Document mpKX9kjaMdmQKxVoaOj7m8k1g

ACACIA MUTUAL LIFE ASSOCIATION tr ] CHARTERED BY SPEC IAL ftCT DP CONGRESS M A R C H 3 1 8 6 9 f HOME OFFICE IDI INDIA NA AVENUE LUA5HINGTN, D.C. March 8, 1929 W M. MONTGOMERY Pr e s id e n t J. H A R R Y C U N N IN G H A M Vic e -Pr e s id e n t J. P. Y O R T Sec r e t a r y a n d a c t u a r y J. C LA U D E K E IP E R Tr easur er C H A R LE S E. B A L D W IN Ass' t . T r eas u r er JO H N B. N IC H O L S . M . D . Me o ic a l Dir e c t o r Dr. Robert Kahoe ' Medical University of Ginn Cincinnati, Ohio In Re: renerai Motors Chemical Company Dayton, Ohio My dear Doctor: This Association has under consideration an application for disability benefits u n d e ^ ^ ^ p o ^ ^ v ^ f insurance held in this Association by M r . In the'papers it is stated that you have n a ^ t h e case under your personal ob servation. M r . V p claims to have been totally disabled since March 26, 1924 rrom nervous disorders caused by Ethyl Gas poisoning while in the employment of the Chemical Department of the Gen eral Motors Chemical Company, and he states that the company has paid him disability compensation in full. The information which we have indicates that this appli cant is not at the present time totally disabled from the per formance of all remunerative work, but that he is able to en gage in light work sufficiently to find some remuneration. In our consideration of the claim it is necessary that we have satisfactory information regarding the degree of actual disability. We wil therefore appreciate it if you will furnish us a statement of the particulars of the case, as it has come under your observation, the degree of disability at the present time, to what extent he is able to engage in remunerative work, etc. For your convenience, a questionnaire is presented on the reverse side of this sheet, which you are requested to complete and return to this office. ? Whatever information is furnished will be of service to Mr. Ross and this Association, and will ;be duly appreciated. Very truly yours^ - K fc 0020988 J3N :EW J. B. Nichols Medical Director 0 NOT L A P S E YOUR P O L IC Y IN A N ' CITHER OLD LIME COMPANY TO T A K E ONE IN A C A C I A DC N OT L A P S E YOU R P O L I C Y IN AC sCIA T O T A K E O N E IM AN-Y O T H E R O L D LIME C C M P A N y State the cause, dste, duration, and particulars of the applicant's illness as it has come under your observation. '.That amount of compensation has been paid the applicant by the company which finally employed him, and for what period has this compensation been paid? . What is your estimate of this applicant's disability, so far as engaging in gainful work is concerned? To what extent does he, or is he able to, engage in any remuner ative occupation? Remarks: Date Signature- kf 0020989