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DIVISION--THIRD DEPARTMENT

State Industrial Commission.

In the Matter of the Claim

of
JAMES WOODWARD,

Claimant-Respondent,
For Compensation under the Workmen's
Compensation Law,

against E. W. CONKLIN & SON, INC., Employer, and

AETNA LIFE INSURANCE COMPANY, Insurance Carrier,

Defendants-Appellants.

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STATEMENT UNDER RULE 41.

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This proceeding was commenced by filing with the State Workmen's Compensation Commission, now the State Industrial Commission, Employer's Second Report of Injury, dated February 4, 1915.

The acci- co dent occurred on Feb. 2, 1915. On March 10, 1915, the Commission recommended an award of three weeks at $7.69 per week. The insurance carrier protested against this award and the case was referred to the Claim Department of the Commission. Subsequently and on June 28, 1915, an award of ten

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Employee's claim for an

weeks' compensation at $7.69 per week, -
was made and the case continued. Subst
this award and on August 4, 1915, an addı
award of seven weeks at $7.69 per week, total $53.
was made and the case continued.

The insurance carrier protested against the making of both the first award dated June 28, 1915, and the second award dated August 4, 1915.

The name of the claimant is James Woodward, the employer is E. W. Conklin & Son, Inc., and the insurance carrier is the Aetna Life Insurance Company, C. P. Jones appearing for the insurance carrier at the hearing held on June 28, 1915, and D. G. Campion appearing for the insurance carrier at e hearing held on August 4, 1915.

This appeal is made from the award made on June 28, 1915, which allowed ten weeks' compensation to the injured and also from the award made on August 4, 1915, which allowed seven weeks' compensation to the injured.

EMPLOYEE'S CLAIM FOR COMPENSATION.
State Workmen's Compensation Commission
Principal Office: The Capitol, Albany, N. Y.
New York Office: 1 Madison Avenue.

Bureau of Claims.
Claim No. 62586.

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Case of James Woodward.
EMPLOYEE'S CLAIM FOR COMPENSATION.

Instructions—To facilitate prompt payment of compensation the injured employee, or someone for Employee's claim for compensation.

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191...

him, should write carefully (using ink or indelible pencil) answers to the following questions, and mail the same directly to the Commission within four weeks after date of injury.

I hereby make claim for compensation for an injury resulting in my disability, due to an accident upon the 2nd day of February, 1915, arising out of and in the course of my employment by E. W. Conklin & Son., Inc., of Binghamton, Broome County, New York.

My claim is:

IF TOTALLY DISABLED: From what date? Feb. 2, 1915. Are you now disabled? Yes. If not, on what date were you able to return to work?..

If still disabled, how long do you estimate disability will continue? About six months.

IF MUTILATED: Thumb?... First finger?... Second finger?.... Third finger?.... Fourth finger?.... Phalange of thumb or finger?.... If so, which?..... Great toe?..... Other toe?. Phalange of toe?.... Of which?.... Hand?. Arm?..... Foot?. Leg? Yes. Eye?.. Both eyes ?.... Did you suffer loss of the member, or loss of use of the member? Yes. If loss of use, is such loss temporary or permanent May be permanent.

IF PARTIALLY DISABLED: From what date? Feb. 2, 1915. Are you still so disabled ?.. If not, on what date did disability cease?.. 191.. If still partially disabled, how long do you estimate disability will continue?.

By how much have your daily earnings been reduced by this injury?....

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