Document aBjQgwqYNn0qEBnopBq9EkLoX
FILE NAME: Contract Unit Workers Comp Claims (WCC)
DATE: 1960
DOC#: WCC035
DOCUMENT DESCRIPTION: Workers Comp File - Templeton, Dean Contains all documents found in the Claimant's file, with one blank page between each separate document
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HSTAATTE Of mMIeCWHtCAAMN '
M M I M ' S tflMPOISJmOH DEPAiTMEK
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APPLICATION FOR HEARING AND ADJUSTMENT OF CLAIM
TH FOMM TO U UUD ro*
I U MMIMIlM tU.na. 0
t. wtitmns W t'iw MI*| 0
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wcplotm D e an Tem p l e t o n,
_ _5885...McGFuir 6........ ..... . T a y l o r Townsh i p ...............
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Street Address
C ity
Jo h n ^ K A n v ille S a le s C orp ., 832 F is h e r B l d g ., D e t r o i t , Mich. i i r w n'pttfrv ex;-Corning: F i b r e g l a C o r p , 15300 W* 8
rown I n s u l a t o r nnmpflnwI 0 ^ g ^ f e b e ^ 1 1 , " z e t r o 1t",~
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DTSUKAKCI CAXRHl .ZiU^^rTrr^..LS.Z.J.........
(Do) noA mfill imn turnntoie*u klonttoowwn)
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The applicant respectfully hews:
1. That this dais) relais* to a personal injury which occurred on or abes*_.... .
6/ 17/60 OK to a diaabiamaat (rota occupational dia--.sa kick occurred on or abouti.
J. That the Injury or disablement occurred a t .... ...................r...o...i..l.................* ? .___________________________________ ..and in <h M ow tof
CHy
County
8tote
.Employee exposed to unusual amounts of d u s t , a s b e s to s and other
irrita n ts .
(Give detail)
MAILED
A U G 3 1960
6/ 17/60
(Lari day worked)
(Daily Wage at time of injury or disablement)
W C M 0 N DEPT.
LANSING, MICH.
(Weekly earmaps)
rI n J u r y t o l u n g s and c h e s t , p n e u m o c o n i o s i s , a s b e s t o s i s , b r o n c h i t i s
3. Katar* of disability.:
(Describe part of body mjured. If occupational disease, state tpocic disease)
ronchiectasis,
,,
,,
/ pneum othorax, r e la te d conditions and the sequelae th ere o f; traum atic
neurosis.
.........
................. .............. ................~.............. ........ ...........
Data oi recovery....... M 1 . . L ? X * . <?. ....................................... Date of return to work 1 ? . ? . 1 * . ................. .......
4. If daath resulted, five date of death..
Kalattocahip of applicant to deceased..
S. Kama* of parsons dependent upon injured employee on date of injury
S. If adjustment of attorney or medical ieee or fanerai espansa is sought, pleas stata which and amount
-Wherefore applicant request* that he be fru ited such relief as h* Is entitled to under the Workmen's Compensation Law of h tichif sa and that the Department set this matter for h te ria f so that th* parties hereto may have a determination of their rights under the Workmen's Compensation Law.
Dated a t ................
Clarence R. Constan Attorney for P la in tiff 23900 Van B o r n Road Dearborn, Michigan
CR 8 - 1 1 1 0
..this.... , . . . _ 8 t h ............. ........jay of....... J y .1 .1 ............. ,.19. 6 0 _
S f * n * d ^ ^ < ?-...irL...j
.
(Applicant m a tt sign hare)
Addrast 5 8 8 5 M c O u i r s , T a y l o r , M i c h .
HOTS:--Either party to t dispute rtfa rd in f compensation matters may apply to the Department for an adjustment of its claim. Three copies of this application must be mailed to the Workmen's Compeaaatioa Department, T^n.iny I3,^tichj*ji. The applicant should keep o at copy.
DECEIVED
JU L 1 9 I960
to tO D rs e n tra li ttn LANAINO, M .CHlGArt
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- * STATE OF MICHIGAN
w r k & e n 's C o m p e n s a t i o n D e p a r t m e n t
L a n s in g . Mic h ig a n
PLAINTIFF
NOTICE OF HEARING DEFENDANTS
9m a
f if e * . I 1 * M .,
STATE OF MICHIGAN,
County of Ingham
}.
To the above named parties and each of them:
f - - ^ _______
B7
PLEASE TAKE N; CE that a hearing on this case will be held before a Representative of the
Workmen's Compensation Department on the matter indicated below:
( S) application for hearing and adjustment of claim ( ) agreement to redeem liability ( ) application for a lump sum advance ( ) petition for additional medical benefits ( ) order or petition for additional testimony ( ) petition for determination of rights
( )
at the 18th FLOOR, CADILLAC SQUARE BUILDING, in the city of DETROIT, county of WAYNE, State of Michigan, on the____ _________DAY OF------------JSSSiifcB P------------- , 19 ^fcommencing at 9:00 o'clock in the forenoon, LOCAL time.
YOU ARE DIRECTED to be present at the time and place above mentioned and to be prepared to proceed with the hearing with such witnesses and proofs as are necessary.
I f approval of attorney fees is required, the attorney must file a statement of the proposed fee on
or before the date of the hearing.
WORKMEN'S COMPENSATION DEPARTMENT
Dated at Lansing, Michigan, this
day o f .
......
'trf tilt JJp an iltB i,
t
pggBDAHTS
Johns-fianville Sales Corp. 32 U s h e r Bldg. Detroit, Sieh.
Travelers Ins. Co. 930 Bis# Bldg. Detroit 26, Rich.
Mansfield, Dobitt, Sulsbach ft Jenkins Attorneys at Lav 1912 Guardian Bldg. Detroit 26, Mloh.
Michigan State Aooident rund 1602 Cedille0 Tover Detroit 26, Michigan
Ians ft Killian Co. 1761 V. Forest Detroit, Michigan
General Accident Assurance Corp. 154*0 V. HoHi chols Detroit, Michigan
vens-Corning Plbroglas Corp. 15300 . 8 Rile Bd. Oak Park, Stich.
Aetna Casualty ft Surety Co. 1000 Guardian Bldg. Detroit 26, M o h .
Alexander, Buchanan ft Conklin Attorneys at Lav 2217 Birst Bational Bldg. Detroit 26, Michigan
Broun Insulation Co. 16200 a&fcfeell Detroit, Mich.
Michigan Mutual Liability Co. 23 . Adana Detroit 26, Mich.
LeVasacur and Berner Attorneys at Lav $15 Bord Bldg. Detroit 26, Mich.
2. 5. Anderson, Xho. 20*33 Woodinghan Detroit, Mich.
9m
Tipiston,
5885
PRAECIPE FOR HEARING
Workmen's Compensation Department State of Michigan
MoOuirs, Taylor, Mich.__________
S a l t s C * r p .. a t a l (&-- a tta a h d H a t )
________________________ P e t o f I n ju r y , J t o t 1 7 , i 960
P le in u ff Defendant
Director Workmen's Compensation Department 1800 Cadillac Square Building Detroit 26, Michigan
P le ase place the above entitled cause for hearing on the ( ) F irst Hearing Docket or (
Regul ar Trial Docket.
I, counsel for
Plaintiff
this praecipe has been served upon all opposite parties.
.in the above cause, hereby certify that a copy of
I, counsel for the on the issu es.
_____________
have discussed this cause with counsel for D s f s n d a n t a
.and we have discussed all po ssib ilities of amicable agreement and I am prepared for trial
I, counsel for die. Plaintiff
.certify that ( ) no medical examination needed in this
cause or ( ) Defendant has complied with Section 19 of Part II and has furnished medical reports to the plaintiff.
/ s / D a v id M. R o b e r ts
----------------------------------------- Barid -3.-Sobartp-- _ Attorney tor Plaintif:
8 3 * 6 0 C h u r c h B d . , O a k P a r k 3 T M i c h . ________________________________________________
A ddress
A ddress
& * s tta e h s d l i s t .
A ttorney for D efendant
Detroit 26, Michigan
FObruary 1 7 ,
isfil
T h is praecipe m ust be file d with the Workmen's Compensation Department, Detroit, Michigan
TO: WORKMEN'S COMPENSATION DEPARTMENT DETROIT 26, MICHIGAN'
STATE OF MICHIGAN COUNTY OF WAYNE
PROOF OF SERVICE
----- Miry 31 atraask---------------- , being first duly sworn, deposes and says that on the-X ^^frday of. Abors naasd defendants and attorneys
Hsbraary--------- , a . d . i & L - , she caused to be served on ( f l S --a t t a c h e d --l i l t ) -------------------
. attom ey(s) for the above named defendant, a copy of this PRAECIPE FOR HEARING by placing same in an
-'envelope addressed to ( f l e e a t t s e h e d l i s t ) -- A T I e o w y a n i e s - a n d a t t o r n e y s ^ -----------------------
and depositing the same with postage duly prepaid in the United States mail
# 1 '.
W aRixaa
Subscribed and sworn to before me `fc is-T P th d a y f ~ F * b , ----------- A.D., l f e -
Notary P u b lic, Wayne County, Michigan
My commission expires:
:
i1
*. i RATS 07 KICHRUK
WBKHSPS 0GHPEaSJLlXC3 QBPAKTKBSfT
2JSAH T2XPL270I, P lain tiff
IU X. A5DSR5C3, I3C. m d STATS ACCZX3ST 90SD,
M to d n U
m ygca to D isarm
Sew osm* U Hiahigaan S ta i AoeLdAnt Amd ad novw to d is a lu u egminrt L taalf the A pplication f ile d bgr the la s t awplngrr and i t s inaurraoe -a rrlo r and Attorney* la oem actlan id th Application far Apportlcm m t adar S cotica 9 A tri VIZ o f tha Vorigcm1! Cospersa*tlo n Act fa r tha reoacn that tha abavo nraaart p la in t if f , D m T--plwton, m s cnplcynl bgr tha R. U* Anderson, Zoo aa April 17, 195 oad A pril IB* 193* -- a period o f two day* -- cm tdjieh dato* tha Stato Accident Ami mm not tha doly r ecorded Wortnan's Compensation carrlar fb r & B. Andaman, In e.
Aarthar, in o m a r t o f tfala Notion t e E&smLm , tha MLcfeAgan Stata Accident Asad arar th a t th a ir p o licy bacano affootiT o on July 15, 1 9 ^ ,
ha&ETOKK, tha Stata AcoLdant A ad reep eatfttlly reqpaete anrlOdar Aon tha fiapertwert d ia d sa ia g than aa a Xhfeolart tartar tha Appartlomant A p p lication .
W trm x T 22, l &
UcrkBeo1* Coapoaaatlxsi raparl-- it
la m in g 13, %eklga& AS: EOan T g*pIotoo w 1 1 A adorsoo, J a s.*
helO M d boravith ploaao fin d Hotion to D im ls* la tho abavo a stltlo d oaooo.
t e y tr a ly yowra,
OOJ J o ta -tte o v lllo Salso Carp. v Trsvolara Xao. 0, tew fU L d , Stf& tt, S a lti*** A JatidLas, Atty .
Owbi ffnraliy; Rbra^Lu Carp,
dotili f*inwltj Sarwty Co. DLnsndar, Poohanam A fomfrUa, Attyo. B rew iH d b t ia i Co. f&efedgn Mbtoal l ia b ilit y Co. loT asaov A te n o r , A ttys. ft. 1. Aadarm , 2no. (Has* A B illo n 0. (tonarsi Aoddact Aasaraaeo Cozp. Hr. David H. Robort, A tty. Hr. H. F, Barisga
Workmen's Compensation Department
NOTICE OF HEARING DATE
DGai. T -1FL*T K
Plaintiff
iGvILLn ofii-uiikj CGrti . 0 *..G~CGfw%X< G r Xuw.i.GL;wS 0 0 :A Liw..i, IKuLi'.TIi ( GO
R . 1. aKu-j ^ON INC. * GLaKL A. JLILLI/u, CO.
Defendant
TRAVELXRG IK S . CO.
ETK.. CGIK-LTY k SU.-.GTY CG. HICKI-A'. M'JTU.aL L.** ILI.. Y CO.
S T A T E CCXiJtA> F U N D Insurance Company
GiatwijfcAx) Cv^XOx^! Ak>c>L -a _ I.!
.
J a Y I j
K. CQNhTAK
AOL Attorney
KiAKSFIELO, OS*.ITT . SUL^ ..CK
ALE: .Gii,
- ICH.J'A?. 6-, CGI, LI I.
LGV*u w Eli;..
A tto rn ey L '1','
hlOiUKu AG'v ^ G , ATTY.
The above captioned matter will be heard on
Marc^i 2 0 , 1 9 6 1 ___
or as soon thereafter as possible at 1800 Cadillac Square Building, in the
city of Detroit, Michigan, commencing at 9:00 o'clock in the forenoon, LOCAL
time.
You are directed to be present at the time and place above mentioned and to be prepared to proceed with the hearing with such witnesses and proofs as are necessary.
WORKMEN'S COMPENSATION DEPARTMENT
Dated March 6 1961
V ~
y I - '
Workmen's Compensation Department
A M E N D E D NOTICE OP HEARING DATE
D S A K T S M P L g T Q N ________________ Plaintiff
JOHN-MANSVILLE SAL.-S corp.
GWEHS-CORNING FIBERGLAS CORP.
BROWN INSULATING CO. R. H. AS05RS0N INC.
Q L A N Z k. K I L L I A N CO._________
Defendant
TRAVELERS INSURANCE CO.
A E T N A C A S U A L T Y fc S U R E T Y CO.
_MICH.IGA]t' _ M i m u r T.TAHTT.TTY C D.
STATE
Insurance CompanyA C C u g ^ T JTUL
GENERAL ACCIDENT ASSURANCE CORP.
C L A R E N C E R. CONSTAN
DAVID M. ROBOTS_________
Attorney
MANSFIELD, DEWITT A SULZBAC.i ALEXANDER, .BUCHANAN A CONKLIN LEVASSEUR, *RKi2*ttomey A HITS EFF RICKARD ROSEES, ATTI.
The above captioned matter vill be heard on A p r^T T ? 3 Q>1______ x>t as scion thereafter as possible at 1800 Cadillac Square Building, in the city of Detroit, Michigan, commencing at 9:00 o'clock in the forenoon, LOCAL
time. This matter h a s been r e s e t bac a u s e t h a s a d leal examinations will not ba conflated until March 27, 1961.
You are directed to be present at the time and place above mentioned
and to be prepared to proceed with the hearing vith such witnesses and proofs
as are necessary.
WORKMEN'S COMPENSATION DEPARTMENT
/^ p ir c to r
Dated M a r c h 9, 1961
iStttanHtit 2 a e . fiaovter
., REDEMPTION ORDER
The agreement to redeem the employer's entire liability for an injury sustained by the plaintiff on
S 9 M * at* 295*
by a single payment in lieu of weekly payments having
been considered by a Hearing Referee of the Workmen's Compensation Department and it appearing
that said agreement should be:
; denied;
^ _.
SS
THEREFORE, IT IS ORDERED that said agreement to redeem the employer's entire liability
for weekly payments herein by the payment of
\ TT TS FTrPTTTFT? n g D T T P F n -that nifi n m K v .
tyt: annmved: denied;
'^ y
)ERED that defendant(s) shall also complete the payment Of weekly catn-
Jm i* r * 3 r u n TM --------
i iniifl
IT IS FURTHER ORDERED, that. o f the transcript of the bearing herein.
-shall pay the cost
TH E ABOVE ORDER IS ENTERED IN ACCORDANCE WITH THE PROVISIONS OF ACT NO.
10, PUBLIC ACTS, FIRST EXTRA SESSION OF 1912, AS AMENDED. IF A REQUEST BY ANY
OF THE PARTIES FOR REVIEW BY THE DIRECTOR, OR NOTICE OF REVIEW BY THE
DIRECTOR ON H IS OWN MOTION, IS N OT FILED WITHIN 15 DAYS FROM THE MAILING
DATE OF THIS ORDER, XT SHALL STAND-AS TH E FINAL DECISION OF THE WORKMEN'S
COMPENSATION DEPARTMENT. 'V '
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SATION DIPARTMHNT
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jt* --T -.-n.^ a d , *r<af aaid date of injury, W W T U il ('S J th ffn w n ( )J a b o r, and had the o
~ ' ' ; -*&? a ^ f i S E w e a i^ - T a d i* s n th e g m p k Q ^ ' ayfcjr r f ' ^ c m . in ju r y **>:
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riF is THICK&FOSaC drbejcrd *"ty^ft*"
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a .i...,, ...^ 4* n iin ifiieaim ^ -A e k sftc of $-------- ---
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p i.*
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per week for
4tnn------- ------------ -- ---------- __---------------- ]i________ S 9 -------_ ' try............. ...... - .... ..
'-` ftiair * * * fi*WM~eI* fry * Hwp-yiE Rei-rr' of ,he W ^ - n e n '* Co.-"*:-
1 ....
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. fcnclosive, . in clu sive,
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. inclusive,
abd for paiftiaHiaAlHty aT & e rato iSt ^
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in c lu siv e ,
aaid cenployac fa afcffl to tally - -partially disabled and D efen d a n ts) ball p a; com pensation at the rate
`TIFiFir. r. F. wnrti! farther- safer- s i tb s :Dtt>caej*sit; w d i th at aaid ^ lW en d r o t(s) -shall reim burse said em ployee
**V -\ b h fatar-e
.'dbr_
r^ yrw n T t.far-rt*?^
T "*i
a t th e rate o f "3% pat awnmn from th e 'date 1
re.) Symcmt waa dDawtotO paid.
l ' -:L i f i l " *: *'<*ir.' -*>?-...*?.. ` ' ^ " t t a t T H K X SFO K S C K D ER K D that tte.^ m p!
41.
p er w eak for be apecific
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ta Jaeai sw from aaid d efen d an t(s) com pensation at the rate from_____________ ____ ________ 19______ fo r
; %nd, th a t aaid D efeoda& t(s) shall reim burse said em ployee
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F*-w>. said O e^fo a eh aliih?f'-a M S a.Sn.cataf"y
P paid AppBcant(i) a t {he rate of
to ta l - partial rhywndsp ti a(. e)
K D ^ p v to oiot but m t to rTrrrd 450 w eeks from th e d sjr and farther, th at aaid t ld a d a r t < i) d w d tp ay $ ....... --, j'S Z ? ------ aa follow s:--------------------- !_____
- < Jr ifereyi^ C T roi e t th e abedf>5% -
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AFFIDAVIT
STATE OF COLORADO ) ) ss :.
COUNTY OF JEFFERSON )
R. B. VON WALD being duly sworn according to law deposes and says he is Vice President and Corporate Counsel of JOHNSMANVILLE SALES CORPORATION, a defendant in this action, that he is authorized to make this Affidavit on its behalf and that the facts set forth in the foregoing pleading have been supplied to him by others upon whom he relies and are true and correct to the best of his knowledge, information and belief.
>0 R. B. VON WALD
Sworn and subscribed, to
before me this JO svux day
or
^ 7 1982.
My Commission Expires 7y Commission expires Oct. 15, 1984 P.O. Box 5723 Denver, CO 80217
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