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ARTMENT OF LABOR AND INDUSTRIES
ISION OF INDUSTRIAL INSURANCE ORDER OF PAYMENT
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fMPIA, WA. 985
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UNI CIAIMAN7'S NAME GATE INlUREO CLAIMANT'S SERVICE LOCATION MAILING GATE TYPE
,IAIM NUMBER
4226812 8 6 BUCHILLO LOUIS T OF-15-7% NREMER'TO(J
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EMPLOYER A([OUNL N0 ,:-
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ANY PROTEST OR REQUEST FOR
RECONSIDERATION OF THIS ORDER MUST BE MADE IN ti
WRITING TO THE DEPARTMENT OF LABOR AND INDUSTRIES IN OLYMPIA WITHIN 60 DAYS.
A FURTHER APPEALABLE ORDER WILL FOLLOW SUCH A REQUEST. ANY APPEAL FROM THIS
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ORDER MUST BE MADE TO THE BOARD OF INDUSTRIAL INSURANCE APPEALS.
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OLYMPIA. WITHIN 60 DAYS FR OM THE DATE THIS ORDER IS COMMUNICATED .
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TO THE PARTIES OR THE SAME SHALL BECOME FINAL.
UNSPECIFI ED
COMPENSATION FOR
DISABILITIES OF 10.00% AS COMPARED TO TOTAL BODILY IMPAIRMENT '
TOTAL AWARD FOR PERMANENT
INITIAL CASH AWARD PARTIAL DISABILITY $ 3.000.00
5 2,640.C0
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BALANCE OF PERMANENT PARTIAL DISABILITY OF S 360.00 TO BE PAID AT THE RATE
OF $886.87 PEP. MONTH, PLUS 6% INTEREST PER ANNUM ON UNPAID BALANCE PURSUANT
TO R.C.W. 51.32.080(5) (CHAPTER 274. LAWS OF 1961)
KEPT ON SALARY
PAY PERMANENT PARTIAL DISABILITY
CLAIM IS HEREBY CLOSED.
NO FURTHER NOTICE WILL BE ISSUED RELATIVE- TG THE DETERMINATION OF PERMANENT
PARTIAL DISABILITY.
RECEIVED
DEC 51980
JEFFERSON COUNTY
ENGINEERS OFFICE
EMP JEFFERSON COUNTY HIGHWAY DEPT
COURTHOUSE
PORT TOWNSEND WASH 98368
11.210 0 aJ.r .1 --.t 41) 745
CHARLES F. MURPHY
SUPERVISOR OF INDUSTRIAL INSURANCE
BY: EVELYN HINKEN
CLAIN ADJUDICATOR
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DEPARTMENT OF LABOR AND INDUSTRIES
DIVISION OF INDUSTRIAL INSURANCE O
OLYMPIA, WA. 98504
ORDER OF PAYMENT I
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CHARLES F. MURPHY
SUPERVISOR OF INDUSTRIAL INSURANCE'
BY: RITA OSBORN
CLAIM ADJUDICATOR
EMP JEFFERSON COUNTY HIGHWAY DEPT
COURTHOUSE
PORT TOWNSEND WASH 98368
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WHEREAS, this claim was cloned by Order and Notice dated September 19, 1968 and
application has now been made for further consideration on the ground of
aggravation, and
WHEREAS, there is no adequate objective evidence that the injury has become
aggravated;
TREMZVRE IT IS ORDERED that the application be denied and that the claim
shall remain cloned pursuant to the provisions of the aforementioned Order
and Notice.
Stephen C. Way?p p
HRidx ??XYllidlXi?bl?i ur_.._Hrian Ruaoby
Claima A ,?U Catif•T
PHILLIP T. BORN
ei uai inr CQZd wM.- 01 11 ..m?urcw,wa EMPLOYER
Jeff. Co. Department of Highways Date: December 18; 1968
Pt. Townsend, Claim Number: F370217
Washington 98368 Name: Louis Buchillo
Gentlemen:
We have received $4.70 as total refund on over-
payment of Medical Aid award.
This refund has been credited to the Medical Aid Fund, Class 8-3
This refund is not to be deducted from your Medical Aid or Accident
Fund premiums.
All refunds will be credited to the appropriate class. In case of refunds
to the Accident Fund, the firm cost experience record will be credited
for rate calculation purposes.
Very truly yours,
SUPERVISOR OF INDUSTRIAL INSUFANCE
By, L. Runyan 1/ ....,.a•uxs
Disability Claims Adjudicator
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S:rA 'E OF WASHINGTON DEPA o'a €WENT eta- EA10:,G R AND UNDUS RIES
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,y DIVISION OF INDUSTRIAL INSURANCE ..... .aA....??.,.....?,.?..,,.?..??....... DUANE S. STOOKEY, SUPERVISOR
Louis Buchillo DATE: Oct 23, 1968 '
19th & Holcomb CLAIM NO: F 370217
Pt. Townsend, Wash. 98368 EMPLOYER: Jeff. Co Dept of Hwy
INJURED: 12-13-65
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Dear Mr, Buchillo: •
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On October 1, 1968 the O'Neill Pharmacy filled pre- q'
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scription R; 510800 for you and submitted their bill
in the sum of $ 4.70 to the Department. Because the prescription was
s, written on Department of Labor and Industries prescription form, it
was necessary that we honor the bill, although your claim was closed p
prior to the date the prescription was written by your physician. It
Is necessary, therefore, that we collect from the responsible party, y _
and we ask that you send us your check for $ 4.70 in payment of
this drug bill.
$ Please attach your check or money order to the carbon copy of this
letter and mail to the Department of Labor and Industries, Olympia,. "F
Washington.
- Very truly yours,
Enc. 41,
_ PL:js SUPERVISOR OF INDUSTRIAL INSURANCE
cc: .
O'Neill Pharma^y, Inc Mrs. "at Levine l.? 4
844 Wnter Medical Treatment Adjudicator I
Pt. Townsend, Wn. 98368
Roger Dickerson, M.D, f
1136 4later
ITI Pt. Townsend, Wn. 98368
Jeff. Co. Dept, d Highways
Pt. Townsend,
Washington 98368
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