Document dQw26zEY40YjjxRGnzzOXd8JG

FILE NAME Bechtel BECH DATE 1974 DOC BECH041 DOCUMENT DESCRIPTION Worker's Comp Claim - Velasquez Esmael P. . 5 . APPLICATION , CCION CCION OF INDUS FOR ADJUDICATION OF DEPARTMENT OF INDUSTRIAL - L WORKER'S CLAIM \ NS TOK POTKPOOTKO COMPENSATIC APPEALS BOARD CASE N 247658 Miss ESMAEL P. VELASQUEZ Mr. . . INJURED EMPLOYEE Social Security 553-07-8240 209 Norwich Drive . . INJURED EMPLOYEE'S ADDNOS FraSn ancFi ras ncc iso co C. 94080 . __ VS. See attached EMPLOYER EMPLOYER'S ADDRESS , EMPLOYER'S INSURANCE CARRIER OR STATE IF INSURED OR PERMISSIBLY UNINSURE)D ADDRESS OF INSURANCE CARRIER IF ANY IT IS CLAIMED THAT 1. The injured employee 5/9/17 Since 11/1/43 11/1/43 to DATE OF RIRYH while employed as insulator + OCCUPATION AT TIME OF INJURY 1/7/74 DATE OF INJURY Lat various places CITY California by the employer sustained injury arising out STATE vascular Lungs vascular systems of and in the course of employment STATE WHAT PARTS OF BODY WERE INJURED inhalation of asbestos dust & other noxious elements 2. The injury occurred as follows EXPLAIN WHAT ENFLOYEE WAS DOING AT TIME OF INJURY AND HOW INJURY WAS RECEIVED 3. Actual earnings at time of injury were . maximum maximum GIVE WEEKLY OR NONTHLY SALARY OR HOURLY RATE AND NUMBER OF HOURS WORKED PER WEEK SEPARATELY STATE VALUE PER WEEK OR MONTH OF TIPS NEALS LODGING OR OTHER ADVANTAGES REGULARLY RECEIVED January 8 1974 to date The injury disability 4. caused as follows SPECIFY LAST DAT OFF WORK DUE TO THIS INJURY AND BEGINNING AND ENDING DATES OF ALL PERIODS OFF DUE TO THIS INJURT . 5. Compensation was paid YES NO . B. Medical treatment was received TOTAL PAID WEEKLY RATE DATE OF LAST PAYMENT 2/19/74 All treatment was furnished by the employer or | YES MO DATE OF LAST TREATMENT insurance company YES other treatment was provided or paid for Applicant NO NAME PERSON OR AGENCY PROVIDING ON PAYING FOR MEDICAL CARE Doctors not provided or paid for by employer or insurance company who treated or examined for this are KAISER - SOUTH SAN FRANCISCO . FEb251974 FEb251974 FEb251974 STATE NAMES AND ADDRESSES OF SUCH DOCTORS AND NANKS OF HOSPITALS TO WHICH SUCH DOCTORS ADHITTED INJURED Industrial Division Accidents Accidents 7. Unemployment Insurance or Unemployment Compensation Disability benefits have been receivedsainomate of injury Applied for YES NO '72 San 8. Other cases have been filed for industrial injuries by this employee as follows Francisco SPECIFY CASE NUMBER AND CITY WHERE FILED expense Temporary 9. This application is filed because of a disagreement regarding liability for Temporary disability indemnity Permanent disability indemnity Reimbursement for medical Medical treatment Compen- . . sation at proper rate Other Specify Lifetime pension and applicant requests a hearing and award of the same and for all other appropriate benefits provided by law Hearing requested at San Francisco CITY Dated San Francisco , CITY California 2/22/74 DATE . JAMES E. MILLER ESQ MCCARTHY JOHNSON & MILLER 605 APPLICANT'S ATTORNEY Market Street - Suite 1300 Francisco TELEPHONE TELEPHONE NUMBER ATTORNEY DIA WCAB FORM 2.72 362-0726 Cf? (Lela EPLICANT SIGNATUREJ EPLICANT SIGNATUREJ file Please signed original and six copies ; and print or type names and addresses Batchelo 00004388 BEFORE THE WORKMEN'S COMPENSATION APEALS BOARD OF THE STATE CALIFORNIA to NOTICE AND REQUEST FOR ALLOWANCE 1-77 Date of Injury OF LIEN Henn 16 Case No. 74 9 27-69 STATE OF CALIFORNIA Department of Human Resources Development P.O. BOX .3534 .3534 Sen Precise CL 94119 Lien Claimant Address aountiee Employee Address SSA No. ' wPww lant Asbestos Company EmpEmlplooyyeer rEmployer Employer & State Compensation Insurance Pand Insurance Carrier 130 64th , CA Seville AdAdresdress 55 Santa Clara Ave Oakland G^ 94610 Address see resures side for additional empleyere and Insurance Carriers OPENING LIEN a 1. The undersigned hereby notifies the Workmen's Compensation Appeals Board that payments of unemployment compensation disability benefits are being made at the weekly rate of ' commencing and continuing Payments will not exceed $ for daily indemnity and $ for additional hospital confinement benefits Request is made that these payments be deter- mined and allowed as a lien in the settlement of this case Upon cessation of payments or on Board request an amended Notice and Request for Allowance of Lien will be filed to cover the totals paid a CS a? AMENDED LIEN 2. The undersigned hereby requests the Workmen's Compensation Appeals Board to determine and allow as a lien the sum stated below as Total which represents the amount of unemployment compensation disability benefits paid to date Further benefits will be paid if the employee is found eligible and the Board notified of any resumption of payments Upon cessation of these continued payments or on Board request a further amended lien will be filed Filed under Disability 1. 182 2 3 105.00 Labor Code Section 4903 benefits at the weekly rate of 105.00 paid days at 15.00 per day From 1-15-74 1-15-74 to days at $ per day From to _days at $ per day From to for the periods shown 7-15-74 7-15-74 inclusive inclusive inclusive below _ 2730.00 Filed under Labor Code Section 4903 Additional benefits for hospital confinement at the daily rate of $ paid to for the period . to t iinncclulsuis veive Total n $ 7730.00 $ 7730.00 the 3. The undersigned declares he has delivered or mailed a copy of this document on to each of named above and listed below If other persons should be served with this document persons please notify the Department of Human Resources Development at the above address Copies also served on the following representatives and attorneys of record Sedgwick 111 Pia 36 37 CA 94111 State of California Department of Human Resources Development No Carthy Jobm&oMin lla er 605 Market R.Puits 13 DE 2581 Rev. 10 7-72 OSP Batchelo 00004389 Sanlevers Fiberglass Engine&eAr ppi lynCg o. 941 last 2nd 3 Les ingales Bechtel Corp 50 Beale St Gen Frandise CA 94119 Owens Corning Fiberglass Co Hibergles Tesser Telaio Ohio Douglass Insalation Co 1360 Yosemite Dr. Sen Presetses Presetses CA 91 Trans World Insulation Os Pallas Tuxes Calif inautenon Carriere to Cana & rltt y y C 600k 600k St Jan Premcisco CA PICS Industrial Indemnity Co 255 California A San Francisco CA 94111 CommerciaCom elrcial Baion samance Co PO Box 714 Jan Francisco CA 94120 Batchelo 00004390 July 3 1974 Mr. Donald Massee Industrial Indemnity Company P. O. Box 5056 San Jose CA 95150 Subject Your Claim Number NOTIHECRRKIENGHERRING CALIF A Not applicable Dear Mr. Massee We are in receipt of your correspondence of June 26 1974 and have obtained the following information from our Tax Department . Mr. Velasques was employed at Rodeo California for Bechtel on Job 7299. His dates of employment were Date of hire 3/18/71 with a date of termination 4/30/71 due to a lay off His total wages while working there amounted to 2,694.48 and he earned 8.07 per hour We hope this information will be of some assistance to you in this claim Very truly yours JCC Cz James C. Cronin Claims Analyst Batchelo 00004391 INDUSTRI^ L INDEMNITY COMPANY June 26 1974 Bechtel Corporation 50 Beale Street San Francisco California San Jose Division 1999 South Bascom Avenue Mailing Address P.O. Box 5056 San Jose California 95150 Tele4p08h3o 71n -77e 10 Re Claim Number 27154 Employer Esmael Valesquez Employer Bechtel Corp. Date of Injury Not Applicable Gentlemen Did you receive our letter of April 9 1974 to obtain the information we requested Have you been able In furtherance of our investigation here we wished to advise you that Mr. Valesquez's social security number is 553-07-8240 and he worked for your Company in the year 1971 approximately January until June Our questions remain to asbestos and what the was same what the nature sort of exposure of his job Are did his he have super- visors and workers still available for testimony May we hear from you shortly and thank you for your cooperatio_n DM ht Donald Massee Claim Representative Batchelo 00004392 Batchelo 00004393 c.ceit 1974-71 allen1971 call allen wa * . ca /b Called 4-24 a 1974-71 INDUSTRIAL INDEMNITY COMPANY April 9 1974 Bechtel Corporation 50 Beale Street San Francisco California San Jose Division 1999 South Bascom Avenue Mailing Address P.O. Box 5056 San Jose California 95150 Telephone 408 371-7710 Attention Workmen's Compensation Insurance Re Claim Number 27154 Employee Velasquez - Employer Bechtel Corporation & various Date of Injury Not applicable Gentlemen I received an Application for Adjudication of this man's claim alleging difficulty with his vascular system and lungs as a result of inhallation of asbestos and other forms of noxious elements We would like to know when this man worked for you and under what circumstances Would you please check his employment re- material dates he was employed cord to find out and what sort of material he was to wwhhiilelemuwcohrkworikingngearned you If he was exposed to asbestos dust and related synthetic materials would you please give us a brief description of his job duties at this time and how long he was exposed to the materials Any and all information you can give us will be greatly appre- ciated and thank you once again for your help and assistance eT ce the Radeo 197 Batchelo 00004395 FILR NOTICE OF BEFORE THE WORKMEN'S COMPENSATION APPEALS BOARD HERRING HERRING OF THE STATE OF CALIFORNIA NOTICE AND REQUEST FOR ALLOWANCE OF LIEN CALIF CALIF CALIF 11-1-43 to 1-7-74 STATE OF CALIFORNIA Departmentof Human Resources * Esmael P Velasques 553-07-8240 Plant Asbestos Co & Fiberglas Engineering Date of Injury Development Lien Claimant Employee Supply Co Case No. 74 S 247-658 P.O. BOX No. 3534 San Francisco CA 94119 Address 209 Norwich Dr South San Francisco 94080 Address 1300 664t4hth St EmeryvillEmeryeville CCAA 94662 941 55 Santa Clara Ave Oakland CA 94610 dress 94104 255 California St SF SF Calif Address PO PO Box 7614 SF SF SF CA 94120 OPENING LIEN 1. The undersigned hereby notifies the Workmen's Compensation Appeals Board that payments of unemployment compen- sation disability benefits are being made at the weekly rate of $ 105.00 commencing a and continuing Payments will not exceed 2730.00 for daily indemnity and 240.00_ for additional hospital confinement benefits Request is made that these payments be determined and allowed as a lien in the settlement of this case Upon cessation of payments or on Board request an amended Notice and Request for Allowance of Lien will be filed to cover the totals paid AMENDED LIEN 2. The undersigned hereby requests the Workmen's Compensation Appeals Board to determine and allow as a lien the sum stated below as Total which represents the amount of unemployment compensation disability benefits paid to date Further benefits will be paid if the employee is found eligible and the Board notified of any resumption of payments Upon cessation of these continued payments or on Board request a further amended lien will be filed Filed under Labor Code Section 4903 Disability benefits at the weekly rate of $ paid for the 1 _days at $ ~ per day From _days at _per day From ne _days at $ per day From periods shown below sunt to von incluisnclusiive invcluseive inclusive 10- we _inclusive $e Filed under Labor Code Section 4903 Additional benefits for hospital confinement at the daily rate of $ paid 10for the period ee .to _inclusive Total $ $ 3. The undersigned declares he has delivered or mailed a copy of this document on to each of the persons named above and listed below If other persons should be served with this document please notify the Department of Human Resources Development at the above address Copies also served on the following representatives and attorneys of record Additional Employers Bechtel Corp 50 Beale St SF SF CA 94119 Owens Corning Fiberglas Co Fiberglas Tower Toledo Ohio Insulation Co 1360 Yosemite Dr ST Trans World Insulation Co Dallas Texas DE 2581 REV 10 7.72 State of California Department of Human Resources Development 94124 A. SELLIN . G SEE NIR OR CLAIMS EXAMINER Lion Claimant ODSP Batchelo 00004396 1972 1973 1974 1973 LIST OF EMPLOYERS AND CARRIERS Last Five Years EMPLOYER Fiberglas Engineering & Supply Co. 941 East 2nd Street Los Angeles CA. Bechtel Corp. 50 Beale Street San Francisco CA. , 94119 Owens Corning Fiberglas Fiberglas Tower Toledo Ohio Co. Plant Asbestos Company 1300 - 64th Street Emerville CA. 94608 Douglass Insulation Co. 1360 Yosemite Drive San Francisco CA. 94124 Plant Asbestos Company Trans World Insulation Co. Dallas Texas CARRIER Aetna Casualty and 600 Market Street San Francisco CA. 94104 Surety Co. Industrial Indemnity Co. 255 California Street San Francisco CA. Aetna Casualty and Surety Co. Commercial Union Assurance PO PO Box 7614 San Francisco Ca. 94120 Co. Unknown # Commerical Union Assurance Co. Unknown | RECEIVED FEB25 1974 Division of Industrial Accidents San Francisco Office RM oom eu i ae me 78 vee Batchelo 00004397 Bechtel Corp 50 Beale St San Francisco CA 94119 5083 REV 2 5-64 ADDRESS INSERT Batchelo 00004398 STATE OF CALIFORNIA RELATIONS AGENCY DEPARTMENT OF HUMAN RESOURCES DEVELOPMENT SACRAMENTO 95814 September 6 1974 8240 Commercial Ins Co. of Newark Jersey 100 Pins St. , San Francisco CA 94111 RONALD REAGAN Governor P. O. BOX NO 3534 SAN FRANCISCO CA 94119 ESMAEL P VELASQUES vs PLANT ASBESTOS COMPANY ET AL and STATE COMPENSATION INSUR FUA NDNITCAEL WOAB CASE 74 S7 247 69888A 553-07-8240 We have received an Order from the Workman's Compensation Appeals Board joining you as a party in this case The malesed copy of our liom will int youe witr h oue r is ntert est ARTHUR SELLINGER SENIOR CLAIMS EXAMINER 11h Emo 601 letter only Wuricman Compensation Appeals Board Board PO PO Box 603 San Francisco CA 94101 Me Carthy Johnson & Miller 605 Market Suite 1300 San FranCc A i 941s 05 Sedgwick Detert Moran & Arnold 111 Pine St State CompeInnssaFtuionnd 55 Santa Clara Ave Astma Casu&aSul ret ty y Co 600 Mark SteSt an 255 California St San Franciscs CA 94111 San Ovens Carning Fiberglass Co Fiberglass Tower Toledo Ohio 1360 Yosemite Dr SanFrancisco CA 94124 San Franci CAn9e 40s 80 Batchelo 00004399 J. KENNETH LYNCH HALLEY CORNELL & LYNCH 2160 Crocker Plaza San Francisco CA. 94104 3 982-2460 JAMES E. MILLER McCARTHY, JOHNSON & MILLER Suite 1300 605 Market Street San Francisco CA. 94104 6 362-0726 Attorneys for Plaintiff Colen Colen Colen -- NOTICE 9 IN THE SUPERIOR COURT OF THE STATE OF CALIFORNIA FOR AND AND 10 THE CITY AND COUNTY OF SAN FRANCISCO ESMAEL P. VELASQUEZ ee 13 - Plaintiffs vs. 14 FIBREBOARD PAPER PRODUCTS 15 CORPORATION a corporation et al 16 Defendants 7 NO 681-172 ) ) NOTICE THAT ACTION HAS BEEN " COMMENCED AGAINST THIRD PERSON > > > > 0 2 TO Bechtel Corporation and Industrial Indemnity Co 22 21 22 2222 2222 -25 26 YOU ARE HEREBY NOTIFIED that on October 11 1974 ESMAEL P. VELASQUEZ commenced an action against FIBREBOARD PAPER PRODUCTS CORPORATION a corporation PITTSBURGH CORNING CORPORATION a corporation PHILIP CAREY CORPORATION a corporation ARMSTRONG CORK CORPORATION a corporation MANVILLE PRODUCTS CORPORATION a corporation RUBEROID CORPORATION a division of G.A.F. CORPORATION CORNING FIBERGLAS CORPORATION a . ee Ee Batchelo 00004400 1 corporation STANDARD ASBESTOS MANUFACTURING AND INSULATING 2 COMPANY a corporation UNARCO INDUSTRIES INC a corporation 3 PICHER INDUSTRIES INC a corporation COMBUSTION ENGINEER- 4 ING INC a corporation DOE ONE a corporation DOE TWO a 5 corporation DOE THREE a corporation DOE FOUR a corporation O&O DOE FIVE a corporation BLACK & WHITE COMPANY a copartnership 7 DOE SIX and DOE SEVEN partners associated in business under the 8 common name and style of BLACK & WHITE COMPANY DOE EIGHT DOE 9 NINE DOE TEN DOE ELEVEN DOE TWELVE DOE THIRTEEN DOE FOURTEEN DOE FIFTEEN DOE SIXTEEN DOE SEVENTEEN DOE EIGHTEEN DOE 11 NINETEEN and DOE TWENTY in the Superior Court of the State of 12 California City and County of San Francisco the same being Case No. 681-172 to recover monetary damages for personal injuries based upon negligence in the manufacture and production 13 of a defective product and strict liability in tort Dated December 10 1974 18 HALLEY CORNELL & LYNCH 20 By Kenneth Lynch Batchelo 00004401