ML20029C164

Notification of Claim Filed Against Beco Arising Out of or in Connection W/Operation of Facililty

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)

Text

.

I *

.4 :g O.

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' (~

Enclosures pyl)$

9103260342 91031a  %

fJhij p n mooex 03o002,3

~_ PDR ,

)-

. - _ _ _ _ - -.2.-

- w ..

"""" Ght Gem'.3ttWealt Of Cassachttschs;b -)

                            '                      DEP/.ATMEN t OF INDUSTRIAL ACC10ENTS . Department 110 6001 Vashing'an Street . 7th Floor, Boston, Massachusetts 02111                                                rwa No                           _

EMPLOYEElg(Ay FOr4 OrFitt ut.t ONiy 1 , (DQfc (tf Trsf(a* tc !;H 'c F T 4A ' d * **!<

         \. ;-( ,..                                                                                  -'P-                                                    _ _ , , , ,               ,          __ _

INSTRL.Cil0NS AND CODES ARE ON THE REVERSE SIDE. PL E ASE P. C& TYPE: _ ,_____ u ,,v*.reeu.me p n.rew,w) 2 sx.i sn,9 Nsmt r' 3 Hn teiew.. I nr AEn0W. It01ERT ELt$$rt i. 019 94S7 i - t a Home A33rt$s (No & StreeI. Cey,6 ste. 29 bode) i Y 1264 BROOK ROAD

• L MT1_ TAW _ MA 091 Af-f 6 Emp40yee's Attorfey Name'(Last, Frst. Mil and Boa'd of Br Overseerf Numter 6 Anorney le eMor>e 617 r.26-7779

! E rAwTgov1T2. surRWIN_Li_l2$3220 I 7. Aftoney A$$'ess (No & Street. City. Stre, Z@ Code) 294 WASHINGTON ST. SUlTE 717 ( knRTOM . MA 02,1QR _. l

     ' e 6 irepicytt tarit                                                                                                                              l 9 Incost*u Cece
          ,                            knRTnM EDIRON                                                                                                _m

10. Employer Addr ess (No. & Street, Csty, State, Zip Cooe)

E l u 800 BOYLSTON STREET i P nneinw.wi n91oo

                                ~

Q " Wo4e's Compensate Neance C4"*' Name (Not loca' Agent or A$wvey l d Eta i wer _ { ,_ ,,,._ _ 1J. ,gtTY M11Tt'A1. IN,LJQ& _ _ _ ,_ h k _,_ _ o meance can,ee Aoa,eis o srarc Aesponsee 'or ina case _ _ ,is s.oi wer .,ete u g 1208 V.F.W. PARKWAY ' WEST ROXEURY, MA 02132

    -                                            .                                                                                                                    == -

l l u Date of injury (MMSD/YY) 10'.30 86 16 Natre of insey Code (s) a 27I lt 99C - ,_$ lc

- w ee m. p.ee er,e p.e- . /'t spio 3 27 87 'e bee, ran cess) - a 439

                                                                                                                                                         ,                   !: 700       ic 20 Titte Ore ot Daawty (MuMyys                                  21 m;Twc,e<Tr.nen .we'i l 4 Firs Dre vi 04atni.ty ivu po%

10 30 _ 86 Ili 3 r 86 O y,, g_ 24 A , twe r, c#-o me y n vu r..

      .. J u er cmx seis                                               p3 g,,p m.,3,          y,,,, 3 cygg,gg                            we te tre t*st s't caar, rewec to th4 c+atnigt t,en o, J

u i QD ru.cee D uoe D, nub y , 75 Dem t Ho* inity occonee ' ( EMPLOYEE WAS EXPOSED TO RADIATION OVER A PERIOD OP 10 YEARS WORKING AT A F NUCLEAR POWER PLANT. 0-

    .nl S, d beciivnts) et La. C.c4c imus ce cne:neos tt'V301                                      ,   01, o. .%fy . ne. neni              ciuA>

t h Uedita' EsmSM 4 a.nena ...Ca,e m ,.u mom.., me i,u 3 C. Willful M4ConduCl of Ernployet (s28) 6 0 eart.,o atry isal DE w n < wen iee', v 0 n e r : - e seen un Xb. t,;cn . . s D- m 1,7A.8',IbA p l' L Oford Deatair.Temporryu) L. ... - -. _ , - - _ .

                                                                                                                      =_
           !P1 repieyee sigevee [ /                                                                                                                         26 ore (Mucony)

_,_,._,_.4_ A1 iud - @ a/- VddIm . QMm5NJ/fAdvii 30 Dre (VV'DDNY) 9.t$_,t,9 0 -

                                          .m    d i ./.                  .       . '. 1 's    m      -.,.                                                 l                 9i 5 90 o=,, so see,n N,ot, ,, ,ov.g .. o. ,ea i, m,,,, ate on+,,, .oe oe,4                                               ,i o%,m, uc. ems a,e i, ye,, you, , econ l

L t. E 4 0 0 9 8 0 6 0 L O '

FC

     ,    "M?'. -                                Gil e Goi. .mnwealti                     l of Cassattgartif )                                                                                                   ;
 '((            .

ErdPARTMEtJT OF INDUSTRIAL ACCIDENTS Department 104 600 Washington Street 7th Floor. Doston, Massachus.etts 02111 p:A 90. USE O m hy '. INIURER S NOUNCAhot4 OF DENIAL OF COMPENSA_1.Q4 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 8 S*N1n$u'er No; S

t, ERIN O'SilEA til71469 - 2000 WC101-765969 A t, tr*.,urer e Attorney Name (Last. Fest, M1) and Board of Bar Overseers' Nurnber 9. Aitorney Tviephone ' . , ( 3 3 to Inwer's Atictney Adses (No. & Street, City, State. Zip Crce) g , , g,  ; ,4 ,

                                                                                                                                                                        .3
                                                                                                                                                                          '4 11 Did inwot Re eve Fest Report t dinjury From Erept                  3 Yes C No               '                                             13 A'l'9'd I'tih Lost Work Day it Date Fasi nnon of injury neeerved (uuoDivy)                   Erlii90                                          _

(MuoDryyj lli 4' 86 l i 14 Ernployer flame (L alt, First, MI) 16 Socia! Security f*! umber * ) r RFARDONaROBERT Rl'SSEl.L 019 9457 l

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-a C No injury ',

k e. Empicyer Not inwil by Th's treur e ., y b. @ lrqury Not Work Related I. O Not an Empioye, .:, 3, A C. O No uedeai P,oor ot D,subihiy D Noi usssachusei s surisd< ion s L f {.5 No Causal Relationship Between vh. 3Other; WITNESSES AND DOC 1%)IS DISPUTE TilAT THEliE -

       .                                          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 f 1,.w Mottred Irmurer Sig e 26 Dale Prepared (MM/DD/YY);

                                                                                                                                                                           ;9/21)90
                                        /\./d. AP _                                             ,           .c

{JOh+1_

 - d m Ema Semii, Number di.ry ii .ne used io c ,we .n uin,s .iih ihe Depa,1meni oiindusiriai Accoenis .nd io n,ocess you,,epo,t LOYEE TO SUBSTANTIATE WORK RELATED CAUSE OP DEATil N6
                                                                                                                                                                                                             \s e                                                                                                                                   ,

B L 8 0 0 tr 9 8 0 6 0 1. 0 '

                                      - -           . . .               . - - -                    -                             -.                         _          .                             - -}}