Document bB9w69eEnzp8OYJZLzbnMGGED

twem C4I WORKMEN'S COMPENSATION the Industrial commission of Ohio DEPARTMENT OF INVESTIGATION COLUMBUS REPORT OF INVES Claim No. _J5D._1Q.Z5.15._______________________________ s. s. Ko. _2?fcO?:^iOS C,e of_____ HeOTJ-' JL. Haorst_,.. decl.d............ Employer Iola I. Hoerat, Mdow-Ciaimant Aa dadj_re__w 10109 Wayne Avenue ------- - _AMAArAers,,*s Philip Carey ----------- 3C2in0eSiR. nV.tai>ynefrAivoenue____ __ _________ To the Industrial Commission of Ohio, Pursuant to instructions, the above numbered claim has been made the subject of an investigation and the following report relative to same is herewith submitted: Date Dictated--?-10;Ou Date of thia report- 2-10-61t Dltet of investigation.-------------------------------------- Date Tran$cribed-2"1CW6U Investigation covered following matters:------------/llarA iaa krial lUMMSat it tA mlttin MtMtd b IkViillrillM J OCCUPATIONAL DISEASE Asbestosis Claim allowed as an 0. D. Claim on 11-15-60 and decedant has been a P. T. D. since 11-16-60. DaTE CF DEATH: CAUSE OF DEATH: 10-17-63 Pulmonary Edema Cor Pulmonale Asbestosis AVERAGE WEEXLY V-AGS: $96.71 INVESTIGATION: ~~ C-2 Death Certificate C-105-R C-5 Autopsy RePrtC-C? C-Ui Marriage Certificate Being duly sworn, Iola T. Hoerst, who resides at 10109 Viayne Ave., Cincinnati 15, Ohio, denos^s and states she is the legal widow of Henry N. Hoerst, deceased, hereinafter known as the decedant. Her mother's maiden name was Jtnueven, both deceased. The affiant further states she was bom Iola Knueven,Sept. 25> 1900 at Heading, Ohio. Catherine Medasch and her father's name was Henry The affiant and decedant were married by Father Joseph Rolfes at S^ James Church now in Wyoming, Ohio, on October 5, 1927. There was no previous marrioge by either party. There were two daughters born of this union, Joan, aged 3ii and Ruth Blout 30 y.-rs of age. The decedant and affiant were living together as man and wife and had never contemplated separation or divorce. The decedant I; worked at 'Philip Carey for twenty-four years. (Continued) lavtstiittor or Depvtj. w .*,**v*v . *V A mm miwui.e/iiu i P..J- u OD 107910 Henry H. Hoerst, DeCd. 10109 Wayne Avenue Cinci nati, Ohio The Philip Crey Big. Co. 320 S. h'ayne Avenue Cir.cinrwti, Ohio In 1957 the affiant had his first attack, he was off for eight months and the asbestosis was found and he went back in another department. The decedant was declared a Pennanent Total on November 15, I960, by the Industrial Co-mission. In March of 1963 the decedant was placed in Christ Hospital and was hone until the fourteenth of September 1963 at which tine he was placed in Good Samaritan Hospital, where he died October 17, 1963- An autopsy was performed. The Schmidt-Dhonau Co., Funeral Directors, were paid $1263.27 by widow-claimant for burial. good health. The affiant was wholly dependant for supi>ort fron the decedant and is in fairly History of a slight heart attack sane four years ago. allowed. The C-iiii shows a direct relationship to Occupational disease for uhicn claim was Philip Carey Mfg. Co. - Claim is Certified PjSCOK?1SNDATION : That file be referred to Ur. Lahley for referral, if necessary, to a specialist. Then to Mr. Lawrence Ojbbs for review and payment of fee biSs as are approved. EPF/mh * EViRET P. TRnUi Claims Investigator