Document xNYRzJ9J8Y5kve6yVZ9xja7y
FILE NAME: Contract Unit Workers Comp Claims (WCC) DATE: 1968 DOC#: WCC046 DOCUMENT DESCRIPTION: Workers Comp File - Nicholson, Clyde
File Name Contract Unit Claim File: Clyde Nicholson Jun. 19/68 ; Amended Sept. 12/68
Scanned ? yes
Source
JMA: NS-JM
Start Year 1968
Stop Year
1968
Contents
claim
Notes
WORKERS' COMPENSATION APPEALS BOARD - CALIFORNIA (INDUSTRIAL ACCIDENT COMMISSION, prior to 1966)
APPLICANT CLYDE 'NICHOLSON_____________________
CASE ANA 2 3
Asbestos Worker
DATE CLAIM FILED June 19, 1968 Amended Sept. 12, 1968
INJURY ALLEGED
Injury to lungs/due to exposure to asbestos
ALLEGED DATE OF INJURY 1946-1968
EMPLOYER/INSURER
Plant Rubber & Asbestos Works et. al. (including JM Sales/The Travelers) 16 employers & carriers
No apparent Canadian carrier___________________ __
OTHER NOTES Med Rpt to applicant's attorney: "...almost certainly from fibrosis of lungs... due to inhalation of asbesto. fibers.., permanently & totally disabled."____________ No other medical reports in file.
DATE OF RESOLUTION Feb. 21, 1969__________________________________
RESOLUTION
Compromise & Release
$8,380 settlemer
apportioned among 10
DOCUMENTS COPIED ^ Compromise & Release
CLAIMANT
l ^ g - N ichblsnn_________________________________
California workers' Compensation Appeals Board
aZ U
CARRIERS INVOLVED:
The AETNA Casualty & Surety Co. oAmerican Automobile Ins. Co. oAmerican Employers Ins. Co. American Motorists Ins. Co. Argonaut Ins. Co. oAssociated Indemnity Corp. oCalifornia Casualty Indemnity Exchange oCalifornia Compensation & Fire Co. ocasualty Ins. Co. of California oEmployers Liability Assurance Corp.Ltd. oEmployers Mutual Liability Ins. Co. of Wisconsin ,, oFidelity & Casualty Co. of New York oFireman's Fund Ins. Co. oGeneral Accident# Fire & Life Assurance Corp. Ltd. oGlobe Indemnity Co. oGuarantee Insurance Co. oGreat American Ins. Co. oHardware Mutual Casualty Co. (Sentry Ins. Co.) Industrial Indemnity Co. olndustrial Indemnity Exchange olnsurance Co. of North America oLiberty Mutual Ins. Co. oLumbermanJs Mutual Casualty Co. oMaryland Casualty Co. oMichigan Mutual Liability Co. oMission Insurance Co. National Automobile & Casualty Ins. Co. oNew Amsterdam Casualty Co. oOcean Accident & Guarantee Corp.Ltd. Pacific Employers Ins. Co. Pacific Indemnity Co. oReliance Ins. Co. (Standard Accident Ins. Co.) oRoyal Indemnity 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.
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1
WORKERS' COMPENSATION APPEALS BOARD
2
STATE OF CALIFORNIA
3
CLIDE NICHOLSON,
4
C ase N o . 68 ANA 23276
5 Applicant
6
vs.
>
7 ARMSTRONG CORK COMPANY, et a l
8
CERTIFICATION
9
DefendantI
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 above-entitled matter.
14
ATTEST my hand and the Seal of the Workers' Compensation
15 Appeals Board of the State of California. 16
17 18
19
20
21
22
23 24 Dated at San Francisco, 25 Californa, this 3^ day 26 of March, 1981 27
D EPA RTM EN T O F IN O U V TRIA L R ELA TIO N # D IV IS IO N O F IN O U ETRIA L A C C ID EN T #
V %
(
1 ROSE, KLEIN & MARIAS Attorneys at Law
2 900 North Broadway, Suits 412
Santa Ana, California 92701 3 Telephone: 541-4128
4 Attorneys for Applicant 5 6
2 :1363
7
8
BEFORE THE WORKMEN'S COMPENSATION APPEALS BOARD
9
OF THE STATE OF CALIFORNIA
10
11 CLYDE NICHOLSON,
)
)
12
Aoolicant, )
)
13
-vs-
)
)
14 ARMSTRONG CORKCOMPANY, et
)
al.,
)
15
)
Defendants. }
16 ________________________________)
No. 68 ANA 23276 COMPROMISE AND RELEASE
17 The parties hereto, for the purpose of compromise only, hereby sub
18 mit the following agreed statements of fact:
19
1.
CLYDE NICHOLSON, 1803 East Commonwealth Avenue,
20 Fullerton, California, employee herein, born on October 23, 1025,
21 having Social Security No. 317-26-1599, claims that he was employee
22 during the period 1945 through 1963 at Various Cities in the State
23 of California as an Asbestor Worker by the various employers signa
24 tory to this Agreement; said employers 'were then insured as to thei 25 respected periods of employment for workman's compensation liabiiit 26 by the various insurance carriers signatory to this agreement; and 27 that the Applicant sustained an injury arising out of and in the 28 course of his employment as result of et-rpesure to asbestos caus 29 ing a pulmonary disorder.
30
2. The' actual weekly 'wages of the employee during the
'3 1 period of injur'/ ware in dispute.
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3. The employee's present disability is in dimpute an *
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1 the employee has not returned to work.
2
4. Uo temporary disability indemnity has been paid to the.
3 employee and the amount cue and unpaid is in dispute, No permanent
4 disability has bean paid to the employee.
5
5. The parties hereby agree to settle any and all claims
6 on account of said injury by the payment of the sum of $8,380.00,
7 in addition to any sums heretofore paid by the employer or the in
8 surer to the employee, said sum to be payable as follows:
9
A. 3y ARGONAUT INSURANCE COMPANY:
10
(1) $238,00 to Alan Frank, M.D., in full satis
11
faction of his Lien;
12
(2) $25.50 to the Applicant;
13
(3) $1,000.00 to Rose, Klein & Marias, as attor
14
neys 1 fees.
15
B. By AMERICAN MOTORISTS
16
INSURANCE COMPANY:
17
(1) $67.50 to Rose, Klein 6 Marias, as reimburse
18
ment for costs advanced in obtaining records from, the
19
Social Sacurity Administration and the California In
20
spection Rating Bureau;
21
(2) $354.90 to the Applicant.
22
C. By PLANT RUBBER & AS3EST0S WORKS, and FI3R230ARD
23
CORPORATION:
24
(1) $726.75 to the Applicant.
25
D. By NATIONAL AUTO & CASUALTY CO., $68.40 to the
26 27 28 29 30 31
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Aonl.i cant.
E. Sy PACIFIC EMPLOYERS GROUP (Plant Insulation
Company), $1,363.25 to Applicant.
F. By PACIFIC EMPLOYERS GROUP (Narine Engineering a .
I
Supply Co.), 350.80 to Applicant.
j
1 . By PACIFIC INDEMNITY COMPANY, >311.35 to Applicanrj
' . By INDUSTRIAL INDEMNITY COMPANY, $167.30 to tha j
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1
Applicant.
2
I. By AETNA CASUALTY & SURETY COMPANY, $475.00 to
3
the Applicant.
4
J. By THE TRAVELERS INSURANCE COMPANY, $2,976.35 to
5
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.
11
7. Name and address of employee's attorney is ROSE,
12 KLEIN a MARIAS, 900 North Broadway, Suite 412, Santa Ana, Califor-
4
13 nia 92701.
14
8. Said attorneys request a fee of $1,000.00. No
15 prior attorneys' fee has been paid.
16
9. Reason for the compromise is substantial issues exist
17 as to injury arising out of and occurring in the course of employ
18 ment, and as to statute of limitations. All parties desire to 19 avoid the hazards of litigation and the Defendants desire to buy
their peace.
10. The undersigned request that this Compromise and
Release Agreement be approved.
11. Upon approval of this Compromise Agreement by the
Workmen's Compensation Appeals Board or a Referee, and payment in
accordance with the provisions hereof, said employee releases and
forever discharges said employers and insurance carriers from all
claims and causes of action, whether now known or ascertained, or
which may hereafter arise or develop as a result of said injury,
including any and all liability of said employers and said insurance
carriers, and each of them, to the dependants, hnirs, e;:eout>r-,
rsprss?ntati''os, administrators or assigns of said employe'.
WITNESS the signature hereof this
day of "cbruiry.
1 1969, at Santa Ana, California.
2
3
/./'i'. 'C'.
4
CLyOS/KICKOLSOi' Applicant
S
6
ROSS, KLEIN & MARIAS
*}
8
By
Howard A. Gebier,
9
Attorneys for Applicant
10
PLANT, ROBBER & ASBESTOS WORKS, and
FIBREBOARD CORPORATION BY:
11
J3R03ECK, PHLEGER & HARRISON
12
13
By :
Rinaldo Sciaroni, 7r77
14
Attorneys for above defendants
15
EARL VANATTA and ATIONAL AUTOMOBILE
& CASUALTY COMPANY
16
17 Bvs (? 18
19
PLANT INSULATION COMPANY and PACIFIC
EMPLOYERS GROUP 3Y:
20
.2OMNI, GINOCCHIO $, TAYLOR
21
22
3v: '.
^
/\y
Ralph J. Ginocchio, ` /
23
Attorneys for above Defendants
C. F. BRAUN & COMPANY, and AMERICAN MOTORISTS INSURANCE COMPANY
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By:
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_______
MARINE ENGINEERING & SUPPLY CO., and PACIFIC EMPLOYERS INSURANCE COMPANY ZONNI, GINOCCHIO S TAYLOR
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By:
_______________________ * H ' . t .
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_____ ^
Ralph J.. Ginocchio,
Attorn.avs for above Defendant
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INDUSTRIES SUPPLY COMPANY of SAN DIEGO
By:-Pacific indemnity company
2 r\
3
By J/ULZ . ->
4
7 ---- ^
BEeCHTTTEEL CORPOPATION AND INDUSTRIAL IN-
DEMNITY COMPANY BY:
5
MANSELL & GIDDENS
6
By:
_
7
^ttorn^ys/f or above Defendants
8
C O I N S U L A T I N G PRODUCTS and ARGONAUT-
INSURANCE COMPANY BY:
9
t^AMUELSEN, BOLSON & WHITEHEAD
10
11
12
Attorneys for above Defendants
13
ARMSTRONG CONTRACTING & SUPPLY CORPORA
TION and"STNA CASUALTY & SURETY COM
14
PANY BY:
^EINGAND, KENDIG & STOCXWELL
15
16
17
18
JOHN MANSVILLE SALES CORPORATION
THE "RAVELERS INSURANCE COMPANY E
19
JJAVID A.^TAYLOR, Attorney at L
20
21
/ X / X ^ / ' / y 7 ///U
Attorney' fo t vabt5ve
22
23 STATE OF CALIFORNIA) )SS:
24 COUNTY OF ORANGE )
25
On this
day of February, 1969 , before r.e, MARY VAL
DEZ, a Notary Public in and for the said County and State, residing
26 therein, duly commissioned and sworn, personally appeared CLYDE NICHOLSON, known to me to be the person whose name is subscribed to
27 the within instrument, and acknowledged to me that he executed the
same.
28
IN WITNESS '/HEREOF, I have hereunto set m.y hand and af
29 fixed my official seal the day and year in this certificate first
above written.
i
30
31
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OFFICIAL SEAL
MARY VALDEZ
Noraftv pgluC'CAlJfOUNIA
P R IN C IP A L o m e t IN
GRANGE COUNTY
i/,
y
Notary Publy: in ana
County and .Lata of Calriartvi a
My Commission Xpi;es August 19. 19S9
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