Document zzZKrJo6k9prx07vmBG5zKM2n

FILE NAME: Insulators Workers' Comp Claims (IWC) DATE: 1959 DOC#: IWC012 DOCUMENT DESCRIPTION: Claimant - Dean, William P f 44r*J 1 / *4 I *# '4, v 2 i STATE OF NEW YORK W O R K M E N ' S C O M P E N S A T IO N B O < y 0 0 n.6 $ 0 0*> 522373 C5931605 ftth . D li.C t d . D is .C t d . 50 PARK PLACE, NEW YORK 7 , N. Y. f a illi * Dao 1 2 /6 /5 9 W . <5$ CASK NO. DATK O F ACCIDCNT Wei *rodv*y K . . . Bpc.Fund a Coos Cosa 20C K.Vind t*I.X*C. _ Mondt Cor* Corps D 7101 TonneU Ar. fZC . o.B<*vgo s C h ari 8 3.Wood A Co. d i M a io * s t U ran s sta ito Coo at r .Co. 6C -607 fa.29t*i Bt. &____r_t_r d_d_____ n CAR RICA CASK NO. 6 1 - 0 7 W o o d s ld Ay . CLAIMANT W opd f i d B ------------------------------- V n t8 o ra A 3fcT4t& 8 C o . jspnpccc 3 7 --1 6 W O th ..1 .C . ----- ~ T r a r T r r In a .C o . , EMPIOYFP 80 Jo h n 3 t .f l.r .C . H jr r f c f n r d A c g > I n .C a .------------------- 1 2 3 w i n l a * `J t . f f . X s C . - a d d ress c a r r ier M gn a t a /. f a r a t o i C o . 1 9 *5 0 C r s c a n t S t . I* .ls C .^ H s X . .d H . In r i i ft tlo n C o . 2 C 5 Sa r f a l c A v a . B r ook ly n fl I r ' A ra a tro a g C o n t r .C o . ADDRESS 130 iftl.MgW S t. lW B 8 l r>i , L u a f a a r a * m f t 2t . X a s . C o . 3 ^ 2 M a d is o n A r . K .X s C . ____ . I, I |y | W fatth a w A s llif lB i'C B " 37-0 3 * * fit._______________ 1 L .Z .C . |S .X . NOTICE OF PRELIMINARY HEARING PLACE: 50 PARK PLACE, NEW YORK, N. Y. DATE: TIME: F a fa .d ,1 9 6 1 130 P . * . _2 9 -PART. Dots of This Notice 1 / 2 6 / 6 1 AW t t e t I n s * fru ad 1 9 9 C fa u re h s t .g .Y X . A ta s C a s .& 's u r r t / C o . 1 5 1 W i l l i * * B t.jH .X s C . . .........; V s i s ^ i f ^ r i n i s s s ir a is ^ -i HW d. Prdiminery H - e c , III b . b.ld . . lb . Km. ocd p ic c b .,. . C d . , dolmen, end ce,,ie, . . . . . b . p ....C . p-.pef.d to le.ni.h In M l d.lell ell el lb . lollewlng ln(e,me.l.n, 1. Notors of the d ispute issues and of ths .y id sn e . that will be producsd at Trial Hearing. 2 Nomss and addresses or other identification of all witnesses on whose testimony the p arti will rely for proofs, Indud- W !M lay witnesses, and brief statement of evidence each ,, expected to g.ve. 3. A day and hour when all witnesses and the parties can attend for Trial Hearing. 4 The time each party will require to present testimony and to cross-examine witnesses of the opposing party. ON THE DATE SET FOR TRIAL HEARING, THE CASE WILL BE DECIDED ON THE EVIDENCE PRESENTED. THERE WILL BE NO FURTHER ADJOURNMENT EXCEPT FOR GO OD AND SUFFICIENT CAUSE STATED UNDER OATH BY THE PARTY WHO HAS FURTHER EVIDENCE TO PRODUCIL__________________________ _ C-210 C-210 C-210 C-210 C-210 At*- Q .JAN 1 1 m STATE OP NEW YORK RKMEN'S COMPENSATION BOX&D 06003650 nth, 50 PARK^ NEWYORK7' N-Y- C5522373 Dla.Ctd. *1111** Man 05931605 M s.C W . 12 3W2 Madloon m B .f .C Mathaw Dal loach Co, 37- 0S 3v*th S t, l .X X .f S tata Inn. TvnA 199 Church S t .H .r x . M taa Can, A &uraty 6c 151 W illi** S t. Saw Xork*H.X. W . 6 9 CASK NO. DAT* O F ACCID*NT c M o ry C ^ a O CAAN,TM C A M NO. 6 1 - 0 7 Mood a id a h i . CLAIMANT W ood a I d a E T Tm taor M IS ifo, o. (Ukar MAMOt _ ,, ADDRESS 2 7 - 1 6 H o t h * * I ,I T riT tlo fi Ina.Co,(H artford) GO J o le S t. S .X X . - em plo yer Ma r t e h o f f R o t t i l a t * H a r h i B f t a g a r -- `M*)1 B" road` way T*o t iC " address 0v*a .Panda Cm * Coast 200 f a a t 2nd S t.K .W Mondt Cork Corp, carrier-- T f i u w i t i Ar a . Ht o r t h ,,_____ - * u arg A P .* * * Aahaatoa CBtruetlo Co, ADDRESS w ,y / t h s t . W .T X 7 Cvhoaarrliaa9 S. kood A Co. 8 8 H l a 8 t . V a a t P r o n t a i f jfc Magnaaia Aboston Oaauxatiw W . NOTICE OF PRELIMINARY HEARING PLACE; 50 PARK PUCE, NEW YORK, N. Y. 0.19*1961 DATE TIME; I I 13O A J t . --PART; 29 Dot. of This Noti 1/6/61 J** H.h 1 . ln a a la lio n C^ 205 B uffalo Ira* Biclyn** Arnatrocg Coatr.Corp. 120 So!! S t. Leocant*rP< 3 9 5 0 C ra a c a n t f lt , Tm T X C a rri.r U caM .nd................................P - W . p a ,manti In IN . c a , a , tal Ih ^ e * "-^ .. ^ d J.T o V l ^. *1. -1 ^and pine. o bb ...,.. .--tot.d.. M claimant and c a rd 0, . I . ta p r ...n l, p r.p o r.d . furnUh I.............. II I - I . Natur I lb . di.putud U .U .. and of Ih addane. tal will ta produed ot Trtal Haarin, r K = s i s i = : ' `, ' ` " 3. A day and hour wh.n all wHnassa and th. partii. can attend for Trial H irin g . 4. Tb. tun. uach part, will rou ira .0 p r...n l ... m an , and la cra.ann. I . al Ita apparta, part,. and will ON THE DATE SET FOR TRIAL HEARING, THE CASE WILL BE DECIDED ON THE EVIDENCE PRESENTED. THERE WILL BE NO FURTHER ADJOURNMENT EXCEPT FOR GOOD AND SUFFICIENT CAUSE STATED UNDER OATH BY THE PARTY WHO HAS FURTHER EVIDENCE TO PRODUCE. _________________________ C-210 C-210 C-210 C-210 C-210 Rt* EMPLOYER STATI OF NEW YORK (^ ) WORKMEN'S COMPENSATION BOAD 3 50 PARK PIACE, NEW YORK 7, N, Y, 05522373 Dia.Ctd 06008650 Dth. Vl i l l * Dean bll dbO 0 5 9 8 16 0 5 Dls.Ctd 2/7/55 W .y.C A N O . ^ CA I'ftlK R C O D CARHIH CA*C NO. CLAIMANT. ADDRESS Mary Pa an__________ ;_________ m*T NANO IU0TNAMI 61*07 Wood ala Avenu*_______ W o o d slA fH .X * NOTICE OF PRELIMINARY HEARING PLACE: 50 PARK PU C E, NEW YORK, N. Y. - PKAPiovPB Vantatore Aaba ato a Cp^--------- DATE: D * l lS l 9 6 0 nrtPFSS 27*16 W th AV*e LXC CARRIER. ADDRESS Lumbermena M nt.Ias.Co* V2 Madlaoa AT* H.Y. Sp**.Funds Cona C obbs* 200 f a s t **2nd St,8C A. Markboff ,Kaq. I01 Broadvay N,IC^_ Mund & Cork Corp. 71 m T o n n w ll A ve^ TIME: I H SO A .M . -PART: 3 0 Dai* of This NoHc* U / 3O/6O AWH Armstrong Cork Co. 295 F i f t h Arano* H ..C . B aiIch Co. L .I.C pBX* C__a_r_r_i_exr t contending, through report filed with the Board and copy sent to the claimant, either that it is not required to make payments in this case, or that its obligation is less than the amount being claimed. In order to set a date for Trial Hear ing on any issues that remain unsettled, a Preliminary Hearing w ill be held at the time and place above stated. Both claimant and carrier are to be present, prepared to furnish in full detail all of the following information: 1. Nature of the disputed issues and of the evidence that will be produced at Trial Hearing. 2. Names and addresses or other identification of all witnesses on whose testimony the parties will rely for proofs, indud ing both physicians and lay witnesses, and brief statement of evidence each is expected to give. 3. A day and hour when all witnesses and the parties can attend for Trial Hearing. 4 . The time each party will require to present testimony and to cross-examine witnesses of the opposing party. At the Preliminary Hearing the Referee will make findings on all issues not in dispute, or as to which dispute is withdrawn, and will then fix a day and hour for Trial Hearing and estimate the time to be allowed for taking all testimony. ON THE DATE SET FOR TRIAL HEARING, THE CASE WILL BE DECIDED ON THE EVIDENCE PRESENTED. THERE WILL BE NO FURTHER ADJOURNMENT EXCEPT FOR GO O D AND SUFFICIENT CAUSE STATED UNDER OATH BY THE PARTY WHO HAS FURTHER EVIDENCE TO PRODUCE. C-210 C-210 C-210 Chairman C-210 C-210 CARRIER 2 STATE OF NEW YORK WORKMEN'S COMPENSATION - BOA&D 50 PARK PLACE, NEW YORK 7 , N. Y. 0 6 0 0 8 6 5 0 !> th * 05522373 Oi.CW . ***** _n5$Slfi5-Dla.Ctd--------12/6/59 Dttu W. C. . CASK NO. DATE O r ACCIDENT Hathe B alio h Co* 37-00 3^th St* L.1*C*,.X* -69- C A R N K R CODE CARRIE* CASK NO. NOTICE OF Mary Daan ' c la im a n t.. 6 i ^Q 7 W oo d a id a Av*- PRELIMINARY HEARING Wooda l a ,BX ADDRESS. AaWa afraa COs- PLACE, 50 PARK PLACE, NEW YORK, N. Y. 27-16 Woth Avant L*XC*X* TravaTara Ina#Co* EMPLOYER Qq J pf e , g % . H .X . -, - ------ DATE, D a .l ^ ,1 9 6 0 H a rk h o ffs G o ttlia b jjA H a F k in a ^ a q a . a d d ress V o i Br oaqvay 8 I Ce------------------ -~ 3pao Fundi Coos Co* 200 V ast **2nd Stif*X*C* c a r r-ie-r------Hn auDnwdwt &V Cv or ka Cv va*rppo* - 7101 Tonnalla Ava. Borth Bargen,s . J* TIME, n*io a , m - - PART' 30 Date of This Notice 1 1 / 3 0 / 6 0 AW ADDRESS f t . . i a a i d t a U o u C p i t ~ . ---------- 205 B uffalo Ava* Blclyn,H.X* Aabastoa C o n stru ctio n Co* feUj-607 W29tfa S t, B*XiCi yCifhlfalfsf* i3d* W*WooUd & wCo** 06 HalB St* Wast Ul'AUga'*' Magnasi Aabaatoa C< 39-50 C rascant St* L*I*C*tB*X* A rm s tro n g Cont r a t i n g Corp. 1--2--0---B--o-.-L--i-n--aL t* 4L,ancas t a r ,-P a , C arrie , Is contending, through report filed with the Board and copy sent to the claimant either that it is not 'q u 'm to make p aym U t, in Ih ii c a !;, or that It.'obligation U less than the amount being claimed. In o rd .rto set a data for Trial Hear Ing on any issues that remain unsettled, a Preliminary Hearing w ill be held at the time and place above stated. Both claimant and carrier are to be present, prepared to furnish in full detail all of the following information, I . Nature of the disputed issues and of the evidence that will be produced at Trial Hearing. 2. Names and addresses or other identification of all witnesses on whose testimony the parties will rely for proofs, indud- ing both physicians and lay witnesses, and brief statement of evidence each is expected to give. 3. A day and hour when all witnesses and the parties can attend for Trial Hearing. 4. The time each party will require to present testimony and to cross-examine witnesses of the opposing party. ond 5lAt the d Preliminary n Hearing the Referee will make findings on all issues < how lor Tool Hoorlo,, ood ..d o Ik . - lo not in dispute, b . allo w d lo , or as to which dispute lo k rr, oil M w | . is withdrawn, ON THE DATE SET FOR TRIAL HEARING, THE CASE WILL BE DECIDED ON THE EVIDENCE PRESENTED. THERE WILL BE NO FURTHER ADJOURNMENT EXCEPT FOR GO O D AND SUFFICIENT CAUSE STATED UNDER OATH BY THE PARTY WHO HAS FURTHER EVIDENCE TO PRODUCE. __________________________ C-210 C-210 v C-210 Chairman C-210 C-210 o V O S/n -- ------------------- " o 9/ /// - - " ;" ~ ~ t t r -------------------- : -- -------------- ^ D ^ 2 P ^ /r ~ --^ g - g v o ^ y - *;*/o "%- - V^ ^ ..... ......... -------------------- ----------- 0 -- ~ p % r ....... - ~ -- ---- ---------- -------------------- ^i/.'cn BALTIMORE NEW YORK CLARKbBURG TULSA ST LOUIS CHICAGO LOS ANGELES ATLANTA PITTSBURGH SAN FRANCISCO NEW ORLEANS MIAMI PHILADELPHIA A IJ X A X D K K & A U 5X A >-H M BBl INCORPORATED in s u r a n c e average adjusters c o n s u lt in g actu aries 2 2 2 5 N O R T H C H A R L E S S T R E E T , B A L T I M O R E 18, MD. March 28, 1962 TELEPHONE TUXEDO 9-A3 bell system TELETYPE BA Sbl CABLE ADDRESS "ALEXBLUE" Mr. William L. Hughes, Manager Insurance Department Armstrong Cork Company Lancaster, Pennsylvania. T ravelers P o lic y No. RUB 7595412 ' ARMSTRONG CONTRACTING AND SUPPLY COMPANY Dear S ir : - Please note d is p o s it io n made o f the fo llo w in g claim*. Date of Accident: October 4 , 1959-'OifcO Claimant: W illiam Dean Location: Claim No.: Disposition: New York B-9230463 $48.50 - Expense Remarks : Indicate Whether: W o r k m e n ' 8 C o m p . _____________ Auto Liability B.I.___ P.D .___ General Liability B.I. P.D. Very tr u ly yours, ALEXANDER & ALEXANDER, INC. LOSS DEPARTMENT. V BALTIMORE NEW YORK CLARKSBURG TULSA ST LOUIS CHICAGO LOS ANGELES ATLANTA PITTSBURGH SAN FRANCISCO NEW ORLEANS MIAMI PHILADELPHIA A l J K X A X D K R & a\ L E X A X D K R INCORPORATED INSURANCE AVERAGE ADJUSTERS CONSULTING ACTUARIES 2 2 2 5 NOR T H C H A R L E S S T R E E T , B A L T I M O R E 18, MD. February 26th, 1962 TELEPHONE TUXEDO 9-A304 BELL SYSTEM TELETYPE BA 582 CABLE ADDRESS "ALEXBLUE" Mr. W allace B. H offerth A s s is ta n t General Manager Insurance Department Armstrong Cork Company Lancaster, Pennsylvania Dear Mr. H offerth: re: W illiam Dean - New York D/A February 7th , 1955 Died - December 6, 1959 F ile B 9230463 _______ We have now rec e iv ed a rep ly from the T ravelers Insurance Company w ith r e sp e c t to our inquiry as to the s ta tu s o f th is old c a se . They a d v ise us under date o f February 21, 1962, as follow s: ''This f i l e was c lo se d by the Workmen's Compensation Board a t a hearing on I a recen t date and th is ca se i s being c lo se d w ith no payment. The T ravelers were r e lie v e d o f any lia b ilit y in th is claim ." case A ccord in gly, we are c lo s in g our f i l e on the S in c e r e ly ALEXANDER & ALEXANDER, INC. 1ENERAL ADJUSTER R BAITIMOKE NEW YORK CLARKSBURG TULSA ST LOUIS CHICAGO LOS ANGELES ATLANTA PITTSBURGH SAN FRANCISCO NEW ORLEANS MIAMI PHILADELPHIA A L E X A X D K K Si A L E X A M ) E K INCORPORATED INSURANCE AVERAGE ADJUSTERS CONSULTING ACTUARIES 2 2 2 5 N O R T H C H A R L E S S T R E E T , B A L T I M O R E 18, MD. February 7th, 1962 lfrf TELEPHONE TUXEDO '>-*304 BELL SYSTEM TELETYPE BA 582 CABLE ADDRESS "ALEXBLUE" Mr. W allace B. H offerth A s s is ta n t General Manager Insurance Department Armstrong Cork Company Lancaster, Pennsylvania Dear Mr. H offerth: re: W illiam Dean - New York D/A February 7 th , 1955 Died - December 6, 1959 We acknowledge your l e t t e r o f February 2nd, 1962 asking th at we secu re an u p -to -d a te s ta tu s rep o rt on this claim . We are asking the T ravelers Insurance Company to fu rn ish us w ith the inform ation requested by you and Just as soon as i t is forthcom ing, i t w i l l be passed on to you. S in c e r e ly k February 2, 1$62 Hr. 0. H. Finlay Alexander A Alexander, 2225 North Charles 8t. Baltimore l8, Hi. Inc. Dear Mr. Finlay: Subject: William Dean - New York of over $20,000. Please ask for statements concerning the adequacy of the reserve and the method used to apportion the loss among prior employers. Very truly yours, Mi/r Wallace B. Hofferth Assistant General Manager Insurance Department May 1 , 1961 Mr. Q. H. F in la y Alexander k Alexander, Zno. 2225 Forth Charlea S t. B altim ore 1 8 , Nd. Bear Mr. F in la y t r Subject! W illiam Dean - lew Yoxfc P/A - 2 /7 /5 5 Died - 12/6/59 9/ M & 3 7 >SU In r ep ly to your A p ril 27th l e t t e r we e n c lo se a Thermo-fax o f a memo w r itte n hy Wallace B. Hofferth* The o r ig in a lly was not w r itte n fo r o u tsid e consumption, however, i t s content in addition to the date of the accident so thoroughly presents a ll th e f a o t s in our p o s s e s sio n we knew you would be happy to g e t the whole sto r y Sorry I l e f t your February U th l e t t e r go unanswered - ay a p o lo g ies. Fery truly yours, NUT Enclosure R. C. S c h ie d t, J r . Insurance Department BALTIMORE NLW YORK CLARKSBURG TULSA ST LOUIS CHICAGO LOS ANGELES ATLANTA PITTSBURGH SAN FRANCISCO NEW ORLEANS MIAMI P H ILA D E LP H IA A lexander & A lexa n d er INCORPORATED INSURANCE AVERAGE ADJUSTERS CONSULTING ACTUARIES 2 2 2 5 NOR T H C H A R L E S S T R E E T , B A L T I M O R E 18, MD. A pril 27th, 1961 Mr. R. C. S c h ie d t, Jr. Insurance Department Armstrong Cork Company Lancaster, Pennsylvania R'l '< 'M Dear Mr. S ch ied t; re: W illiam Dean D/A February 7th . 1955 R eference is made to our l e t t e r o f February 14, 1961 in connection w ith claim in v o lv in g the above employee. We are wondering i f you have determined the c o r r e c t date o f the a c c id e n t, so th at we may s e t up th is ca se in the proper f i l e . Tour comments w ill be a p p recia ted . S in c e r e ly TELEPHONE TUXEDO 9-4304 8ELL SYSTCM TELETYPE BA SB2 CABLE ADDRESS "ALCXBLUE" BALTIMORE NEW YORK CLARKSBURG TULSA ST LOUIS CHICAGO LOS ANGELES ATLANTA PITTSBURGH SAN FRANCISCO NEW ORLEANS MIAMI PHILADELPHIA A lexa n d er & A lexa n d er in c o r p o r a ted INSURANCE AVERAGE ADJUSTERS CONSULTING ACTUARIES 2225 NORTH C H A R L E S S T R E E T , BALTIMORE IB, HD. February 14th, 1961 L) TELEPHONE TUXEDO 9-A304 BELL SYSTEM TELETYPE BA 5S2 CABLE ADDRESS "ALEXBLUE" Mr. R. C. S c h ie d t, J r. Insurance Department Armstrong Cork Company Lancaster, Pennsylvania Dear Mr. S ch ied t: Subject W illiam Dean D/A 2 /7 /5 5 We have your l e t t e r o f February 10th, 1961 en c lo s in g l e t t e r fro the S ta te o f Hew York Insurance Fund in connection w ith the above case. We note you g iv e the date o f the a c cid en t as _Fe.bruary 7 th , 11095555 ,,whheerreeaass tthnee Cu omppensation Claim Exam^inerDienand icdaietde>s date o f in ju ry as December 6, 1959, the date yo XUo 111 you p le a s e l e t u . know t h e c o r c e c t d a t e o f the t * / TMtt" unable^to i ^ V r ^ o u s ' r . c o r d If n o t r e " o " d'appreciate your sending u. copy of the report for the completion of ouf file. In the meantime, I t would appear to be e n tir e ly in order to fu rn ish the Compensation Claim Examiner of The S ta te Insurance Fund, the Inform ation which they r eq u e st. S in ce r ely ALEXANDER & ALEXANDER, INC. R r L'^- - k\ Fabruary 10, 1961 Mr. C hristopher H off Alaxander It Alaxandar, 2225 Morfch C harlas St* B o ltin o ro 1 8 , Md Ino Door Christ / S u b je c t ! y V i l l i a a De*o VV / k - 2/7/55 , 7*. Wh.t .hoold io .boot th . .tU ohJ r to ..t f r o . th . * fork 8 U t. In .o r.n o . FuadT Oor m . l n d l o t .. v i l l i . . D*n' 4 . t h , B c .b .r 6 , }959 > ou.4 / Th. f lr o t h o .iin f by t h . *.w fork V o r W . C o^ jnM tlon B o.ri . . . h .ld S .p t .b .r T 2 8, I960 and a aaoond hearing was aoheduled fo r February B, J-Vcu t o data T ravelers haa not requested a v a fe statem ent. Sinea rsir yours. HLT Enclosure R. C. S o h ia d t, J r . Inauranoa Department The State Insurance Fund w chuuch n u n hiw to 7, h. r. Worth 7100 WILLIAM 6 FOLGER . HICUTIYI OiMClO* . " To : Address : Armstrong C ontracting Corp* 120 No. Lime S tr e e t L e ic e ste r, fa* ' IN MK( FLlASi Itit* tO ClAlMt Ptt**TMINT m D .P .A . , The claimant referred to helo, .a. injured hlle in the employ of Matthew Belich Corp* Under the provi.ion. of U r,*r.-rv for us to ascertain the claimant s earning From : June, 1959 To 1 December, 1959 . H I y o u , therefore, complete the s. s ^ i - Thank you for your cooperation in thie matter. C a s e N o . : . 5566 i16*04 S.S. N o . : C l a i m a n t : William Dean I n j u r e d ; 12/6/59 Date : 2/2/61 D. Bosw o r t h .............................................. .............................. flnoifrrr Compensation Claims Examiner C - 1M r ft T h e State Insurance F u n d m CHutcM m tn w tot* 7.h.r. WOnfc 47100 WILLIAM ft FO LC E i n c u l i v i Olmeto To ' Address : Armstrong Contracting Corp. 120 No. Lime Strt Lancaster, la. in m r u * * u 1 0 CIAIM I biatwikt . P . A . Th. claimant referred to halo. .a. injured .hil. in th. employ of Matthew Bellch Corp. Under the provisions bf the Workmen's Compensation Las it is n ecessa ry for us to ascertain the claimant's earnings From : June, 1959 ] To : December, 1959 Will vou therefore, complete the enclosed payroll statement, in diplic i.Tn^icatl^ thereon th. cl.imanfe e.rninee while in your employ, and mail it to our offibe in th. enclosed return envelope. Think you for your cooperation in this matter. Case N o . : S.S. No.: Claimant: Injured: 5566 416-04 William Dean 12/6/59 Date ; 2/2/61 t * ' D. 6osworth.............. -- ----- " ^ T o m p V n s a T i o n Claims Exaainsr ft WAGE STATEMENT SUBSEQUENT TO DATE OF ACCIDENT THE STATE INSURANCE FUND 199 CHURCH STREET, NEW YORK 7, N. Y. WOrth 4-7100 r Armstrong Contracting Corp Date...... February 2, 1961 n Cu.No 5566 4 1 6 -0 4 120 No. Lime Street Lancaster, Pa* Injured Employee. W l l l i a m D e a n ........ L J In order to properly handle the above captioned case at the Workmen's Compensation Board, we would appreciate your completing the table and questiona below, in duplicate, indicating the employee's earnings fromA/..\?.5?_..1:. ... ...... and immediately returning them to this office in the enclosed envelope. THE STATE INSURANCE FUND D . B osw orth By------------------------------------------- . Claims Department W EEK ENDING tl H Month Day Year i 2 3 4 5 6 7 8 9 10 11 12 13 14 IS D ari Worked Grow Salary Including Ail Overtime 4 16 W EEK ENDING Month Day Year Daya Worked 17 18 19 20 21 22 23 24 25 26 27 28 29 30 Total Groae Salary Including Ail Overtime 1. Occupation ______ __ . . . , ... -- . ---- --------- -- ---------- -- 2. Soc, Sec. N o .----- -------- ---- - ------ ----------------- 3. Was this employee given Iree rent, lodging, board, tips, bonus or other allowance in addition to above earn in g s?----------------------------- If ye*, s ta te w eekly value t h e r e o f -------------------------------------------------------------------------------- ----------------------------------------------------- ----- ------ ------------------ -- -- Describe------------------------------------------------------------------------------ ----- --------------------------------------------------------- --- ----------------------S igned__________________________________________ Title -------- ... -- ------------------------------------------------------------------------------- Date of this r e p o r t __________________ __________ Name of Employer .............- ---------------------------------- ------- ---- --------------------Note: Give reasons, if known, for lost time, if any. (For example: lack of work, personal illness, weather conditions, accident, seasonal work, etc.) C-63 NEW YORK. 6-6-58 30M (7B-736) WAGE STATEMENT SUBSEQUENT TO DATE OF ACCIDENT THE STATE INSURANCE FUND 199 CHURCH STREET, NEW YORK 7, N. Y. WOrtii 4-7100 r Armstrong Contracting Corp Date..... F e b r u a r y 2 . 1 9 6 1 C u e No.. 3 5 6 6 4 1 6 * 0 4 . . 120 No. Lima Straat Lancaster Pa. Injured Employee... W i l l i a m P fS A L J In order to properly handle the above captioned caae at the Worlunen'a Compenaation Board, we would appreciate your completing the table and questiona below, in duplicate, indicating the employee'* earning* fro n L 6 /1 9 5 9 tQ . 1 2 / 1 9 5 9 ____ MXXfttt, anl immediately returning them to thia office in the enclosed envelope. THE STATE INSURANCE FUND By---------J ? __ ______ ______ ___ _____ Claim* Department Week Number WEEK ENDING Month Day Year l 2 3 4 5 6 7 8 9 10 11 12 13 14 IS Days Worked Gross Salary Including All l l Overtint* n 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 WEEK ENDING Month Day Year Total Days Worked Gross Salary Including All Overtime 1. O ccupation________________________________________ .________ ________ 2. Soc. Sec. No. -- ......... ................... 3. W u this employee given free rent, lodging, board, tips, bonus or other allowance in addition to above earnings? ___ ____ If yea, state weekly value thereof ---------------------- ------------------------ ------------- ---- HaapriK# Signed ... ......... Date of thia report .. ._ Till. Name of Employer __ .. ......... . . . . . . . _____ .. . . -. . . . . . . . ,, Note: Give reasons, if known, (or lost time, ii any. (For example: lack of work, personal illnesa, weather conditions, accident, seasonal work, etc.) W ) N EW YORK. W-5S JOM (7B 736) ^ g ^ a a W Cl 3 ro 4 **7 2v * * .T a i* C*0 C a u /-> joc R.vaoa 3t.xxa STATOFNEWYOWC W i S d t * C Tlt C O T p . r RKMEN'S COMPENSATION BOARD 7x01 Tamil A# /2C S 0 6 0 0 8 6 90 !> tb . 50 PARK PLACE, NEW YORK 7 . N. Y . 05522373 Dt*Cfcd. i ll # 05941605 D i*-C t4. 12/6/59 CHh*a3r?i 3>od A C# a h la 3 t . * t o ra t *tb* toa Caoatr.Co. 1 w. CAM NO. OATS O S ACCIDENT 6 0 -6 0 7 * # 2 9 tk 4 t .A C CAMUCR CA M NO. 6 1 -0 7 W ooda li A V . CLAIMANT Wivxi l tH T U r t i m A s tr a l C o . 27--'l6 ^ 1 * ** T .TJ!.,M.Y# r a 1 la a .C e * \ \ ; 8 0 Jo h n d t .J U f'C CMririYFP 123 uUUafMt. Istt..fffi.rnx. b c r 3 9 - 5 0 Croiooat S t # B ^ !lt la a ttl a t la s C o . _____ c a r r ier 3C 5 a o f f a l o A o el l t fr t r l7 l l * ~~ -- A m t r o a i Coatr#Co# a d d r es s 1 3 0 Mo . U s a 0 t # L a i w a a t i f Ltaib*r s i* D i ttttt.Xaa.Co. 3V2 X a i a e o A > . M . r x # _______________ W a tth a a A a llif lB h C ' M O- N O T IC E O F P R ELIM IN A R Y H EA R IN G PLACE: 50 PARK PU C E, NEW YORK, N. Y. DATE: TIME: f t b .8 ,1 9 6 1 H30 fJI. BABT 29 - PARTl Dot# of Thi* Notice 1 /2 6 /6 1 M il ett* la# * 199 Chm B st-I-l- . M t M C a a .2 S o r t7 151 lU llM t - J U lX . K>" C arrier it contending, through report filed with the zsx x ssz * * d o ; TM <tod c o c r t to b . p r . i . n t , p t o p < . ^ J J j^ n J ^ ^ .T ^ w d e M r t e t ' a date for Trial Hear- \ t o n * . to to .to . 0. t o . t o . t o . i n , t o t o , . , 1 Non,TM <* to . dbpM d t o .. <d to . M m . too. will b . ptotoK) - THd i w m ,. 3. A day and hour when oil wHneffef and the partief eon attend for Trial Hearing. 4. T h . to . toKh p * , t o t o P to to - -- I- <" d " -- * wB" ~ " ^ * " ^ POrt' - ^ " " t ^ ^ ^ " ^ ^ ^ ont o . ' ^ut o * 2 % ^ T * " w ' th e DATE SET FOR TRIAL HEARING, THE CASE WILL BE DECIDED ON THE S S h D. THEBE W ill BE NO M n - U # ^ W FOR GO O D AND SUFFICIENT CAUSE STATED UNDER OATH BY THE PARTY WHO HAS FURTHER EVIDENCE TO PRODUCE.______________ _____________________ f ' 4M A A&~~. ru n C -710 C-210 .JA N 1 1 MH 060C8S5D B%he B i* % 059& 1605 M C t4 e STATEOf NEWYOC RKMEN'S COMPENSATION BO 50 PARK PLACE, NEW YORK 7 , N . Y. M l P ili T T t - f7i W w # t I. C A M NO. DATE O F ACCIDENT 3f*2 M id i M I I V . B e X e fit M e tb rti B i l i i s c h C o * 3 7 -0 6 3 V t b d t l* X C o f ] B is t Sa I W 1 99 C te rcfe If c X X X Is t M Ca A t f ly C a . 151 V U liM SB* M Z o r ly X J i CANNIER C A M NO. d l-0 7 tto o d a U A CLAIMANT-- M -- d ir f d # M _ w . <m T t a m lilt il C . a d d r e s s -- ^ 7 --1 6 H o t h l i t I X > t l T r T n iw lt r a lB i.C (B m 6 r 9 ) 6o M b * . .T X . EMPLOYER Vo i b ADDRESS r .* , CARRIE! _ f i a t V f e t f s B e B oX eC M a a lt A C e ik C o r . _______ ___ A 1 t i e n C e n a t v a a t l a a C a # ADDRESS Ma9t B St TeC^ O b e r i 8 . b a n d A C e 6 8 M a ia S i V e t i O r n i a t l ^ . f a g a a t li A W iW i t o A Ii t n r e r N O T IC E O F P R H JM IN A R Y H EA R IN G P U C E* 5 0 PARK P U C E , NEW YORK, N . Y. DATE. . 1 9 , 1 * 1 TIME. *** -N *. Date of This Notice 1 /8 /4 1 m 1 N. 0 5 B e f f a la da B k ly i,I X * A s n ttn a c C e D tr C e r . 1 0 O oL L m A . l * a a a * W * F * * C arrier is contending, through report filed with the Board and copy sent to the claimant, Either that it is not required to make paym ents In this case, or that its obligation is le u than the amount being claimed. In orderto " a date for Trial Hear ing on any issues that remain unsettled, a Preliminary Hearing w ill be held at the me and place above stated. Both claim ant and carrier are to be present, prepared to furnish in full detail aN of the following informationi 1. Nature of the disputed Issues and of the evidence that will be produced at Trial Hearing. 2. Names and addresses or other identification of all witnesses on whose testimony the parties will rely for proofs, includ ing both physicians and lay w itnesses, and brief statement of evidence each is expected to give. 3 . A day and hour when all witnesses and the parties eon attend for Trial Hearing. 4 . The me each party will require to present tesNmany and to cross-examine witnesses of the opposing party. At the Preliminary Hearing the Referee will make findings on all issues not in dispute, or as ^ d is p u t e " withdrawn, and wit) then fix a day and hour for Trial Hearing and estimate the time to be allowed for taking all tesrimony. O N THE DATE SET FOR TRIAL HEARING, THE CA SE WILL BE DECIDED O N THE EVIDEN CE PRESENTED. THERE WILL BE N O FURTHER ADJOURNMENT EXCEPT FO R G O O D AND SUFFICIEN T C A U SE STATED UNDER OATH BY THE PARTY W HO HAS FURTHER EV1DB4CE TO PRODUCE. ___________________ _____ C-210 C-210 C-210 C-210 C-210 <u. - i ^ ^ >t Daoaabar 30, I960 Workman* a Compensation Board f a t a l A ccid en t Claim U n it 50 Park Plaoa law Tork 7 , law Tork O am tlaaam Subject Caaa So* 06000630 V i l l i am Daaa In r e p ly to 70wr December 27 l e t t e r , T ra v elers Insurance Coepaay, H artford , C on n ecticu t waa owr c a r r ia r d u rln f 1939* Vary tr u ly your, ARMSTBOIIG COVTRACTIRQ AID 80PFLI C0FP0RA7I0I T. C. A tkinson C oatroller MLY T A T E O F HEW YORK W O R K M E N 'S C O M P E N S A T IO N B O A R D SO P ark P l a c e . N ew Yo rk 7 . N. Y. s e. S E N IO R CHAIRMAN December 2 7 I9 6 0 C a se N o. O6OO865 0 -D e a th D ec'd : W illiam Dean r. Employer* Ventmore A sb e sto s C o. ' A rm strong C o n tra c tin g C orp. 120 N o rth Lime S t r e e t L ancaster, Penna. G entlem en: T his Board i s c u rre n tly in v e s tig a tin g a claim fo r th e d eath o f W illia m Dean who w as i n y o u r em ploy d u r in g th e y e a r o r 1959. W ill you k in d ly subm it th e name and a d d re ss o f your in s u r a n c e c a r r i e r who c o v e re d you a t t h a t tim e . A h earin g i s being contem plated in th e n ear f u tu r your name and your c a r r i e r 's name w i l l be p laced on n o tic e . FACTM /ib Very tr u ly y o u rs, SOL MESSIAS DIRECTOR OF CLAIMS :< ? / X > /X 'IC'lt FATAL ACCIDENT CLAIMS UNI Q, EMPLOYER STATE OF NEW YORK Z " " '} 3 WORKMEN'S COMPENSATION BOA^O 50 PARK PIA CE, NEW YORK 7 , N. Y 05522373 x > i* .c t d . 06006650 D th . V illin i Ovali C ia 6 Q -U l 05981605 D ia e G t d . 2 /7 /5 5 CARRIKR COOK CLAIMANT 0M je w r& w CARRIER C A M NO. NOTICE OF PRELIMINARY HEARING ADDRESS 6 1 - 0 7 VoodaHa A m a v m V o o d s lA fH .X * PLACE: 50 PARK PLACE, NEW YORK, N. Y. -- EMPLOYER. YvBf o r v AfV tlrtQ CRa ADDRESS. 27-16 Hoth AYi IreleCe,*? CARRIER. ADDRESS In lM iM R i M at.I .Co 3^2 Midlgp ATt. jftEg %>Jftada Coat C on* 2 0 0 M i t **2nd A. Karkhoff ,Saq t o U r a a f a a r V il C Mrmd A Cork Corp. n o i TrmnwtT Aa. DATE: TIME: D a .1 ^ ,1 9 6 0 11130 A e *. --PART: 30 Dot* of Thit Notic 11/30/60 AIA Araatroag Cork Co. 295 P ifth Arano I.X.C* B aiich Co C arrier is contending, through report filed with the Board and copy tent to the claimant, either that it is not required to make payments in this case, or that its obligation is lest than the amount being claimed. In order to set a date for Trial Hear ing on any issues that remain unsettled, a Preliminary Hearing w ill be held at the time and place above stated. Both claimant and carrier are to be present, prepared to furnish in full detail all of the following information: 1. Nature of the disputed issues and of the evidence that will be produced at Trial Hearing. 2. Names and addresses or other identification of all witnesses on whose testimony the parties will rely for proofs, includ ing both physicians and lay w itnesses, and brief statement of evidence each is expected to give. 3. A day and hour when all witnesses and the parties can attend for Trial Hearing. 4 . The time each party will require to present testimony and to cross-examine witnesses of the opposing party. At the Preliminary Hearing the Referee will make findings on all issues not in dispute, or as to which dispute is withdrawn, and will then fix a day and hour for Trial Hearing and estimate the time to be allowed for taking all testimony. O N THE DATE SET FOR TRIAL HEARING, THE CA SE WILL BE DECIDED ON THE EVID EN CE PRESENTED. THERE WILL BE N O FURTHER ADJOURNM ENT EXCEPT FO R G O O D AN D SUFFICIEN T CA U SE STATED UNDER OATH BY THE PARTY W HO HAS FURTHER EVIDENCE TO PRODUCE. C-210 C-210 C-210 Z Ch airm an C-210 C-210 2 a CARRIER STATE O F NEW YORK a ORKMEN'S COMPENSATION BOBD 5 0 PARK PLACE, NEW YORK 7 , N. Y . i 06008650 OHu 05522373 &l*Ct6. V IU Imi 0o -05581605 PlseCt&e_____13/ 6/59 P tn , W. C. B. CASK NO. DATE OS'ACCIDENT lU thev Blionfa Co* 3 7 -0 $ 8 t I mJ sC s i XsZ 60 CARRIER COOK X fjr CLAIM ANT. . ^ ^ y CARRIER CASE NO. j . Nona of PRELIMINARY HEARING b o o d * i # t * X P U C E . 50 PARK PtACE, NEW YORK, N. Y. 2 7 l6 ^ O th A Y io m t * I C |X * T s T n H l i N lB*C*. - EMPLOYER M a rfc h o ff.G k ittll b |A H s k JjB t2 q e ADDRESS V O I Br o a d l y B , T , g , -------------------- BfMSeFsnds Ce Corn. riB B ie# 2 0 0 s t V a n a 9 t . i i . r x B CARR1ER--Me a lt * C orte C o r p s--------------------------- ADDRESS. 7101 T onnelle Aie* Serth B erten ,I X . DATEi Bee.lV9i560 l l l i o A - M - ~ PARTi v > Dato of This Notice 1 1 /3 0 /6 0 U K 205 Boff le Ave. B klja.M .r. Asbesto CoBstrvietloa Co. -6 0 3 ^ 8 0 7 w . m b a t . a . t x . -- Cheis. 3 . Wood * Ce. 8i n K l B S t * K * C T B C t j I . J . Megnesls Asbeste Z ssa letlo o Ce< 35-50 C rescent St leXCe,**X* in u tN B g Ceetree tin g Corp. 120 Bo.Llae at* L*oc*Ur,Pis C arrier it contending, through report filed with the Board and copy sent to the claimant, either that it is not required to make payments in this case, or that its obligation is less than the amount being claimed. In order to set a date for Trial Hear ing on any issues that remain unsottld, a Preliminary Hearing w ill be held at the tim# and place above stated. Both claimant and carrier are to be present, prepared to furnish in full detail all of the following Informationi ' 1. Nature of the disputed issuos and of the evidence that will bo produced at Trial Hearing. . X ; ' 2. Names and addresses or other identification of all witnesses on whose testimony the parties will rely for proofs, Includ ing both physicians and lay witnesses, and brief statement of evidence each is expected to give. . 3. A day and hour when all witnesses and the parties con attend for Trial Hearing. -< 4 . The time each party will require to present testimony and to cross-examine witnesses of the opposing party. At the Preliminary Hearing the Referee will make findings on all issues not in dispute, or as to which dispute is withdrawn, and will then fix a day and hour for Trial Hearing and estimate the time to be allowed for taking all testimony. O N THE DATE SET FOR TRIAL HEARING, THE CA SE WILL BE DECIDED ON THE EVID EN CE PRESENTED. THERE WILL BE N O FURTHER ADJOURNMENT EXCEPT FO R G O O D AN D SUFFICIEN T CA U SE STATED UNDER OATH BY THE PARTY W HO HAS FURTHER EVIDENCE TO PRODUCE. C-210 C-210 C-210 ^ /^ & U sU r\ Chairm an C-210 C-210 A JL L k .Z Armstrong C ontracting and Supply Corporation Workmen's Compensation Claim Vil i a m Dean ;j/> ' r j t ' i September 27, I960 The attached Notice o f Hearing was received in th is o ffic e l a t e in th e afternoon o f September 26. The hearing was scheduled fo r 11:00 AM on September 28 a t th e Workmen's Compensation Board, 50 Park P lace, New York C ity . From the in form ation a v a ila b le on th e n o tic e , i t was alm ost im possible to determine whether the hearing concerned determ ination of d i s a b il i ty under th e Workmen's Compensation Law o r under the S ta te D is a b ility B en efits Law. The d ate o f the accid en t shown was February 7, 1955, tout our records fa ile d to show any accid en t to a William Dean. P a y ro ll reported th e employment of a W illiam D. Dean working out o f the A tlan ta O ffice in 1947. I t seemed improbable t h a t t h i s employee was the one in q u estio n . P ay ro ll also reported a W. Dean employed in New Tork S ta te between June 15 and October 2, 1959. In view of the d ate of accid en t, i t seemed improbable th a t th is in d iv id u al could be the one in question. Being unable to id e n tify th is accident in any re s p e c t, I c a lle d the Workmen's Compensation Board and requested in fo r mation on i t . A fter id en tify in g myself a t le a s t six tim es, I f in a lly talk ed to the in d iv id u a l responsible fo r t h i s p a r tic u la r case. I was advised th a t William Dean died on December 6. 1959 and th e d ate of February 7, 1955 was the date o f f i c i a l l y deal grated by th e Board as the d ate f o r commencement of d i s a b i l i ty . The deceased died o f Ashesto a la . I t was a t the hearing h eT T IO ep U m E erT 1959 th a t th e re fe re e d ire c te d th a t Armstrong Cork Company and two o th ers be brought in to any fu rth e r proceedings on the case. Why wej^. did not receive a copy o f th is d ire c tiv e I do not know. The in d iv id u a l I conferred w ith a t the Board was able to fu rn ish me with the so c ia l se c u rity number of the deceased, and we were thus able to id e n tify him as being employed by AC&S from June 15 to October 2, 1959. The s o c ia l se c u rity number of the deceased is 097-03-2801. Since the hearing to be held on September 28 involved apportionment to p rio r employers, i t was e s s e n tia l th a t AC&S be rep resen ted . , P a y ro ll furnished us with the dates of employment, gross earnings, and t o ta l hours worked by c o n tra c t number fo r W illiam Dean. These c o n tra c ts were then id e n tifie d as to customer, jo b , and type of work performed. In each in sta n c e , the deceased worked as an asbestos worker. One of the c o n tra c ts, 231955 was excluded from The T ra v e le rs' Workmen's Compensation P o licy since th is insurance was provided by the customer. The customer, however, placed the insurance w ith The T ravelers so The T rav elers i s concerned w ith a l l four c o n tra c ts . The employment record o f William Dean i s attac h ed . Since The T rav elers was not l i s t e d as receiving a copy of th e Notice o f Hearing, I c a lle d the New York O ffice of The T rav elers to in q u ire p f they had received any o f f i c i a l n o tif ic a tio n . The gentleman I talk ed to was a Mr. R. Eckberg o f the Workmen's Compensation Claims S ection, and although he persona l l y did not have access to t h e i r f i l e on th is claim , he knew th a t th e in d iv id u a l respo n sib le intended to appear a t the hearing in our b e h alf. This being the case, he said i t was unnecessary to send a copy of the Notice o f Hearing o r th e in d iv id u a l's employment record a t th is time. MLT l: ? v -vf j l .v ,;^ *,, > v . ^ T A T * e r N SW TONIC r | ^ v Lf * *+ **f w S f t P RKM EN's COM PENSATION BOARD - 1 5 3 2 J2 ? c t a * 8 0 PARK PUVCB. NEW YORK 7 . N. Y. Im - ': -j ? fito & to p . * % M illi* Of9 - _ 0j$8l605 ' S 1*AMiKgsr ^ -TV . . . , , ...v W . C . B* C A M NO. . ,. .. . --O---A--T-S_o. r . -A--C--C--ID---E-N--T- IM P O R T A N T - MC'wM j I ^>#' &*T VI*444 -' C A A R I K A 6 A S B N O .- J'kf *'*?.<** ^ C LA IM A N T " r"*'* ,, ADDRESS *s ` -. . ' * awtoi^i-Nd4iiL a tyoT is *>; MAMtt ' IW W TNAM f)-,. !imj09 V a M i U t l m o - - " H >' .' 'W i'n n im u N f i^ . . ,. ; i f..- ^;---- ',ytV ,, -` _ i, ,-*' N O TICE O F H EARIN G -.......... ; - _ ' ` -''2 ;><?j flAEt Sp p ^ PIACE, N W fJfQ ^ N, Y. ... se v fer^ M PLO YER, .r.n'.i` , '' Si ;,.' Y -* v** tur< ri& V # = .-V.^ , ,~A ;7 ^ADDRESS 1- ^ to frU e T e * t-'-1rodarti TIME! U l O O A a J t f ^ART 3 0 V - i. -,v K v t Xm*+C * * m .X .T A . .' il; J "fet^.- *,,-.'T':T'~''f & * '-UvV.v% 7T^- -^ * ' f? V Y 4 ta a >- # s$si im *a* 40t?n / _V, fv ^gfgRy tue-r*; oi?o' ` t t-firt li?nd%* '- -. ..r Jg*t***.\ (Ppr->r.t-.-'eV4Lh-i--'T-X>, U- *~ ' fKe--iL-<w*; - .'>VI -'. nrvs-'!^-.^ sw .il .1.1' A *ff avi `'v ar/fe : ^.CUIMANT AND .ARRJER,- SHOUIJi.^r PRESENT AT. % U HEARING AND PRODUCE NECESSARY EVID EN CE`+S& f s I* vit (-*,* ~i *J- C.' t TAKP iA O f `.*rm O SS,J!A P A U S K M jr C D T k ^ e r^ - -' ' 2 ^ . r*-"l1**" toa Cib-Va INDICATED BELOW , OTHERWISE, THE REFEREE vtC-TU^^.-vV-D 5 CLO.S-E C'_ASE; O N..e--E'^V.I-D.EN4C*E -sIiN'v_A.y^I>LrrE'. i^ -'# -T ' . !. -ii-K lt h> taf-ntt* MAY ? :*-' *' y ^ M I| t i.w n'Ti<w mi*iP Ii lly IT^ 3 ^t itf'vA' `> ^ n itk V B S C C^rt-C# '-'' - r.1 . C V .Hot Only ItemIndicated fry r-M 9 9 9 * * * * * m tm m * - -- -- -- apply to Hi* hearing. ' p* r . i v ',. p is,s .?P . : . 'J --.-' "i^-p-pew. -'-v PURPOSE OF HEARING ^ T .^ 'iy r e r y s - r..^J**=# TO i i t M f t t M f t ONi [ I Period and xfBt ef dI*abllly, T O HAVE CLAIMANT EXAMINED BY STATE PHYSICIAN T ,V , -''W*", DIaWIIy, ---rf--- ^-- ,*n*L--*j^ ` y^ * * 'aC* ' Accident -- Notice to mploytr. " #^r- - -. -p' . Cotai felationthlp of oddent lo ln|utyf : -. .'^ . . x-i.\. .>!( Fodol ditflgurtm^nt. ^ ^ Rote of compeMorieo, *-- I -- , (Ai .niWlb'1io*r - - -. { I lo** of eornlng ^ '-p*' M MMnnirr imw Further consideration.' 'p ,,^4 t'ev. __ - - >^gr.-if. i -w*-HI' U Final Adiu*tment. /.Seei- ";fe' - - jji f .,A w., . y , J- '-4 | Q . Operation or Traatroeni., *%k- ; ^ 4'V ; *S -..P: 4- 1 V>y^ . . . ........................ .... -- is 'J BY CLAIMANT! V EVIPB4CE TO BE PRODUCED > .fr.'**'' 4^- .^ - ir * * : a '4*- BY EMPLOYER kt M , *w k< " I I X-ltay^ OR CARRIER M l -RUO Y I j Record of eornlng* tine ofxldert* ".f- M W RA D iSfr^ TSO W aS ~ i r , n t i^ i * '. : * $ . w i h r - s L J i S :,4 S i r " p~ " ' i .. M < - .4 I . . . . . . . . . I I C -l l (N o tlc, of Injur#. pnon'i ralurn to w ork). ^ .. Hospital recordsi------- ,_____ ------------------- C-2 (Employer's first report of injury).