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EMPLOYEE
. v. Osvald
HOAD
313 Templeten Drive
DATE OF INJUR`
NUMBER
Fort Nerth, Texse
16002
INSURANCE
co. NO.
V 11672
INDUSTRIAL ACCIDENT BOARD
WALTON BUILDING
AUSTIN 14, TEXAS
YOUR
Notice of Injury and
Claim for Compensation
vs
EMPLOYER
. King Candy Company
IN CONNECTION WITH THE ABOVE STYLED CASE HAS BEEN
INSURANCE
RECEIVED. ACCORDING TO OUR RECORDS THIS CASE IS NOW
Liberty Insurance Company of Texes
BEING HANDLED AS SHOWN BELOW. PLEASE NOTE THAT THE
CARRIER
.
PROPER COURSE' TO FOLLOW HAS BEEN MARKED WITH AN
Box 939
"X" IN THE LEFT HAND MARGIN.
Fort Worth, Texas
WHEN WRITING TO THE INDUSTRIAL ACCIDENT
BOARD CONCERNING YOUR CLAIM FOR COM-
PENSATION ALWAYS GIVE THE BOARD'S NUMBER
AND STYLE OF THE CASE.
You are receiving weekly compensation payments in the correct amount. So long as you are receiving compensation and
medical attention the Board will take no action on your claim. If these payments are suspended before you have re-
turned to work or fully recovered, the Board will be glad to assist you in securing a satisfactory settlement.
You have not lost sufficient time from work to be entitled to compensation for lost time. Compensation is not due you until
you have been absent from work for eight days. If your injury has permanently affected your ability to work, you must
file a signed, up-to-date, detailed medical report from a licensed Doctor in support of your claim. If your medical bills
have not been paid, please advise this office, and furnish US itemized, signed copies of all unpaid bills.
You have probably been paid all compensation due you for time lost from work. If you are claiming further disability,
please advise US and furnish a signed, up-to-date, detailed medical report from a licensed Doctor in support of your claim.
xxx
Notice of Injury and Claim for Compensation has been received. In accordance with your wishes the Board will
take no further action unless requested to do so. For their information, we are notifying the insurance carrier that
claim has been filed.
Remarks:
No further action will be taken by the Board unless requested by you and unless
supported by the necessary evidence as outlined above.
INDUSTRIAL ACCIDENT BOARD
LN:egb 4-27-59
Joe EXECUTIVE G. DIRECTOR mans.g
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"ocrText": "-\n\"\nEMPLOYEE\n. v. Osvald\nHOAD\n313 Templeten Drive\nDATE OF INJUR`\nNUMBER\nFort Nerth, Texse\n16002\nINSURANCE\nco. NO.\nV 11672\nINDUSTRIAL ACCIDENT BOARD\nWALTON BUILDING\nAUSTIN 14, TEXAS\nYOUR\nNotice of Injury and\nClaim for Compensation\nvs\nEMPLOYER\n. King Candy Company\nIN CONNECTION WITH THE ABOVE STYLED CASE HAS BEEN\nINSURANCE\nRECEIVED. ACCORDING TO OUR RECORDS THIS CASE IS NOW\nLiberty Insurance Company of Texes\nBEING HANDLED AS SHOWN BELOW. PLEASE NOTE THAT THE\nCARRIER\n.\nPROPER COURSE' TO FOLLOW HAS BEEN MARKED WITH AN\nBox 939\n\"X\" IN THE LEFT HAND MARGIN.\nFort Worth, Texas\nWHEN WRITING TO THE INDUSTRIAL ACCIDENT\nBOARD CONCERNING YOUR CLAIM FOR COM-\nPENSATION ALWAYS GIVE THE BOARD'S NUMBER\nAND STYLE OF THE CASE.\nYou are receiving weekly compensation payments in the correct amount. So long as you are receiving compensation and\nmedical attention the Board will take no action on your claim. If these payments are suspended before you have re-\nturned to work or fully recovered, the Board will be glad to assist you in securing a satisfactory settlement.\nYou have not lost sufficient time from work to be entitled to compensation for lost time. Compensation is not due you until\nyou have been absent from work for eight days. If your injury has permanently affected your ability to work, you must\nfile a signed, up-to-date, detailed medical report from a licensed Doctor in support of your claim. If your medical bills\nhave not been paid, please advise this office, and furnish US itemized, signed copies of all unpaid bills.\nYou have probably been paid all compensation due you for time lost from work. If you are claiming further disability,\nplease advise US and furnish a signed, up-to-date, detailed medical report from a licensed Doctor in support of your claim.\nxxx\nNotice of Injury and Claim for Compensation has been received. In accordance with your wishes the Board will\ntake no further action unless requested to do so. For their information, we are notifying the insurance carrier that\nclaim has been filed.\nRemarks:\nNo further action will be taken by the Board unless requested by you and unless\nsupported by the necessary evidence as outlined above.\nINDUSTRIAL ACCIDENT BOARD\nLN:egb 4-27-59\nJoe EXECUTIVE G. DIRECTOR mans.g"
}