ML20029C164
| ML20029C164 | |
| Person / Time | |
|---|---|
| Site: | Pilgrim |
| Issue date: | 03/18/1991 |
| From: | Fulton J BOSTON EDISON CO. |
| To: | Murley T Office of Nuclear Reactor Regulation |
| References | |
| NUDOCS 9103260342 | |
| Download: ML20029C164 (3) | |
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nomwauw 800 Bc/hton Street Boston, WWKhusetts 02199 John M. Fulton, Esq.
(617) 424-2553 Legal Department March 18, 1991 m
Dr.- Thomas R. Murley, Director Office of Nuclear Reactor Regulation U.S. Nuclear Regulatory Commission Hashington, D.C. 20555 RE:
License N;. DPR-35 QQ.tket No. 50-293.
Notification of Claim
Dear Dr. Murley:
-Pursuant to the requirements of 10 CFR 140.6 this letter serves as notification that a claim has been filed against Boston Edison Company arisin out of-or in. connection with its operation of Pilgrim Nuclear Power. Station. g A copy of'the_ legal documente are attached for your information.-
.Should.there be any questions concerning this notification, please contact.
me.
Very truly yours, kw AC JMF/cis'
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Enclosures pyl)$
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FC "M?'. - Gi e Goi..mnwealti of Cassattgartif ) l l ,'(( ErdPARTMEtJT OF INDUSTRIAL ACCIDENTS Department 104 600 Washington Street 7th Floor. Doston, Massachus.etts 02111 p:A 90. USE O m h INIURER S NOUNCAhot4 OF DENIAL OF COMPENSA_1.Q4 y INSiriUCil0NS ARE ON THE REVERSE SIDE. PLEASE PRINT OR TYPE: t,ir,wance Carner Name and Adiess 2 Name and Ao$ess of B'anch or Other Responsible for Ttus Case LIBERTY HUTUAL ' INSURANCE COMPANY LIBERTY MUTUAL INSURANCE COMPANY 13 RIVIE IDE ROAD 1208 VIV PARKWAY WESTON MA 02193 WEST ROXBURY HA 02132 ATTHi ALPRED ZATERKA ,', 3. cas nes,e enme Nam. . cia.ms nen teiennune i s,,.iniu,en O ve. uo 7 inwer case ne Number S ERIN O'SilEA til71469 - 2000 8 S*N1n$u'er No; WC101-765969 t, A t, tr*.,urer e Attorney Name (Last. Fest, M1) and Board of Bar Overseers' Nurnber
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3 ( 3 to Inwer's Atictney Adses (No. & Street, City, State. Zip Crce) g g,
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.3 '4 3 Yes C No 13 A'l'9'd I'tih Lost Work Day 11 Did inwot Re eve Fest Report t injury From Erept d Erlii90 (MuoDryyj lli 4' 86 it Date Fasi nnon of injury neeerved (uuoDivy) i 14 Ernployer flame (L alt, First, MI) 16 Socia! Security f*! umber * ) r RFARDONaROBERT Rl'SSEl.L 019 9457
- 16. Home Address {tio s, Street, City, State, Zip Code)
- 17. Date el Aheged in;urf (MMODIYYr
- 18. First Date or Alleged Disability t
1264 BROOK ROAD (MM/DD/YY) R 0 MILTON MA 02186-10 00186 10' 31 86 C E 19 Employei Name 20 Emp6yer Aotets (f.o & Street. City. State, Zip Code) E BOSTON EDI';0N COMPANY 800 D0YLfrT0:1 STREET BOSTON }{A 02129 2i. Grounds 10: Demat (Check An That Apyy) - ~ t-k a C No injury e. Empicyer Not inwil by Th's treur e y
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C. O No uedeai P,oor ot D,subihiy D Noi usssachusei s surisd< ion s A v 3Other; WITNESSES AND DOC 1%)IS DISPUTE TilAT THEliE - L f {.5 No Causal Relationship Between h. Disat4hty end in}ury llAS BEEN A.WORKepriATED INJ1]EY THAT trAn yo THE EMPLOYEES DEATill H DO.ggttE!RS,1{0.T SUBMIIIED_nLEMELQIEILIQ_SUBSTANTI ATE WORK.LPLEA?!spEciryinrt.Avrn cAitst or nrAvit 0 27.Empdun speahc FactualBasis for Dendof compenss9enB-INJURY NOT WORK RELATEDIWITNESSES AND DOCUMENTS DISPUTE TilAT N Tile ALLEGED INJURY IS WORK RELATED D-N0 CAUSAL RELATIONSilIP EETWEEN DISABILITY ASID INJURY: $ WITNPSSES AND DOCl4 TENTS DISPUTE TilAT TilERE IS A CAUSAL RELAT10NSilIP BETWEEN Tile DISABILITY / DEATil AND ALLE0ED WORR RELATED INJURY h-0TilERiWITNESSES AND DOCl4fENTS DISPltTE TilAT TilERE IIAS GEM _.A__W98K _RELAIED l&111RY TilALLEAD TO Tile _EMELOYEE'JLDEAT11; DOCUMENTS _ NOI_gU3MIIIED BY EMP-23 Ingare@ parer s Name (P6 ease Prira Or Type)
- 24. Insurer Preparer's 11'io
~ c LISA LES.llAllD 'PROCESEQR II1 26 Dale Prepared (MM/DD/YY); f 1,.w Mottred Irmurer Sig e*
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