD 1950-55. W e HAVE BEEN PRESENTED WITH ANOTHER ASBESTOSIS CLAIM AND THIS PARTY ALLEGES HE WORKED FBS YOUR COMPANY DURING THIS PERIOO. Your immediate attention to this matter will be appreciated INASMUCH AS THIS CASE HAS ALREADY BEEN PRESENTED TO THE {NOUSTRIAL Accident Commission and is oue to be set up for a hearing shortly. Very jruly yours, VED/ms ENV ENCL Vera E. Dowling Claim Representative I0 - ) $ M ' \ c - *'5'\ 1-^-pF ^ Planet Insurance Company. Detroit Standard Accident Insurance Company, Detroit Pilot Insurance Company, Toronto z IIUTE OFFICE/ COMMUNICATION To J, E, Zeller, Lancaster From A, L, Stokely, San Francisco Subject Clifford Harding - Asbestos Worker Asbestosis Claim January 16, 1961 C O N T R A C T IN G Attached are two copies of the Travelers .Insurance Company's letter of January 12th informing us of an application before the Industrial Accident Commission by Clifford Harding, claiming Asbestosis and seeking compensation. Our records do not go back to the years indicated. We have no, memory of a Clifford Harding working for us. I understand that these claims are properly handled by referring We have been unable to determine from John Murphy's old records that Clifford Paul Harding of ll;07 Howe Avenue, Sacramento, California, whose Social Security Number was 56i+-50-226fy, qUit our employ on Ja ruary 7 1955 when sent to work in the Shipyard, DJM i January 12, 1961 < Armstrong C ontracting Company 304 Shaw Road ! South San F ran cisco, C a lifo r n ia Re t B Armstrong C o n ta c tin g Co^any C liffo rd Harding - Injured D/A ? , Gentlemen* ' ~ r ` ` ' The question I am about to ask you will probably involve getting records of this m a n 's employment from your Eastern office We ha. a an A p p lication f i l e d b efore th e I n d u str ia l A ocident Commission by Mr. Harding a lle g in g over th e y ea rs he has con tracted a s b e s t o s ls and i s soaking compensation b e n e fits therefor I do not have the ex a ct dates o f employment, but i t w ill undoubtedly in * v o lv e the p revious c a r r ie r , The Standard A ccident Insurance Company a lso * To th e b e s t o f our a b i l i t y to le a r n , he was employed by you during 1953 54 and 5 5, and h i s p r e se n t address i s 1407 Hove Avenue, Sacramento 5* m Ve do not have h i s s o c ia l s e c u r ity number, but h is d ate o f b ir th i s given a s February 28th, 1896 Would you k in d ly s e t in motion the machlmjgv to secure fo r u s th e ex a ct d a te s o f h is working fa r you and h is ex- Ci w eekly ea rn in g s, so th a t we w i l l know what p o lic y year to charge t h is l o s s to I am sending t h i s l e t t e r t o you in d u p lic a te in th e even t you wish t o r e fe r i t to the Standard O ccident Insurance Company Thank you