Document d6kZQpx3OJgkwKyDD3wxwQ1q
FILE NAME: Contract Unit Workers Comp Claims (WCC)
DATE: 1965
DOC#: WCC026
DOCUMENT DESCRIPTION: Workers Comp File - Chester, Charles Contains all documents found in the Claimant's file, with one blank page between each separate document
Aj-iatf-?- O * '?
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TM OK PEN N SYLV A N IA
i I-\K- lA lEN T ^IE LAHOR ANO INDUSTRY
CLAIM PETITION FOR COMPENSATION FOR SILICOSIS, ANTHRACO-SILICOSIS
ANO ASBESTOSIS
HAKKISUUKO. PA. .Sh MIN RftoM 1 2 -0 0 ^ 3 122,170
charlea Cheater
-tnt or T n n u n of Claim ant
IVI6 Bertwood Ave.
Gloucester*
N.J*
Claim Petition No.
ja& xoL 19.
u-m atrong _ C o n tra c tin g & S u p p ly Co.
I.in ployof
J2 5 N. B road S t. P h ll a . P a . Addice*
Inaurane Carri Addreaa Occupational DIm i u m Fund
TO THE WORKMEN'S COMPENSATION BOARD, COMMONWEALTH OF PENNSYLVANIA:
The claimant respectfully represents:
1. My name is ___________ C h a r l e s C h e s t e r _______________________________________
/
\
2. I became totally disabled as the result of
| on
( Asbestosis
)
j of
Septem ber,
19. 65
3. My total disability is result of employment in a hazardous occupation having a
.day
j hazard,
and I have been so employed in the Commonwealth of Pennsylvania at least two years in the aggregate during the ten years next preceding the date of disability as follows:
Dut of E m ploym ent
N ame of Employer In P e n n jy lra n ta
Addreaa
From
To
D elaw are I n s u l a t i o n Co. 5 th & C olem an S t . , W ilm in g to n 1956 th r u Nov. 1957
Han do
-- --------------------------------------- *Dc T T 9 S 7 " " E T iru 'Jari r 196 3
m is t rb rig " Con t " 2 925~''N .~lir o acT'B t . ;- " P h 'I 'I 'a :~ 'P a :~ ----------- :X 'PSB T T 351'"" t h r u J u . 1963
b e e h i ; u c a T " I n a u l a t i o r i 'C o .,~ '3 T T W. M tT 'PIeriQ'ari"t""'Ave7'Ihira " A u g u s t', .. 1 96'3
Mec h a riTc a I " i ri a'u I aiori~C oT 7 3TT" W. MF.~''FTe a a a ri"t~~Ave,'IhiXn "No v . ' 19 G'l t K r u W ay 1 9 G 4
r r l d a y 'S u ppT y ~C6"'."'r " ^ 7 3 7 "l ^ `mCamb'r i d g F "'NF.''7T?h'iT a T 7 ~ P aT"* 'S e p F .'...I9 6 3 '" "t'Kr ' "ct". 19C
A r m s tr o n g "CorfETi 2 9 2 5 N . B ro& cT 'S t. 7"'TrhIT&'. PA'.
)( `J u r ie "T95'4"'''Ehru N v." 1964
O v ens' C o r n i n g ~ Q la s a ^ c T . J a c K s o n t '"Sw lm oon"^ 't T TM i iHIXaT BarrTcarie'Coatirig 'C o ., 1" N7"'K I n g s '"~S't.7Glouc8'e'r7N73.
P h i 1 a'7"A s S 'io t " " 'C T T ^ ' 'i r r T O t h s e : " P n ' 7 7 "P a r Fr id y ^ "u p p 3 [^ l T 7 ~ '^ ^ ^ 3 T ^ 7 ~ C u n b rid g o i, 'St"."T "PKITar,~PT
'Nov."""l'964 ' t h r u F e b ." 196 5 "Fe'B".""T9'5"""thru M arch 1965 "MafcH I9 6 5 t'riru ju n 196 5
8"
p i t a l l z e d 8 e p t J_:*965
4.
The
above
named
defendant
was
my
employer
when
I
was
last
exposed
to
a
j
SIKk k Asbestos
j
^azard
and I was in the defendant's employ from
J 5 S A ._ _ to S e p te m b e r , 1 9 6 5 .
5. Since the date of leaving the defendant's employment, I have been employed as follows: ----- ----does n o t apply.
6. I served notice of my disability on the above named defendant on _____"-rar ... ..... ..... day of
November t
19
jn the following way: 1. e t t o r s e n t b y my a t t o r n e y an d
....py...fce le p l^ .a ft._ c .a ll_ J ^ fijs w L J ^ a th A .r^ H A ri3 .1 d w C h j! F a r ,
7. Before my disability began I earned | 1 7 5 09.
.. ?.atea*t.Qj._wgx>tftS___________________
(hr* UU n a tu n of wort dot)
a week as m c b im c i n s u l a t i o n an d
(See Reverse 8ide)
8. I I Libnot 1 receive medical, surgical, dental or hospital services as follows: Hilhn.eX0.6XU3----H o s p i t a 'ily Axel K. Olsen, M.D.; Jack J. Peril, M.D.y West Jersey Hospital
(But nm of doctor or OoapttaU)
9, I | cHnot j request the defendant to furnish such services; and they j
the defendant.
10. If medical, surgical, dental or hospital services were procured at your own expense
was spent by you for each D r . O la e n $ 8 2 5 .0 0 ? V
.a s tJ e ^
11. My social security number is:
179-07-6245
12. I believe the following additional facta to be important:
j furnished by
state what sum ^ -------------
Wherefore I ask that your Honorable Board shall make an award foi such compensation as may be due
My Commission Expires on
( T b it ffld arit m *7 b* worn to bfor C om penaaU on Referee or any other panton authorised to adm lni*tr an oath).
day of
19.
NOTICE: This petition may be signed and sworn to by any dependent for himself and all other dependents.
I
.yiA i .t?'V\ V>
Please enter my appearance for petitioner
A ttorn *r
. L
735 P .S .F .S . B ld g ., 12 S . 12th S t .,
JjfaAi a...
AddroM
-- ...........................
. . Bank & M in e h a rt, E aqa.
NOTICE:
This petition should be filed In original and five exact copies either typed or printed. The party
taking oath Is requested to type or print fuD name and complete address of Petitioner signing
this petition. It is necessary to make affidavit to only the original copy of the petition.
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July 22, 1966 (
The Aetna Casualty and Surety Ccojpany Suburban Station Building
1617 John F. Kennedy Boulevard Philadelphia, Pennsylvania 19X03
Gentlemen:
Subject:
Fatal Occupational Disease Claim P etitio n Marie Chester, Widow
versus Armstrong Cork
P etitio n 191,555
( t : - J
Armstrong Contracting and Supply Corporation should be named in th is claim p etitio n rather than Armstrong Cork. I t is our wholly owned subsidiary engaged in the insulation contracting business.
An answer is required w ithin 20 days of the date o f the p e titio n . We request that you answer as required and take whatever other stepa are necessary to protect our in te r e st. We w ill be happy to cooperate in any way we can.
The periods o f enployment lis te d in the p e titio n are essen tia lly correct.
Very tru ly yours,
DHB Enclosures
Wallace B. Hofferth Insurance Manager
! NTF OFFICE COMMUNICATION
To
From Subject
F. L ^Gardner, juancaster
J. T, Boyd, Philadelphia
Workmen's Compensation Board Notice of Patal Occupation Claim Petitlote Charles Chester - Deceased 816 Bgrtwod Are. Gloucester, New Jersey
July 20, 1966
We are attaching subject n o tlie received from the Department of Labor and Industry* Workman's Compensation Board*
I suppose you w ill turn i t over to our insurance carrier for attention
me atto
FORM 1501 P rin ts In U.S.A.
5
rONM U C I - I I I M I H - ' M Q k
CominsBwttUh of PenmylTonl DEPARTMENT OF LABOR AND INDUSTRY
WORKMEN'S COMPENSATION BOARD
NOTICE O F ^ - j ^ - . ^ - ^ ----------PETITION
The enclosed copy of petition has been presented to the Workmen's Compensation Board.
$rlo Chester, Widow
-Charles Chaster
816 Hertwood
.... ..............G lo u c e ste r* . ILau-JoraayAdram
PETITION NO. ,,.191*555____
Doiaodtat ~Armstrong Cork 2925 'J. iiroad t.
------P h i l * . . * V ;1 9 1 3 2 -
AGREEMENT NO. Sr,78T
Harrisburg, Pa...... ....
The above petition has been assigned to COMPENSATION REFEREE --------------------------
Leonid! b Ion D IS T R IC T __________________________________ A D D R E SS__________________________________
runa., Ps.
for investigation and determination in accordance with the provisions of the Pennsylvania Workmen's Compensation Act.
We hereby notify you that unless an answer shall be filed with the said Referee at his office within twenty days from the date of this notice, the facts alleged in the petition will be deemed to be admitted and no testimony will be required from the claimant to prove, nor heard in your behalf to deny, such
f&Ctfl* Attj o. V., Hughes, Jr,, K-q.
Seat 128,309
W ORKM EN'S COM PENSATION BOARD
Aetna C;.s, & Surety Suburban `tation UT g 1617 Pn. iilvd. Phila., Pa. 19103
NOTE; Yauf war muti b* mad 1a tripli** and *Mad with Ihe Rafaraa. ro
iJ } .
7. D i J tiic
empl oyee ie i'. c i:,v .. 1, ' {.. ic_.t !, m i
< c' :
:
...............; .................... . .
S. Wluit ss eie the e s p . n s e c ot the !.. t , a u . .,nd ' a n a . ' l i as the employer paid any pait al t.u e, :l sa, !.,m m...:i
9. I he weekly wares ut ills UwAi.Iau m me empi.,. ui the n
10 Was compel! .ation paid d eecdem r s t ^n the 11!in n.tal
t ilO 1. . `.lull
ad , i! v.,,, S
._ .
.!' ::;l_s Ik mu aikl the dale ut hi s cLatlm
1 1. T h e decedenl s Miniai sec mils n. aabei a ;.,
' '_
12. T h e claimant set tuith 'die full a in.: a d d . . : u n d l a d s wl.iJ; a:e p . l i e sc d to he impoi t.int
l u l l , ' : ' 1 . .
, -
i .
Wherefore the claimant
ass
t!,c W m ...aien's C o m p . m..: i, ,n l i oaid to make ail a a. aid that the Dclendaiit
shall pa) sin.li cumpensaii un as due undei Ilk Os epationa! 0 , s . ,, s e C uinpensaliun Act.
i,,. . i
nr
S a b s c n h e d and s w u m tfi licituie pie. ' hi ,
at
1 lO O -td w
My Commission l spues un
/V
d..\ ,'l
1`) C,
May s . w riN TRA uo
ii fiotary Pulire i'iuCudriptu*!iphamif||;hii ' ......... "
My Comimss.il.) I,,-1,1m K. u'c-ir.l'cr 12 1%G
d is ut
I l)
N O l l C l . : Thi s petition n u n he sipncd and s wu m ! i In a m <1cpunitc-nt lor hiniscl) and all other di pendent e. Pici e cine; ms a p pe. nance lui petiliunci
NO I lCL:
I his pitilion should he Died in oiipin.il and live ev. nl copies cither Is |c it or printed. 1he pally lakinp oath is reiinested to ! \ pe or print lull n a me and complete a ddicss ot Petitioner sipninp (his petition. It is neccss j i y to make attains it to only the original cops ot the petition.
FORM L I B C - 3 6 A - Z O M - 11- 5 Commonwealth of Pennsylvania Departm ent of Labor ijnd Industry
C laim ant
DEFENDANT'S ANSWER TO CLAIM PETITION
Kureau of Workm en's Compensation
Harrisburg, Pa.
Claim Petition No............. 19..
Iaur*nc6 Carrier
City and Stata
Addreai
TO THE WORKMEN'S COMPENSATION BOARD, COMMONWEALTH OF PENNSYLVANIA: The answer of the defendant to the above entitled claim petition respectfully represents:
1.
2.
G (b). _ _ --- --- ----------------------------------------- 6 ( c ) . -------------------7_________ _______________ ______ ____________________________
As a further matter of defense the defendant states the following:
Wherefore the defendant prays that the claim petition be dismissed.
Enter my appearance for defendant
____________ _-- --------D eiaadtnt
A ttorney
Addreae
Add. e u
Subscribed and sworn to before me, this ............ ....... ....day of .... ................ .............................. 19.......
(THIS attauvit may be worn to before a Compenaatlon Kele.-w or any other peraon authorized to admlulater an oath )
My Commission expires on t h e ___ _____________ day o f ...... .......-- ............. ........ .................. 19.......
T h is answ e r should be filed direct, w ith the office of th e R e fe re e to w hom (he case Is assigned Answer m u s t be filed w ithin 20 duj., Eveiy a llig atio n in a claim petition not specifically denied will be deem ed to be ad m itte d . B lan k e t denials or "proof d e m a n d e d " will not be a com pliance w ith this requirem ent.
/
March 8, 1966
/
Mr. David 7 . Kellner Attorney Suit 1600 2 Pena Center Piase Philadelphia, Pa, 19102
Dear Mr. S a lla r
Subject
84 0C 113079 Charlas C heetr SS #179 07 6245 8I 6 Bertwood Avenue
G loucester, lav Jersey
Armstrong Contracting and Supply Corporation
We hare been requested by Mr. Q. H. Alhena, Oala Reprsentative of the Philadelphia O ffice o f The Aetna Casualty and Surety Compon/ to send you vages paid to Charles Chester, aa f o il ove
&3S 2- 12-S3 2-18-63 2-25 3H 3-11 3-18 3-25 4M 4-8 4-15 4-22 4-29 5- 6 5-13 5-20
6-10-63 6-17 6-24 7- 1 7-8 7-15
5-28-64 6- 1 6- 8 6-15
2-17-63 2-24-63 3- 3 3-10 3-17 3-24 3-31 4- 7 4-14 4-21 4-28
5- 5 5-12
5-19
5-24 80
6-16-63 6-23 6-30 7- 7 7-14 7-16
80
5-31-64 6- 7
6-14 6-21
work verb
SSSflfi I 40.80 176.00 176.00 176.00 176.00 176.00 176.00 176.00 158.40 176.00 176.00
176.00 140.80 176.00 176.00
448.80 140.80 246.40 176.00 246.40 73.60
73.60 184.00 184.00 1f4.00
Week
Oroae
6-22-64 6-28-64
$165760
6-29 7 - 5
147.20
7-6
7-12
184.00
7-13 7-14
73.60
Labor dinput
3-14-64 8--16-64
36.80
8-17 8-23
299.20
3-24 8-30
316.80
8-31
9- 6
170.88
9 - 7 9-13
154.56
9-14 9-21 9-28
10- 5
9-20 9-27 10- 4 10-11
191.04 115.20
192.00 192.00
10-12 10-18
192.00
10-19 10-25
192.00
10-26 10-28
115.20
Bo work
# 7247.68
Tery truly your*,
Mabel B. Barnet Inaurenoe Department
Copie to i Mr. 0 . H. Aiken, Claim Rapreaantatlve The Aetna Casualty and Surety Coopcngr 1617 John f . t&aamiy Boulevard Philadelphia! Pa. 19103
Armstrong Contracting and Supply Corporation Architect# Bui.1ding 17th and Saneoa Street Philadelphia! Pa. 19103
CHARLES CHESTER 816 Bertwood Avenue G lo u cester, fi. J .
SS #179 07 62A5 - - Armstrong C ontracting ^& Supply Corp. employee
MEBarnet 3/ 8/66
The in su ra n c e company needs wages f c r th e s e p e rio d s
1 !
1
;
P e b . 9, 1963 t o May 2 3, 1963
I !
!
i -
! !
June 9, 1963 to Ju ly 16, 1963
May 2 8, 1964 to O c t. 28, 1964
I
However, a n o th e r re c o rd I have s t a t e s he was employed by ACSS a s fo llo w s : P eb. 1963 th ru J u ly , 1963 j
June, 1964 th ru Nov. 1964 '
So perhfips you had b e t t e r g iv e me M s e a r n in g s , by week, f o r th e dates he was employed in 1963 and 1964,
th e n I ' l l have i t when th e a tto r n e y s f o r th e o th e r s id e w rite f o r in fo rm a tio n . Thanks.
Mabel
41?
The /Etna Casualty and S urety Company Th e S tandard Fir e In su r a n c e Co m pa n y
H a r t f o r d . C o n n e c t ic u t
PHILADELPHIA OFFICE
Armstrong Contracting & Supply Architects Building 17th & Sansom Streets Philadelphia, Pa. 19103
Corporation
Attention: Mr. John Boyd
S U B U R B A N S T A T IO N fclUILOING 1617 JOHN F KENNfrOY U O ULLVARO
PH ILA D ELPH IA . PA 19103 LOCUST 8 1 3 0 0
March 2, 1966
Charles Chester 816 Burtwooc Avenue Gloucester, New Jersey
D ear Mr. Boyd:
We th a n k you l o r y o u r co m m unication o f F e b ru a ry 22 w here you gave u s t h e d a t e s o f em ploym ent o f t n e above C n a r le s C h e s t e r , we need ad d itio n al inform ation fo r our atto rn ey before th is case goes to t r i a l . W ill you p le a s e fo rw a rd u s , on y o u r Company s t a t i o n e r y , the wages paid th e above C harles C hester fo r th e follow ing periods:
February 9, 19o3 to May 23, 1963 June 9, 1963 to July 16, 1963 hay 28, 1964 to October 28, 19o4
We w ould a p p r e c i a t e i f you w ould f o rw a rd t h i s in f o r m a tio n d i r e c t l y to David F. K a lin e r, A tto rn ey , S u ite 1600, 2 Penn C en ter P laza, r h ila d e lp n ia , Pa. 19102 and forw ard copy of tn is com m unication to t h i s o f f i c e t o t h e w r i t e r 's p e r s o n a l a t t e n t i o n . We th a n k you f o r your cooperation.
Very t r u l y y o u rs,
gha/dra
G. li. a ik e n s , C laim R e p r e s e n t a t i v e Claim Departm ent
A K K II.IA T r.M O F .K T N A I .IK K IN H IIU N K C O M P A N Y
J a n u a r y 2 0 , 1 966
The Aetna Casualty and Surety Company Suburban Station Building
l6 l7 John 7 . Kennedy Boulevard Philadelphia, Pennsylvania
Gentlemen:
Subject!
d alia P etitio n for Compensation Charles Chester
versus*" Armstrong Contracting and Supply Corp. Claim P etitio n 188,309
This cla in p etitio n a lleg in g to ta l d isa b ility as a resu lt o f asb estosis has been file d against Armstrong Contracting and Supply Corp. and others. An answer must be file d with the designated referee a t h is o ffic e within 20 days
of the data o f the p e titio n .
Since th is claim is insured by you, we assuas you w ill work with the Philadelphia o ffic e of Armstrong Contracting and Supply Corp. in completing and submitting defendant's answer. I f our understanding is incorrect, please l e t us know in a e d ia te ly .
Very tru ly yours,
Wallace B. Hofferth Insurance Manager BHB
& 3closurea
Mr. J . 7 . Boyd, Branch Manager Armstrong C ontracting and Supply Corp. A rchitects Building 17th and Sanscm S tr e e ts P h ila d e lp h ia , Pennsylvania 19103
inter/
OFFICE COMMUNICATION
/ / 3 h r
To
S-w--t r GfiKdher, Lancaster
From
J. F. Boyd, Phi la*
Subject
Charles Chester 816 Bertwood Ave. Gloucester, N. J. Compensation Claim Petition
( A r m s t r o n g contracting January 17, 1966
We are forwarding to you the attached occupational claim petition received In this office on Mr. Chester.
me
FORM 1501 Prlnt.d In U.S.A.
r om Lic -3 a o -* * M -i* -* 4
Ceeuwinwealth of Pnaijlm ilt
DRrARTMKNT OF LABOB AND INDUSTRY
WORKMEN'S COMPENSATION BOARD
NOTICE OF 0 0 C laij>________ PETITION
The enclosed copy of petition has been presented to the Workmen's Compensation Board.
Claimant
Add reft*
C h a rle s Chee t e r _____________________ 8 l6 BertVOOd ATS. G lo u c e s te r # N o J # ______________
108,309
PETITION NO____
P h ila d e lp h ia
Defendant AddreM
Armstrong Contracting SSupply Co 2`,>25 H. BrOSd St. Fhila., Pa 19132_______
AGREEMENT NO. . 1^2
Harrisburg, P a . ____________________________
The above petition haa been assigned to
COMPENSATION REFEREE ____________Lnid&a.JLa...A llan --------------------------
DISTRICT ------------------------------------------- `JL--------------------------------------------------
ADDRESS _____________________________ U
&
8 . . j>....Py!lg'..tA...i.i**
for investigation and determination in accordance with the provisions of the Pennsylvania Workmen's Compensation Act.
We hereby notify you that unless an answer shall be hied with the said Referee at his office within twenty days from the date of this notice, the facts alleged in the petition will be deemed to be admitted and no testimony will be required from the claimant to prove, nor heard In your behalf to deny, such
facts.
Aetna Casualty & Surety Co* Suburban Station Bldg* Phila., Pa. 19103
Atti C. K* Hugh* JT* Esq.
MOTt Yur . mww M* k* . . . to |H*Hm< *d (M wNh Ik. R ikw .
bs
WORKMKNTI COMTCNSATTON BOARD
J' 'U. 8cretry
y
. n I82- I 5M -2-J ^ '5
11M MoNW KAi.TH OK P E N N S Y L V A N I A IMI. I MENT OK I.AltOK AND INDUSTRY
CLAIM PETITION FOR COMPENSATION FOR SILICOSIS, ANTHRACO-SIIICOSIS
AND ASBESTOSIS
\I t e .f t f d f c W , .
HAHItlSBURO. PA.
RaoM 1 2 -1 0 -6 5 122, 17a
:h a rle a C h aster
Print or Typ* turn* of Cl*lm*nt
i>IS Ba r t v o o d A v a . AiiilrrM
T.
Q lo u castar,
N. J ,
m n s t r o n g Co n t r a c t i n g & 8 u p p l y C o .
i.i!!jiloyr
J 25 N. B ro a d S t . F h l l a . , Pa. Address
Claim Petition No.
Inaurane* Carri* Addre** Occupational Dl**aa* fund
JRU3Q9.19____
TO THE WORKMEN'S COMPENSATION BOARD, COMMONWEALTH OF PENNSYLVANIA:
The claimant respectfully represents: 1. My name is ___________ C h a r l a a C h a s t e r _______________________________________
2. I became totally disabled as the result of
of
S eptem ber,
19. 6 5
[SftcSS*
\
DWPiPfaWfiWt** on
Asbestosis
)
3. My total disability is result of employment in a hazardous occupation having a j
.day j hazard,
and I have been so employed in the Commonwealth of Pennsylvania at least two years in the aggregate during the ten years next preceding the date of disability as follows:
Name of Employer In Pennsylvania
Address
Ditte* of Employment
From
To
L'elav/are I n s u la tio n Co.# 5 th & Coleman S t . , W ilm ington . . 1956 th ru Nov. 1957
Man d e t"Co^?K~'C^';"nr~rTStiiirK Sft
"DcT"T957""thru 'TahT 196 3
rm stfo n g " Cht77~2925~"NT^r^<J'"Bt . 7'T hT Ia77~ F a7~ ------- ;X"PBTT9(n..thru J u ly 1963
;:e c h i n ic a T " ' h'sl a t T n C o. ,
. ME'. P Ie i a h t" `v7'ffX* "A u g u s t', T 9 6 J
^ ie c h h ^ c a ^ "Y h u Ia 'i ' '" Co77 3TT"W. HE 7 T I e a s a n Z liW .'ttH "Nov"'."""I96"3"" t h r u Hay 1964
r r i cy'"3uppTy'Y ro7"r^737"'W7~CSridg~SliT,""ThTTi"~P'7 "Sept";..I963~' th'ru "cE". 191
A rm strong "ConTfTi 2925 JH. Brohd S t . 7~"PKT8'. # P.
)( "Jue"T954""th"r Nv:" 1 964
O w eni Corn l n g a C o ., J a c k s o n fc""Swanson"Si"7i~"iK'IIa Barr 75a3e C oatin g ^0"'.~ "^0r'"N7~lQ.ngs'"^'Fri (I'c'sT ef",li`J .
P h i 1 a . "sBeo t o a '6".7 210"N . l O t h SET, P h 'iT a . ."" P a '. Fr iday^3ppT y~ C 5T 7'"27 37 W rY^^rldga"'St7'7'T>hITr,~P'T~
"N ov.~94 thru Feb.'" 1 9 6 5
__ _
'March 1 9 6 5
C a r c h i 90S thru Ju n e 1965
"pTt a i z iad S e p t ., 1965
\ S6K 4. The above named defendant was my employer when I was last exposed to a j Asbestos ( "azart*
and I was in the defendant's employ from
__ to
-
5. Since the date of leaving the defendant's employment, I have been employed as follow s:----does not app ly.
6. I served notice of my disability on the above named defendant on .....
November t
19. 6 5 ln t h e fo llo w in g w a y :
..jey ....t
j^aiU ^JtoJiLjRyJkc& tJtL^^
~<rar
day of and
7. Before my disability began I earned $_Zi-9.Q-
...
% 9.^aSJASX.___________________________
I hwi *t*t* fu tu r* of watt Som)
WW.V mi mmch n n l c l n a u l t i n a n d
(See Reverse Side)
8. I I H obapplitta l f
1 reciv* medical, surgical, dental or hospital services as follows: H ahnem ann.. Ax e l K, O l s e n , M .D .? J a c k J . P e r i l , M .D .; W ent J e r s e y H o a p i t a 1
(B u te name of doctor* or boeplU le)
A j 9- 1 f
the defendant.
| request the defendant to furnish such services; and they
j furnished by
10. If medical, surgical, dental or hospital services were procured at your own expense state what sum
was spent by you for each * O ls e n $ 8 2 5 .0 0 ; w e s t J e r s e y Hg a p 1ta^frS Q & j.S .?_________
11. My social security number is:
179-07-6245
12. I believe the following additional facts to be important:
Wherefore I ask that your Honorable Board shall make an award for such compensation as may be due me under the Occupational Disease Compensation Act.
KtmI
Subscribed and sworn to before me, this
at
Ph i l a d e l p h i a * Pe n n a* __
My Commission Expiree on
-fllfi.Bartwaod-Ava* .Qlaucaatar^-N^L Addr*a*
-day of
MAY S. W C1NTRAUB
.A
19.6.5__
,, ,,y |.u, r u u . . . l e l p n - . a CO
.
t.<d.r-s Vll.'M'' ' IZ- l5v'
(T h l* ffldlt mT b* worn to b*for* Oom pnuUoD Refera* or eny oth*r person kutborlaad to tdm Inlet r *n oath).
day of
19-
NOTICE: This petition ma/y be.signed an. d! sworn to by any dependent for himself and all other dependents.
..CM 1, v
Please enter my appearance for petitioner
I ' .
A tto rn e y
735 P . S . F . S . B l d g . , 12 S. 12th S t . ,
Addrae*
NOTICE:
. Bank & M in eh art, Eaqs.
This petition should be filed In original and five exact copies either typed or printed. The party taking oath is requested to type or print fuD name and complete address of Petitioner signing this petition. It is necessary to make affidavit to only the original copy of the petition.
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i 'ommott* *alth of PenitsylvftitiA
|)'|iartnirnl of Labor ynd Induatry
DEFENDANT'S ANSWER TO CLAIM PETITION
Bureau of Workmen'* Cmn|Mnxahn llarriflhurg, Pa
Clntmaut S tu rt Number City and State Kmpioytr
\ Claim Petition No.
>
188,309 19.
Street Number
Inuroca Cantar
City and Stata
Addraaa
TO THE WORKMEN'S COMPENSATION BOARD, COMMONWEALTH OF PENNSYLVANIA:
The answer of the defendant to the above entitled claim petition respectfully represents:
4. ____
............... ..................._______
............................-.. ..........
....
....... .......
5................................... f, (b). .. _
.... 6 (a). .... 6 (c). __
_ .... -
....................................
-
---- - .........
As a further matter of defense the defendant states the following:
Wherefore the defendant prays that the claim petition be dismissed.
En ter my appearance for defendant
_________________ ______
Defandtnt
A tto rn ey
Addrwe
Addr**
Subscribed and sworn to before me, t h i s ____________ day o f ___________________________19.........
iT h ie tffldavlt m ey t>e (w orn to before a C o m p e n u tlo a R eferee o r e a r o th e r pereon e u th a rta e d to edm ln later *n o ath .)
Mv Commission expires on the _________________day o f _______________________________ 19.......
T int n.twfr should be filed direct with the office of the Referee to whom the case U assigned. Answer must be filed within 20 days. Ever; allegaUon In a claim petition not specifically denied will be deemed to be admitted. Blanket denial1, or "proof demanded" will not be a compliance with this requirement.
Noveafcer 12, 196$
ti
O Aetna Caeualty ad Surety Ccevany
t
3tburt*ui Station Building
l 6lT John F. Kennedy Boulevard
ifciladalphia, Pennsylvania I 9ID3
Orniti want
Subject! Charles Chester ASbeatosls .<
lb s enclosed la tta r frcm tbs la v o ffleas o f Bonk ad Minehart 1 notlea to our subsidiary, Annstroug Contracting and Supply Corporation, o f an asbestos!* claim file d on behalf o f Charles Cheata r . Evidently, papers to th is e ffe c t v i l i c o n through In due course.
We have not referred to our record concerning Mr* Chester's aplcymsnt. We v i l i do so i f end vben the information i s required.
Vmry tru ly yours,
Wallace B. Sofferti
Insurance Manager
J3BB
Mr. J. F. Bqyd, Branch Manager Armstrong Contracting and Supply Corp. 2925 North Broad Street Philadelphia, Pennsylvania 19132
Mr. Fred L. Ckrdner, A C iS, Lancaster
IN T E R OFFICE COMMUNICATION
To
From
Subject
Fred Gardiner, Lancaster
J. F. Bcyd, Philadelphia
Charles Chester Bank & Minehart
November 8, 1965
I am enclosing letter of November Uth regarding Charles Chester. We have not acknowledged this letter to the above law firm.
JFB/dmd
e n d . (1)
r '
FORM 1501 P rin t.d In U .S .A .
ff
i
/
)
Th o m a Z Min ih a n t
Mu v i n Alan S ana Ma u a i C k A. B a n k
/
LAW O FFICES BANK A N D MINEHART 7 3 8 PHILADELPHIA SAVING FUND BUILD ING TWClVC SOUTH TWELFTH STBCCT
P H ILA D E LP H IA . PA 19107
November 4, 1965
I
MAmkct
A rm strong Cork C o n tra c tin g & Supply Co. 2925 N orth B road S tr e e t P h ila d e lp h ia , Penna. 19132
RE: M r. C h a r le s C h e s te r
G entlem ens
P lease be advised th a t th is o ffic e has f ile d a claim p e titio n fo r a sb e a to sis fo r th e above nam ed i n d i v i d u a l whom we r e p r e s e n t .
P le a se be ad v ised th a t you have been
named a s d e fe n d a n t and n o tic ie i s Jjyereby g iv e n t h a t
our c lie n t was t o t a l l y d is a b le d .b eg in n in g Septem ber,
1965 and c o n tin u in g to d a te .
'
l .
/
S in cerely y o u rs,'
BANK &WfNEHART
VBCspak
By. Vincent B. C o r s e t t i
a
*