Document kD74Rv5VBR3qLoKJwwrbjBGn
FILE NAME Manville JMA
DATE 1968 DOC JMA135
DOCUMENT DESCRIPTION Contract Unit Claim File - Clyde
Nicholson
WORKERS COMPENSATION APPEALS BOARD -
INDUSTRIAL ACCIDENT
CALIFORNIA
COMMISSION prior to 1966
APPLICANT ___ CLYDE NICHOLSON
Asbestos Worker
CASE #ANA 23
DATE CLAIM FILED June 19 1968 Amended Sept. 12 1968
INJURY ALLEGED
Injury to lungs to exposure to asbestos
ALLEGED DATE OF INJURY
1946-1968
EMPLOYER
Plant Rubber & Asbestos Works et al
including JM Sales Travelers
16 employers & carriers
No apparent Canadian carrier
OTHER NOTES
Med Rpt to applicant's attorney almost certainly :
from fibrosis of lungs due to inhalatioonf asbesto
fibers permanently & totally disabled
No other medical reports in file
DATE OF RESOLUTION Feb. 21 1969
RESOLUTION
Compromise & Release
apportioned among 10
DOCUMENTS COPIED
1 Compromise & Release
8,380 settlemer
# OF
CLAIMANT
Clyde Nicholson
California Workers Compensation Appeals Board
26
CARRIERS INVOLVED
The AETNA Casualty & Surety Co. American Automobile Ins Co. oAmerican Employers Ins Co.
American Motorists Ins Co.
Argonaut Ins Co.
OAssociated Indemnity Corp.
Exchange
oCalifornia Casualty Indemnity Exchange oCalifornia Compensation & Fire Co.
oCasualty Ins Co. of California
Employers Liability Assurance Corp.
Employers Mutual Liability Ins Co. of Wisconsin
oFide&lCaisut aly ty Co. of New York
"
oFireman's Fund Ins Co.
oGeneral Accident Fire oGlobe Indemnity Co.
Assurance
& Life Assurance
Corp.
Corp.
Ltd.
Co.
oGuarantee Insurance Co.
oGreat American Ins Co.
oHardware Mutual Casualty Co. Sentry Industrial Indemnity Co. oIndustrial Indemnity Exchange
oInsurancCoe. of North America
oLiberty Mutual Ins Co.
Ins
Co.
Co.
OLumbeMurtumalaCansu'als ty Co.
oMaryland Casualty Co.
oMichigan Mutual Liability Co.
oMission Insurance Co.
National Automobile & Casualty Ins Co. oNew Amsterdam Casualty Co.
oOcean Accident & Guarantee Corp. Pacific Employers Ins Co.
Pacific Indemnity Co.
oReliance Ins Co. Standard Accident Ins
oRoyal Indemnity
Co.
oSecurity Ins Co. of Hartford U.S. Casualty Ins Co. oState Compensation Insurance Fund
oTransport Indemnity Co.
The Travelers Ins Co.
oThe United Pacific Ins Co.
_
OU.S. Fidelity & Guaranty Co.
oZenith National Ins Co.
oZurich Ins Co.
' Pacific Employers
.
Group
-
we
00
5/81
mom
1
WORKERS COMPENSATION APPEALS BOARD
3
CLYDE NICHOLSON
4
STATE OF CALIFORNIA
Case No. 68 ANA 23276
5
Applicant
OD VS.
7 ARMSTRONG CORK COMPANY et al
8 .
9
Defendant
10
11
I hereby certify that the attached documents are true
12 and correct copies of the original documents filed in the records
=
13 of this office in the entitled matter
14
ATTEST my hand and the Seal of the Workers Compensation
15 Appeals Board of the State of California
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20
Workers Compensation Judge
?
Workers Compensation
Appeals Board
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j
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24 Dated at San Francisco
25 California this 31
day
26 of March 1981 _
27
DIA WCAS For 119 NEW 1-79
TOTOEE P TOP EP
DEPARTMENT OF INDUSTRIAL RELATIONS
DIVISION OF
ACCIDENTS
INGUSTRIAL
ACCIDENTACSIDENTS
tee ee
er.
.
.
"
1
.
. .
any
o -
or ors
.
C .
me
*
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Mo
al .
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1 ROSE KLEIN & MARIAS Attorneys at Law
2 900 North Broadway Suite 412 Santa Ana California 92701
3 Telephone 541-4128
4|| Attorneys for Applicant
ee
he
.
MAS 1969
;
6
7
@
ss 8
BEFORE THE WORKMEN'S COMPENSATION APPEALS BOARD
9 OF THE STATE OF CALIFORNIA
10
11 12 13 14 25 16
CLYDE NICHOLSON
)
:
)
Applicant }
) -75- )
)
ARMSTRONG CORK COMPANY et
)
al
)
1
-
Defendants )
;
)
.
No. 68 ANA 23276 COMPROMISE AND RELEASE
17 The parties hereto for the purpose of compromise only hereby sub18 mit the following agreed statements of fact
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Ny
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a 31
,
1. CLYDE NICHOLSON 1808 East Commonwealth Avenue 104
Fullerton California employee herein born on October 23 1895
having Social Security No. 317-26-1599 claims that he was employed
during the period 1946 through 1963 at Various Cities in the State
of California as an Asbestor tory to this Agreement said
Worker by employers
the various employers signa-
were then insured as to their
respected periods of employment for workmen's compensation liability by the various insurance carriers signatory to this agreement and
that the Applicant sustained an injury arising out of and in the
course of his employment as a result of exposure to asbestos ^aus-
ing a pulmonary disorder
.
:
:
2. The actual weekly wages of the employee during the
i
period of injury were in dispute
3. The employee's present disability is in dispute and
-1-
wee
1 the employee has not returned to work
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4 5
7
8 g 10
1112
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1616
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4. llo temporary disability indemnity has been paid to the
employee and the amount due and unpaid is in dispute
disability has been paid to the employee
No permanent
5. The parties hereby agree to settle any and all claims
on account of said injury by the payment of the sum of 8,380.00 in addition to any sums heretofore paid by the employer or the in-
follows surer to the employee said sum to be payable as
A. By ARGONAUT INSURANCE COMPANY :
1 238.00 to Alan Frank M.D. in full satis-
faction of his Lien
,
oo,
2 25.50 to the Applicant
3 1,000.00 to Rose Klein & Marias as attorneys fees
B. By AMERICAN MOTORISTS
INSURANCE COMPANY
1 ment for
67.50 to Rose Klein & Marias as reimburse-
costs advanced in obtaining records from the
Social Security Administration and the California In-
spection Rating Bureau
2 894.90 to the Applicant
C. By PLANT RUBBER & ASBESTOS WORKS and FIEREBOARD CORPORATION
1 726.75 to the Applicant D. By NATIONAL AUTO & CASUALTY CO 68.40 to the Applicant
E. By PACIFIC EMPLOYERS GROUP Plant Insulation
Company 1,363.25 to Applicant
Pr. BY PACIFIC EMPLOYERS GROUP
Supply Co. 50.80 to Applicant
Marine EngineeringEngineering &
9 BY PACIFIC INDEMNITY COMPANY 315.35 to Applicant
BY INDUSTRIAL INDEMNITY COMPANY 167.22 to the
-?-
oe.
Applicant
2
,
I. By AETNA CASUALTY & SURETY COMPANY 475.00 to
10
the Applicant
a
eb J. BY THE TRAVELERS INSURANCE COMPANY 2,975.35 to
oO
the Applicant
6 . 6. Medical and hospital expenses have been paid all by
7
the employee and none by the employers or carriers Unpaid bills
8 amount to none Future and hospital expenses are estimated at
9 4,000.00 Unpaid and future medical and hospital expense is to be
10 assumed all by the Applicant
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12 12
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1716
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7. Name and address of employee's attorney is ROSE
KLEIN & MARIAS
nia 92701
900
North Broadway
Suite
412
Santa Ana
Califor-
.8 Said attorneys request a fee of 1,000.00 No
prior attorneys fee has been paid
9 Reason for the compromise is substantial issues exist
as to ment
injury and as
arising out of and occurring in
to statute of limitations All
the course of employ- employparties desire to
avoid the hazards of litigation and the Defendants desire to buy
their peace
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Release
10. The undersigned request Agreement be approved
that
this
Compromise
and
11 Upon approval of this Compromise Agreement by the
Workmen's Compensation Appeals accordance with the provisions
Board or a Referee and payment in hereof said employee releases and
forever discharges said employers and insurance carriers from all
claims and causes of action whether now knowonr ascertained or
which may
including
hereafter arise or develop as any and all liability of said
a result of said injury employeransd said insurance
carriers and each of them to the dependents heirs executors
representatives administrators WITNESS the signature
or assigns of said employer
hereof this
,
43s day of February
TOR
ame
ee
eee
ee
1969 at Santa Ana California
hitih. 01/11/7/7 01/11/7/7
NICHOLSON Applicant
ROSE KLEIN & MARIAS
'
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32 !!!!!A ! TE
Howard AL Gebler Attorneys for Applicant
PLANT RUBBER & ASBESTOS WORKS FIBREBOARD CORPORATION BY BROBECK PHLEGER & HARRISON
and
.
Rinalah Secin By
Rinalah
Rinaldo Sciaroni Jr.
Attorneys for above Defendants
EARL VANATTA and NATIONAL AUTOMOBILE & CASUALTY COMPANY
INSULATION PLANT COMPANY and PACIFIC
EMPLOYERS GROUP BY
ZONNI GINOCCHIO TAYLOR
Ralph Ginocchio
By
Attorneys for above Defendants
C. F. BRAUN & COMPANY and AMERICAN NOTORISTS INSURANCE COMPANY
a
By AU KLE ele tine
MARINE ENGINEERING & SUPPLY
PACIFIC EMPLOYERS INSURANCE ZONNI GINCCONTO & TAYLOR
CO , and COMPANY BY
;
By
'
r
firey
:
oleae Lis oe
Ralph .. Ginocchio Ginocchio
a oa
Attorneys for above Defendants
Oa ak eT ee
Tete.
seer.
1
3 4 10 6 7 8 9 10
6.
.
12 13 14 15 16 27
,
18 19
PACIFIC INDUSTRIES
By :
SUPPLY COMPANY of SAN INDEMNITY COMPANY
DIEGO
By JJa ack ck A Milkes Milkes |
BECHTEL Milkes Jack
BECHTEL CORPORATION AND INDUSTRIAL DEMNITY COMPANY BY
MANSELL & GIDDENS
IN-
torneys HE By \@
1)
torneys for above Defendants COAST INSULATING PRODUCTS and ARGONAUT
INSURANCE COMPANY BY
SAMUELSEN BOLSON & WHITEHEAD
, Ben
Attorneys
, for above
Defendants
ARMSTRONG CONTRACTING & TION and AETNA CASUALTY
PANY BY
CORPORA- SUPPLY
& SURETY COM-
WEINGAND KENDIG & STOCKWELL
Sbseph Gleason By
DY
gin
~
>
Gleason Sbseph st
Attorneys for above Defendants
JOHN MANSVILLE SALES CORPORATION and
THE TRAVELERS INSURANCE COMPANY BY
DAVID A. TAYLOR Attorney at Law
;
22
23 STATE OF CALIFORNIA
24 COUNTY OF ORANGE
SS )
Attorneyfor above Defendants
25 26 27 28 29 301
21st On this
day of February 1969 before
DEZ a Notary Public in and for the said
me MARY VAL-
therein duly commissioned and
County and State residing
NICHOLSON known to
sworn personally appeared CLYDE
the within
me to be the person whose name is subscribed to
instrument and acknowledged to me that he
same
executed the
fixed above
;
.
IN WITNESS WHEREOF I have hereunto set
hand
my official seal the day and year in this
my
and af-
written
certificate first
;
;
qi
ste
OFFICIAL SEAL MARY VALDEZ NOTARY CALIFORNIA PRINCIPAL OFFICE IN