Document V5dpGyw0yNyvOwwvjBBkOZZ

FILE NAME: Contract Unit Workers Comp Claims (WCC) DATE: 1959 DOC#: WCC028 DOCUMENT DESCRIPTION: Workers Comp File - Thorsted, Roy Contains all documents found in the Claimant's file, with one blank page between each separate document f i I1 PILED AND SERVED: 1 2 -3 0 -5 9 On a l l p a r t i e s o f re c o rd --R.Crow ley 1 BEFORE THE INDUSTRIAL ACCIDENT COMMISSION OF THE STATE OF CALIFORNIA CLAIM NO. OAK 1367 2 3 ROY THORSTED 4 ) A pplicant ) 5 vs. ) 6 PLANT ASBESTOS COMPANY, ARMSTRONG ) CORK COMPANY, PACIFIC EMPLOYERS 7 IINNSDUERMANNITCYE CCOOMMPPAANNYY,, SINTADNUDSATRRDIAL ) 8 ACCIDENT INSURANCE COMPANY an d ) TRAVELERS INSURANCE COMPANY 9 D efendants ) 10 ) FINDINGS AND ORDER 11 The above e n title d m a tte r having been re g u la rly su b m itted 12 b e f o r e Jo h n H. A n k e le , R e f e r e e , s a i d Refi (ee now m akes h i s d e c i s i o n 13 as follow s: 14 FINDINGS 01 15 1 . Roy T hors te d , an i n s t a l l e r , born December 1, 16 1926, was em ployed by P la n t/ /sbe^tbs^C om pany and A rm strong Cork 17 Company f o r v a r i o u s p e y ip a s \ i ~ t> me a s i n d i c a t e d b y t h e r e c o r d , and 18 a lle g e s th a t he sustalta^japM L nJury a ris in g out of and o ccu rrin g in 19 th e course o f h is em ploym ents, c o n s is tin g of an a s b e s to s is . 20 2. A pplicant d id not su sta in any in ju ry a ris in g out of or 21 o c c u r r i n g i n t h e c o u r s e o f h i s s a i d e m p lo y m en ts. * 'i 22 3. The d i s a b i l i t y o f w hich a p p lic a n t co m plains was n 23 p ro x im a te ly c au se d , o r cau sed a t a l l , by any in ju r y a r is in g o u t o f 24 o r o c c u rrin g i n th e c o u rse o f h is em ploym ents, o r by h is employment! 25 ORDER 26 IT IS HEREBY ORDERED t h a t a p p l i c a n t t a k e n o t h in g b y r e a s o n 27 o f h i s c la im a s s e r t e d i n t h i s p ro c e e d in g , 28 IT IS FURTHER ORDERED t h a t t h e Amended C laim o f L in e f i l e d 29 h e r e in by th e D ep artm en t o f Employment on A p ril 2 7 , 1 9 59, be and 30 th e same i s h e re b y d is a llo w e d . `C (SEAL) i7 39 H JOHN H. ANKELE, REFEREE INDUSTRIAL ACCIDENT COMMISSION d/<-< 1 /1 '4 /^cicj ~ T % \ c r s f ? c / ^Tni i'< ( C -L u in / % /1 f i s L e S A s Cc^iy fP*\ y f i fu * S ^ r o 'itj G /" I S '/n Ve CL (xlt f o r /%*./ G^. /2 / 3 0 /S -? // INTER ' OFFICE COMMUNICATION To J . E . Z e l l e r , L a n c a s te r From J , S . T a y l o r , S an F r a n c i s c o Subject R e p o r t o f F in d i n g s & O rd e r Roy Thors te d v r s . E m ployers tU tr- r^}-'J.V1 * ( A r m s t r o n g contractini January 6, I960 Enclosed re p o rt of F indings and c la im o f Roy T hors te d b e fo re the the S ta te of C a lif o r n ia , I assume you w ill want to ad v ise our In su ran ce C a rrie r through the A rm strong Cork Conpany o f th is d e c is io n . DJM FORM31501 1.5 Maroh 17 I960 Mr. D. B . Edgar 7* L . P . S h r ir e r Agency 1801 Union Bank B u ild in g P itts b u r g h 22, Pau Daar Darl 3ubjeot* Claim ^6-0-928392 Roy Thorst e d . D A ^V fS /5 9 - C d if. Hy tardy acknovladgaent c a r ta in ly doea n o t in d lo a ta a la c k o f apprciation on ay p a rt o f your March 9 la t t a r ragarding tha d isp o sitio n o f th ia d a im . Aa you kn ov, theaa pneumonoooniosis and a sb a a to a ia claim a ara on tha i n - craaaa i n many aaotiona o f th a co u n try, and va ara c a r t a i n ly happy to haar th a t Standard A cciden t* a dafansa r a a u lta d o n ly in an azpanaa item o f 8183 for legal aarrice*. ------ Thank you. Yaiy txuly yours, R. C. Schladt, J r . Znauraaoa Department JEZ 'i # <> % | T li % : # V.L. P. SHRIVER AGENCY, General Agent 1801 U NIO N BA N K BLDG. PITTSBURGH 22, PENNSYLVANIA Phona Oran* 1-7*00 March 9 , 19&0 KE&1 01960 WLH Mr. B . C. S chiedt, J r . Insurance Department Armstrong Cork Company Lancaster, Penna. Dear Mr. Schiedt: B e:- Claim No. 96-C-928392 Boy T horsted, In ju red Employee - 2/19/59 P o licy No. AZ-688800 The Standard Accident Insurance Company has closed th e ir f i l e on the captioned case. No payments vere made and the only expense to them was $183.00 fo r le g a l se rv ic e s. The above was an Asbestos Worker in C a lifo rn ia and suffered what is known as Pneumonoconios is w ith date of d is a b ility in d ic ate d as February 18, 1959. You may r e c a ll fu rn ish in g the San Bruno, C alifornia o ffice of the Standard Accident Insurance Company w ith Mr. Thorsted*s employment record fo r the years 1950 and 1951. We are clo sin g our f i l e in the m atter. Thanking you, we are Very tr u ly yours, VOL'.' P. SHBIVEK AGENCY y 1S / / --> D. B. Edgar / / PILED AND SERVED: 1 2 -3 0 -5 9 On a l l p a r t i e s o f re c o rd --R.Crow ley BEFORE THE INDUSTRIAL ACCIDENT COMMISSION OF THE STATE OF CALIFORNIA 1 CLAIM NO. OAK 1367 2 3 ROY THORSTED 4 5 vs. ) A pplicant \) ) 6 CPLOARNKTCOAMSBPEASNTYO, SPCAOCMIFPIACNYE,MAPRLMOYSTERROSNG ) 7 IINNSDUERMANNITCYE CCOOMMPPAANNYY,, SINTADNUDSATRRDIAL ) 8 ACCIDENT INSURANCE COMPANY an d ) TRAVELERS INSURANCE COMPANY 9 D efendants ) 10 ) FINDINGS AND ORDER 11 The above e n title d m a tte r having been re g u la rly subm itted 12 b e f o r e Jo h n H, A n k e le , R e f e r e e , s a i d R e fp ^ e e now m akes h i s d e c i s i o n 13 as follow s: 14 FINDINGS 01 15 1 . Roy T h o rste d , an in au L ^ tid n i n s t a l l e r , b o rn December 1, 16 1926, was em p lo y ed b y P la n tf ^ b e s j t p s N'com pany an d A rm stro n g C ork 17 Company f o r v a rio u s p e rie x is \*^im e a s in d ic a te d by th e r e c o r d , and 18 a l l e g e s t h a t h e s u s t a i * ^ M j 3p r \ n j u r y a r i s i n g o u t o f a n d o c c u r r i n g i n 19 th e co u rse o f h is em ploym ents, c o n s is tin g o f an a s b e s to s is . 20 2. A pplicant d id not s u s ta in any In ju ry a ris in g out of o r 21 o c c u r r i n g I n t h e c o u r s e o f h i s s a i d e m p lo y m en ts. 22 3. The d i s a b i l i t y o f w hich a p p lic a n t com plains was n o 23 p ro x im a te ly c a u se d , o r cau sed a t a l l , by any in ju r y a r is in g o u t o f 24 o r o c c u rrin g in th e co u rse o f h is em ploym ents, o r by h is employments 25 ORDER 26 IT IS HEREBY ORDERED t h a t a p p l i c a n t t a k e n o t h in g b y r e a s o n 27 o f h is c la im a s s e r te d i n t h i s p ro c e e d in g . 28 IT IS FURTHER ORDERED t h a t t h e Amended C laim o f L in e f i l e d 29 h e r e i n by th e D e p artm en t o f Employment on A p r il 2 7 , 1959, be and 30 th e same i s h e re b y d is a llo w e d . c (SEAL) 7 ISM JOHN H. ANKELE, REFEREE INDUSTRIAL ACCIDENT COMMISSION JdSSf tu AS*KX, Hfo rc e Oa&laj lu ? *3 TE3KST3D In ju ry j 59 A 1 3 `--T A tstb*i$ r &p q o t o p S ? e : The em ployee, axi I n s u la t io n i n s t a l l e r , to r n December 1, 1926, c la im s to have s u s ta in e d an abetoai& &s a r e s u l t o f gk~ plogsterit w ith v ario u s defersdants, ISSUES: Qcc u p a tio n in ju ry ?'edical D isab ility S tatu te of lia lta tio n o Lao*. o f n o t i c e a n d p r e j u d i c e Mari t I n e J u r i s d i c t i o n L it i ra t ion co sta Idem 5l a i n Departi&cnt o f SSsoloyacnt <3EHALL' L . liv * , M.D*, t e s t ! f l e d on b e h a l f o f t a p p lic a n t in ui-stance a t follow o* He l e d u ly l i c e n s e d t o p r a c t i c e n e d i c i n e i n t h e S t a t e of C a lifo rn ia , B is sp e c ia lty i s d ise a ses o f th e cheat and t h o r a c i s s u r g e r y . He f i r s t s a * t h e a p p l i c a n t on Deeestfcer tjf lyyw , In hi.a o f f ic e and re c e iv e d a H isto ry sa in d ic a te d in h is ro& ort and th e h o s p ita l re c o rd s. IS b a s e d h i u c o , e l u s i or. on t h e p a th o lo g y r e y s r t o f D r, t a t son ami h is c lin ic a l ex am in atio n . A pplicant has a pathology caused by th e In iu tla tio n o f a s b e s to f i b e r s , w orking w ith a prod* u e t c o n ta in in g o p t fcayne s lu a and l p f a a to fc to s. K ls e x p e rie n c e in d ic a te d th a t i f a s b e s to s c a r t lo le a a.-e s u f f ic ie n t in am ount, -e t i l l c a u se a c Jtrrln g o f th e lux At t h i s tim e he can not s t a t e w h eth er o r n o t th e r e k i l l be a p ro g re s s1i*oTn\ bKsut?t i^fy t h e r e i s no f u r t h e r e x p o s u re , th e r e w iyht nos to any major d i s a b i l i t y , ills a d v ic e would be a g a in s t f u r t h e r ex p o su re t a &$oe&to&. he cairn wor.-v a t I d s o ld J o t by uain,,; in h & la to r& o r p r o te c tiv e Be d o es n u t .vnow now ea ch th e r i c r e a i v i l i p ro g re s s in ih p f u tu r e . The- lu n g ha u far.-ao-tlo r e s e r v e . Culy tirso w i l l * 't e l l i f th e present condition w ill w ar: without fu rth e r exposure. Be was p a id 5.9.) f o r h ia te a tla o n y . Time s u r g e r y w as f o r d i a g n o s t i c rorpaocc. the tin e ^ <?* Vi the surgery, th e applicant wait n o t disabled* The w ar *: h i s i or-, was t a t e n ty tn nunc-c a f t e r iso had seen th e p a t i e n t , Tn alo e o f ttsc p a r t i c l e s o f uste at on and th e con te n t r a t io n were- i o p a r t an; klsen he l a s t s.xasincd th& a ry T lc a n t rsn s e to b e r i, lj. the- v i t a l c a - a c i t y avraycd abuut *> l i t c r s , an s ?ib- l i t e r s p e r eins? i a n o t f a r o f f fro r. n o rm al. The re coxy a ls o t e c h e m ic a l actio n in aaD estoals cases tu t in asLeatoaisj i t i s onl usoeoie whci*cas th e Chem ical a c tio n io Unwn in a i l i e o i . TH38STED T h ere a eso p h y sete. Be c a n n o t g iv e the- a i s e o f t h e p a rt i d e a n ecessary to cause a s b e a to a ie . They K ill cause a lo aa o f e l& iitic ity o f th e lung* fie ha# se e n two o th e r c a se c f &*t e a t o s l o , fe llo w em ployee o f t h e a p p lic a n t * este o f w hich a rruch spore s e v e re . H is charges are act fo rth In th e h i l l . acco rd an ce w ith th e eu stem o f th e c o u n ty . They e e in S ix fib e rs p er cubic centiixsrtsr a re a assail amount, file ta a r/ l a an im p o rta n t f a c t o r i n th e d ia g n o s is . isftiat es&kes I t co n clu siv e la th e p ath alc& ist* s re p o rt Even I f he had not known o f th e two fe llo w employee* h av in g a s b e s to s ! , h i con c lu s io n i n t h i s ca.e would have beer* th e anas, lie does n o t know th e e x a c t work h i s t o r y o f th e o th e r em ployees in v o lv e d fcut u n d e s t a t e s th e y worked w ith a s b e sto s and f ib e r g la s s o v er te n y e a rs * He would say t h a t ex p o su re t o f ib e r g la n a p la y s no p a r t in &opl 4_** cam t1 d i a a o l l i t y , lie doe# n o t know how asueh tSL&e was sp e n t w ith flsre r.g la a s and how Btuch t i s e w ith s a b e s ta u . The l a s t X -ra y was tak en s t a t e r 3 , Xypy, H is i - r a / read !n g d iffer fro n th e rea d in g s o f h r, H inste. The aab esto i s i s n o t s e v e re but i n w orking t e ntust have a p ro p e r In h a la tor*. The e y sp to a s can be in d ic a tiv e o f any o th e r d is e a s e s , The d ia g n o s is was p o s itiv e a f t e r su rg e ry , A n u n te r o f p a r tic le s w o u ld n o t be u n i f o r th r o u g h o u t t h e l u r e . He d u e p e r f o r a n a j o r surgery fo r d iag n o stic purposes and th is is very d e fin ite ly th e p ra c tic e o f o th er s p e c ia lis ts . I t i s an accepted su rg ic a l p ro - te d u ru . HEUaXHfl o? BSCB3SS 3# XS5y* H. c a ftk l'i lUKSHA*, k , d , # t e s t i f i e d in t-e h a lf o f d e fe n d a n tt in s u b s ta n c e &a f a llo w s i i l l s s p e c i a l t y lu I n t e r n a l c e d i c i n e , e s p e c i a l l y d i s t a s e s s f th e c h e a t f o r th e la c k its y e a r s , fie e x a d ned t h e a p p lic a n t on Septem ber 3 * 1 >?>.. A f t e r th e exam inai lets he examined th e t is s u e . esoved a t th e t in e o f th e s u r g e r y , fie a l s o review ed th e x - r a y s and th e r?i>ori s i D r . Crenshaw , and th e p ath o lo gist ' a report as com bined In the reso rt o f fir, crensnax. True o r i g i n a l repot*;, o f D r. Wat so .;, th e p a t h o lo g is t , o r P e lo te r 1 , 1 :-:* d o es not ch arg e th e o r i g i n a l o p in io n e x p re a se e in hi& *-,,?ort o f eottsber 10, and fep te-rster t-, l y r . T h e `h i c - to ry co n tain e d in h is re p o rt was d ic ta te d in a p p lic a n t *s p rese n ce, Be, filase If* find# no a s te s to c ia , and a p p lic a n t doec not te w u s - t e s t o s ! s now n o r d id he have a s t e s t o s i a b e f o r e . Ess i s not l e a d e d . D r. Wat on, th e p a t h o lo g is t , found no ln fla .a ta i.a ry t i s s u e , but sor. s p a r s e a sta s-to a p a r t i c l e s , b u t Uvoee t e c l e a d id not produce suiy d i s e a s e . S r , fiovexan i n t h e p -a th u lo g io ts r e p o r t end t h e h o c .,'its, 1 r e c o r d i n d i c a t e s oora s c a r r i n g *r* t h e . s e c t io n t h a t he e-. D r, t a t on c u e s no; f i n d any su c h c h a rrin g * fie c u e s n o t b e l i e ; t t e t he saw th e r e t o r t o f D r, tewm- b e fo re t u t t t e o u to r e ld n o t i n d i c a t e th e c a u s e . In any e v e n t, t h i s r e p o r t d >es n u t r e f u t e n o ru a l b re a th in g c ap a city n o r th e lac.; of .x-rays evidence o f a te o to s ls o r c lin ic a l evidence of ascesfoal . Tberirf>ri o f th * two p a th a lo lf ttt a r e n o t i aatroeaar.t Dr* fc&sooa fo u n d f l b e n t# Car. Sowaan fo u n d none* T he l i b e r a found latere v e ry f e u . f,ueh f i b e r a r e n o t e a s i l y ra is e e d . P r . W atson was v ery d e f i n i t e a s t o th e fin d in g o f no p a th o lo g y in th e lung tis s u e . I t 1 rea ao n ah le to assume th a t I f f ib e r s ere not fo u n d by Dr* Dansaan, t h a t t h e p a th o lo g y h e fo u n d w as n o t c a u s e d t v a s b e s to s - . Is** Bowssan aade no f i n d i n g o f a s b e s t o s ! e o r a d i& a il i n g Ituag c o n d itio n b u t t h i s w itn e s s can n o t o ta te th e cau se o f t h e c o n d i t i o n s fo u n d t-y D r. bowsaan. W ith a h i s t o r y g iv e n by a d o cto r* th a n th e r e roust i e an -ra y e sa ja ln a tio n . P re v io u s a- ra y s tuet a ls o he stu d ie d * i f a v a ila b le * a s w e ll a s th e scdie-al liis to r y . I f th e s e n a t t e r s daieonfi-rat a p-neu^onocoistoalii* th e re should he a b re a th in g c a p a c ity t e a t. Then if- th e re i s so d e f i n i t e d ia-cg n o s ls , I t w o u ld n o t h e u n u s u a l t tak* a b io p sy # vith n e g a t i v e f i n d i n g s o n 3 - r a y s a s I n t h i s e-aae* he* w ould n o t hav p e rfo rm e d a lu n g b i o p s y feu-; t h e r e a r e o t h e r s ho would* fees for biopsy vary. Certain fee schedules, such as the Industrial Accident Coaoiaaion* the aihiroal fee a arc not ad hered to by any cost ora. The Kedical Asea-slat ion has a fee suhedule. Iho docs not kno what iu ..amiable or cuatotoary* owever-, he* lu x tself would n o t ha^e trap p ro ce d u re in th is ease, in finding of diiutlou cl' energy i s not diag n ostic. Fatigue and pair, across the cheat arc not necessarily ey-sriicK2i> of asrefttoft!. fthortes of breath a fte r a c t iv ity la one of the ycaptaus- but not ar^ccIftcully of asbestesia. The jusortneas o f breath on a c t iv ity ia generally diagnostic e-f osse lung or h e art d iso rd e r. Cougii and p ro d u c tio n o f y e llo w is h a p u tu a a ls o i t di&rno&t Is but not o f any epee t f i e lung d is o r d e r , w ith th e rw ,ao a t o r y o f e h srin e iM t o r io re u th on a c t i v i t y * c o u g h pr5Xfcifttn sil a su tu u arid o th e r f in d in g s and c l i n i c a l h is to r y in T h c r a te d v o u lo n o t l a u d h i s t o rojJsc & t e n t a t i v e d i a ^ o a i a o f a a b e s t c a i s . Me w ould t h e n p ro c e e d w i t h f u r t h e r t e s ta . A lu r-i b io p sy i en a c t hod o f get ting; a diagnosis. i s aad&r- su rg e ry * n o t salc a r . I f he uape?tec. a lu n g dl& euse f o r W iiirh t r e a t s a n t w ould b e n e f i t * he w ould p e r f one a hiOps/* ar.e rtp o r . -or D r. B auson was n o t t o t a l l y c o n s i s t e n t w i t i. ast-eat i ii a o n ly e x p l a n a t i o n o f t h e d ifi*es*fcr?ce l e t s e n t h e rc-?c?rt c f D r. Vv&iaor. an d t h a t o t . L ts M i c . U i a t th e y * a <U ff'ere?r:t p o r t i o n o f t h e l u n g s . FrcEj th e re c o rd th e ct&ount o f lu n g t i s s u e ri&tseved i s aaoui. th s a lii o f h a lf th e pair, o f one*a Itenu, and t h i s , o f so u r, i s enough r c r a a ty e lic it . ir.-gfericrxl a l l p o rtion a of th o lu n g w i l l ;:s s i m i l a r l y a f f e c t e d but u j {? u t i l n ot t o e n t i r e l y u n ifo r u a a a f i n d i n g o f f i b e r s o f a s t e a t o s . He* h ls u te lf* U U i t x tn a t th e - r a y s t h a t fc review ed n rc no ntul* a lth o u g h D r . Crer.cha' t h3Uf';h th e n to be atriOr:- !. He d o es not- thin.-, th a t Dr* Crenshaw* a r c r e a s o n a b le I f they lo o ;c a t th e oar.e f l l r s c . The." i? r-'j way of resolving car tissue or the bestrurtion eauser: by tynScal awhestosifi. The progress is- irrevertille. The lux.; f u " c t i v n leasts- t h a t he to y - were < ju iic t j r c i l . Forced fere a t h i r,,_. s ere i s c w i l l c l e a r u; caucus in b lo c red s r e ts # t u t th ey w i l l c l e a r out th e m s e lv e s i f th e p a t ie n t feres,th e a d e e p ly . TTfcre te rtruuftcafely l i t t l e a c t u a l in c r e a s e in lu n j c a r a c it y fo llo w in g forced breath in g., alth o u gh th e re o fte n Is a scarred reuse o f w ell b ein g, fo llo a lr.u aaxn treatm ent. THOftST - * Th a d d i t i o n a l i n f o r m a t i o n J u s t o b t a i n e d from t h o h o s p i t a l recxord w hiob c o n t a i n s a h i s t o r y o f cutc*B&iv* K ta k la g o f a b o u t 30 c ls a r o ttc a a day* la d him to c o n clu d e th a t any one ho atoices th a t aany c ig a r e tte would he e n ti t le d to a l l th e syn p to a* th a t T h aratcd had. ben he took th e h isto ry * he only receiv ed a h is to ry o f p a e k l n s a fen# c i g a r e t t e s a d a y . I t i a rach o re l i k e l y t h a t h ro n J iI e t a a i s c a u s e d t h e p a th o lo g y foutidl by Dr* Bowman &a H r , Daresaan fo u n d n o a s b e s t o s f i b e r . Thts symptom h i s t o r y In th e f i r s t p a ra g ra p h o f P r . Crenshaw*s r e p o r t on ita y 3, 1 *5 ?* I i n d i c a t i v e o f a n y l u n g d i s e a s e s o r none a t a ll When t h e p u tu s i s y e l l o w i s h . I t i n d i c a t e s a n i n f e c t i o n o f sosae s o r t . B e fo re a b io p s y h e w ould t e a t th e s p o t u s h u t w ould n o t t-e c r i t i c a l i f i t w ore n o t d o n e. The s e c t i o n r e f e r r e d t o by f i r . Bowcss&n w as p r o b a b ly t h e w h o le s e c t i o n . A d e s c r i p t i o n o f fcte* e p e c iia e n a s a w h o le i s t h a t o f norm al lung tis s u e . The o p e ra tiv e fin d in g o f D r. Crenshaw d o es n o t mean noch to the w itness. J r-a in a rily , & sb o to ai3 i a a p r o g r e s s iv e an& Itism 3 lo a g a s th e re i s co n tin u ed ex p o su re. I t ia not Ilk s i l i c o s i s where tfware i s p r o g r e s s io n w ith o u t f u r t h e r .apoaure* A lthough th e r e I s auras (Sis p u te in t h i s r e s p e c t , i t i a in a cc o rd a n c e w ith E r i t i s h o p in io n . A sbestos f ib e r s w ill produce i r r i t a t i o n , JuiflassuU ion a n d f i b r o s i s . F i b r o s i s c a u s e s t h o luw2 t o teeesae r i g i d an d l e a s capahifc o f e x p a n sio n , i t i s p ro b a b ly & i&sdhanie&l iain g : a a d i e tilg e t fract a chem ical i r r i t a t i o n as ia caused by s ilic o s is , in s lllc o a iu th e p a rtia l # a re very m inute and th ey a re re ta in e d I n feed l u n g , an d c o n ti n u e t o i r r i t a t e t h e l u n g . Ferh& pa many t.hi?usaiids o f f ib e r a r c not h arm fu l In th e lu n g b u t t r e a t h in g t a illie r . would* unci c e r t a i n p e rs o n a would b e tore s u s c e p tib le th a n e th e r * T h e re I * no e v id e n c e of an y a a e fc a n ic & l i r r i t a t i o n c f tu e lung in re sp e c t to th e tis s u e s hre they were found. A l o t o s fib e rs can be e x p e lle d . ' I th e tu& les o f D r. banders he found no p ro g re s s io n but d id not &artton any im provement o v er the period. APPLICANT t e s t i f i e d i n s u b s ta n c e a b f o l l o w s ; He h a s beer, w orking w ith a s b e s to s m a t e r ia ls f o r l o or IA yfears, a p p ly in g iriw u la tlo n on w ater l i n e s And b o i l e r , he- u ses th e ash esto ssateri& l In block form , and th e form th a t r ib s th e p iiie . The b lo c w i l l u s u a lly run tnrs-s fe e t lo n g , and the th ic r 'n e ss i s in a cco rd a n ce w ith th e s p e d r ie s tla n x . Th p ip e fernes are th e sa^o le n g th and th e y a rc cut w ith saws and th e c u ttin g cau ses a fin e powder, and acraetlmca causes dust to th e exten t th a t a 7^ron i a c o v e re d w ith th e <2u x^ and h i s h a ir tecon.ce w h ite , lie th in k s t h i s i s a t y p ic a l s it u a t io n Wording w ith asbesi-ot. saberl a l a . Tisl* i s a t y p ic a l work s i t u a t i o n a t P la n t A cteotoo and t h e s a j o r i t y o f war, f o r A rm strong was s l n i l & r t o t h i s s i t u a t i o n . TH3S2TZ2 - 5 About a y c * r ago h* got sh o rt ef treats h and p o o le d , and hf went to &i2s hr, c re ttsh a # . l%a n o tic e d th e e h -tr tn c s s o f b re a th een c l i s l i n ^ a s ix fo o t la d d e r and climbing.' ta k in g . A ft r threjp f l i g h t s o f fc t a ir s i ;i t h i s b u i ld i n g , he would t>*sosse onort o f b r e a th , ilia h e a t &ehidau: ha u^hed a l o t . He f i r s t rw tised, X-hs co u g h in g t c r a r a h ir t m - s i o f s r e n t h , T r.c f i r s t t i n t hs atupped t o r - was t*\> nd or it b r u a r y * th e n fe* writs o f f a p p r o / is u s l two dU te f a r e u r ^ e r * , He M fciU t h a t tb a p p r o x l s a a e d a t e wap r*ur*&ry l - o .- , tw A p r i l ,, o , fee- M U m e d t o aror* t o t aan Aicb^fttaa an d to p p e d w u rtls p : f o r I t e s aso-ui s i x its s g f . i f-i-d-t. * * h l t o w o rt f o r Tho A f t e r he was o f f a w^ek i t h th e f l u , h e w as e m p lo y e d i-y T h o rp e. He f i r s t k:i*5? ha Had a s b e a to s ia a f t e r tfce a u r r itr y . He ih ru g n t he Had I t c e f o r e h u t not be fo r* he vsmi t o a c e I-r* CrensiUH-, The tratu*x;e a f t e r o rre ry h e lp e d . Blue C ross sa id c :j t h e s u r g e r y o n l y , The laluiw -'t ne s i l l i s u n p a id . A d d it io n a l c h a rg e s w i l l le & v * * t-alauc: *-.` v-`v;--',u.= f o r t r e * cue; Hr aid th a balance o f th e h o s p ita l c x1 X, a h o \ Ha c>Xu wno si- p<iid x s Hs rutia $-. :5.o* f o r two p r e s c r i p t i o n s , Ik- was ui*char~.e4 by th e dost;* In ;c f p tv r li> > ir o u treu taen c^& m i i s t o r e tu r n n uly I f he does :> :. k -e l r l g h - . Kr rttc a iv c U ify o y -V l uneuploy-ieru. d i ^ a h i l l i y . T*a>r3teSHrJyVehree. stoBpepfeodre sauhri;gi:e:grybuhse; sooAliii 'jJnip:sr.-ttea & day. the la st ire r,onths h ix sr reft iho wore he stssoiced ftboui four >*' i i Vti r'our i.C dayo herv &v'l31*" a v --i. ir.p'ulatior. r--JL fait- 9> * *r ruo vaa ays iS'iJS*. C*sVx, T Cor;., thro hv used uty, >-lr--"' fOrisrtdryay, . >.*. on* Jus tu? U&&U 4s0>1 felt He did nut w0**fv Vltd fct; r eU *'Ma jot- lasti ror Artatrosy Ar.-r.1'T.*urtlhp for Am sfroi.; het useh-e ,-,,,iC^.aeei->r hrC .~-3U11, 5:ilii CV41- vox- the difiejrCi.-e : $tarte-c? -in the? hsrd spa r ; t,. Am I .c i * r*t-un*W,"';>,'* i f viu-i Js ^ ti vt1<a "e j ,i-:'t 1A.y-.* e t At Art *fr v;p'r'.tv -nai. f t pc titlws stri*iu 1A- lma.o' stXL-ttsv-oerr-yf *wj>*u`,*2-**^4whainivUeesrt.llrin Ui--it-Ci-l-svifuisn.'iralipnteoa. fi- There were a coarle- ;-f toa1! Joe *,J0rt Chip/hjrcs SulwiVi , Alps workad st *i<_^? LeSv- hf'Ol i Ai e> a? tht hit; Lzt* io a sitsl `os. The fo u lly dosser is r h.d fra a hi'u is a. ouslu* cr;eN- Fa hn >11 did - r y ^. *r t AAlydi?f4.i.w-ttr*^w; , . v AAisl l * ** h"k1 no. hs. ar otrsj to tab hus itaX io r as l ^S- OX-S4 *'*0*A 1jl*. CO 1 wor<vfu v-eUt1v-i1v : ; r* PXiiTaw rtiiUif' hsvo4%*-,k{mo-ff.c.t!.hec Jr.sss o sily. ll& ' A; ion ou.. for Lp- FlariV. &-*bC8b0 or thc t inr h *W'<*"1ru~/ c ^x fifew }iJ iS2i f!Acroivie*brSmUg*V. Also S.X1C t'i.dcr^ia i!3 Or,d 1^ w:1 X^ * XI2V-^ v%*5i 1i ' er in very nit lit .-.tsi tie 'u !/^"4? la.sa. c^v^PiTv^ u-iliwi JCA&*W*- is al2*^al 1C%' aei. otos. TillHSTH) - C D Z S C C S S I O S A>D D C X 5 X 3 tti The g re a t preponderance o f th e n e d ic a l evidence In d ic a te d t h a t a p p lic a n t- d o e s n o t and <!ta n o t have a s h e s t o e l s , th e re fo r , a d e n ia l award w ill la a u e . JH A wo JOHh 12, AKiLELS, R e f e r e e W ARREN L. H A N N A D O N A LD R. B R O P H Y W ALTER JAKO BSEN IV A N A. S C H W A B RO BERT N. M AC LE AN JO HN A. MAC DONALD E D W A R D P. M C A L E E R HERBERT C. JENSEN EDWARD W. KORAS J. M. MC ELRATH TH O M A S B. R IC H A R D S O N D O N A LD V. M IT C H E L L GEOROE W. BONNEY LAWOFFICI* OF H an na & B rophy 1840 San Pablo A v b n u i O A K L A N D 12. C A L IF O R N IA T E m p l ib a r 2 -5 8 6 O o to b e r 1 6 , 19f?9 S an F ran cisco O ffice TOO B u s h S t r i c t S an F ran cisco 4 Fresno Qffici S ecurity Bank Bldo. F resno 21. C alif. Sacramento O ffice 9 2 6 J Street Sacramento M . Calif. San J ose O ffice 2 0 0 0 H eooino S treet S an J o s e 2 8 . C a l if. A rm stro n g C o n tr a c tin g & S u p p ly Corp< 301; Shaw Hoad South San F ra n c isc o , C a lifo rn ia A t t e n t i o n : M r, J o h n S* T a y l o r Re: Roy T h o rste d v s , Armstrong Cork C o ,, e t a l C ontienen i T h is c a se i s coyitejc up f o r f u r t h e r h e a r in g , end i t i s im porn<m t t o h a v e nov d e t a i l e d i n f o r m a ti o n a s to th e ty p e o f p r o d u e t \ h a n d i e d b V l f r , T h o r s te d and h i s w o rk h i s t o r y , Ye hav e e a r n i n g s r e p o r t / b u t we wouijd l i k e a d e t a i l e d r e p o r t s i m i l a r t o t h e r e n g r t t h a t you 53jb m i t te d v x d e r d o te o f S e p te m b e r 11;, 1959 t o T ra v e le ] I n s u r a n c e Company, on th e claim of Robert Z in i. D r. H in s h a k r e c e i v e d tc h i s t o r y h a t M r. T h o r s te d d id a good b i t o f w ork on tocxs at/E S eth lch e m S h ip y a r d , VJe w ould l i k e t o know w h e th e r t h i s va n e w \sh ip c o n s tr u c tio n o r work on b o a ts t h a t had p re v io u s ly #een comm^ssio Very t r u l y y ours, iA S Jjin c ,c , A rm strong Cork Co, L ancaster, Pa, A t t : h , C. S c n i e d t , J r . Insurance D ept. c .c T ra v e le rs Insxirance Co. O akland (B-89726b.6) c .c , S ta n d a rd A cc, I n s . Co. (9 6 -C -9 2 8 3 9 2 ) R i d o tur ; xj 'a i I Hl. i ; ; ' INSURANCE CuMPANi U ,, o W h ^T L R ST. OAKLAND 12. CAL1B. TEmpleba* 2-6200 June 3 0 , 1959 Armstrong Cork Company, 304 Shaw Road, San Francisco, C alifo rn ia, B-8972646 Armstrong Cork Co. re t Roy Thorated d /a 1-1-52 Gentlement Please subm it, in q u ad ru p licate, a statem ent showing d ates of employment hourly r a t e , occupation, lo c a tio n o f employmeht, d ate of and reason fo r term in a tio n , gross earnings fo r th e twelve month period immediately preceding term in a tio n , whether Mr. Thorsted was a temporary or permanent employeem and whether in h is employment with your company h is d u tie s ex posed him to asb esto s. A hearing before th e I n d u s tria l Accident Commission w ill be held very s h o rtly , and t h is inform ation i s required by our attorneys so th a t we may affo rd you a proper defense. NHAj J J cct Armstrong Cork C o., L ancaster, P a ., / - I( Ll TI. R. Abreu Adjustor EMPLOYER'S REPORT OF INDUSTRIAL INJURY TO STATE OF CALIFORNIA DEPARTMENT OF INDUSTRIAL. RELATIONS DIVISION OF LABOR STATISTICS AND RESEARCH Claim Department THE TRAVELERS INSURANCE COMPANY 195 W ebster 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, Sect i ons 6407*6413) Please make this report in DUPLICATE 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 ( Gi ve na me under whi ch 1. Na me concern does busi ness) -- -- ................. - ( No. and (City or 2. Office address S tr e e t).......... ............................................. ........................ ....................................-- Tow n)-- (M an u factu rin g shoes, retailing m en's 3. N a tu re of business clothes, trucking for hire, etc.) ....... INJURED EMPLOYEE DO NOT WRITE IN THIS COLUMN Case No. Employer No. 4. Name-- 5. Address (No. and S tr e e t) .... (City and ..S ta te )...... ..Soc. Sec. No., Industry 6. Age.---------------------- - 7. Sex: Check (V ) Male... Female.. 8. C heck (V ) M arried ______ Single^ 9. N um ber of hours w orked per d a y ----- .----------- ---- per week.. N um ber of day w orked per week--__________________ __ _ Age 10. W ages: $_____________ ________ per hour, or $------ _________ __per day, or S....... ................. .............--..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 ad v an tag es furnished in addition to wages, give estim ated value .....-- per day, or $ ..................................... per week ACCIDENT 12. Place of accident (No. and Street).... (Yes or 13. On em ployer's premises N o)........ (City or T o w n )..-- 14. D epartm ent___ ___ _________ (C o u n ty ) Sex aod Marital Status Weekly Wage IS. D ate of accid en t----- ---- -------- --------------------- 16. H our of day___ _____ (Yes or accident? N o ) .......... ............ 18. If yes, give d a te last w orked-- ........ __A.M./P.M. 17. Did injury result In disability beyond day of ...... ...... .. 19. W as injured paid In full for (Yes or this day? No) ..................... 20. If injured in a mine, check (v 0 accident location; Surface................. M ill................. U nderground ......S h aft................. CAUSE OF ACCIDENT 21. O ccupation (job title )................................- __ ,_____ ____ _____________ _____ _________________ _____ _____ 22. How long employed by you a t this County Accident Date occupation? Check (vO Less th a n 6 m o n th s.................; 6 m onths to 2 years_________; over 2 years.--------- 23. W h a t was em ployee doing w hen accident (Describe briefly, such as: loading truck, operating occurred? drill press, shoveling d irt, w alking down stairs, etc.)......... ....................................................................... -- .......................................... -- ---- -- . . . ---- Occupation ..... (D escribe fully, statin g w hether the injured person fell, was struck, etc.; give all 24. How did th e accident happen? factors con trib u tin g to accident. Use other side of report for additional space) -- Accident Typo (N am e the specific machine, tool, appliance, 25. W hat machine, tool, substance, or object was most closely connected with the accident? gas. liquid, etc., involved) (S tate if gears, pulley, 26. If m echanical a p p a ra tu s or vehicle, w h at p a rt of it? motor, etc.) (Yes or .-- ............................................................................................ ................ ..--......----(Yes or 27. W ere m echanical guards, or other safeguards provided? No) ..................................... 28. W as Injured using them ? No) ......................................... (S tate the specific preventive measures th at can be taken by employer and workers. 29. W h at do you recom m end for p reventing th is ty p e of accident? Do not say. " By being more careful." Specify w hat should or should not be done) Agency Agency Part Mech. Detect Unsafe Act NATURE OF INJURY AND PART OF BODY AFFECTED (Describe in detail th e nature of the injury and the part of the body affected For example: am putation 30. of right index finger a t second jo in t, fractu re of ribs, lead poisoning, derm atitis of left hand, etc.) .................. ................. ........................ 31. N am e an d 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 34. If yes. give d ate....................................... 35, A t w hat wage? $..............................per.__. . . . . . 36. Did injury result in death? N o)................. 37. If yes. give d a te ..-- ............................................ ............... --....................................... ....... ..................... .. 38. In case of d eath, give nam e and address of nearest relative . . . ....................... ..................... - ............................................................................................................. 39. N am es and addresses of w itnesses.--.__ ___ 40. Is injured related to Em ployer?---- If so h ow ?.. D ate of this report__ ... S ig n e d b y -------------------- ----- --------------- Signature ....Official position______ C-4587 R ev . 7-53 p r i n t e o Filing of this report is not an admission of liability................N...o...r..e..p..o..r.t....o.f...i..n^jur..y....r.e..q..u..i..t.e..d....t.o. be .h..i.ed bv an em ployer or an insurer by ( his chupiui "lull bo u d m isd b e as evidence m a n y u d\ ersar) pr oceeding before the In d u strial Accident C o m m iss io n .'* L ab o r Code, Section 6413. Personal Defect Nature of Injury Location E xtent of Injury Insurance Carrier Report Lag Coded by June 23, 1959 Standard A ccid e n t In su ran ce Company 840 V . San Bruno Arana San Bruno, C a l i f . Gentleaen Attention Yera E . Dowling In re p ly to your l e t t e r o f Ju n e 1 5 , ve en clo se Roy T horsted*s employment reoord f o r th e y e a r s 1950 and 1951* ----------------- -- Very tru ly yours, ARMSTRONG CORE COMPAST JEZ Enclosures V .L .P . Shriver Agency 1301 Union Bank B u ild in g Pittsburgh 22, Pa. R. C . Schiedt, Jr* Insurance Department Earnings of Employes i Claim No.9 & 9 2 8 3 9 2 Standard Accident Insurance Co. DETROIT Compensation Claim Department A ,s,,reH to astro n g Cork Company Tnjlir<tfj Boy Thorated KeAAmt February 18 |q 59 Schedule of Weekly Earnings ^ Week No. j Please give actual earnings of injured employe for ' ( explain basis of earnings. Week From To Date Date Amount Paid including overtime or extra work Number of days worked 1 I3/25/5O I2/3I/5O 84 00 4 - 2 W 5L 1I/7 /5 I 84 00 4 3 1/8/51 1/14/51 1 . 105 00 5 4 1A 5/51 5 I / 22/ 5I I / 2I / 5I I/2 3 /5 I 84 00 4 105 00 5 6 1/29/51 7 2/5/51 8 '2/ 1 2 / 5 1 2 /4 /5 I 2 /1 1 /5 1 2 /1 8 /5 1 105 00 5 105 00 5 105 00 5 9 2/19/51 2 /2 5 /5 1 10 2 /2 6 /5 I 3 /4 /5 1 11 3 /5 /5 I 3/II/5I 84 00 4 94 50 5 105 00 5 12 3 A 2 /5 1 13 3 A 9 /5 1 14 3 /2 6 /5 1 IS 4 /2 /5 I 3A 8/51 3 /2 5 /5 I 4A /51 4 /8 /5 1 105 00 5 105 01 5 105 00 5 105 00 5 16 4 /9 /5 1 17 4 A 6 /5 1 4A 5/51 4 /2 2 /5 1 105 00 5 105 00 5 18 4 /2 3 /5 1 4 /2 9 /5 1 19 4 /3 0 /5 1 5 /6 /5 1 20 5 /7 /5 I 21 5 /I 4 /5 I 5 /1 3 /5 1 '5 /2 0 /5 I 22 5 /2 3 /5 1 5 /2 7 /5 I 23 5 /2 8 /5 1 6 /3 /5 1 24 6 /4 /5 I 6 /1 0 /5 1 25 6 /1 1 /5 1 6/17/51 26 6/18/51 6 /2 4 /5 1 105 00 5 94 50 5 105 00 5 105 00 5 10a 40 5 102 98 5 108 40 5 108 40 5 108 40 5 Total Carried Forward weeks preceding accident. If not on daily or weekly basis, Week No. 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 Total Week From To Date Date Brought Forward 6 /2 5 /5 1 7 /2 /5 1 7 /9/51 7 A /5 I . 7 /8/51 7 /15/5I 7A 6/51 7 /2 3 /5 1 7 /2 2 /5 1 7 /29/5I 7 /3 0 /5 1 8 /6 /5 1 8 /I3 /5 I 8 /2 0 /5 1 . 8 /5 /5 I 8A 2/51 8A 9/51 ` 8/26/51 8 /2 7 /5 1 9 /3 /a 9 /2 /5 1 9 /9 /5 I 9 /1 0 /5 1 9 /1 7 /5 1 9A 6/51 9 /2 3 /5 I 9 /2 4 /5 1 9 /3 0 /5 1 I0 A /5 I 1 0 /7 /5 1 1 0 /8 /5 1 10A 4/51 I0A 5/5I 1 0 /2 2 /5 1 IO /2I/5I ' 10/28/51 IO /29/5I 1 1 /V 5 1 1 1 /5 /5 1 llA l/5 1 1 1 /1 9 /5 1 U A /s T ^ 1 1 /1 8 /5 1 II/2 5 /5 I I 2/ 2/ 5I " W 3/51 I2 /9 /5 I 12A 0/51 12A 6/51 12A 7/51 I2 /2 3 /5 I Amount Paid including overtime or extra work Numbe of days worked 108 40 5 65 04 3 Did He t 1 i r k 108 4 P 5 113 40 5 90 72 4 113- 40 5 113 40 5 113 40 5 ____ 90 72 90 56 4 90 72 4 113 40 5 113 4Q_ 5 113 40 5 113 40 5 113 40 5 113 40 5 113 40 5 113 41 5 90 72 A 90 72 4 113 40 5 113 40 5 113 40 5 113 40 5 A R emarks I certify that the above is a true copy of payroll record of injured's earnings as shown on employer's records. Form L. C. 127S Ed. Oct. 1924 Signed <* , Earnings of Employes Claim No 9C920392 Standard Accident Insurance Co. DETROIT Compensation Claim Department Ar.iir.i4 t o t r o a g Coric Company , ni,, red ' Af nH.n, r b ,n M T M i<> " Schedule of Weekly Earnings jg. ( Please give actual earnings of injured employe for______ i_weeks preceding accident. If not on daily or weekly basis, 0 ` | explain basis of earnings. Week No. 1 From ' Date Week To Date Amount Paid including overtime or extra work Number of days worked Week No. 1 7/24/5O 7/3O /5O 94 00 5 27 2 7/3V 50 6/6/5O 98 80 5 28 3 8 /7/50 8 /1 3 /5 0 QQ 00 5 29 4 8/14/50 8 /2 0 /5 0 100 00 5 30 5 8/21/50 8 /2 7 /5 0 100 00 5 31 6 8 /2 8 /5 0 9/3/5O 100 00 5 32 7 9 /4/50 9 /1 0 /5 0 80 00 4 33 8 9/U /5O 9 /1 7 /5 0 100 00 5 34 9 9/18/50 9 /2 4 /5 0 70 00 4 35 10 9/25/5O 1 0 /1 /5 0 100 00 5 36 11 IO /2/5O IO /8/5 100 00 5 37 12 IO /9/5O IO /I5/5O 100 00 5 38 13 10/16/50 10/22/50 100 00 5 39 14 IO /23/5O IO /29/5O 100 00 5 40 15 IO /30/5O 1 1 /5 /5 0 105 00 5 41 16 1 1 /6 /5 0 1 1 /1 2 /5 0 63 00 3 42 17 1 1 /1 3 /5 0 1 1 A 9 /5 0 105 00 5 43 18 II/2 0 /5 O 1 1 /2 6 /5 0 84 _0_0_ l 44 19 II/2 7 /5 O 2 /3 /5 0 105! 00 5 45 20 1 2 /4 /5 0 I2/IO /5O 105 00 5 46 21 I 2/ I I /50 1 ^ /1 7 /5 0 105 0 5 47 22 12/18/50 I2/24/5 105 00 5 48 23 49 24 50 25 51 26 52 Week From To Date Date Brought Forward Amount Paid including overtime or extra work Numbei of days worked . Total Carried Forward Total $ j R emarks I certify that the above is a true copy of payroll record of injured's earnings as shown on employer's records. JUN2219B& Form L. C. 1275 Ed. Oct. 1924 Signed D M FERRY. J R Cha.r of lh# 8 o*rd L K KI RK Pf*Mdnt S Y M B O L OF S E R V I C I F OR 7S Y E A R S Standard A ccid en t Insurance Com p any I N C O M O M T t D I 4 ROY W. SM ITH Manager CASUALTY FIRE MARINE FIDELITY SURETY No rth ern C a lifo r n ia Br a n ch O ffice phon* junos-.ooo 840 W EST SAN B R U N O A V E N U E San B r u n o , Ca l if . June 15, 1959 JUN 1 9 1959 WLH Armstrong Cork Company Lancaster, Pennsylvania Attn: Mabel E. Barnet Insurance Department Re: 96-c 928392 Armstrong Cork Company Roy Thorsted Date of Disability: 2-18-59 Policy No : AZ 688800 " 1-1-50/1-1-51 Ge n t l e m e n : We have received a copy of an Application from the Industrial Accioent Commission on the above captioned. We have not formally been SERVED ANY PAPERS AS OF THIS DATE, AND IF YOU HAVE RECEIVED ANY WE SHALL APPRECIATE YOUR FORWARDING SAME TO US. Attached to the Application is a copy of his employment record that INDICATES THAT ROY THORSTED WORKED FOR ARMSTRONG CORK FROM 195 T0 *952 WILL YOU PLEASE CAREFULLY CHECK YOUR RECORDS AND ADVISE US THE EXACT periods Roy Thorsted worked for your company and the exact wage received AND THE EXACT LOCATION OF EMPLOYMENT. WE SHALL APPRECIATE YOUR IMMEDIATE ATTENTION TO OUR REQUEST AND ADVISE US AS SOON AS POSSIBLE BY RETURN A IR M A IL . VED/ms c c : V.L.P. Shriver Agency 1801 Union Bank Building PITTSBURGH 22, PENNSYLVANIA cc: Hanna t Brophy, Attorneys 15^0 San Pablo Avenue Oakland, California Vera E. Dowling Claim Representative Standard Accident Insurance Company. Detroit Pilot Insurance Company, loronto Earnings of Employes Claim No._____ Standard Accident Insurance Co. DETROIT Compensation Claim Department Assured_______________________________________ InjurecL_______________________ Accident__________________ 19 Schedule of Weekly Earnings Note- i ^ ease 8've actual earnings of injured employe for________ weeks preceding accident. If not on daily or weekly basis, * (. explain basis of earnings. Week No. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 Week From To Date Date Amount Paid including overtime or extra work Number of days worked Week No. 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 Week From To Date Date Brought Forward Amount Paid including overtime or extra work Numbe of day? workec - Total Carried Forward Total . R emarks I certify that the above is a true copy of payroll record of injured's earnings as shown on employer's records. Form L. C. 1275 Ed. Oct. 1924 Signed ^ R o y 'I'HoJSTe.b $ S * 5 C,o - a<? - s a 4A- bo ' V ' " ,' O ILAoI O Ai<f' u j e < >1 . 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