Document m6B3MRdGw0dnYZQ5DBgBeyzB

STATE OF CONNECTICUT) ) SS. Bridgeport COUNTY OF FAIRFIELD ) U.s. DISTRICT COURT EASTERN DISTRICT OF TENNESSEE C E RT I F I CAT I 0N THIS IS TO CERTIFY that the attached Is a true and accurate copy of the Agreement to Compromise, Petition to Compromise and Order from the records of the Office of Workmen's Compensation Commission, State of Connecticut, Fourth District, in the case of: John Haydu vs. Raybestos Company, now Raybestos-Manhattan, Inc. and The Travelers Insurance Company; The Hartford Accident and Indemnity Company; The American Surety Co. of N.Y.; The Employers' Liability Assurance Corporation. ^Given under my hand and seal this F(itl day of 1978. 0 rs n ^ ->Gon N A. ARCUDI, rkmen's Compensation Commissioner urth District b JOHN HAYDU, CLAIMART VS. RAYBESTOS COMPANY, now RAYBESTOS-UARHATTAN, INC. Employer and EEPLOYERS LIABILITY ASSURANCE CORPORATION and AMERICAN SURETY COMPANY and HARTFORD ACCIDENT & INDEMNITY CO* and TRAVELERS INSURANCE COMPANY Insurers RESPONDENTS CORAHi COMPENSATION COL'MISSIOEER FOURTH CONGRESSIONAL DISTI BRIDGEPORT, CONNECTICUT FEBRUARY / , 1939. AGREEMENT TO COMPROMISE. PETITION TO COMPROMISE. And ORDER. * .-AvO^ . . WHEREAS, on or about tbe 30th day of September. 1938. and for a number of years prior thersto. st intermittent periods, the claimant. John Haydu of Fairfield. Connecticut, was an amployee of tbe Raybestos Company, now Raybeatos-Manhafctan, Inc. of Bridgeport. Connecticut} and IVHEREAS. the said employee and employer had accepted and were at all times herein mentioned subject to Part B of tbs Workmen's CompensationAot of tbe State of Connecticut, as amended, and the employer bad Insured its liability thereunder for various periods during which the said claimant was employei with the Employers Liability As uranee Corporation, ths AUipiMbOU JUi'BV,/ oompuuy. IIW UUI.1WU OVBiUBUIl UU ^uuouuut; Company, and Ths Travelers Insurancs Company, all of siileb said companies exist and do business under the laws of this State and are duly authorized to take such risks in this Stats and WHEREAS, the claimant clalme that on or about ths 30th day of September, 1938, ha a offarad an occupational dlaaaaa, to vlti aabestoalaj and further alaiata that aaid occupational dlaaaaa arose out of and in the ooirrse of hla anilojaent with the aald employer} and farther clalata that aald dlaaaaa la compensable} and further cl alma that ha haa been disabled from all work since aald Septezriber 30, 1938} and further elalma that he will be disabled In the future, all of ahlch aald olalms each and all of aald respondents deny} and WHEREAS, the claimant and respondents are In further dis pute as to tha actual periods of employment of the said cl aimant with the said employer} and WHEREAS, the aald claimant and tha respond ant a are In fur ther dispute as to the particular company carrying the comp ensation Insurance during tha parloda of the aald claimant*8 employment with the aald wnploywr} and WHEREA3, a partial hearing of aald claim was held befora the Compensation Commissioner for the said Fourth Congressional District as will more fully appear in the files of aald office} and WHEREAS, the said John Haydu has a wife, Anna, and one minor child, to wlti John Haydu, Jr., both of whom are potential dependents, and WHEREAS, the said claimexit was represented at the afore said bearing and is now represented by counsel} end WHEREAS, It Is the desire of the claimant and the said re spondents to reach an amicable adjustment of the above disputed claims to the end further litigation be avoided end doubtful and disputed claims be rendered certain. THERE 13 TO CERTIFY, that I, the claimant, have agreed to recolvo From the Employors Liability Assurance Corporation $12.44 From the Amorican Suroty Company $296.82 From the Hartford Accident and Indemnity Co, $435,46 From The Travelers Insurance Company $245,26} In full aocord and satisfaction of above disputed claims, ABB TO FURTHER CERTIFT that In consideration of said sums so paid, I, the claimant, do hereby remise, release and for ever discharge the employer and all the Insurer respondents frcm all claims for compensation benefits whether for comp ensation In any form payable to me under said Aot or for surg ical, medical or hospital benefits payable on my behalf, and whether said claims have already arisen or hereafter might arise by reason the aforesaid elalm far occupational disease, AND TO FURTHER CERTIFY that I, Anna Haydu, wife of afore said claimant, John Haydn, do agree that In consideration of said sums so paid to remise, release and forever discharge each and all the above named respondents from any and all claims ehleh I might hereafter have against any and all of them by reason of the alleged Incurring of an occupational disease by the said John Haydu while In the employ of the said employer-r e apondent, AND TO FURTHER CERTIFY that I, the claimant, John Haydu, as parent, natural guardian and next friend of aforesaid minor ohlld, potential dependent, and I, Anna Haydu, wife of said John Haydu, potential dependent, and mother of aforesaid minor child , and potential dependent, do. In further consideration of said sums so paid, discharge each and all the above named respondents from all olalms which might hereafter be cade tvw them j mj.j. of the above named respondents by reason of the aforementioned alleged Incurring of an occupation al diseaso by the said John Haydu while in the employ of the above named employer-respondent, AND TO FURTHER CERTIFY that we, the claimant and the respondents, hereby submit the written agreement to the Comp- ensatlon Commissioner of the Fourth Congressional Dlstrlot and respectfully ask that said agreement my be. approved with the foroe of a full and final asard* IN WITNESS WHEREOF, ve hereunto set our hands the day and date first written above* Witnessed by / Claimant, parent, natural guard** lan and next friend of John Haydn, Jr*,} potential claimant* Potential claimant andparent* BAYBESTOS COMPANY, now THE RAYBESTQS-VAITHATTAN, INC. Employer By. Approved Fobrua.ry EMPLOYERS LIABILITY ASSURATJCK CORPORATION By =Jt&=Atta AMERICAN SURETY COMPANY Br Ite Attorney- HARTFORD ACCIDENT AND INDEMNITY.CO. Bt JptvsAttoms^-- 1939 THE TRAVELERS IN3URANCK COMPANY By AjuOOA^ V_ ------ j Compensation Commissioner of the Fourth Congressional District*