Document V2NbnYabL7Ko6Ogaz5brq7pq

FILE NAME Insulators Workers Comp Claims IWC DATE 1968 DOC IWC046 DOCUMENT DESCRIPTION Claimant - Nicholson Clyde From M Archive Name Contract Unit Claim File Clyde Nicholson 19/68 ; Amended Sept. 12/68 Scanned ? yes Source JMA NS Start Year 1968 Stop Year 1968 Contents claim Notes ' WORKERS COMPENSATION APPEALS BOARD - CALIFORNIA INDUSTRIAL ACCIDENT COMMISSION prior to 1966 APPLICANT CLYDE NICHOLSON Asbestos Worker CASECASE #ANA 23 DATE CLAIM FILED June 19 1968 Amended Sept. 12 1968 INJURY ALLEGED Injury to lungs to exposure to asbestos ALLEGED DATE OF INJURY 1946-1968 EMPLOYER Plant Rubber & Asbestos Works et al including JM Sales Travelers 16 employers & carriers No apparent Canadian carrier OTHER NOTES Med Rpt to applicant's attorney ..almost certainly from fibrosis of lungs due to inhalation of asbesto fibers permanently & totally disabled No other medical reports in file DATE OF RESOLUTION Feb. 21 1969 RESOLUTION Compromise & Release apportioned among 10 DOCUMENTS COPIED 1 Compromise & Release 8,380 settlemer CF # CF CLAIMANT _ Clyde Nicholson California Workers Compensation Appeals Board CARRIERS INVOLVED The AETNA Casualty & Surety Co. oAmerican Automobile Ins Co. American Employers Ins Co. American Motorists Ins Co. Argonaut Ins Co. oAssociated Indemnity Corp. oCalifornia Casualty Indemnity Exchange California Compensation & Fire Co. oCasualty Ins Co. of California Employers Liability Assurance Corp.Ltd Employers Mutual Liability Ins Co. of Wisconsin . oFidelity & Casualty Co. of New York oFireman's Fund Ins Co. Assurance oGeneral Accident Fire ; & Life Assurance Corp. Ltd. oGlobe Indemnity Co. oGuarantee Insurance Co. oGreat American Ins Co. oHardware Mutual Casualty Co. Industrial Indemnity Co. Sentry oIndustrial Indemnity Exchange oInsurance Co. of North America Ins Co. Co. oLiberty Mutual Ins Co. oLumberman's Mutual Casualty Co. oMaryland Casualty Co. oMichigan Mutual Liability Co. oMission Insurance Co. National Automobile & Casualty Ins Co. oNew Amsterdam Casualty Co. oOcean Accident & Guarantee Corp. Ltd. Pacific Employers Ins Co. Pacific Indemnity Co. oReliance Ins Co. oRoyal Indemnity Standard Accident Ins Co. oSecurity Ins Co. of Hartford U.S. Casualty Ins oState Compensation Insurance Fund oTransport Indemnity Co. The Travelers Ins Co. C^ oThe United Pacific Ins C^ . Co. OU.S. Fidelity & Guaranty Co. oZenith National Ins Co. oZurich Ins Co. Pacific Pacific Employers Group oc 26 5/81 1 WORKERS COMPENSATION APPEALS BOARD 2 STATE OF CALIFORNIA 3 CLYDE NICHOLSON F&F CASE No. 68 ANA 23276 5 Applicant 6 VS. CERTIFICATION 7 ARMSTRONG CORK COMPANY et al 8 9 Defendant I hereby certify that the attached documents are true 2 12 and correct copies of the original documents filed in the records 4 13 of this office in the entitled matter 14 14 ATTEST my hand and the Seal of the Workers Compensation 1515 Appeals Board of the State of California 16 17 18 18 N N N N Workers Compensation Judge 5 Workers Compensation Appeals Board j N N N24 Dated at San Francisco 25 California this 31 day 2266 of March 1981 _ 27 DIA WCAS Fork 115 NEW 75 COCOMM T DT EP DEPARTMENT OF INDUSTRIAL RELATIONS DIVISION OF INDUSTRIAL ACCIDENTS 1 ROSE KLEIN & MARIAS Attorneys at Law 2900 2900 North Broadway Suite 412 Santa Ana California 92701 3 Telephone 541-4128 4 Attorneys for Applicant 5 6 Dhtee0 Toe Cees ran MA201969 MA201969 MA201969 tea ates ; 7 8 BEFORE THE WORKMEN'S COMPENSATION APPEALS BOARD . 9 OF THE STATE OF CALIFORNIA 10 11 12 13 14 25 16 17 18 19 20 21 22 23 24 25 26 27 28 29 i 30 31 i AY CLYDE NICHOLSON 1 ) Applicant ) ) -75- ) ) ARMSTRONG CORK COMPANY et ) al } ) Defendants ) } No. 68 ANA 23276 COMPROMISE AND RELEASE The parties hereto for the purpose of compromise only hereby submit the following agreed statements of fact 1 CLYDE NICHOLSON 1608 East Commonwealth Avenue 104 Fullerton California employee herein born on October 20 1096 having Social Security No. 317-26-1599 clairs that he was employed during the period 1946 through 1963 at Various Cities in the State of California as an Asbestor Worker by the various employers signatory to this Agreement said employers were then insured as to their respected periods of employment for workmen's compensation liability by the various insurance carriers signatory to this agreement and that the Applicant sustained an injury arising out of and in the course of his employment as a result of exposure to asbestos ^aus- ing pulmonary disorder 2. The actual weekly wages of the employee during the period of injury were in dispute 3. The employee's present disability is in route an x ; -1- - I the employee has not returned to work 3 4. ilo temporary disability indemnity has been paid to the employee and the amount ~ ue and unpaid is in dispute No permanent 4 disability has been paid to the employee 5 5. The parties hereby agree to settle any and all claims 6 on account of said injury by the payment of the sum of 8,380.00 7 in addition to any sums heretofore paid by the employer or the in8 surer to the employee said sum to be payable as follows , 0 A. BARGONAUT INSURANCE COMPANY 1010 1 238.00 to Alan Frank M.D. in full satis- 11 faction of his Lien . 13 2 3 25.50 to the Applicant 1,000.00 to Rose Klein & Marias as attor- 14 14 neys fees 15 B. By AMERICAN MOTORISTS 16 16 INSURANCE COMPANY 17 17 1 67.50 to Rose Klein & Marias as reimburse- 18 18 nent for costs advanced in obtaining records from the 19 19 Social Security Administration and the California In- 20 20 spection Rating Bureau 2222 24 25 26 2727 28 30 32 2 894.90 to the Applicant C. By PLANT RUBBER & ASBESTOS WORKS and FIBREBOARD CORPORATION 1 726.75 to the Applicant ,BY NATIONAL AUTO & CASUALTY CO 68.40 to the Applicant E. By PACIFIC EMPLOYERS GROUP Plant Insulation Company 1,353.25 to Applicant 3 ' BY PACIFIC EMPLOYERS GROUP Marine Engineering & Supply Co. 50.80 to Applicant { 1 . BY PACIVIC ILDENNITY COMPANY 5315.35 to Applicant . By INDUSTRIAL INDENNITY COMPANY 167.00 to the | -7- i i H HH Applicant BS I. BY AETNA CASUALTY & SURETY COMPANY 475.00 to Ow the Applicant hk J. BY THE TRAVELERS INSURANCE COMPANY 2,976.35 to 5 the Applicant oa 6 Medical and hospital expenses have been paid all by 7 the employee and none by the employers or carriers Unpaid bills 8 amount to none Future and hospital expenses are estimated at 9 4,000.00 Unpaid and future medical and hospital expense is to be 72 assumed all by the Applicant 7. Name and address of employee's attorney is ROSE 72 KLEIN e& MARIAS 900 North Broadway Suite 412 Santa Ana Califor- 13 nia 92701 37 8 Said attorneys request a fee of 1,000.00 No 15 prior attorneys fee has been paid 227 9. Reason for the compromise is substantial issues exist 227 as to injury arising out of and occurring in the course of employ18 ment and as to statute of limitations All parties desire to 19 avoid the hazards of litigation and the Defendants desire to buy 20 their peace 21 10. The undersigned request that this Compromise and 22 Release Agreement be approved 23 11 Upon approval of this Compromise Agreement by the 24 Workmen's Compensation Appeals Board or a Referee and payment in 25 accordance with the provisions hereof said employee releases and 26 forever discharges said employers and insurance carriers from all 27 claims and causes of action whether now known or ascertained or 28 which may hereafter arise or develop as a result of said injury 29 including any and all liability of said employearnsd said insurance 30 carriers and each of them to the dependents heirs executors 31 representatives administrators of assigns of V~ employer 32 WISS the signature hereof this 8/47 day of ebruary -3- . 'eeeematem stem Se ee wee Ow 1 1969 at Santa Ana California 3 6 00 10 12 14 15 16 } 17 18 19 . 20 NNN NNN 22 22 25 26 27 28 29 30 31 32 SPIE ETSL : Applicant CLYDE NICHOLSON NICHOLSON Applicant Applicant CLYDE NICHOLSON Applicant ROSE KLEIN & MARIAS By fh Howard A. Gebler Attorneys for Applicant PLANT RUBBER & ASBESTOS WORKS FIBREBOARD CORPORATION BY PROBECK PHLEGER & HARRISON and Rinaldo Sciaroni Jr.~fi Attorneys for above Defendants COMPANYNATIONAL EARL VANATTA & CASUALTY COMPANY AUTOMOBILE By He @chut @chut PLANT INSULATION COMPANY EMPLOYERS GROUP BY and ZONNI GINOCCHIO & TAYLOR PACIFIC ay Ginocchio Ralphah By . \ (2A J. Ginocchio Attorneys for above by by Spe ft Defendants INSURANCE C. F. BRAUN & COMPANY and AMERICAN NOTORISTS INSURANCE COMPANY fh ao By -. fLCe ellie gpa MARINE ENGINEERING & SUPPLY PACIFIC EMPLOYERS INSURANCE ZONNI GINOCCHIO & TAYLOR CO and COMPANY BY 37 ; - / ves ; leuses. an wy Ralph J. Ginocchio . oo Attorneys for above Defendants Se wee +t eeprom cente + Otome tee PACIFIC INDUSTRIES SUPPLY COMPANY of SAN DIEGO 2 By INDEMNITY COMPANY 1 Ne. By 2% ax. at LIP g bbs 3 & BECHTEL CORPOPATION AND INDUSTRIAL IN- 5 DEMNITY COMPANY BY MANSELL & GIDDENS Dm 7 By Joe , for above Defendants ---- -- on ARGONAUTI COAST INSULATING PRODUCTS and ARGONAUTI COAST o INSURANCE COMPANY BY SAMUELSEN BOLSON & WHITEHEAD 11 By; op 12 Ben Whitehea,d Attorneys for above Defendants 13 and ^ ETNA ARMSTRONG CONTRACTING & SUPPLY CORPORA- 14 TION CASUALTY & SURETY COM- PANY BY 15 WEINGAND KENDIG & STOCKNELL 16 , > 17 By / 4 7 ~ cy Attorneys for above Defendants 18 JOHN MANSVILLE SALES CORPORATION and 19 THE TRAVELERS INSURANCE COMPANY BY A. TAYLOR DAVID Attorney at Law 20 Ca H H a 21 22 23 STATE OF CALIFORNIA 24 COUNTY OF ORANGE SS ) befendants 25 On this day of February 1969 before DEZ a Notary Public in and for the said me MARY VAL- 26 therein duly commissioned and County and State residing NICHOLSON known to me to be sworn the personally appeared CLYDE 27 the within person whose name is subscribed to instrument and acknowledged to me that he executed the same 28 29 IN NITNESS WHEREOF I have hereunto set my hand and af- fixed my official seal the day and year in this above written certificate first 30 Ed VALDEZ 31 NOTARY -- Va--l,la | j PRINCIGPRANAGEL OFFICE CALIFORNIA California COUNTCOUY NTY i NCooutnatryy 32 : Ne IN GRANGE Pe tty Publi and for and California fate of } fate of California My Commission Expires August 19. 1969