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U. S. DEPARTMENT OF LABOR
JAMES J. DAVIS, Secretary
BUREAU OF LABOR STATISTICS
ETHELBERT STEWART, Commissioner
BULLETIN OF THE UNITED STATES)
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BUREAU OF LABOR STATISTICS J .................. WO.
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W O R K M E N ’ S IN SU R AN C E AND C O M P E N SA T IO N SE R IES
PROCEEDINGS OF THE TWELFTH ANNUAL MEETING
OF THE
INTERNATIONAL ASSOCIATION OF INDUSTRIAL
ACCIDENT BOARDS AND COMMISSIONS
HELD AT SALT LAKE CITY, UTAH
AVGUST 17-20,1925
APRIL, 1926
WASHINGTON
GOVERNMENT PRINTING OFFICE
1926
ANNUAL MEETINGS AND OFFICERS OF THE INTERNATIONAL ASSOCIATION OF
INDUSTRIAL ACCIDENT BOARDS AND COMMISSIONS
Annual meetings
President
Date
Place
Apr. 14,15,1914...........
Jan. 12,13, 1915.......... .
Sept, 30-Oct. 2,1915...
A pr. 25-28, 1916.......... .
Aug. 21-25,1917...........
Sept, 24-27, 1918..........
Sept, 23-26, 1919......... .
Sept 20-24, 1920......... .
Sept 19-23, 1921......... .
Oct. 9-13, 1922............. .
Sept.. 24-26, 1923......... .
Aug. 26-28, 1924...........
Aug. 17-20, 1925.......... .
Lansing, M ich ........
Chicago, HI..............
Seattle, W ash..........
Columbus, Ohio—Boston, Mass..........
Madison, W is...............
Toronto, Ontario.........
San Francisco, Calif—
Chicago, 111_______
Baltimore, M d .......
St. Paul, M inn.......
Halifax, N ova S c o tia Salt Lake C ity, Utah_
N o.
1
0)2
3
4
5
6
7
8
9
10
11
12
1Special meeting.
II
John E . Kinnane.
.do.
.do.
Floyd L . Daggett—
D udley M . Holman..
F. M . Wilcox_______
George A . Kingston..
W ill J. French...........
Charles S. A ndrus.
Robert E. L ee__........
F. A . D uxbury..........
Fred W . A rm strongO. F. McShane_____
Secretary-treasurer
Richard L . Drake.
D o.
Do.
L . A . Tarrell.
R oyal Meeker.
Do.
D o.
Charles H . Verrill.
Ethelbert Stewart.
D o.
Do.
D o.
D o.
CONTENTS
;
MONDAY AUGUST 17—MORNING SESSION
Page
Chairman, O. F. McShane, president L A. I. A. B. C.
Remarks of Hon. George H. Dern, Governor of Utah, on workmen’s
compensation_________________________________________________
1-3
Address of the president________________________________________
3-9
Business meeting.
Appointment of committees_____________________________________
9
General report of the secretary-treasurer_________________________ 9-11
Financial statement of the secretary-treasurer-__________________ 12—14
MONDAY, AUGUST 17—AFTERNOON SESSION
Chairman, O. F. McShane, president I. A. I. A. B. C.
Remarks of Ethelbert Stewart, United States Commissioner of Labor
Statistics re the status of certain States regarding membership
in the association------------------------------------------------------------------15
Remarks of Christopher M. Dunn, Deputy Commissioner of Labor of
Rhode Island, relative to Rhode Island affiliating with the
I. A. I. A. B. C_______________________________________________ 15,16
Chairman, D. H. Bynum, chairman Indiana Industrial Board.
Follow-up and investigation of results of compensation awards, by
Rowena O. Harriso^, director of claim division, Maryland State
Industrial Accident Commission______________________________ 17-19
Discussion:
D. H. Bynum, of Indiana_______________________________
19
L. W. Hatch, of New York______________________________ 19,20
Follow-up of promptness of compensation payment, by James A.
Hamilton, Industrial Commissioner of the State of New York____ 20-25
Discussion:
Fred M. Wilcox, of Wisconsin------------------------------------------25-42
O. F. McShane, of Utah_________________________________ 28-44
George L. Eppler, of Maryland---------------------------------------- 28-32
George A. Kingston, of Ontario---------------------------------------- 28-37
Frank W. Ingram, of Nevada____________________________
29
Rowena O. Harrison, of Maryland____________ ___________ 29-38
Christopher M. Dunn, of Rhode Island___________________ 30,31
Ethelbert Stewart, of Washington, D. C--------------------------- 31-41
F. A. Duxbury, of Minnesota------------------------------------------- 34-40
Andrew F. McBride, M. D., of New Jersey_____________
35
W. H. Horner, of Pennsylvania__________________________ 35-57
J. D. Clark, of Ohio____________________________________ 37,38
John A. McGilvray, of California________________________ 39,40
T. Henry Walnut, of Pennsylvania______________________ 42,43
,
TUESDAY AUGUST 18-MORNING SESSION
Medical problems. Chairman, Ralph T. Richards, M. D., of Salt Lake City.
The relation of trauma to cancer and tuberculosis, by Joseph E.
Tyree, M. D., of Salt Lake City_______________________________ 45-48
Chronic infectious hypertrophic arthritis of the spine and its rela
tion to industrial accidents, by J. C. Landenberger, M. D., of Salt
Lake City____________________________________________________ 49-55
Trauma and its results from an administrative point of view, by
James J. Donohue, M. S., F. A. C. S., member Connecticut Board
of Compensation Commissioners_______________________________ 56-61
hi
CONTENTS
IV
Medical problems—Continued.
Page
Phosphorus necrosis of the jaw, by Robert P. Bay, M. D., chief
medical examiner Maryland State Industrial Accident Commission- 62-66
Discussion:
Andrew F. McBride, M. D., of New Jersey_______________
66
Robert P. Bay, M. D., of Maryland_______________________ 66-70
Fred M. Wilcox, of Wisconsin___________________________
66
Ethelbert Stewart, of Washington, D. C_________________ 66-71
J. D. Clark, of Ohio____________________________________
68
O. F. McShane, of Utah_________________________________ 70-75
George A. Kingston, of Ontario__________________________
70
70
Joel Brown, of Idaho___________________________________
T. Henry Walnut, of Pennsylvania_______________________ 71-75
Joseph B. Tyree, M. D., of Salt Lake City________________ 72,73
J. C. Landenberger, M. D., of Salt Lake City------------------- 73,74
James J. Donohue, M. D., of Connecticut_________________ 75,76
76
John A. McGilvray, of California_______________________
,
TUESDAY AVGUST 18—EVENING SESSION
Medical problems (concluded). Chairman, Andrew F. McBride, M. D., commissioner.
New Jersey Department of Labor.
Report of committee on preparation of medical work bearing on the
etiological relation between trauma and the various known dis
eases, by G. N. Livdahl, commissioner North Dakota Workmen’s
Compensation Bureau_________________________________________ 77,78
Report of committee on compensation for eye injuries, by L. W.
Hatch, director of the Bureau of Statistics and Information, New
York Department of Labor____________________________________ 79,80
Discussion:
Ethelbert Stewart, of Washington, D. C__________________ 80,81
L. W. Hatch, of New York__________ , __________________ 80,81
Report of committee on eye compensation of* Section on Opthalmology of American Medical Association______________________ 81-86
Discussion:
L. A. Tarrell, of Wisconsin--------------------------------------------86
James J. Donohue, M. D., of Connecticut________________
87
George A. Kingston, of Ontario__________________________ 87,88
Frank C. Trebilcock, M. D., of Toronto-----------------------------88,89
Discussion of paper on “ Phosphorus necrosis of the jaw,” by Robert
P. Bay, M. D .:
Arthur L. Murray, M. D., of Salt Lake City__________________ 89-91
Ethelbert Stewart, of Washington, D. C______________________ 92-98
F. M. Williams, of Connecticut______________________________ 93-96
George L. Eppler, of Maryland______________________________ 94-96
J. D. Clark, of Ohio_________________________________________
95
L. A. Tarrell, of Wisconsin-------------------------------------- ------------96
L. W. Hatch, of New York__________________________________ 96,97
F. A. Duxbury, of Minnesota________________________________
97
Chester E. Gleason, of Massachusetts------------------------------- -----97
Fred M. Wilcox, of Wisconsin-------------------- ---------------------------97-99
T. Henry Walnut, of Pennsylvania---------------------------------------97
E. Ryan, of Nevada________________________________________ 97,98
Frank W. Ingram, of Nevada______________________________ 98,99
John A. McGilvray, of California----------------------------------------99
Preexisting disease—Its relation to workmen’s compensation, by
R. E. Wenzel, commissioner North Dakota Workmen’s Compen
sation Bureau_______________________________________________99-107
.
WEDNESDAY AUGUST 19—MORNING SESSION
Chairman, Mrs. F. L. Roblin, chairman Oklahoma Industrial Commission.
Report of committee on statistics and compensation insurance cost on
American remarriage table, by L. W. Hatch, director Bureau of
Statistics and Information, New York Department of Labor____ 108-112
Co n t e n t s
v
Report of committee on statistics, etc.—Continued.
Pa&e
Discussion:
Frank W. Ingram, of Nevada----------------------------------------112,113
L. W. Hatch, of New York_______________________________
112
Ethelbert Stewart, of Washington, D. C---------------------------113
Ontario’s mortality and remarriage experience, by T. Norman Bean,
statistician Ontario Workmen’s Compensation Board___________ 113-116
Discussion:
George A. Kingston, of Ontario__________________________
116
R. E. Wenzel, of North Dakota__________________________
117
Necessity for national accident rates, by Lucian W. Chaney, of Wash
ington, D. C________________________________________________117-121
Jurisdictional problems arising out of shifting labor, by John A. McGilvray, chairman California Industrial Accodinet Commission_122-127
Discussion:
O. F. McShane, of Utah________________________________ 127-130
What the South is up against (or the purpose of the proposed Rich
mond convention), by Walter H. Monroe, of the workmen’s compen
sation livision, Bureau of Insurance of Alabama______________ 130-136
Discussion:
Bolling H. Handy, of Virginia__________________________ 136,137
Ethelbert Stewart, of Washington, D. C_________________
137
Mrs. F. L. Roblin, of Oklahoma________________________ 137,138
,
WEDNESDAY AUGUST 19—.AFTERNOON SESSION
Chairman, Mrs. F. L. Roblin, chairman Oklahoma Industrial Commission.
Discussion of papers read in morning session:
Richard H. Lansburgh, of Pennsylvania____________________ 139,140
Ethelbert Stewart, of Washington, D. C____________________ 140-151
R. G. Lucas, of Utah_______________________________________
141
F. A. Duxbury, of Minnesota—_____________________________ 141-150
Joel Brown, of Idaho______________________________________ 142-150
Fred M. Wilcox, of Wisconsin_____________________________ 142-150
O. F. McShane, of Utah____________________________________ 142-145
Frank W. Ingram, of Nevada______________ ______________ 143,144
T. Henry Walnut, of Pennsylvania_________________________ 144-147
J. D. Clark, of Ohio_______________________________________ 145,146
W. H. Horner, of Pennsylvania_____________________________ 147,148
L. W. Hatch, of New York__________ _______________________
149
F. M. Williams, of Connecticut______________________________
150
E. Ryan, of Nevada________________________________________
150
John A. McGilvray, of California___________________________
150
Chairman, Fred M. Williams, chairman Connecticut Board of Compensation. Commis
sioners.
Administrative cost—What items should constitute and enter into
such cost, by George A. Kingston, commissioner Ontario Work
men’s Compensation Board__________________________________ 151-153
Discussion:
W. H. Horner, of Pennsylvania________________________ 153-156
Fred M. Wilcox, of Wisconsin__________ _______________ 155-157
George A. Kingston, of Ontario_________________________ 156,157
Richard H. Lansburgh, of Pennsylvania_________________
157
Ethelbert Stewart, of Washington, D. C_________________
157
D. H. Bynum, of Indiana----------------------------------------------157,158
Factors used in rate making for compensation—Their explanation
and illustration, by William Leslie, general manager National
Council on Workmen’s Compensation Insurance______________ 158-175
Discussion:
Fred M. Williams, of Connecticut_______________________
175
William Leslie, of New York__________________________
175
J. D. Clark, of Ohio___________________________________ 176-181
Lucian W. Chaney, of Washington, D. C__________________
179
Richard H. Lansburgh, of Pennsylvania_________________
179
Fred M. Wilcox, of Wisconsin__________________________ 179,180
F. A. Duxbury, of Minnesota___________________________ 180,181
CONTENTS
VI
,
THURSDAY AVGUST 20—MORNING SESSION
Chairman* Fred M. Wilcox, chairman Wisconsin Industrial Commission.
Report of joint committees of the International Association of In
dustrial Accident Boards and Commissions and the National Asso
ciation of Legal Aid Organizations, 1925______________________ 182-186
Discussion:
William M. Scanlan, of Illinois_________________________ 186-195
R. E. Wenzel, of North Dakota________________________ 192,193
O. F. MeShane, of Utah_______________________________ 193-195
Joel Brown, of Idaho____________________________________
194
Carlos V. Ariza, of Salt Lake City______________________ 194,195
Frank W. Ingram, of Nevada---------------------------------------196
Round-table discussion of administrative problems.
Compensation liabilities in bankruptcy proceedings, by F. A. Duxbury, commissioner Minnesota Industrial Commission-------------- 196-199
Discussion:
Ethelbert Stewart, of Washington, D. C__________________
200
200
F. M. Williams, of Connecticut__________________________
William M. Scanlan, of Illinois___________________________
200
F. A. Druxbury, of Minnesota__________________________ 200,201
George A. Kingston, of Ontario__________________________
201
Neuroses from a compensation standpoint, by F. M. Williams, chair
man Connecticut Board of Compensation Commissioners_______ 201-203
Supervision of compensation in settlements, by Andrew F. McBride,
M. D., commissioner New Jersey department of labor__________ 204-206
Business meeting. Chairman, Fred M. Williams, new president I. A. I. A. B. C.
Report of committee on resolutions_____________________________ 206-209
Discussion as to appointing a membership and attendance committee:
Walter H. Monrie, of Alabama_____________________________ 209—211
Fred M. Wilcox, of Wisconsin_____________________________ _ 209-210
Eehelbert Stewart, of Washington, D. C____________________ 209—210
J. D. Clark, of Ohio_______________________________________ 209-210
210
Chester E. Gleason, of Massachusetts________________________
F. M. Williams, of Connecticut_____________________________ 210,211
George A. Kingston, of Ontario_____________________________
210
Mrs. F. M. Roblin, of Oklahoma_____________________________
211
Report of auditing committee___________________________________
211
APPENDIXES
Appendix A.—Officers and members of committees for 1925-26------------- 212,213
A ppendix B.—Constitution of the International Association of Industrial
Accident Boards and Commissions-------------------------------------------------214,215
Appendix C.—List of persons who attended the twelfth annual meeting of
the International Association of Industrial Accident Boards and Com
missions, held at Salt Lake City, Utah, August 17-20,1925-------------- 216-218
BULLETIN OF THE
U. S. BUREAU OF LABOR STATISTICS
no. 406
WASHINGTON
APRIL>1926
PROCEEDINGS OF THE TWELFTH ANNUAL MEETING OF THE
INTERNATIONAL ASSOCIATION OF INDUSTRIAL ACCIDENT
BOARDS AND COMMISSIONS, SALT LAKE CITY, UTAH, AU
GUST 17-20, 1925
MONDAY, AUGUST 17— MORNING SESSION
CHAIRMAN, O. F. M’SHANE, PRESIDENT I. A. I. A. B. C.
The twelfth annual meeting of the International Association of
Industrial Accident Boards and Commissions was called to order by
the president, Mr. O. F. McShane. Addresses of welcome were
delivered by Hon. C. Clarence Neslen, mayor of Salt Lake City, and
Hon. George H. Dern, governor of Utah, to which response was
made by K. C. Norman, of the Georgia Industrial Commission. In
the course of his address Governor Dern made the following remarks
on the subject of workmen’s compensation:
Governor D erist. The subject in which you are interested, work
men’s compensation, is one in which I have been very much interested
for quite a number of years. I used to have the management of a
mining company which employed from 500 to 700 men, and one of
my jobs was to act as a go-between between a hard-boiled adjuster
and a man who had been injured, or a widow whose husband had
been killed, and it was the most disagreeable work I was called upon
to do. Of course my position with the company made it my duty to
get the best settlement I could, but my sympathies alwavs seemed to
be with the other side. I recognized the injustice of the system
under which we were operating and got no pleasure out of that part
of my work.
In the course of time we commenced to hear about workmen’s
compensation. I do not remember just when that idea developed,
but when I heard about it it immediately appealed to me. I made
a careful and thorough study of it and became converted to the
justice of that system. In 1915, when I was elected to the legis
lature, a workmen’s compensation bill was introduced, but the State
was apparently not quite ready for it, because the bill did not pass.
A few years later the political party to which I belong came into
power and, part of its program being the enactment of a work
men’s compensation law, before the legislature convened party cau
cuses were held for the purpose of deciding upon the kind of bill
to be introduced. A sharp difference of opinion developed as to
whether we should have a workmen’s compensation law embodying
exclusive State insurance or one embodying optional features. It
was finally decided in a party caucus that we should have a law
giving the insurer the option of insuring in the State fund or with
1
2
REMARKS BY GOVERNOR DERN
a private carrier, or of carrying the insurance himself, if he could
give proper security, and I was selected to draft a bill embodying
those features. In that way it happened that I became the author
of the Utah workmen’s compensation law, although it was intro
duced as a committee measure. In subsequent sessions the law was
considerably amended until it reached its present form.
Probably our workmen’s compensation law is regarded as a fairly
liberal one in its benefits and in its general terms, and I believe,
generally speaking, the dual or triple options are working pretty
well. A great many employers still prefer to insure with a private
carrier rather than with the State fund, notwithstanding the fact
that it costs them more than if they patronized the State fund.
I do not think that any State can claim that its law is the last
word on a subject of this kind. Inevitably it is necessary to adopt
certain arbitrary standards to start with, with the idea that as
experience dictates changes shall be made and the law modified to
fit the conditions better, and I assume that such will be the case
with workmen’s compensation legislation in this State and elsewhere.
In this State we have apparently arrived at a stationary condition
in our workmen’s compensation law, for there has been no material
change in it in the last four years. I am impressed with the fact
that a thing that seemed to be radical at one time is regarded as
very conservative at some other time. For example, in 1917, besides
the workmen’s compensation law, we enacted a public utilities law,
and we thought we were very progressive. To-day a good many
people think they are progressive because they want the public
utilities law repealed. So the progressive of one day becomes the
conservative of another day. We thought we were very progressive
because we wanted a workmen’s compensation law, but to-day such
a law is taken as a matter of course, because it works and because
it is right and just. Any measure that is based on simple justice,
as the workmen’s compensation law is, is bound to justify and vindi
cate itself as time goes on, so I do not think we should be afraid
to strike out and stand for things based on simple justice between
man and man.
I have felt for a long time that not only industrial accidents but
also occupational diseases ought to be compensated. Nobody gets
injured on purpose and nobody gets an occupational disease on pur
pose. I do not see any distinction between those two classes or in
juries. They are both risks which are inherent in the industry, and
the industry rather than the individual should bear the burden. We
ought to make it plain that there is injustice in not extending the
law to cover matters of that kind. You who are engaged in work
men’s compensation administration are engaged in a work of justice
and humanitarianism, a work of which you ought to be proud, and
I honor you for the work you are doing in it. There are too many
people who, when their own living is assured, are not particularly
concerned with the welfare of their fellow beings. Indeed, in the
last few years there seems to have been quite a reversion to a spirit
of extreme individualism and it has become unfashionable to ad
vocate anything in the way of social welfare. The fate of the child
labor law is a case in point. There is no question that two or three
years ago the country was overwhelmingly in favor of the child
labor amendment, and yet on account of an intensive campaign of
REMARKS BY GOVERNOR BERN
3
propaganda, there was a revulsion of feeling and the amendment
was very disastrously defeated. There seems to be a sentiment pre
vailing throughout the country now that everybody ought to look
after himself, and welfare work seems to be more or less discredited.
I do not think that can last, because I do not think the human be
ing is built that way. A man must work to eat, and he should not
be deprived of the bread that he earns through his work. The
workmen’s compensation law is a measure that will insure to him
the fruits of his toil, and any measure of that kind is based on
simple justice and is bound, as I said before, to vindicate itself and
to commend itself to all fair-minded people.
ADDRESS OP THE PRESIDENT
B Y O. F. M ’ SHAN E, PRESIDENT I . A . I. A . B. C.
A new system of settlement between employees and employers of
claims arising out of industrial accidents was introduced into Ger
many a little more than two score years ago. The system met with
instant popular approval there and soon spread over Continental
Europe and the British Isles, and thence to Canada and the United
States. It is doubtful if any class of legislation within the history
of man has taken such a firm grip upon the hearts of so great a
number of people, spread with such rapidity, or met with such uni
versal approval as has the system known as workmen’s compensation
insurance.
Even were it desirable, time would not permit of going into the
history of the causes which led up to the introduction of this new
plan. Suffice it to say that the harsh standards*established by the
common law were rejected and in their stead was reared a new code,
more definite, more certain, more equitable, and less expensivemore definite in that the liabilities of the employer and the rights
of the employee were fixed in advance; more certain in that the
controversies incident to litigation under the old system were almost
entirely eliminated; more equitable in that the burden is shared
by the employee, the employer, and society; and less expensive for
the reason that all claims under the new system can be settled, on
the average, for considerably less than the amount of the filing fees
under the old common-law practices.
I do not wish to be understood as conveying the idea that the
burden of cost under the workmen’s compensation system is borne
by the three interested parties in equal proportions. As a matter q|
fact, the consumers of the products of labor’s efforts pay the entire
compensation costs, and the laboring men and their families (who
constitute the greater part of the consuming public) as a matter of
course pay the greater portion of said costs. It isiquite true that the
employer is called upon to advance the money, in the form of pre
miums, out of which compensation is paid, but it is also true that
he adds his premium cost plus a profit thereon to the price of his
wares and passes the burden on to the consumer.
There is also another angle from which to view compensation costs,
and that is in connection with the statutory provision distributing
the wage loss arising out of industrial injury. For example, the
Utah law provides that the injured workman shall receive 60 per
4
ADDRESS OF THE PRESIDENT
cent of his average weekly wage, etc. This provision on its face
gives the impression that the injured workman bears the burden of
wage loss only to the extent of 40 per cent and that the employer
bears the other 60 per cent. Nothing could be farther from the
truth. For the law also provides for a maximum payment of $16
per week, which reverses the above distribution of burden, and only
the very low wage earners receive the 60 per cent of the average
weekly wage provided for. The Utah coal miner receives less than
35 per cent of his average weekly wage, and the underground metal
miner not more than 45 per cent. It is conservative to state that in
Utah the injured workman does not, on the average, receive over 40
per cent of his wage as compensation. An analysis of the provisions
of other States on this point will indicate a similar condition. This
digression is made for the purpose of lending support to a recom
mendation to be made later on.
FORMATION AND PURPOSES OF THE ASSOCIATION
In April, 1914, representatives of the States of Indiana, Iowa,
Massachusetts, Michigan, Ohio, Washington, and Wisconsin met in
Lansing, Mich., and formed the National (later the International)
Association of Industrial Accident Boards and Commissions. An
nual meetings have been held ever since. These States were blazing
the tjail in matters of compensation administration and by their
action they hoped to establish an agency dedicated to the solution of
the many new and perplexing problems with which they were con
fronted and for which there was no fund of experience upon which
to draw.
One of the many difficulties encountered at the outset was lack of
uniformity in laws. Thus an injury compensable in one State was
not compensable in another; some States gave extraterritorial effect
to their laws while others were silent on the question; different
methods of procedure obtained; different agencies of administration
were established; some laws were compulsory while others were
elective; some laws were monopolistic and others competitive; the
activities of some of the administrative bodies were confined entirely
to compensation problems, while those of others covered not only
compensation administration but also inspection service, sanitation,
labor, and in fact every activity having to do with the life, health,
safety, and welfare of employees.
It does not appear that the charter members of this association
ever thought that a model compensation law with uniform provisions
could or should be adopted by all the States. While they perhaps
believed that uniformity could be approached, it is doubtful if they
thought absolute uniformity possible or even desirable. It was rec
ognized that conditions in the various jurisdictions varied perhaps as
much as the laws.
Mr. Justice Brandeis, in his dissenting opinion in the case of New
York Central Kailroad Co. v. Winfield, 244 U. S. 147, expresses this
view in the following language:
There must, necessarily, be great diversity in the conditions of living and in
the needs of the injured and his dependents, according to whether they reside in
one or the other of our States and Territories so widely extended. In a large
majority of instances they reside in the State in which the accident occurs.
WORK ACCOMPLISHED BY THE ASSOCIATION
5
Though the principle that compensation should be made, or relief given, is of
universal application, the great diversity of conditions in the different sections
of the United States may, in a wise application of the principle, call for differ
ences between States in the amount and method of compensation, the periods
in which the payment shall be made, and the methods and means by which the
funds shall be distributed. The field of compensation for injuries appears to
be one in which uniformity is not desirable or at least not essential to the
public welfare.
This difficulty was overcome, however, and more and more atten
tion is now given at our annual meetings to the matters set forth in
the constitution of the association as the objects of its creation and
upon which all could agree: (1) The reduction of accident fre
quency; (2) the standardization of medical treatment for injured
workmen; (3) the standardization of means of reeducation and
return to industry of injured workmen; (4) the standardization of
methods of compiling accident and insurance costs; (5) the stand
ardization of methods of administering compensation laws; (6) the
extension and improvement of compensation laws; and (7) the
standardization of reports and tabulations of industrial accidents
and illness.
WORK ACCOMPLISHED BY THE ASSOCIATION
These activities embrace about everything pertaining to compen
sation laws and other matters incident thereto. It therefore seems
proper that we should take stock of our accomplishments if we
have any to our credit. We should inquire: Have we as an associa
tion been a useful factor in improving conditions in the field of
endeavor to which we have assigned ourselves and dedicated our
energies ? Have we obtained results ? If not, how shall we proceed
in the future in order to obtain the desired ends ?
The association now includes 34 active members (including 3 non
paying members) and 4 associate members. In view.of the fact
that the annual dues of active members have been increased from
$25 to $50, it is safe to conclude that the growth of the association
has been due to the real service which it has rendered to those
charged with administering the various workmen’s compensation
laws.
It is difficult to point to tangible results which can be attributed
solely to the work of the association, but if the cause of many im
provements that have taken place could be analyzed, its influence
would be found to be a very large factor.
REDUCTION OF ACCIDENTS
The first object of the association is to cut down accidents. The
importance of this undertaking is emphasized by the rather startling
statement of the late and much-loved Carl Hookstadt, of the United
States Bureau of Labor Statistics, who made a careful study of this
question and concluded that the annual economic loss due to indus
trial accidents was approximately $1,040,000,000.
That Utah contributes her quota to this estimate is evidenced by
the fact that for the seven years ending June 30, 1924, more than
75,000 industrial injury claims were handled, classified as follows:
Permanent total disability, 19; death, 784; permanent partial dis
ability, 1,003; and temporary disability, 75,383—at a total cost of
6
ADDRESS OF THE PRESIDENT
$5,587,987.69. This amount represents compensation costs alone
and does not take into account the economic loss in man power due
to 19 permanent disabilities, 784 deaths, and 762,738 eight-hour shifts
lost on account of temporary injuries. Utah being a small State in
dustrially, it will be readily seen that if our loss be projected in
proper ratio to the Nation at large, the annual economic waste due to
industrial accidents is astounding.
While specific responsibility in the field of accident prevention is
assigned by a minority of laws, it is believed that through discussion
and much airing of the importance of accident-prevention work the
association has been the cause of a number of States broadening
their laws to include this among the other duties of the compensa
tion administration bodies.
STANDARDIZATION OF MEDICAL SERVICE
The second object is the standardization of medical, surgical, and
hospital treatment for injured workmen. An analysis of recent
legislation indicates that this object has gone forward to an en
couraging degree. During the five-year period ending with 1924,
19 States liberalized their laws in this respect in amount, limits of
time, or other aspects. This matter has been a prominent one in
our annual conventions and it is reasonable to assume that the influ
ence of these discussions has had considerable effect in bringing
about this liberalization.
INDUSTRIAL REHABILITATION
Our third object—rehabilitation of injured workmen and their
return to industry—is coming to be generally recognized as desira
ble, economic, and just. In 12 compensation States there is now
separate provision for rehabilitation, while the compensation acts
oi seven States embody such a provision. The system of Federal
cooperation has been accepted by 34 compensation States, this num
ber including States having rehabilitation provisions in their com
pensation acts. The association is on record in several papers on
the subject, as well as in formal resolution, as encouraging such
procedure.
STANDARDIZATION OF COMPUTING COSTS
Standardization of methods of computing industrial accident and
illness insurance costs is set out as our fourth object. As but few
State laws cover sickness in any form, our activities have heretofore
been directed almost entirely to the first item. The association is on
record favoring compensation for all industrial injuries, whether
accidents or diseases. Papers dealing with compensation costs have
been given in our conventions, and the committee on statistics and
compensation insurance costs has included this among its studies.
STANDARDIZATION OF ADMINISTRATIVE PRACTICE
The association’s activities in relation to its fifth object—standardi
zation of practices in administration of compensation laws—are
expressed in the reports of our committee on forms and procedure.
This is a matter wherein local conditions play an important part.
In view of the frequent statements of various commissioners in our
conventions that the methods in use in their particular State are best
WORK ACCOMPLISHED BY THE ASSOCIATION
7
suited to their peculiar conditions, it is doubtful if as much progress
has been made here as in some of our other fields of endeavor.
IMPROVEMENT OF LEGISLATION
The next object deals with extension and improvement in com
pensation legislation and it is obvious that here results have been
obtained. A chart covering the principal features of compensation
laws was prepared by the United States Bureau of Labor Statistics
in 1919 and revised in 1925. Comparison of the two charts shows
that, in the interval, all the States except three had amended their
laws and in two States new legislation had superseded the earlier
laws. Among the outstanding changes that may be noted were the
reduction of waiting time, increases in compensation benefits, and
liberalization in regard to medical aid. There were also some ex
tensions of inclusion, or coverage, either by way of specific inclusion,
or by lowering the number of workmen necessary for inclusion under
the act. In 1920, 16 States provided for the payment of $12 or less
as a maximum weekly amount; in 1925 no State had less than $12 as
a maximum for temporary total disability, and onlv 6 had so low a
standard; in 1925, 12 provided for a maximum ox $18 or more as
against 5 at the beginning of 1920. The waiting time is now less
than 1 week in 8 jurisdictions, 1 week in 28, and more than 1 week
in 10; in 1920 only 4 laws fixed a waiting period of less than 1 week
while 20 provided for a longer period, 22 making 1 week the required
waiting time. Two States in which insurance had not been required
amended their laws so as to make it obligatory. Here again the
question is impossible of determination as to what extent any one
influence has been effective. Legislation is purely a matter for
determination by the States, but there does seem to be fair ground
for assuming that the constant interchange of opinion has contrib
uted much to the progress which has been made.
STANDARDIZATION OF STATISTICS
Last, but not least, is the matter of standardizing reports and
tabulations of accidents. The committee on statistics and compen
sation insurance costs has produced valuable reports along this line,
including a comprehensive list, of classifications and standard tables.
It is in this field that the association has done one of its most con
spicuous pieces of concrete and tangible work.
OTHER PROBLEMS
In addition to the subjects mentioned above there are many
problems confronting the compensation administrators which must
be solved, and through the annual conventions of the association the
experience of those who have solved such problems can be placed
within reach of those to whom they are new. Thus, payment of
compensation to aliens, legal aid, back conditions, direct settlements,
jurisdictional conflict, compensation for eye injuries, extraterritorial
problems, hernia, methods of carrying insurance, lump-sum settle
ments, nervous conditions, merit rating, occupational diseases,
preexisting disease, compensation for permanent disabilities, physical
examinations, claim procedure, rates, remarriage of widows, reserves,
8
ADDRESS OF THE PRESIDENT
second injuries, and computation of wages, are some of the questions
which puzzle even the old and seasoned administrator of a workmen’s
compensation law, to say nothing of the man who has just assumed
office and has an entire new subject to master. These and many other
questions have been discussed time and again at the conventions of
the association, and a member can turn to the proceedings of the
association and there find guidance through the experience of others
who have solved similar problems. The proceedings of the asso
ciation form a series of valuable reference books to those charged
with the administration of the workmen’s compensation laws.
While it is difficult to point to the specific effects of the associa
tion as a driving force behind the improvements which have taken
place, it is absolutely certain that the organization has had a tre
mendous influence in an intangible way. And while it may not have
effected complete standardization along any of the lines as set forth
in its constitution, it is still working toward the end of improvement
of all matters in the field of workmen’s compensation.
CONCLUSION
In conclusion permit me to urge that the association reaffirm our
former declaration on the following propositions:
(1) That the 34 compensation laws of the United States making
accidental injury or fortuitous event a condition precedent to the
payment of compensation be amended by striking out the words
“ accident or fortuitous event,” as the case may be, and providing for
compensation to all who sustain injuries arising out of or in the
course of the employment. This would bring within the provisions
of all compensation laws the miner afflicted with tuberculosis or the
painter afflicted with lead poisoning who has given the best years
of his life to the industry and wakes to a realization of the fact that
he is an industrial wreck without either funds or claim upon his em
ployer for compensation. Do not let the cry of added burden to
industry deter you. Kemember, the workingman, in the final
analysis, pays the greater part of all compensation costs.
(2) That every State which has not done so already make com
plete provision for the rehabilitation and return to industry of
injured workmen, not as a matter of sympathy but because of their
economic value to society. Every State should provide an agency
for this purpose. It should be properly organized and manned by
people capable of observing critically the injured and placing him
in the field of industry most suitable to his capabilities and most
likely to draw forth his best efforts. Those in charge of such work
should be experts fitted by natural endowment and by training in
their line. They should also be secure in their tenure. Such an
organization properly set up and adequately financed is the best
investment a State can make, for by its activities consumers are
turned into producers; receivers of alms become providers; beings
bowed down by the weight of despair are lifted into the sunshine of
hope; melancholy is dispelled by cheer. It is true that not all can
be rehabilitated—some because of the nature of their injury, some
because of their mental limitations, and some because of age; these,
however, are questions for a skilled director to determine.
GENERAL REPORT OF THE SECRETARY-TREASURER
9
(3) That the weekly maximum be increased to $25 or any limita*
tion thereof removed entirely.
(4) That all laws which do not now so provide be amended to
provide for the social needs of the injured workman or his depend
ents in case of death.
(5) That all laws which do not already so provide be amended to
provide for unlimited medical and hospital attention. This would
be in accordance with the just determination of any case.
(6) That Federal legislation be secured giving effect to the com
pensation law of a jurisdiction in all cases of interstate injuries
within that jurisdiction.
Crystallize into law these recommendations and you will have
gone far to bring in an era of understanding and good will between
employer and employee.
BUSINESS MEETING
After the roll call of States, the convention, at the suggestion of
the secretary, Ethelbert Stewart, United States Commissioner of
Labor Statistics, arose, in recognition of the fact that the Indiana
Industrial Commission, after 10 years’ solicitation, had become a
member of the association.
The following committees were appointed:
Committee on nominations.—Fred M. Wilcox, Wisconsin, chairman; Leonard
W. Hatch, New York; George A. Kingston, Ontario; Mrs. Faye L. Roblin,
Oklahoma; H. R. Witter, Ohio; George L. Eppler, Maryland; R. 0. Norman,
Georgia. *
Committee on resolutions.—F. A. Duxbury, Minnesota, chairman; Miss
Rowena O. Harrison, Maryland; James J. Donohue, Connecticut; D. H. Bynum,
Indiana; Andrew F. McBride, New Jersey; Richard H. Lansburgh, Penn
sylvania ; John A. McGilvray, California.
Auditing committee.—L. A. Tarrell, Wisconsin, chairman; H. C. Myers, Okla
homa; W. H. Horner, Pennsylvania; A. E. Brown, Maryland; Andrew F.
McBride, New Jersey.
The report of the secretary-treasurer, covering the business of the
past year, was then presented.
GENERAL REPORT OF THE SECRETARY-TREASURER
The International Association of Industrial Accident Boards and Commis
sions now includes 34 active members;
United States Bureau of Labor Statistics.
United States Employees’ Compensation Commission.
Connecticut Board of Compensation Commissioners.
Georgia' Industrial Commission.
Hawaii Industrial Accident Boards (counties of Kauai, Maui, Hawaii,
and Honolulu).
Idaho Industrial Accident Board.
Illinois Industrial Commission.
Indiana Industrial Board.
Iowa Workmen’s Compensation Service.
Kansas Public Service Commission.
Maine Industrial Accident Commission.
Maryland State Industrial Accident Commission,
Massachusetts Industrial Accident Board.
Minnesota Industrial Commission.
Montana Industrial Accident Board,
Nevada Industrial Commission.
New Jersey Department of Labor,
10
BUSINESS MEETING
New York Department of Labor.
North Dakota Workmen’s Compensation Bureau.
Ohio Industrial Commission.
Oklahoma Industrial Commission.
Oregon State Industrial Accident Commission.
Pennsylvania Department of Labor and Industry.
Utah Industrial Commission.
Virginia Industrial Commission.
Washington Department of Labor and Industries.
West Virginia State Compensation Commissioner.
Wisconsin Industrial Commission.
Wyoming Workmen’s Compensation Department.
Department of Labor of Canada.
Manitoba Workmen’s Compensation Board.
New Brunswick Workmen’s Compensation Board.
Nova Scotia Workmen’s Compensation Board.
Ontario Workmen’s Compensation Board.
During the year one member, the Michigan Department of Labor and Industary, dropped out of the association, and the Idaho Industrial Accident Board
changed its membership from associate to active.
The United States Bureau of Labor Statistics, the United States Employees’
Compensation Commission, and the Department of Labor of Canada are exempt
from the payment of dues.
The following are associate members:
Industrial Accident Prevention Associations, Toronto, Ontario.
Porto Rico Workmen’s Relief Commission.
Republic Iron & Steel Co., Youngstown, Ohio.
Leifur Magnusson, American correspondent of the International Labor
Office, Washington, D. C.
Leifur Magnusson has been admitted as an associate member since the
last meeting.
During the year no meeting of the executive committee was held.
At the Halifax convention it was ordered that the following papers read at
that meeting be printed and distributed in advance of publication of the pro
ceedings. This was done.
Compensation for Eye Injuries, by Dr. Nelson M. Black, Milwaukee, W is;
Etiology, Diagnosis, and Treatment of Back Pains, by Dr. T. B. Acker, ortho
pedic surgeon, Halifax, Nova Scotia; Hernia as a Workmen’s Compensation
Problem, by Dr. J. G. McDougall, F. A. C. S., of Halifax, Nova Scotia; Method
of Rate Making in an Exclusive State-Fund State, by T. J. Duffy, chairman
Industrial Commission of Ohio.
The Halifax convention passed resolutions calling for the following com
mittees, and the persons named were appointed as members thereon:
Committee to work with a committee of the Ophthalmic Section of the Ameri
can Medical Association for the purpose of working out a scale of compensa
tion for eye injuries.—L. W. Hatch, New York, chairman; Charles H. Verrill,
Washington, D. C.; Dr. Ralph T. Richards, Utah; Ethelbert Stewart, Washing
ton, D. C. (ex officio member).
Committee to consider the question of the preparation of a medical work
hearing upon the etiological relation between trauma and the various known
diseases.—G. N. Livdahl, North Dakota, chairman; George A. Kingston, On
tario; Dr. Robert P. Bay, Maryland; Dr. James J. Donohue, Connecticut;
Ethelbert Stewart, Washington, D. C. (ex officio member).
Committee to meet with a similar committee of the National Association of
Legal Aid Organizations to consider mutual proUems and report to this con
vention.—W. H. Horner, Pennsylvania, chairman; James E. Donahoe, New
York; H. R. Witter, Ohio; Ethelbert Stewart, Washington, D. C. (ex officio
member).
The above committees will report to this convention.
During the latter part of January the secretary was informed of the death
of Mr. H. G. Wilson, of Manitoba, under very sad circumstances. This left
GENERAL. REPORT OF THE SECRETARY-TREASURER
11
a vacancy on the executive committee, to which Mr. James A. Hamilton, of
New York, was appointed.
On December 31, 1924, the term of office of former representatives of the
association on the safety code correlating committee expired, and the follow
ing were appointed to serve until December 31, 1926:
Representatives.—Ethelbert Stewart, U. S. Bureau of Labor Statistics; Row
land H. Leveridge, Department of Labor of New Jersey; M. H. Christopherson,
Department of Labor of New York; Richard H. Lansburgh, Department of
Labor and Industry of Pennsylvania; Bolling H. Handy, Industrial Commission
of Virginia.
Alternates.—G. N. Livdahl, Workmen’s Compensation Bureau of North
Dakota; Henry McColl, Industrial Commission of Minnesota; H. R. Witter,
Department of Industrial Relations of Ohio; John Roach, Department of
Labor of New Jersey; G. R. Yearsley, Industrial Commission of Utah.
The association was represented during the year on the sectional committees
formulating the following safety codes:
Building exits.
Machine tools.
Compressed-air machinery.
Mechanical refrigeration.
Conveyors and conveying machinery. National electrical code, revision.
Electrical power control.
National electrical safety code.
Elevators.
Rubber machinery.
Exhaust systems.
Sanitation.
Floor openings.
Textile.
Forging industry.
Walkway surfaces.
Gas.
The Bureau of Labor Statistics has published the following safety codes to
date, in the formulation of which the association took part:
Bulletin No. 331. Code of lighting: Factories, mills, and other work places.
Bulletin No. 336. Safety code for the protection of industrial workers in foun
dries.
Bulletin No. 338. Safety code for the use, care, and protection of abrasive
wheels.
Bulletin No. 351. Safety code for the construction, care, and use of ladders.
Bulletin No. 364. Safety code for mechanical power-transmission apparatus.
Bulletin No. 375. Safety code for laundry machinery and operations.
Bulletin No. 378. Safety code for woodworking plants.
Although a member of the association, the Industrial Accident Board of
Honolulu, Hawaii, has never been able to send a delegate to any of the con
ventions. In response to an invitation to attend this meeting it stated that
although unable at this time do so, it is very much interested and hopes to
be able to send a delegate some time in the future.
Recognizing the value of the proceedings of the association as a guide in
matters of compensation-law administration, the secretary during the past
year has had prepared in his office an index to these proceedings. This has
been published by the Bureau of Labor Statistics as Bulletin No. 395, and
copies are available at the desk. It is thought that it will prove of much value
to the administrators of the compensation laws.
The proceedings of the Halifax convention have been issued by the Bureau
of Labor Statistics as its Bulletin No. 385, and copies are available for mem
bers who desire them at the headquarters here.
Respectfully submitted.
E
th elbert
Stew ar t,
8 ecretary-Treasurer,
Ju ly
31, 1925.
73891°—26----- 2
12
BUSINESS MEETING
FINANCIAL STATEMENT OF THE SECRETARY-TREASURER, AUGUST
11, 1924, TO JULY 31, 1925
BALANCE AND RECEIPTS
1924
Aug. 11. Balance (bank deposits, $1,023.96; Liberty bonds, $1,700;
Canadian bonds, $500; unexpended postage and tele
graph fund, $4.03)___ _______________________________ $3,227.99
12. Oklahoma Industrial Commission, 1925 dues____________
50.00
Connecticut Workmen’s Compensation Commissioner, third
district (Charles Kleiner), 1925 dues----------------------10.00
Nova Scotia Workmen’s Compensation Board, 1925 dues
(Canadian exchange deducted)______________________
49.38
14. Connecticut Workmen’s Compensation Commissioner,
fourth district (E. T. Buckingham), 1925 dues________
10.00
Illinois Industrial Commission, 1925 dues________________
50.00
Connecticut Workmen’s Compensation Commissioner, fifth
district (F. M. Williams), 1925 dues__________________
10.00
15. Pennsylvania Department of Labor and Industry, 1925
50.00
dues------------- -----------------------------------------------------------25. North Dakota Workmen’s Compensation Bureau, 1925
dues_______________________________________________ _
50.00
50.00
27. Montana Industrial Accident Board, 1925 dues---------------New York Department of Labor, 1925 dues______________
50.00
Sept. 2. Maine Industrial Accident Commission, 1925 dues_______
50.00
3. Utah Industrial Commission, 1925 dues_______________ :_
50.00
15. Interest on $500 Canadian bonds as of February and Au
gust, 1,924_______ ___________________________________
27. 50
Interest on $1,000 United States Liberty bond as of Oct. 15,
1923, and Apr. 15, 1924_____________________________
42.50
50.00
17. Oregon Industrial Accident Commission, 1925 dues______
23. Hawaii Industrial Accident Board, 1925 dues____________
50.00
Oct. 16. Interest on Liberty bonds (2 at $100 each, and 1 at $500)_
14.88
25. Porto Rico Workmen’s Relief Commission, 1925 associate
9.50
membership dues (exchange deducted)_______________
Washington Department of Labor and Industries, 1925
dues____________________________________________ ___
50.00
Nov. 29. New Jersey Department of Labor, 1925 dues____________
50.00
Dec. 9. Virginia Industrial Commission, 1925 dues---------------------50.00
1925
Mar. 2. Ontario Workmen’s Compensation Board, 1925 dues (ex
change deducted)___________________________________
49.76
14.87
Apr. 16. Interest on Liberty bonds (2 at $100 each, and 1 at $500)_
17. Interest on $1,000 Liberty bond as of Oct. 15, 1924, and
Apr. 15, 1925_______________________________________
42.50
Interest on Canadian bonds, $500, as of February, 1925___
13.75
27. Idaho Industrial Accident Board, 1925 associate mem
bership dues________________________________________
10.00
July 1. Interest on bank account______________________________
19.94
8. Connecticut Workmen’s Compensation Commissioner, third
district (Charles Kleiner), 1926 dues------------------------10.00
Connecticut Workmen’s Compensation Commissioner, first
district (Leo J. Noonan), 1926 dues---------------------------10.00
11. Maryland Industrial Accident Commission, 1926 dues___
50.00
14. Nevada Industrial Commission, 1926 dues--------------------50.00
Connecticut Workmen’s Compensation Commissioner, fifth
district (F. M. Williams), 1926 dues_________________
10.00
20. Republic Iron and Steel Co., associate membership dues,
1926________________________________________________
10.00
Kansas Public Service Commission, 1926 dues___________
50.00
Leifur Magnusson, American correspondent of Interna
tional Labor Office, associate membership dues, 1926____
10.00
23. Iowa Workmen’s Compensation Service, 1926 dues_______
50.00
25. Oklahoma Industrial Commission, 1926 dues_____________
50.00
FINANCIAL STATEMENT OF THE SECRETARY-TREASTJRER
1924
July 28. Industrial Accident Prevention Association, 1926 dues
(Canadian exchange deducted)________________________
30. Pennsylvania Department of Labor and Industry, 1926 dues.
31. Unexpended postage and telegraph fund_________________
13
$9.88
50.00
8. 77
4, 571.22
(Receipts for the year, $1,343.23.)
DISBUBSEMENTS
1924
Aug. 11. Unexpected postage and telegraph fund_________________
13. Mason A. Winston, printing report secretary-treasurer,
1923-24_______________________________________________
Gibson Brothers (Inc.), printing 1,000 programs, 1923-24—
Sept. 2. Cash, postage and telegraph fund_______________________
Gibson Brothers (Inc.), printing 400 letterheads_________
4. Clara Smith, stenographic services, eleventh annual con
vention _____________________________________________
12. Nova Scotia Nursery, flowers for Mrs. F. W. Armstrong
(resolution passed at eleventh annual convention)_____
15. Master Reporting Co., reporting eleventh annual conven
tion, Aug. 26-28, Halifax, N. S__________________ _____
25. Maryland Casualty Co. (Clark & Clark), bonding of sec
retary-treasurer, Oct. 23, 1924, to Oct. 23, 1925-------------30. F. W. Armstrong, postage 1923-24, $6.12; telegrams, $3.20Oct. 13. Cash, postage and telegraph fund______________________
24. Ethelbert Stewart, partial payment, honorarium 1923-24—
Glenn L. Tibbott, partial payment stenographic and clerical
services 1924-25_____________________________________
Eva M. Taylor, as above_______________________________
Nov. 4. Gibson Brothers (Inc.), printing 2,000 letterheads (re
print) ; 1,000 envelopes; 500 second sheets-------------------Postage and telegraph fund____________________________
1925
May 6. Eva M. Taylor, partial payment stenographic and clerical
services 1924-25_____________________________________
27. Ethelbert Stewart, balance honorarium 1924-25-------------June 5. Postage and telegraph fund____________________________
Glenn L. Tibbott, balance stenographic and clerical serv
ices, 1924-25 ________________________________________
Eva M. Taylor, as above------------------------------------------------
$4.03
5.00
35.00
5.00
6.50
25.00
15.00
252.88
12. 50
9.32
5.00
175.00
75.00
75.00
47.25
5.00
35.00
125. 00
10.00
75. 00
35.00
1, 032. 48
July 31. Balance (bank deposits, $1,329.97; Liberty bonds, $1,700;
Canadian bonds, $500; unexpended postage and tele
graph fund, $8.77)------------------------------------------------------ 3, 538. 74
4, 571.22
BILLS RECEIVABLE
Connecticut Board of Compensation Commissioners, second and
fourth districts-------- ------------------------------------------------------------Georgia Industrial Commission-------------------------------------------------Hawaii Industrial Accident Boards---------------------------------------------Idaho Industrial Accident Board_______________________________
Illinois Industrial Commission__________________________________
Maine Industrial Accident Commission__________________________
Massachusetts Industrial Accident Board------------------------------------Minnesota Industrial Commission----------------------------------------------Montana Industrial Accident Board-------------------------------------------New Jersey Department of Labor_______________________________
$20.00
50.00
50. 00
50.00
50. 00
50.00
50.00
50. 00
50.00
50.00
BUSINESS MEETING
u
New York Department of Labor__________________________________
North Dakota Workmen’s Compensation Bureau_________________
Ohio Industrial Commission____________________________________
Oregon State Industrial Accident Commission____________________
Utah Industrial Commission____________________________________
Virginia Industrial Commission-------------------------------------------------Washington Department of Labor and Industries________________
West Virginia State Compensation Commissioner________________
Wisconsin Industrial Commission_______________________________
Wyoming Workmen's Compensation Department_________________
Manitoba Workmen's Compensation Board_______________________
New Brunswick Workmen’s Compensation Board_________________
Nova Scotia Workmen’s Compensation Board____________________
Ontario Workmen’s Compensation Board________________________
Porto Rico’s Workmen’s Relief Commission----------------------------------
$50. 00
50.00
50. 00
50. 00
50.00
50. 00
50.00
50.00
50. 00
50.00
50.00
50.00
50. 00
50. 00
10.00
1,180.00
Balance, consisting of bank deposits, Liberty and Canadian bonds,
unexpended postage and telegraph fund________________________ 3, 538. 74
Bills payable-^-Gibson Bros. (Inc.), printing programs____________
4, 718. 74
35.00
4,683. 74
The following bonds are in safety deposit box S-363, National Savings &
Trust Co., Washington, D. C., Ethelbert Stewart:
No. 1217874________________________________________________________ $100
No. 1217875—______________________________________________________
100
No. 236204_________________________________________________________
500
Unregistered bond__________________________________________________ 1,000
Dominion of Canada bonds (5), Nos. 1852-6, inclusive, at $100 each— 500
2,200
Respectfully submitted.
E thelbert St e w a r t ,
July
31, 1925.
Secretary-Treasurer.
The general report of the secretary-treasurer was, on motion duly
made, seconded, and carried, accepted and placed on file, and the
financial statement was referred to the auditing committee after the
secretary-treasurer had explained that since the date of the report—
July 31, 1925—nearly all of the bills receivable, representing unpaid
dues of the States, had been paid, so that the amount on hand at the
time of the convention, including bonds, was $4,683.74.
Meeting adjourned.
MONDAY, AUGUST 17— AFTERNOON SESSION
CHAIRMAN, O. F. M’SHANE, PRESIDENT I. A . I. A . B. C.
The C h a i r m a n . Before we begin with our regular program, our
secretary-treasurer, Mr. Stewart, has something to say.
Mr. S t e w a r t . The secretary’s report this morning was technically,
legally, strictly true. It was so true that it was not quite the truth-—
I think you statisticians will understand that. The report said that
California had withdrawn from the association. Technically that
is true, but as a matter of fact the new commissioner of California
sent me his personal check for $50. California’s dues are paid.
Of course you understand that when California withdrew, it did
so with extreme regret, and you also know how much this associa
tion regretted to lose California, as it has, perhaps, been more help
ful to the association than any other one State.
The governor, I understand, is entirely in favor of California
coming back into the organization, but it has one of those commis
sions (which some of the other States also have) which objects
to money being spent for travel outside the State. So far as the
secretary’s report is concerned, I had to say that California had
withdrawn from the association, but I have not the slightest doubt
that within 60 days it will be back in the association.
I reported that Michigan had withdrawn from the association,
which is true. One of the largest manufacturers in the State came
to me to-day and wanted to know why Michigan had withdrawn
from the association, and I told him it had withdrawn, not because
it wanted to, but because some commission had forbidden the ex
penditure of money outside of the State. The remarks that he made
were right in line with my ideas; I do not know where he went
to school, but he said it in the same kind of words I would have
used. He said that when he returned he was going to call on the
governor; so I do not believe Michigan is permanently out of the
organization.
Khode Island is technically not a member of the association. It
has a delegate here, however, with credentials from the governor,
and probably within 60 days Khode Island will be a member of
the association. So the secretary’s report, while telling the truth,
drew a very much darker picture of the year’s work than is actually
true. I would like to have you call on Mr. Dunn, from Khode
Island, to tell us just what the situation is there.
Mr. D u n n . I came here at the instance of the Governor of Khode
Island, who is very much interested in the subject of workmen’s
compensation. While we have no State fund which would permit
affiliation of our State with this organization, the governor is
heartily in sympathy with the work of the organization, and sent
me here to make a survey of its work and to report to him on my re-
15
16
REMARKS
turn. This morning I spoke to Mr. Stewart about the matter, asking
him just what the purpose of the organization was, and Mr. Stewart
said that he would be glad to have me explain my mission here.
I am here to make a survey in the interest of the State of Rhode
Island. From what I heard this morning, I can frankly say that
I believe Rhode Island will become an active member of the Inter
national Association of Industrial Accident Boards and Commis
sions. I can assure this organization that upon my return I will
report immediately to the governor and urge that Rhode Island
affiliate officially with this association, and I am sure that that will
be done.
[A motion was made, seconded, and carried that the president’s
address be published by the secretary in pamphlet form for distribu
tion to the members.]
CHAIRMAN, D. H. BYNUM, CHAIRMAN INDIANA INDUSTRIAL BOARD
The C h a i r m a n . Some fun has been poked at Indiana for ignor
ing this body for 10 years. I hold no brief for what has gone
before or for the persons who have preceded me, but we now feel
that we want the benefit of the experience of men who have been
investigating these matters longer, men of broader vision, and men
from States which not only have given wider scope to workmen’s
compensation but also have expended greater sums than the State
of Indiana. In other words, I am here to learn and to carry back
what I can to our board. If we have not the best compensation law,
we want the best administration under it that we can possibly have.
Not from my experience in compensation matters, because that
has been brief, but from my experience in governmental affairs
I would like to sound a note of warning. The courts and compensa
tion boards have followed the rule that the compensation law is to
be liberally administered and liberally construed, but I notice a
tendency of the legislatures, when asked by compensation boards
for increased compensation and increased powers, to back away
from it, and I am wondering what that means.
The statement has been made that under compensation there is a
burden on the small employer. This burden really results from the
fact that it costs the small employer more to produce than it does
his larger competitor. Consequently, when you add the insurance
premium to his work he can not pass it all on to the consumer as
can the big manufacturer and employer but has to assume a certain
amount of it. Therefore I disagree with that statement in part.
In regard to increases in compensation, I think in some States,
possibly my*own, the compensation may be too low, but (I am put
ting this in the form of a question, and I wish you would think it
over) has not compensation changed to rehabilitation ? We can not
compensate a man for the loss of an eye or even of a finger. We
started out with the idea of compensation, but has it not in the
last 10 years changed to that of rehabilitation? Now, if the idea
is that of rehabilitation, should not the amount of compensatory
benefits be brought to some happy medium? I do not know what—
if it is too large, it will encourage malingering and bring criticism
upon the boards by legislatures and also restricted legislation; if it
is too small, there will be suffering.
FOLLOW-XJP OF COMPENSATION AWARDS
17
The first address to-day is along this line, “ Follow-up and investi
gation of results of compensation awards.” From a follow up of
awards we should find out about what the compensation should be,
that happy medium we all want. It will be different in different
localities, of course, where standards of living are different and
where costs are different, but at least we will get an insight that
will guide us at home.
[A motion was made, seconded, and carried that the privileges
of the floor be extended to Mr. McGilvray, of California, and Mr.
Dunn, of Khode Island.]
The C h a i r m a n . This follow-up of awards is a question of going
into the homes to see whether an adequate amount has been pro
vided. I know of no one better to talk upon this question than
Miss R. O. Harrison, of the Industrial Accident Board of Mary
land.
FOLLOW-UP AND INVESTIGATION OF RESULTS OF COMPENSATION
AWARDS
B Y ROWENA O. HAEEISON, DIRECTOR OF CLAIM DIVISION OP MARYLAND STATE INDUS
TRIAL ACCIDENT COMMISSION
The various boards and commissions are not following up, to any
satisfactory extent, the awards that are passed by them to see whether
events prove each award to be the proper award in the case.
Almost every State has made some small investigation of results of
compensation awards, but I do not believe that ally State, with the
possible exception of Massachusetts, has a distinct or established
follow-up system.
How can we know as to the effectiveness of our efforts if we do
not occasionally take a retrospective view and weigh the results of
our past acts and endeavors? It can not be gainsaid that it would be
profitable, if not helpful, to have a clear and definite comprehension
as to whether or not the awards made are the most helpful to the
particular party or parties in whose behalf they are made, and this
can be determined only by a proper and effective follow-up system.
In many cases it may be all right to drop the case after the final
receipt, but, on the other hand, in many instances some sort of a
follow-up system might result in a real benefit. Some commissions
have followed up in a small way the results of the granting of lump
sum awards, and the outcome of their investigations is a warning to
all administrative boards to grant few, very tew, lump sums. Last
year the committee on forms and procedure for compensation admin
istration recommended to this association that very few lump sums
be granted. This recommendation was made largely because of the
results of investigations into the granting of lump sums. From the
information as to lump sums gained from these slight investigations,
it would seem that no argument should be required to convince those
interested in the administration of this work that follow-up investi
gations should be made with regard to other awards as well.
Again, a follow-up system would probably enable the commissions
to prevent malingering. This is now a problem that the insurer
must guard against and endeavor to overcome, whereas the com
mission should take some part in watching over the case after the
18
FOLLOW-TJP OF COMPENSATION AWABDS
award has been passed and terminate or continue its payments, as
the facts may warrant. It will then be more efficiently administer
ing its law. The insurance carriers will not be imposed upon. For
instance, I know of a case where a man had made an average weekly
wage of $15.18, and his compensation was $10.12, while he got from
little 10-cent-a-week policies and one or two other sources about
$8.50, making altogether $18.62 a week during his disability, or $3.44
more than he received in actual wages prior to the injury. The
doctor was also getting fees for unnecessary attendance. How far
would a case like this go if it were not checked up or followed up
by commission or insurer after the award was passed, and is it the
insurer’s duty alone to follow up the case ?
As a preliminary to the preparation of this paper inquiries were
made as to what is being done by the various States in the matter
under discussion. The replies showed great interest, but also di
vulged the fact that practically nothing is being done in this line,
with the exception, however, of Massachusetts, which State seems
to be making a serious effort to establish a workable and practicable
follow-up system generally.
Massachusetts has a consistent follow-up system on lump-sum set
tlements, chiefly for the purpose of keeping members advised of the
danger in permitting employees in all but border-line cases, where
the burden of proof has not been sustained by them, to accept lump
sum settlements. As to widows, that State has an unwritten rule
not to approve lump-sum settlements even though the greatest pos
sible pressure is exerted to compel the approval qf such payments.
That State makes one exception, namely, where the widow is, for
example, an Italian or a member of some other alien race and the
board is satisfied that she can take her little group of children back
to her native land and invest it in an estate which will provide for
her and them for the rest of their lives, or in the case of children
particularly until they can support themselves. Such lump sums,
probably not more than one or two a year, go through under proper
safeguards.
In other cases Massachusetts has a consistent follow-up through
mail inquiry and visits from a staff of six inspectors. Every am
putation case is followed up, by mail or through a visit from an
inspector, to see that all rights due under the statute have been safe
guarded. No suspicious case involving amputation of any portion
of fingers, toes, hands, or feet, nor any case involving reduction of
vision, is allowed to be filed until routine precautions are taken.
Every back case involving strain or injury to the back is similarly
followed up. Every case involving future rights of young and inex
perienced workmen is followed up, usually by a visit from an in
spector. Mail investigation is made only in the most trivial of
these cases. All cases in which there is even a suspicion that com
pensation may be due, or in which full compensation has not been
paid, are investigated and steps taken to get them into a hearing
stage, if, upon notification, insurers fail to pay in accordance with
the statute. In all cases under investigation steps are taken to write
to employers, employees, and insurers—to the first named, to get
information first hand about return to work; to employees, to verify
facts; to insurers, for medical reports. Inspectors get into per
DISCUSSION
19
sonal touch with the parties and upon their reports further steps
are taken, such as arranging for impartial reports, requesting in
surers to make the payments indicated on the basis of reports made,
and arranging for hearings when necessary.
Another letter in reply to my inquiry stated that while check-ups
may bring to the attention or a board errors in judgment or in
method of making awards they do not rectify the mistakes that have
been made. A check-up after the award is passed will in a good
many cases enable the commissions to rectify any mistakes; but the
real purpose is that the commissions may profit by experience in the
results of their work, and that better judgment may be used in future
cases, and that the method of making awards may be continually
improved.
Some States plead insufficient funds. The majority of commis
sions have investigators, auditors, or employees who travel, and it
seems to me that a start at least toward following up awards could
be made through these individuals at a very low cost.
The whole subject of follow-up is important, not from the stand
point of or with a view to extending paternalism, but solely with
the view that the various boards can be assured that full and com
plete justice is being accorded, under the present method, to all
concerned—no doubt important enough to warrant the appointing
of a committee to consider it or work out a plan for a definite fol
low-up system for all boards and commissions having charge of the
enforcement and administration of workmen’s compensation statutes.
DISCUSSION
The C h a i r m a n . I am impressed with the talk that Miss Harri
son has just given us, especially in the light of a case which was
brought to my attention just before I left. I had approved a lump
sum agreement for an elderly man, thinking that a man who had
attained the years he had would safeguard his money. He wanted
to buy a little home. He was to get something like $1,600. A
lawyer in the town wrote to me the results of this lump-sum settle
ment. At the first real-estate men tried to unload property with a
bad title on him, and when a good title was insisted upon they fi
nally sold him a piece of property with a good title and it was put
in the joint names of himself and wife. Then the automobile men
got busy, but they could not handle the joint piece of property very
well, so they had the old man and his wife convey to a third party,
who then conveyed back to the husband, and the husband, an injured
man, then mortgaged the home for an automobile. Five months
later he could not pay'a two-dollar electric-light bill that he owed.
Indiana has no follow-up, but something will have to be done there.
The president stated that 34 States had a waiting period of a
week. Indiana has that waiting period; consequently, the first com
pensation payment time is on the fifteenth day. It has been a strug
gle to get payment on that day. The larger insurance carriers live
pretty well up to that, but the smaller and cut-rate insurance car
riers do not. Just what to do about that, I hardly know, but I hope
that L. W. Hatch of New York can tell us.
Mr. H a t c h . On the first of January the waiting period under the
New York compensation law was reduced from 14 to 7 days. From
20
FOLLOW-UP OF PROMPTNESS OF COMPENSATION PAYM ENT
the point of view of the administration of the compensation law,
that meant a good-sized additional job as before that there were as
high as 70,000 to 75,000 compensated cases out of 375,000 reported
accidents. The reduction in the waiting period has produced a tre
mendous increase in volume of work, for which the legislature pro
vided very substantial additional appropriations, but the actual
pressure of which in practical work began to come only in the spring
and is just now beginning to reach full effect. There was some
delay in knowledge of the reduction of the waiting period, etc.
This added work will explain why Commissioner Hamilton, who
on January 1 became the new head of the department, felt that
he should stand by the job this summer. At the same time I can
voice for him his interest in- this association, which takes the practi
cal form of this discussion of the question of follow-up of compen
sation payments embodied in the following paper.
FOLLOW-UP OF PROMPTNESS OF COMPENSATION PAYMENT
B Y JAM ES A . HAM ILTON, INDUSTRIAL COMMISSIONER OF THE STATE OP N EW YORK
[Read by L. W. Hatch]
How far should the State go under a workmen’s compensation
law to see that injured employees receive promptly the compensation
benefits to which the law entitles them? That is the general ques
tion with which this paper has to deal. This is a question of com
pensation administration but by way of preliminary to the consid
eration of it from that point of view it will be well to recall what the
fundamental purpose of a compensation law is. It is always use
ful in consideration of any question relating to administration to
start with a reminder of what the goal of the particular kind of
administration is. So let us start by recalling what a compensation
law intends to do, which is, of course, the goal and measure of what
our administrative methods must achieve.
It would seem to be fairly axiomatic to say that the purpose of a
workmen’s compensation law is to pay compensation to injured
workmen for part of the financial loss which they suffer when
injured at work. It may seem almost superfluous to state the point,
particularly before such a body as this whose members are daily
associated with such laws. But the foundation truth that compen
sation laws are to help injured workmen, because perhaps of its very
simplicity and familiarity, is not always kept uppermost in discus
sing compensation problems, owing apparently to the secondary
effect of such laws upon other interests than that of the victim of
accidental injury himself, which interests sometimes seem to over
shadow the primary interest of the workmen under the law.
In providing financial relief in the emergency of accidental injury
the basic motive of a compensation law is in no degree one of favor
but that of justice. It is because in the long run social justice is
served by a compensation law that society has been willing to lift
a part of the financial loss from the shoulders of wage earners to
those of the employer in the first instance, and ultimately from his
to its own shoulders. This principle of justice takes specific form
in the schedule of benefits by which the law defines, in the different
classes of disabilities occasioned by accidents, what part of the
FOLLOW-UP OF PROMPTNESS OF COMPENSATION PAYM ENT
21
money loss shall be shifted from injured wage earners to society.
Herein is the cue to the first administrative problem presented by a
compensation law. First of all, an industrial accident board or
commission has on hand the determination of how much, if any,
compensation each injured workman is entitled to under the law.
The proper performance of this quasi judicial function constitutes
undoubtedly the primary duty ‘which the administration of a com
pensation law has to undertake.
But is that all the duty of such an administration if the benefits
intended by the law are to be fully realized? Let us recall at this
point a bit of history at the genesis of compensation legislation, be
cause it will afford a clue to the answer to this question.
Most of you will, no doubt, recall that one of the serious indict
ments against the principle of negligence as a rule for determining
division of loss in industrial accidents between employers and em
ployees under the old employers’ liability laws (which, along with
others, led to the substitution of compensation statutes for those
old laws) was the delays which were involved in determining
negligence by the court procedure involved in that old system. It
took so long—frequently years—to get a suit for damages to final
decision that even if the injured employee recovered the very delay
had partly defeated the benefit of the damages recovered. The
saying that “ justice delayed is ofttimes justice denied ” is peculiarly
applicable in the case of accidental injuries to wage earners. It was
not only for greater justice but also lor prompter justice that com
pensation laws were substituted for liability laws.
In the light of this definition of the purpose of compensation laws
it seems to me clear that the administration of a compensation law,
if it realizes fully the fundamental intent of such a statute to afford
relief to injured workmen and to afford it promptly, must go a step
beyond equitable determination of claims to the matter of prompt
payment of awards when made, or of compensation in advance of
awards. In other words, the State must not only determine what
the injured employee is entitled to but also see that he actually gets,
and gets promptly, what is due him.
The question with which this paper commenced was “ How far ”
should the State go in this direction? If I have established the
proposition that on general principles the State administration of
a compensation law must extend to the matter of prompt compen
sation payment the original question has been answered in a general
way. The State must go far enough to insure prompt payments,
is the logical answer from the point of view of general consider
ations.
But before a body such as this, which is daily grappling with the
details of administration, trying to find out just how the things
that should be done may best be done, I should fall short of proper
contribution to the forum for dissecting and comparing experiences
on our various administrative problems which this convention offers
if I did not go on to consider the specific means for follow-up of
compensation payment. To do this it seems to me that it would be
most appropriate, perhaps, to submit to you an outline of how
the matter is handled in New York State, where a great deal of
thought has been given to it and where for the largest compensation
22
FOLLOW-UP OF PROMPTNESS o f c o m p e n s a t i o n p a y m e n t
jurisdiction in the country there has been wrought out of much
experience a pretty well developed system of dealing with the prob
lem. In doing this it will perhaps best conduce to helpful discus
sion to center attention on one aspect of the subject alone, and so I
will set forth only the New York method with respect to the main
element in prompt payment of compensation, namely, prompt begin
ning of payments, leaving out of account on this occasion other
items which have a bearing on the general subject, such as prompt
reports of accidents, prompt adjudications, continuing promptness
in successive installments of compensation, etc.
The New York method as to prompt first payments has four gen
eral features: (1) Legal limits of time prescribed by law for compen
sation payments; (2) penalties prescribed by law for nonconformity
with those limits; (3) compulsory reporting to the department ox
time of payment; and (4) systematic check up of time of payment.
Without attempting to cover all the details, let me explain the
chief points of each of these.
1. The limits prescribed by law.—Under our statute if a case is
not “ controverted,” that is, “ if the employer or insurance carrier
does not controvert the injured workman’s right to compensation,”
payment of compensation must begin within 18 days of the begin
ning of disability. As there is a seven-day waiting period in New
York this means that the first payment in uncontroverted cases is
required to be made within four days after the first week’s compen
sation is due. If a case is controverted, upon the making of an
award, payment must be made within 10 days thereof. If a case is
appealed after award, however, such appeal operates to suspend
payment pending a decision.
2. Penalties prescribed by law.—I f an employer or insurance
carrier in New York fails to make a compensation payment within
18 days after it becomes due, he is required to pay to the injured
workman or his dependents an additional 10 per cent of the amount
then due. Such a penalty, it will be seen, has two advantages—it
virtually fines the employer, and it reimburses the injured workman
for the delay in receipt of his compensation. In addition to impos
ing penalties for failure in promptness of payment, the New York
law confers power on the industrial commissioner to require an
employer or insurance carrier to make a deposit with him “ to
secure the prompt and convenient payment ” of compensation, out
of which he may himself make payments to the claimant.
3. Compulsory report of payment.—After prescription of a legal
time limit backed by penalties for nonobservance, the next step
to make compensation payment prompt is obviously some means
to check up observance of the law. This step the New York statute
also takes by requiring that employers or insurance carriers must
immediately report to the industrial commissioner when compen
sation payment has begun, or must within the time limit set by law
for first payment file notice of controversy giving the reason why
compensation is not being paid.
4. Systematic check-up of time of payment.—It is obvious, of
course, that any requirement of law, even when backed by penalties
and supported by compulsory reporting of compliance, will not
automatically be complied with by everybody. Of those upon
FOLLOW-UP OF PROMPTNESS OF COMPENSATION PAYM ENT
23
whom the law lays a duty, those who are fair-minded and reasonable
may largely be depended upon to obey the law when they under
stand it. But there are always with us those less scrupulous who,
when it is to their interest, will ignore or evade such duties. So
that always there must be a check-up by the State to insure com
pliance. In such a matter as compensation payment, where so
great a number of individual cases and parties in interest scattered
throughout the territory of an entire State have to be dealt with,
it is especially necessary that a watchful follow-up shall be prose
cuted in a systematic manner. Accordingly, New York State now
takes also the final step in this matter, that of systematically tabu
lating dates and time of compensation payments in all cases with
reference to their conformity to the legal limits prescribed by the
law. In other words, the process of statistical analysis, akin to
the operation analysis method now so widely applied in mod
ern business, is being applied to this compensation administrative
problem.
While I say that it is now being applied in New York, this is
as a matter ox fact a development of the present year. The depart
ment had previously considered the method and even tentatively
planned for it, but owing to lack of necessary resources had been
unable to undertake it before in full fashion. On the occasion
of a legislative inquiry into the general question of delays in com
pensation payment last January the department recommended to
the special committee making that investigation that additional help
to make it possible be provided as one means of promoting prompt
payment, and this recommendation was favorably acted upon by the
committee. As a result New York is now rounding out its system
as above outlined by inclusion of this fourth essential feature for
insuring early payment of compensation following industrial acci
dents.
In this interstate conference of compensation administrators it is
especially fitting that I should note that in the development of this
fourth feature New York has paid to the State of Wisconsin that
sincerest compliment of imitation. So far as I am aware, Wiscon
sin was the pioneer along this line. Also, unless I am mistaken,
Wisconsin and New York are so far the only States to carry out
the idea in a comprehensive and systematic way. But I am sure
Wisconsin will join New York in commending the method to other
jurisdictions as a worth-while aid in securing to injured employees
the full measure of benefit intended by a compensation law which
includes not only just awards, but also prompt payments.
While paying my respects in this way to the sister State of Wis
consin, I feel bound to say in fairness to the Empire State in which
I have the honor to serve that to the best of my information New
York is really going considerably farther in the development of
this fourth feature than does Wisconsin. If I am mistaken in this
I shall be glad to have the matter corrected. New York’s current
analysis of operations includes data as to promptness of accident
reporting, promptness of adjudications, etc., as well as prompt first
payments. The New York statute has requirements bearing on
those indirect or incidental elements in prompt compensation, as
well as the matter of payment, and our operation analysis is de
24
FOLLOW-UP OF PROMPTNESS OF COMPENSATION PAYM ENT
signed to afford as full a measure of the entire compensation process
as is practicable. I believe this wider application of the same method
may well be commended to other States also.
1 shall not undertake to set out here the details of our methods of
analysis as to payments, but before closing I wish to bring out
one further important point, namely, the practical use of such an
analysis to get results with employers and insurance carriers.
It is notoriously difficult successfully to prosecute a violation of
a law in which the point at issue is whether or not an act was per
formed within a certain time limit. The necessary proof of dates
is impossible or hard to get. That is conspicuously the case in such
a matter as compensation payments. But it happens with respect
to these that a peculiarly effective pressure can be brought to bear
through publicity. In competition between insurance carriers, who
in a State like New York pay most of the compensation, they now
make a great deal of “ service ” features which are offered to em
ployers and one such feature which now more than ever, as employ
ers are giving more and more attention to personnel problems, is be
ing emphasized, is handling of claims in such a way as to promote
good industrial relations. To make good on that feature of service
means, of course, prompt compensation payment. The carriers
therefore have a business interest in good standing on that point.
In addition, of course, they can not ignore the force of public opin
ion generally, which is naturally for prompt relief of injured work
men. This situation puts in the hands of a State department admin
istering a compensation law a powerful means of pressure through
publicity of comparative records of carriers as to prompt payments.
That is just the weapon which the operating analysis above referred
to affords. Let me give you an interesting illustration of how effec
tive it may be. It happens that this is drawn from Wisconsin ex
perience where the method has been tried out. Lest the representa
tives of that State here may think I am stealing their thunder, let
me say that this evidence was brought to light in New York, and I
am not sure how much of it is known in Wisconsin, so I feel free
to use it for illustration.
Among the witnesses at a hearing last winter in connection with
the investigation in New York, above referred to, of the subject of
prompt compensation payment was a high official of one of the
larger casualty insurance companies writing compensation insur
ance. He was asked what the experience of his company had been
with respect to the Wisconsin method of making up the scores of
different carriers as to promptness of payments. His reply was
most interesting. It was in substance that when he received the
first notice of how his company stood in comparison with others he
found it was not very far up on the list. Accordingly, he sent
notice to the company’s Milwaukee office that the standing was not
satisfactory to the company and that those responsible for such mat
ters in Wisconsin must see that their record was improved. This
was done, with the result that its standing soon rose and was being
maintained where the company was willing to have it seen in com
parison with that of other companies. In general, he added, he
believed that such a method of follow-up of payments was a good
thing for all concerned.
1>]BCUSSIOH
25
Is not that kind of experience “ proof of the pudding in the eat
ing,” showing that this method of systematic check-up and publicity
is no theoretical statistical proposition but an effective practical
method of securing to injured employees the benefits of promptness
in compensation payments ?
DISCUSSION
The C h a i r m a n . Mr. Wilcox, of Wisconsin, will open the discus
sion of the two papers just read.
Mr. W i l c o x . Miss Harrison sounds a well-warranted warning to
all compensation administrators of the necessity of more careful
follow-up. We ought to know whether our awards are just or other
wise, and we can know that with real certainty only by going back
into the history of a case, seeing the person, "and finding out just
what the disability has proven to be and whether or not the amount
of compensation received was what it ought to have been.
Wisconsin, perhaps, is a bit more given to lump-sum awards than
Maryland or Massachusetts, and sometimes, perhaps rightly so, we
may be criticized as being too liberal in that respect.
I take very sharp exception to the idea that lump-sum awards
are not a practical thing, and I would hate to have Wisconsin have
the reputation of granting no widow a lump-sum death benefit
unless she was an Italian woman who was going back to her native
country. We grant many, many of these awards. A few weeks ago
the general manager and superintendent of the Fiske Eubber Co..
in supervising the construction of its new building, fell off the root
and was instantly killed. He was a man of means, and left a widow
and two children in good financial circumstances. I think it is
petty to pay her $18.20 a week over a period of six or more years.
The commission, not only on its own notion but with the advice,
approval, and encouragement of the Travelers Insurance Co. com
muted that death benefit to a lump sum and paid it to her.
We advise lump-sum payments in many cases, but always under
the right supervision. If the widow is able to maintain herself out
of her income, the efforts of her family, and the interest on the
investment of the lump-sum benefit, we are glad to make her death
benefit payable in a lump sum and to give her an opportunity to
invest it. That money is paid to some bank or trust company of
her own choosing and invested by that bank or trust company with
her advice. We supervise the nature of the securities; that is to
say, they must be first mortgage real estate securities or Govern
ment or municipal bonds. Those securities are required to remain
with the trust company during the period that her benefit would
otherwise have been payable to her and are not to be withdrawn
except by consent of the commission. The interest, however, is to
be paid to her as it accrues. That is what we generally do with the
larger lump-sum payments.
The Wisconsin act gives full authority for that sort of a thing,
and we apply the same procedure in the case of the more serious
disabilities.
Our new law not only takes account of the wage and the period
of disability—the extent of the disability—but, following California,
26
FOLLOW-UP OF PROMPTNESS OF COMPENSATION PAYM ENT
makes it possible for us to encourage people to get back to work and
to learn early what the disability really is.
This question of payments I commend, as Mr. Hatch did, to those
States who have not thus far undertaken to make a study of it. The
Wisconsin act provides for the first payment to be made on the fif
teenth day after the accident. We have the week waiting period,
and unless the disability actually extends to or beyond the twentysecond day there is no payment for this first week. On the twentysecond day we are supposed to go back and pay for the first week.
In that connection, I want to suggest a bill changing that waitingperiod provision which we have worked out in Wisconsin and pro
pose to present to the next session of the legislature. It is to the
effect that all compensation payments shall start on the eighth day
after the man leaves work as the result of the accident; provided,
however, that if there is reason to believe that the injury has not
caused any permanent disability, or temporary disability extending
to or beyond the twenty-second day, compensation for the first week
may be withheld until the fifteenth day. That will mean that liabil
ity attaches in all our schedule injuries immediately and we may
start paying. That will, I think, lend a lot of encouragement to
employees and insurers generally to get ready to make payments,
and they will simply seek out the less serious injuries and withhold
the payments on them until the fifteenth day. I wish you also would
think that over.
We made our first study just after Illinois had made a study of
promptness of payments. Illinois made what I think, and I guess
it thinks so now, was a mistake in publishing to the world only the
standing of each insurance company in the matter of compensation
payments; a lot of its information was misinformation and presented
some companies in a light which they did not deserve, and so created
a lot of dissatisfaction.
Our first tabulation of experience was made in code form. In pub
lishing it we gave the experience of the individual companies, but
it was published by number. We gave to each individual insurer
the standing of his own company, so that he knew which one of those
experiences he saw in the tabulation was his own. Then this instance
Mr. Hamilton spoke of came up. I know the exact circumstances, be
cause I had that conference with the insurance company. The Hart
ford representative of this company came on to Wisconsin with the
Wisconsin manager, and said the company could not occupy that po
sition in compensation payments, it must have a better record and it
was up to the company to make it. I found that the company was re
quiring the employer to secure from the injured man a receipt for
the compensation in advance, and that this was largely responsible
for this insurance company’s situation. I f you investigate in your
own State, I think you will find that many of your companies are
getting that receipt in advance. That is very unfair practice. There
is no more reason why an insurance company can not trust an in
jured man than there is that the injured man should be asked to
trust the insurance company to see that this deal is carried out. So
we have encouraged our insurance companies, if they want a receipt,
to issue a check with the receipt attached, so that when the man signs
DISCUSSION
27
for his money he gets his draft; the detachable receipt they may
use for their files or for filing with the commission as they see fit.
In our first classification of this experience—that for the first half
of 1921—we found that 1.5 per cent of all compensation payments
by insurance companies were made in less than one week, whereas
the self-insurers paid only 0.7 per cent of their claims. Of course
the law did not require them to make these payments then, but you
can see how small a percentage they started with.
The experience also showed that the insurance companies paid
16.5 per cent and the self-insurers 14 per cent of their claims in less
than two weeks, and these claims were not due, you see, until the
fifteenth day.
In the next group fall the payments that were due, and we
found that in that year 41.2 per cent of the payments by insurance
companies were actually made during the third week, while 38.7
per cent of the payments by the self-insured employers were made
in the same time.
During the period from 1921 up to the second half of 1924, insur
ance companies raised their percentage of payments made in less
than two weeks from 16.5 to 38.3, and the self-insured employers
raised theirs from 14 to 22.2. The payments in less than three
weeks, which were the valid obligations, insurance companies
raised from 41.2 per cent to 66.9 per cent, and self-insurers from
38.7 per cent to 59.6 per cent. During the second half of 1923 the
insurance companies reached the high point of 69.9 per cent in their
payment of claims within the required time. That is perhaps an
outstanding record in the country. In the last half of 1924 we got
to the point where the insurance companies paid 78.5 per cent of
their claims in less than four weeks and the self-insurers paid 78.3
per cent.
Lest there be some misunderstanding about these figures with
regard to self-insured employers, I wish to explain that in our
earlier tabulation of the self-insured employers’ experience we had
grouped the State, counties, towns, cities, and villages, a large per
centage of which are self-insurers. They do not insure with insur
ance companies, and it is our experience, and I am quite sure it is
your experience, that they are the worst of tailenders. The public
is the last to meet its obligations—the county perhaps worst of all—■
and it is necessary for us to group them by themselves in order to
make them see their own shortcomings.
In our tabulations as to insurance companies, as mutuals and stock
companies are always contending as to which is giving the better
service, we have tabulated our domestic mutuals, our foreign mu
tuals, and our stock insurance companies separately, and they run
along a pretty even pace.
The C h a i r m a n . H o w did you get your figures on the experience
as to time of payment, Mr. Wilcox?
Mr. W i l c o x . We require the insurer or the employer to send us
a report of the date when a payment was made, and if payment was
not made on the date required by law, we require him to show the
reason for the delay. We have the same provision Mr. Hatch spoke
of as being in the New York law, by which we can add a 10 per
73891°—26----- 3
28
FOLLOW-UP OF PROMPTNESS OF COMPENSATION PAYM ENT
cent increase to the compensation for unfair delay in making the
payment.
There are many reasons why payments can not be made strictly on
time in all cases. Many a time an employee refuses to take his
compensation, or he may be, as it would be here in Utah in your
mines, far away from you and it is hard to get the information and
the money to him. So there is a lot to be taken into account, and
for that reason I urge upon all of you, if you do come to the time
when you publish such statistics, that you play the game fairly
with your employer and your insurer by not publishing their names,
because they want to cooperate with you, they want to give you
their best, and they want to meet this requirement. If they are
not making a real effort to do it, you have the information upon
which you may act. We have just discussed with our commission
the advisability of sending out notices to employers and insurers
that we will publish the names of those companies which do not
make their first payments by the end of one week after the initial
payment is due. Maybe we will not do it, but that is what we are
talking about at the present time.
The C h a i r m a n . In your State, does the dependency of a widow
cease upon her remarriage?
Mr. W i l c o x . It does not. Those States which do not suspend
compensation payments or which suspend them in part on the
widow’s remarriage must of necessity keep away from this idea of
lump-summing the payments. Wisconsin has nothing of that sort.
If a wife loses her husband, she gets her benefit, equal to four years7
earnings of her deceased husband.
Mr. M c S h a n e . And in Wisconsin the more husbands she loses,
the more money she makes ?
Mr. W i l c o x . A woman has always lost something by the loss
of a devoted, hard-working husband.
Mr. E p p l e r . In the case o f a widow without dependents, what is
your position on lump sum?
Mr. W i l c o x . A widow without dependents?
Mr. E p p l e r . Yes; just a lone widow. Does the compensation cease
with her death?
Mr. W i l c o x . N o , it does not. On her death it goes to her ad
ministrators in a lump. In the granting of lump-sum payments,
we always take into account the number of children she has and
what her prospects are for supporting that family before we allow
the lump-sum payment, Just her announcement to us that she will
be able to make a go of it herself always causes an inquiry as to
whether her income is sufficient to take care of her budget expense.
Mr. K i n g s t o n . You would grant a lump sum to a widow with no
children?
Mr. W i l c o x . We would, but still under those restrictions.
Mr. E p p l e r . Then, you have a string on it, do you not?
Mr. W i l c o x . Yes.
Mr. E p p l e r . That is not our idea of a lump sum. We think that
when you give a lump sum you give a lump sum.
DISCUSSION
29
Mr. W i l c o x . For the reassurance of the people who are combat
ing this problem let me suggest to you that you write into your law
a provision giving you absolute control of the determination of
how this money shall be paid. Under the law in Wisconsin the con
trol of the commission is absolute; the method of payment of the
amount coming to any person is with the commission, which may
pay it to a trust company in a lump, in partial payments, or in
any way it sees fit.
Mr. K in g s t o n . Do you ever give it, out and out?
Mr. W i l c o x . We gave it, out and out, in a lump sum, to the wife
of this superintendent of the Fiske Rubber Co. We often do it if
the beneficiaries are women of means, have business experience, and
have plenty with which to take care of themselves.
Mr. M c S i i a n e . If you want to get about the last word in lump
sum settlements, in opposition to the Wisconsin idea, read in the
proceedings of the Baltimore convention a paper by Ethelbert Stew
art on “ Lump-sum settlements.”
M r . I n g r a m . I n a w a r d in g lu m p s u m s t o th e w i d o w a n d t h e d e
p e n d e n ts , w o u l d y o u m a k e t h e a w a r d f o r th e d e p e n d e n ts t o th e
w id o w as g u a r d i a n f o r t h e c h il d r e n ?
Mr. W i l c o x . It all goes to her; no part of the benefits, so far as
the liability of the employer or the insurer is concerned, goes to the
children. It all goes to the widow, with one exception, and that is
where the children are children of a former marriage; then, of
course, you have to apportion the death benefit. In Wisconsin we
have a State fund built up out of contributions by those employers
who have deaths of employees without dependents, or with partial
dependents only, of a maximum of a thousand dollars in each case,
and out of this fund benefits are paid to the children in death cases,
as follows: One full annual wage of the deceased to a child under
1 year of age, fourteen-fifteenths of the annual wage to a child
between 1 and 2 years, and so on, the child between 14 and 15 getting
one-fifteenth of the annual wage. That comes out of the State fund,
so these children are protected individually.
Miss H a r r is o n . Mr. Wilcox, you stated that the widow drew in
terest on that lump sum. Do you discount the lump sum in the
beginning? Our law provides that in all commutations of indem
nity the amount is to be discounted at the rate of 3 per cent per
annum, compounded annually, but then, of course, her investments
net her 5, 5^, or 6 per cent.
Mr. I n g r a m . We have a provision for the payment of compensa
tion to the widow until death or remarriage and two years’ com
pensation on remarriage. Of course, you could not figure any lump
sum for a widow under those circumstances, because you certainly
can not use the expectancy-of-life figure on anything like that.
Mr. W i l c o x . Those States, of course, have a different problem.
The C h a i r m a n . In Maryland the dependency ceases upon remar
riage, does it not ?
Miss H a r r is o n . It does.
Mr. E p p l e r . And on the death of the widow.
30
FOLLOW-UP OF PROMPTNESS OF COMPENSATION PAYM ENT
Mr. W i l c o x . Of course, that must always be taken into account.
It is a different matter.
The C h a i r m a n . Christopher M. Dunn, commissioner of the De
partment of Labor of Rhode Island, is the next to discuss these
papers.
Mr. D u n n . The Rhode Island law is a peculiar law and very
imperfect in many phases. Under it contested claims go to the
superior court. The department of labor is an office of record, and
has general supervision over the filing and approving of workmen’s
compensation agreements, yet it wTas given only half a job when
given the approval of compensation agreements but no right to
enforce that approval.
Agreements are drawn in workmen’s compensation cases in our
State and sent to the commissioner of labor for his approval. He
examines the agreement, and if it meets with the spirit of the law
approves it, but in the case of dispute that approval is enforceable
only by a justice of the superior court.
Rhode Island is one of the three States in the Union which has a
very small death compensation—$3,000 is our maximum. That
does not seem much for a human life. When our law was enacted
in 1912 (it became operative October 1, 1912) the legislature valued
a human life at a maximum of $3,000. We all know the value of a
dollar in the year 1912 and the value of a dollar to-day, and yet
there have been no changes made in our compensation for death.
When our law was first drawn the maximum weekly compensation
for total disability was $10. By continued agitation it has been
raised to $16, and our present weekly minimum is $7. While the
compensation for death is a maximum of $3,000, it can run down to
anything—down even to 90 cents a week for partial dependents.
The commissioner and deputy commissioner of labor are usually
considered the administrators of the workmen’s compensation act.
We have very little authority with reference to enforcement, but
we are able to effect many good settlements through mediation. We
suggest that different claims be settled, and in a just cause we never
hesitate to use a threat—we believe it is proper, we believe that it is
justice to poor unfortunates who can not help themselves—and urge
the claimant to file a petition in the superior court, and many times
we succeed by saying we will appear in court in defense of the
claimant.
Rhode Island wants to learn. At the last session of our legisla
ture I suggested many amendments to our workmen’s compensation
act. One was a graduated death benefit—for a widow with no chil
dren, a widow with one or two children, and a widow with three or
more children—putting it on a graduated basis. We were able to
pass that bill through the senate, but when it came to the house for
concurrent action—it was the last thing upon the calendar—on the
very last day (our legislative session is supposed to be 60 days, yet
we ran into 63 days), and after a 24-hour continuous session some
one moved to adjourn sine die, and we were unable to have any
amendments passed.
We have no follow-up. It would shock some of you if I were to
mention the amount provided by law for the operation of our depart
ment. The great State of Ohio, I see by reports, appropriates half
DISCUSSION
31
a million, and my sister State of Massachusetts possibly $350,000,
and yet we of Rhode Island are compelled to administer our work
men’s compensation law upon an annual appropriation of $5,000.
That does not provide for the salary of the commissioner or deputy
commissioner, but that is all we are allowed each year to carry out
the work of our workmen’s compensation act.
We are vitally interested in the amendment of our law. Our gov
ernor is vitally interested in the subject of workmen’s compensation.
He said to me just before I left home, “ I hope that you will come
back with some good ideas. We need them.” I said, “ Well, Gov
ernor, I will do everything I can; I will at least bring back some
ideas of what other States do.” He said, “ We need them; I want
that law amended in the next legislature, and it will be done or some
thing else will not be done.”
As I told you to-day, in my opinion it is the intent, of the governor
that our State should be represented in this organization. He wants
our State to be in line with other States. He wants adequate com
pensation. He wants the people of our State treated as the people in
other States are treated.
Rhode Island has 80,000 people working in textile mills, 25,000
people in jewelry factories, 20,000 people m the machine industry,
and approximately 18,000 people in the rubber industry. We are a
very large manufacturing State, considering the size of our popula
tion, and the governor is vitally interested in adequate compensation
for persons receiving personal injury arising out of and during the
course of their employment.
I did not come here with any set purpose of entering into the dis
cussion but wanted to let you know the conditions we have to con
tend with in Rhode Island. I am very much interested in the sub
ject and I hope to go back with many good ideas. I want to extend
my sincere thanks to this organization for granting me the right to
sit in this session without first having become a member.
Mr. S t e w a r t . I do not want you to get frightened; I am not going
to discuss the lump-sum settlement question. You all know exactly
where I stand on that. I think you ought to abolish the whole
business. Mr. Wilcox recommended that you have your law amended
so that in case of a lump-sum settlement you have a string tied to it.
I recommend that you have a provision put in your law that abso
lutely no lump sum shall be granted under any condition or circum
stance whatsoever. But as I have said, I promised you I would not
discuss the lump-sum settlement.
It has come to the attention of your secretary that certain uni
versities have recommended follow-up of the work of compensation
commissions as a subject for research work upon which to base a
thesis to be submitted for a Ph. D. degree, in some instances a M. A.
degree. The State University of Ohio has had a student on this
work for two or three years. The State University of Wisconsin
has put a student on this subject within the last year.
It occurs to me that these studies could be made very instructive
to the members of this association, but in order that they shall be
instructive there should be very close cooperation between the asso
ciation and the universities and students engaged in this work. The
trouble so far has been that the students handle too few cases and
32
FOLLOW-UP OF PROMPTNESS OF COMPENSATION PAYM ENT
go into a lot of detail that is of no interest to the members of this
association. I f follow-up work is to be done by outside parties and
this work is to be connected up in any way with the activities of
compensation commissions, the follow-up should be along such lines
only as can be related directly to the compensation commissions’
responsibility. So far as this work has gone, my impression of it
is that all semblance of forest will be lost in the multitude of trees
and that the investigators will likewise be lost.
However, it raises a question as to whether or not this association
should form a permanent committee to draft a satisfactory typical
and topical outline for a follow-up study and then be the official
channel through which State universities and university students
desiring to take up this line of work can communicate officially with
the association.
Mr. E p p l e r . In Maryland we have been very unfortunate with
lump sums. We have not perhaps as much of a follow-up system
as some of the other States have, and perhaps only the bad results
reach us, but all the people we have set up in chicken farms have
failed. Of all these various lump-sum propositions there seems to
be so many that do not work out.
To my mind it does not seem sensible to hand over to a widow
with no business experience an amount of money in cash; it does
not seem fair to her. Yet, I think our secretary perhaps has struck
the real note, and that is the follow-up system, not of lump sums—
I am not so much worried about lump sums; in fact, I do not like
them, I agree with the secretary on that—but of compensation
awards.
Mr. K i n g s t o n . As one of those who have been attending the con
ventions somewhat longer than most of the others, I want to wel
come our good friend from Rhode Island. We have been trying to
get Rhode Island in for a long time, and at last it has come in.
I did not hear all of Miss Harrison’s paper, but I understand the
substance of it is a recommendation of rather intense activity on
the part of compensation boards in the matter of follow-up of com
pensation—follow-up to ascertain whether or not the compensation
is serving its purpose. Possibly, incidentally that will be to ascer
tain whether or not the compensation which is paid is adequate.
That, of course, is a matter for legislation, but perhaps the boards,
as a result of some such follow-up investigation, might be able to
offer some advice to their respective legislatures.
That follow-up idea is long overdue. None of us has done as
much of it as we could or as we would have liked to do. Perhaps
the reason may be that the appropriation is not large enough. That
is not so with us, because we have all the appropriation we want,
inasmuch as we spend the money that we need out of the accident
fund. But the trouble has been to find the time in which to do
this follow-up work among the multitude of duties that devolve
upon the administering boards and the staff workers. There has
not been the time—at least, we have thought that other things were
more important than following up claims, but I see now, and I
think our board is coming to see, that we should devote some atten
tion to following up claims—not that we give lump sums, because
we do not, but rather to see whether or not the pensions that we
DISCUSSION
33
give are adequate and are spent in a way that does credit to the
beneficiaries.
As to lump sums, I have spoken before on that and I think the
convention, for the most part, has been in favor of the ideas ex
pressed by our secretary, Brother Stewart. The principle of these
compensation laws is against the payment of lump-sum settlements,
except in minor cases. In most of the State laws, even minor cases
are paid, I understand, not by lump sums, but by a shorter number
of weeks. With us in Ontario provision is specifically made in
the law that in all cases where the compensation is rated as less
than 10 per cent the board may pay in lump sums. That means,
of course, in all the digit injuries and injuries involving the pay
ment of perhaps less than a thousand dollars, and a few odd cases
where it is less than 10 per cent. By reason of large wages and in
the case of comparatively young men the amount of a 10 per cent
disability will be considerably over a thousand dollars, but in the
great majority of our lists of 10 per cent cases it means a lump
sum of considerably less than a thousand dollars, so it is not regarded
as a serious matter. But under no consideration would we think
of allowing a widow a lump sum in settlement for the death of her
husband; in fact, we are not permitted. The law, in the first in
stance, provided a $20 monthly pension for life; that has since
been increased to $40. In addition to that there is a payment of $10
a month for each child, so you can conceive the possibility of the
pension amounting to $110 a month, if a widow has seven children
under 16 years of age.
The capitalized value of our maximum pension represents a
charge of something like $22,000 as the largest sum you can con
ceive of being paid under our law. That, of course, is not paid
except in the form of a pension, but it is a capitalized sum that is
immediately set aside in our pension reserve account to provide for
the future payments in those cases. Under no consideration would
a widow receive anything more than that $40 per month for herself
until she remarries, and $10 a month for each child until that child
becomes 16 years of age. I f the widow remarries, there are two
years’ pension payable to her—that is, $960—in lump sum.
Mr. Hatch refers to the importance of follow-up in connection
with the promptness of payments. I suppose I will be accused
again by our insurance friends—I mean our publishing insurance
friends—of uttering propaganda in favor of exclusive State insur
ance, but—and my friend Clark from Ohio will appreciate what I
say—we have no such troubles regarding the prompt payment of
claims in State insurance jurisdictions. I said a year ago that if
you want anything done quickly, you must do it yourself. That is
pretty true with workmen’s compensation payments, and in those
jurisdictions where the compensation board is charged not only with
the administration of the law—that is, ascertaining and determin
ing what is proper compensation—but also with the collection of
the fund with which to pay and the actual payment, it simplifies
that question of promptness.
With us, with 55,000 claims a year—of course, there are not pay
ments in respect to all of them—our payments are made actually
somewhere between 24 and 48 hours after the paper is filed. We
34
FOLLOW-UP OF PROMPTNESS OF COMPENSATION PAYM ENT
have had our statistician gather that information, and that is the
record of the board. It has been improved somewhat during the
last year over that of the previous year, the payment being made
only a little over 24 hours following the receipt of the final paper.
Understand, we have to have our employer’s report, our doctor’s re
port on the case, and the man’s report. As soon as those three re
ports are in, taking all of the cases by and large, the check is issued
and it is on the way to the workman within somewhere between 24
and 48 hours after those papers are filed.
Mr. D u x b u r y . D o you have any statistics with reference to the
time which it takes from the date of the injury to the date of your
payment ?
Mr. K i n g s t o n . I have not got that.
Mr. D u x b u r y . That is the basis on which Mr. Wilcox spoke,
and that is an entirely different basis, you understand. You give us
your results from the time when the papers are completed which
show the basis of the claim, without any reference to when the acci
dent happened.
Mr. K i n g s t o n . From the nature of things that must be so with us.
The responsibility of putting in the papers is, first, upon the
employer, and, second, upon the workman.
Mr. D u x b u r y . With us the payment commences with regard to the
date of the disability without any proceedings whatever. The com
pensation is due and is paid; it is due, just the same as wages are due,
at the first due date of wages, and in a very large number of
instances instead of getting their wages the men get their compen
sation; the adjudication of the rights may take place any time after
that.
Mr. K i n g s t o n . I was coming to that in a moment. The moment
we learn that an accident has happened (and we take notice in every
sort of way; we take notice of an accident even from a newspaper)
we send Form 6, which is our workmen’s form, and along with that
Form 8, which is the doctor’s form. That goes immediately when
we hear of an accident. The employers are supposed to have a sup
ply of their forms in hand, and the law provides that they shall
report the accident within three days of its happening. Of course,
it sometimes does happen that there is delay in getting the full
reports to us, but there is no responsibility on the part of the board
in connection with that. All we can say is that as soon as the
reports are in hand there is the greatest possible expedition in get
ting the check to the workman.
Speaking of the waiting period, I am glad my friend Wilcox
is urging the cutting down of that waiting period. I think he has
a long way to go yet before he has gone the distance he should go.
My idea is not that there should be no waiting period—I believe in
a short waiting period—but rather that it should be an absolute
waiting period. In Ontario we have a three-day waiting period,
but it is conditional. If the disability lasts seven days, we go back
and pay from the beginning. I think there is room for improvement.
I f I had the making of the law, my idea would be to make it an
absolute three-day waiting period. I suppose we have all noticed
that there is a certain amount of petty malingering. I f a man is
DISCUSSION
35
disabled six days, lie is going to be disabled seven days. We recog
nize that is a condition of human nature. There is petty malingering
going on in every jurisdiction with reference to that type of case,
I have no doubt, but if you had an absolute waiting period of three
days and compensation began on the fourth day there would be none
of that.
I am glad to see throughout all of the jurisdictions in these later
years a tendency to shorten the waiting period; when the disability
lasts for a certain length of time, if you do not have an absolute
waiting period, the next best thing is to go back to the beginning.
I do hope something will be accomplished by the various jurisdic
tions by way of follow-up to ascertain whether or not the compensa
tion which is being paid is adequate and if it is fulfilling the pur
pose for which it was intended.
Doctor M c B r id e . New Jersey has had a very unhappy experience
in lump-sum settlements. In New Jersey nobody can receive a lump
sum settlement without the most rigid investigation. The act pro
vides that no lump-sum settlement shall be made unless it can be
conclusively proven that it is for the best interests of the person
involved. I do not think any State in the Union has a more rigid
investigation than New Jersey. I oppose lump-sum settlements
unless it can be conclusively proven they are to the best interest of
the persons whose interests are at stake. Our experience has shown
that 75 per cent of all lump-sum settlements have been wasted, prac
tically totally wasted. We have not made a complete investigation,
but that is our experience. We now start our investigator out just as
soon as the application is made. After he has made a complete and
thorough investigation—the questionnaire is most extensive; every
phase of the question is gone over in detail—his report is sent to the
secretary of our commission. The matter then comes before our com
pensation board, and all the parties involved are invited to that hear
ing. We may recommend it or recommend it in part, but it must
be conclusively shown to be to the best interest of the claimant. Our
investigation is very complete and very thorough.
We are instituting the follow-up system in all compensation pay
ments. Of course that is a tremendous task. I say all; that is, all
the important ones, not the minor ones where not much is involved.
I think it is a system that should be inaugurated and followed up by
every State and every Province having a compensation law.
The C h a i r m a n . Have you had a follow-up, Doctor McBride, as to
whether the amount of compensation is adequate, and also as to
whether it has been judiciously used by the workman’s family and
the workman?
Doctor M c B r id e . Not a very extensive one. We are beginning that
now. We have had some follow-up.
The C h a i r m a n . But you have no figures to give at this time?
Doctor M c B r id e . That has been inaugurated only recently.
Mr. H o r n e r . I believe that an efficient follow-up system is an im
portant factor in the successful administration of any workmen’s
compensation law. For the past several years Pennsylvania has had
a follow-up system somewhat similar to the system followed in Mas
sachusetts and explained by Miss Harrison. We follow up not only
36
FOLLOW-UP OF PROMPTNESS OF COMPENSATION PAYM ENT
compensation cases but accident reports as well. We make it a point
to see that the injured workman is advised of his rights before the
statutory period expires. If necessary, he is assisted in filing a claim,
and in many of those cases the adjusters who are connected with the
bureau of workmen’s compensation represent the claimant at the
hearing before the referees.
We also follow up all our open compensable cases from time to
time. Of course more important cases, such as permanent injury
cases, where compensation is payable for a definite period of time—
the loss of a hand or the loss of a finger or a thumb—we check very
carefully to see that the injured workman receives the full benefit of
the compensation law, and in many instances we have required either
the employer, if he is a self-insurer, or the insurance company to
enter into a supplemental agreement to provide for compensation for
a longer period of time because of that permanent injury. In these
cases as well as in the accident cases if necessary, our adjusters assist
the claimant in filing a claim and then represent his interests before
the referees.
Several years ago we made a study to determine whether em
ployers operating as self-insurers and insurance companies were
making compensation payments promptly. As a result of that study
some of our insurance companies became very much exercised be
cause their record did not show up so well, and to-day it is not an
unusual thing for the bureau of workmen’s compensation to receive
a letter from an insurance carrier stating that compensation pay
ment in a certain case has been delayed because the employee refused
to sign the company’s compensation agreement. There has been a
tendency to cut down the period and to enter into those agreements
and file them with the bureau of workmen’s compensation as
promptly as possible.
In Pennsylvania possibly 60 per cent of our employees are cov
ered by self-insurance, and I want to say that we have met
with better success in securing medical and hospital service beyond
the statutory period on the part of the self-insurers than we have
from the insurance carriers. Recently a very complete and exhausttive investigation was made in permanent total injury cases, in
which, under the Pennsylvania law, compensation is payable for
500 weeks. We have cases of that type in which the compensation
payments will terminate shortly. I recall one case especially where
a workman, a man of middle age, had lost both eyes. He was
given the benefits of our bureau of rehabilitation and was educated
so that he could go into some factory (I believe it was a broom
manufacturing concern), where he earned a few dollars in addition
to his compensation. When this investigation was made, the in
vestigator asked this man what he proposed to do when his com
pensation payments ceased, and he said he supposed it would be a
street corner and a tin cup for him. When the report was received
by the bureau we immediately communicated with the employer, who
was a self-insurer, sent him a copy of this report, and also called
attention to this situation, with the result that that employer decided
to continue compensation payments as long as the man lived. That
shows what these investigations, this follow-up work, result in.
DISCUSSION
37
I can not give you any report with respect to lump-sum settle
ments. About five years ago an investigation of such cases was
made in Pennsylvania, but, as I recall, possibly 60 per cent of those
cases turned out to be satisfactory. I repeat again that I think the
follow-up system is one of the important factors in the administra
tion of a compensation law.
Mr. C l a r k . With reference to the follow-up system, I can under
stand how that might be a serious question in some jurisdictions—
more serious than with us. I was surprised to hear the gentleman
from Pennsylvania say that 60 per cent of the employers were selfinsured.
Mr. H o r n e r . I said employees.
Mr. C l a r k . I misunderstood you. In Ohio we have 35,000 men
paying into the fund direct; we have 400 self-insurers, so we do not
have very many people to follow up. Where there is any question
on the report of our own medical department, and our physicians
say, “ This man will be disabled for so many weeks or so many
months,” the award is paid to that time, with an order for medical
reexamination. Consequently, our physicians are in close touch with
the cases. I can see how malingering might be lessened in our State
by a follow-up system somewhat closer than we have, but it was not
that that I wish to talk about.
I have been much amazed, and while I hesitate to take issue with
the two veterans of this convention—Brother Kingston and Brother
Stewart—on the question of lump sums, I can not understand in
what atmosphere they, as well as a number of the other gentlemen
here, have been. I can not quite see why in Pennsylvania only 60
per cent of lump-sum cases prove satisfactory. Why, in Ohio we
count the lump sum the most beautiful blooming flower on the j)lant,
and it has proven so. We have gotten more favorable publicity,
more commendation from both employers and employees, through the
practice of allowing lump sums than through any other practice in
the administration of the law in our State.
There are thousands of women whose husbands died more than six
years ago living under their own roofs in Ohio to-day who would
be subjects of charity in their communities except for that practice
by the Ohio commission. I do not know why there seems to be so
much trouble about it.
Mr. K i n g s t o n . On the $40 pension?
Mr. Clark. We do not give them $40 pensions. Of course, if we
pensioned them like Ontario does they would be at the mercy of their
landlords. I can cite hundreds of cases—I am sorry that the director
here did not bring along some of the records on that subject—where
a woman has been put into a $1,600 bungalow, an $1,800 bungalow, or
a $2,000 cottage, and her weekly compensation reduction did not
amount to the rent she had previously paid to some landlord who
did not half keep up the house because there was no man there to
fight for his rights. What is the difference if a widow has her com
pensation reduced and yet has as much cash left at the end of every
few weeks from the commission as she would have if she took the
other fraction of that cash and handed it over to some landlord?
It seems to me that is for the benefit of the widow. You will get
38
FOLLOW-UP OF PROMPTNESS OF COMPENSATION PAYM ENT
into trouble right away if you go to Ohio and begin to oppose the
buying of homes for widows and their children.
We take precautions that some of the other gentlemen do not
take. We buy no home for a widow until our own man has ex
amined the title, reported it favorably, examined the family, talked
with the neighbors, talked with the widow, made an appraisal of her
ability, examined the children, and reported to us how soon this
child will earn and how soon that one will earn, and we follow his
advice in most cases as to whether or not to give the lump sum. It
may be safely said that not 5 per cent of all the lump sums made in
Ohio prove bad or disastrous or not to the eventual benefit of the
children. When the eight-year period has run out, instead of a
claimant like that referred to by the gentleman from Pennsylvania,
the widow has a home and her children are joint owners with her.
Under our law she does not take the title; her children are jointly
interested with her. The deed is made to her and to her as trustee
for her children, or in some cases it is made to her and to the
children, naming them. The condition is always put in the deed
that no mortgage can be put upon that property and no transfer
made of that property within the period covered by the death
award, which is eight years in our State, without the consent of the
commission, and the result is that we are constantly bettering that
woman’s condition by helping her to sell the property and buy one
better fitted to her condition. I am rather proud of the fact that
in the last eight years I have gotten to be quite a real estate man
and have helped a lot of widows make money on their transactions,
because it is provided in the deed that we can do that if we wish and
that she can not sell unless we consent. So I do not know what sort
of atmosphere you fellows have been working in that you can not
somehow or other work out a proposition that not only is safe but
also puts the woman on the dignified plane of being a home owner.
It gives her a place where she does not have to creep to anybody.
That is the part about the lump sum that I like.
I do not think they give any lump sums in Rhode Island. The
idea of paying for the death of a man at $3,000, as they d o ! The
idea of valuing a human life at what you would a race horse! Why,
down in Ohio we give $6,500 and are kicking ourselves because it
is not higher than that.
I could not let this attack on what in Ohio is the finest thing wo
do go unchallenged, and if you folks can not get the system of lump
sums worked out in a way that will make you happy and give you
fine publicity, come over to Ohio and we will clear the hearing room
some morning and show you a system that is 100 per cent. Once in
a while we have a settlement that does not turn out well, but that
is also sometimes the case with the fellow who did not get his money
through workmen’s compensation.
Miss H a r r is o n . I believe that the majority of lump sums are
asked for in good faith; they are granted and paid in good
faith, but last year I noticed particularly the lump sums that
were granted to employees to go into business. Yes; they
went into business, generally a business in which they had no ex
perience whatever, and they spent their money. They were failing
all the time, losing what they had* They borrowed to keep the
DISCUSSION
39
business going with the hope that they would catch up and get
on their feet, and finally, when they found they could not, not only
had they lost the lump sum but they were in the hole and owed
money.
You have to watch the widows. For instance I know of a case in
Maryland where we had an application for a lump sum by a widow
who had a child. We could have gone ahead and allowed the lump
sum. It would have been all right, but the commission saw fit to
deny it, and the next thing we heard, the widow had remarried.
In Maryland if she has a child and remarries she gets the money
*just the same. Then we received news that the child was being mis
treated—the orphans’ court has appointed a guardian now. I f our
commission had granted a lump sum in that case, it could not have
done a thing. As it is, we have the power under the law to appor
tion that compensation and allow so much to the widow and so
much to the guardian for the child until the end o f the compensa
tion period.
Mr. Kingston recommended a three-day waiting period. In
Maryland the law was amended in 1920 and the waiting period was
reduced from two weeks to three days, arid it is proving satisfac
tory. When we do allow lump sums in Maryland, business is busi
ness, and we allow the same discount to the insurer that he would
get in interest if he had that money. I f I might make a suggestion
to this association, if it sees fit to appoint a committee to follow up
the awards I would suggest that it appoint as members of that com
mittee Mr. Grandfield, of Massachusetts, and Mr. Horner, of Penn
sylvania.
Mr. M c G i l v r a y . In California we believe in lump-sum settle
ments. In fact, we believe in them so much that we devote a con
siderable part of our time to the adjustment of lump sums. We
believe them to be a step ahead in the way of rehabilitation. I
have not heard that phase of it spoken of here, but we have found
that in many cases we can materially assist the man who is trying
to help himself by giving him a little bit of money—more than he
ever had in his life, perhaps—and then help him use that money
in a good way. In that we have the full cooperation of other de
partments of the State; for instance, the real estate commission,
which works with us in ascertaining whether or not reliable firms
are handling the real estate transactions; it even goes so far as to
handle personal property transactions in the conveyance of business
properties. We work in connection with the rehabilitation depart
ment, which is not under our immediate supervision, and various
other divisions, and just in passing I might say that we have drawn
very heavily on the other States for material to assist us in our
work, having people with the commission from Wisconsin, Mary
land, Ohio, Iowa, and some of the other Eastern States.
We are a State-fund State. We are hoping that we are going
to be an exclusive-State-fund State at no far distant date. We are
working on follow up through our State fund, an indirect method
because we can not pursue it directly, and working through and
giving the publicity to the fund we find that it is making the insur
ance companies a little more anxious to get their payments out more
rapidly and there is great competition for business. In fact, as I
40
FOLLOW-UP OF PROMPTNESS OF COMPENSATION PAYMENT
left California the insurance trust case was rising on the horizon.
I do not know what the insurance companies are going to do, but
anyway they are getting busy, and that always means that we aro
making progress.
The question as to how far the State should go in this matter
interests me. That is a very hard question to answer in a gather
ing of this kind, because each State, I presume, has its own problems.
In our State it is not feasible at this time for the State, through this
department, to undertake the follow-up system. We would not
get to first base if we tried it that way, and other States may find
the same difficulty. I think we all agree, though, that in order to
make the compensation system workable to its fullest extent we
should have a follow-up system.
I want to say in regard to Canada, and particularly Ontario,
that I think you have an admirable system. If we, in California,
pensioned our people to the extent that you do, we certainly would
not have to grant lump-sum settlements. I think that in your com
munity, in your particular locality, you really do not need lump
sum settlements. In our State we do, because the payments cease
in four years and after' that time the people who have been re
ceiving compensation become subjects of charity, except in cases of
70 per cent disability or more, where life pensions have been granted.
Taking it all in all, with my experience and my observation of the
experience of those who preceded me, I am for lump-sum set
tlements.
Mr. D u x b u r y . We seem to have a variety of ideas as to what is
meant by follow-up. The discussion indicates that some think it
means lump-sum settlements, some think it means the question of
whether or not the award was adequate, and some others think it
means whether or not payments were being made promptly. For
that reason I think that the suggestion of the secretary-treasurer
was, as usual, very wise, that a committee be appointed and that we
get a definition of what we mean by “ follow up.”
Listening to the discussions, I find that in Minnesota we do con
siderable follow-up in certain particulars, although there is a par
ticular character of follow-up which we do not do as well as we
should. Our follow-up of lump-sum settlements has not been sys
tematized and regular. We have no grounds for conclusion as to
whether or not our lump-sum settlements have been 75 per cent wise
and 25 per cent foolish, or the reverse. We know that there have
been some of them that we do not want anybody to know about,
because we are not proud of them. The suggestion of our president
is good that if you are interested in what is dangerous about lump
sum settlements the best thing to do is to get hold of the paper
which was read by the secretary-treasurer on lump-sum settlements
at the Baltimore meeting of this association. There you will get the
extreme view on the other side.
I have heard both sides of this discussion for some time, and the
result, so far as I am personally concerned, is that I am what they
call “ hard boiled” on lump-sum settlements. I am not from Mis
souri, but they will have to show me. If I am going to make any
mistakes, I would rather make them on the side of denying lump
sum settlements, because most of the beneficiaries of compensation
DISCUSSION
41
are people without business experience; that is generally the case.
A great many of them are like the old lady who once consulted me
about her* embarrassments. She told me that her husband had died
and that she had several children, and she said, “ We had plenty of
money, you know, but, goodness knows, it didn’t last long.” Now,
the story is all in that. There are a lot of people who have plenty
of money, but they spend it. They have plenty of money as long
as it lasts, but, goodness knows, it won’t last long.
Of course, a wise and experienced commission like that in Ohio,
which appoints itself a business guardian for widows and probably
makes wise investments for those widows in such a way that the
property can not be gotten away from them, can be proud of what it
has done and ought to be commended, but that is only one of a very
few instances. There are those chicken farms and all sorts of things
where the beneficiaries want lump-sum payments. There is one case
which I will consider favorably. If the person owns his own home,
but has a mortgage on it and the payment on that mortgage is com
ing due, I will consider a lump-s'um payment to take care of that
mortgage installment, but it must be paid directly to the person hold
ing the mortgage. So many times the person will think that the
mortgage can run a little longer and will buy a talking machine or a
Ford automobile; that is probably what you will find he has bought,
unless you see to it that the order directing a lump-sum settlement
specifies the particular purpose for which it is made.
I do not quite agree with Mr. Stewart’s conclusion that in no case
whatever should a lump-sum settlement be made, because in many
cases it should be. We have sometimes allowed a lump-sum settle
ment for the purpose of buying a home. When we do that, we have
the title examined and the thing thoroughly looked up, and take
every precaution.
Mr. S t e w a r t . One of the things President McShane left out of
his paper has come up in this discussion, and that is the anxiety of
the insurance companies to have quick settlements, and so on and so
forth. One of the first things the association did was to put Carl
Hookstadt on the question of promptness of payment, and it was that
report on promptness of payment which put the insurance companies
on the map as to seeing who wo'uld be prompt and who would not be
prompt. All this godliness about prompt payment is the result of
the exposure that came through the investigation of Carl Hookstadt,
which was recommended by this association.
I want to answer just in a minute the gentleman from Ohio. Of
course, you have to define what you mean bj lump-sum settlements.
To buy and sell real estate for a widow for eight years is not a lump
sum settlement. Let us understand what we mean by lump-sum
settlements. Most of the cases of out-and-out lump-sum settlements
are illustrated by a story I heard this morning. A fellow had an
automobile. It was patched in every place where it could be patched.
The top was off; the thing was just able to run and that was all, and
across the back of it was written, “ If I can pay one more install
ment, she’s mine.”
Mr. W i l c o x . I do not want to lose sight of the suggestion of the
secretary for a committee of this organization actually to determine
what sort of studies ought to be made in these universities. As Mr.
42
FOLLOW-UP OF PROMPTNESS OF COMPENSATION PAYM ENT
Stewart said, Wisconsin is now engaged in such a study; a student
for a Ph. D. degree is studying this very problem of the lump sum
ming of money to widows and those who have serious accidents, and
I have had to bother the various jurisdictions for information, for
which I want to express thanks here. We are trying as hard as we
can to direct this student’s investigation so as to make it serviceable
first to Wisconsin. We told her that we wanted to make use of the
information she got in prevailing upon the legislature that it was
necessary for Wisconsin to have some high-type individual devote
his entire time to this matter of following up the cases after a couple
of years and determining what lump sums ought to be granted. We
told her further that she must, through the department, make avail
able for distribution to the various jurisdictions administering com
pensation a copy of her thesis. I know how difficult, because of con
flicting laws, it is to make a study that will be an advantage to all
unless it is well worked out in advance. You* will have applications
from your universities right away, as you may be sure that they
know what is being done in Ohio and in Wisconsin. Somebody in
your State will be asking for your help and your permission to go
ahead and survey your work and interrogate these people who have
been injured. You will have to give him a letter of introduction to
these families, encourage them to give the desired information, and
you ought to know before you have to meet the problem just what
the study ought to be. It is a delicate thing to limit the students’ in
vestigation, because you do not want to be criticized as having edited
it, or so to restrain it that it will not really show the facts. As a
matter of fact, I want her to show the bad spots in the Wisconsin
administration, because I feel certain that they are there, and if I
know where they are I can prevail upon the legislature to give me
sufficient appropriation to carry on that work.
The C h a i r m a n . The chair has attempted to sit here as a one-man
jury, unbiased, and waiting for information. I do not believe, to
use a legal expression, the defense shows that there has been any
effective follow-up system among any of the States or in Canada as
represented here.
Mr. W il c o x . The United States Women’s Bureau did make a study
in some of the States of injuries to women, the purpose being to
determine how fairly men dealt with women’s disabilities.
The C h a i r m a n . That is limited in its scope ?
Mr. W i l c o x . Yes; to women who have been injured in industry.
There was a study made in some of the States, one in Wisconsin,
and I do not know just where else.
The C h a i r m a n . I hope that the secretary-treasurer will make a
motion for a committee along the lines he suggested.
Mr. W a l n u t . In Pennsylvania we have recently had a limited in
vestigation. We investigated first the permanent total disabilities
over a period of years; then in the county of Philadelphia we in
vestigated our commutations, going back for a period of about four
years. We have undertaken to follow up the commutations which
have since been made.
Mr. Horner referred to the percentage of successful cases and of
unsuccessful cases; the first may be right, but judging from the
DISCUSSION
43
reports we have received it is a very difficult matter to determine
the percentage of unsuccessful cases. We have, first of all, the
group of cases in which a foreigner who has been pretty seriously
injured wants to go back to his own country. It may be for his
practical benefit to go back or it may not be, but here is a man who
is not much good in this country and who wants to get back home, and
the only way for him to get back is for* you to commute enough
money so he can go back. It seems to me not only a reasonable,
practical thing, but the humanitarian thing, to give him enough
money so that he can get back to his home and family on the other
side. That constitutes a very considerable percentage of our com
mutation cases.
Then we have another group who ask for money for the payment
of debts. That, I think, is as difficult a group of cases to handle as
any. They probably need two or three hundred dollars and they
make the plea, “ We can not live on $12 a week,” which sounds
reasonable. When a widow says, “ I owe money for my rent; if you
don’t give me the money, I go out to-morrow,” or “ I am buying my
furniture on the installment plan; I started to buy it before my
husband was killed; I am three months behind, and if you don’t
give me the money to pay for it they will take it away and I will
have no furniture for myself and my children,” it is very difficult for
the commission to turn down that plea, which we find is really
made in good faith, so frequently we do commute for the payment
of debts. It is a very unfortunate thing to be called upon to do,
but those are the facts you face, and often as a practical matter you
feel you must do it.
Then, of course, we have another group who want money to buy
homes and pay off mortgages, and looking back over the last five
or six years, ix the commission had refused to give it, it would have
done a great injustice to many of the claimants, because there has
been almost a perpendicular rise in the value ox real estate in the
past six or seven years; in fact, it goes back even earlier than 1918.
Most of these people we have started off with homes had been thrown
out by reason of the landlord’s requirement that they move in order
that he might sell. We secured them homes which they purchased
and owned and the price of which has practically doubled in the
last six years, so I think we have nothing to complain about on
those commutations.
The particular commutations that I think we have been most at
fault in are those in which the claimants have gone into business.
The mortality among the businesses we have started has been rather
high, but where a man is getting compensation for the loss of a hand
which will run over a period of a few years and he takes that money
and goes into business, if the business supports him for a few years,
even though he* does then lose it, he is really no worse off than if
he had not put the money into it. The compensation would have
terminated anyhow, and he had a good gambler’s chance of winning.
So we often grant money for business purposes as well as the other,
although, as I said before, I think they are the most treacherous of
all commutations.
73891°—26----- &
44
FOLLOW-UP OF PROMPTNESS OF COMPENSATION PAYMENT
Mr. M c S h a n e . In the matter of lump sums, I know that in Utah
we have made too many; we have made some mistakes. I believe
that the question of lump-sum settlement is one of each case stand
ing on its own merits, that each case should be thoroughly investi
gated, and then we should do the thing that all the facts and cir
cumstances indicate.
[The president announced that T. Henry Walnut, of Pennsylva
nia, would serve on the resolutions committee instead of Richard H.
Lansburgh. He also referred to the resolutions committee the sug
gestion of Mr. Stewart that a permanent committee be appointed
to draft a satisfactory typical and topical outline for a follow-up
study and to cooperate with State universities and university stu
dents desiring to take up this line of work.]
M r . M c S h a n e . I w a n t t o c a ll y o u r a t t e n t io n t o a r e s o lu t io n p a s s e d
a t th e H a l i f a x c o n v e n t io n . I w i l l r e a d it , b e c a u s e I t r ie d t o m a k e
th e t h o u g h t o f t h a t r e s o lu t io n th e c e n t r a l p a r t o r th e h e a r t o f th e
p r o g r a m h e r e f o r t h is a s s o c ia tio n . I b e lie v e i t is im p o r t a n t .
Inasmuch as numerous diseases following trauma have to be dealt with by
the various accident boards and commissions of this association, and whereas
up to the present time no authoritative work has been published bearing upon
the etiological relation between trauma and the various known diseases which
follow: Therefore be it
Resolved, That a committee be appointed to consider the question of the
preparation of a medical work bearing upon the etiological relation between
trauma and the various known diseases.
Such work to be written or compiled by recognized medical and surgical
authorities in collaboration.
The chief purpose of such a work to be a comprehensive and adequate rec
ognition of trauma as a causative factor in relation to all known disease or
pathological conditions.
This was unanimously adoped, and I have read it for the purpose
of calling your attention to the medical section, which convenes to
morrow morning. You will observe by referring to your program
that the subjects relate and hark back to this resolution.
[Meeting adjourned.]
44
TUESDAY. AUGUST 18— MORNING SESSION
CHAIRMAN, RALPH T. RICHARDS, M. D., OF SALT LAKE CITY
MEDICAL PROBLEMS
The C h a i r m a n . The first paper will be “ The relation of trauma
to cancer and tuberculosis,” by Dr. Joseph E. Tyree, of Salt Lake
City.
THE RELATION OF TRAUMA TO CANCER AND TUBERCULOSIS
B Y JOSEPH E. TYREE, M . D., OF SALT LAKE CITY
For a long time it has been the habit of clinicians and pathologists
to speak of the actual or exciting causes of a disease and the remote
or predisposing causes. To take an example outside of our subject,
we know that the cause of typhoid fever is the typhoid bacillus, but
there are many factors that predispose or render the patient liable
to contract this disease—age, for instance—the disease is much more
common between 15 and 35 years; and season of the year—it is
much more prevalent in spring and autumn. Again, take diabetes;
here the predisposing factors are much better defined than the
actual ones. Very fat people and members of the Jewish race are
particularly liable to contract this malady. Among the causative
factors actually or remotely concerned in the inception of disease,
trauma—injury—holds a prominent and ancient place. When one
reviews the gropings of the human mind after knowledge he is
always struck with the grotesque and bizarre linking of cause and
effect that has at one time or another been used to explain natural
phenomena. I f one peruses the writings of Plutarch, particularly
his commentaries, the above statement is wonderfully illustrated.
The human mind at his time was very active in asking questions
and the explanations were peculiar in the extreme. About ninetenths, at least, of the conclusions come to by philosophers of his
day in the explanation of scientific facts are now thought to be
faulty and puerile.
In the realm of medicine no one factor has held a more prominent
position as a causative agent for almost any ailment than injury.
It has always been and at the present time still is very easy to
ascribe the onset of any set of symptoms to a preceding injury.
Physicians have had not a little to do with fostering this idea; par
ticularly in the day when our profession knew very little about the
fundamentals of disease it was very easy to pan off on to a preced
ing injury or a series of injuries the causation of almost any obscure
condition affecting the patient.
It is rather pathetic to read the speculations of some of our not
very ancient professional brethren concerning the real mode of onset
of some of our simple diseases. Everything from insanity clear
45
46
MEDICAL PROBLEMS
on down the line has been ascribed to injury. The doctor is now
and always has been asked questions by his patients and their friends
which, either through his ignorance or the general lack of knowl
edge, are hard to answer and, of course, every self-respecting
physician likes to satisfy the curiosity of his patients. To ascribe
almost any condition to a series of injuries has frequently been the
last resort of the harassed physician and seems usually to satisfy
the mind of the anxious patient.
The relationship between a cancer and preceding irritation or in
jury has been fairly well established for 1,000 years. Just what a
cancer really is and just exactly why it happens we do not yet really
know. To put the thing rather simply, a cancer is the rioting of a
group of cells or of small bits of tissue which has reverted to the
original embryonal type. Some rather recent work done at the
Rockefeller Institute in this country, and independently by gentle
men in London, seems to show that the cancer cell is a sick cell
rather than simply a young one and that its abnormal activity is
due, maybe, to the presence of a minute microorganism acting upon
this already sick cell. This minute organism causes these apparently
sick embryonal cells to grow inordinately and to disport themselves
in an unseemly, wanton manner. It is as if some microcosmic foun
tain of youth had bathed these cells, rejuvenated them, and that
they had gone wild with the joy of living, roamed around and
multiplied, obeying no laws and knowing no bounds. This is, in
simple language, a picture of cancer behavior.
There are two distinct general types of cancer—sarcoma and car
cinoma. A sarcoma usually develops in the tissues covered by the
skin and mucous membrane. In some of the cancers of this type
there is a very definite preceding history of a single more or less
mild blow or rail; particularly is this history obtainable in cases of
sarcoma of the bone.
Every surgeon or pathologist who has written on the etiology of
bone sarcoma during the past hundred years has ascribed a promi
nent part in the inception of this condition to preceding injury.
What the injury really does is probably this: In the course of repair
of any injury there is a reversion to primitive type of cells such as
are seen in the embryo. These cells, of course, are always endowed
with the property of growing, more so than an adult cell. I f now
with a set of young cells endowed with the ability to grow there is
introduced this probable actuating element in the xorm of the micro
organism above referred to, we have all of the factors necessary to
cause a sarcoma.
Carcinomata are cancers arising in the skin and mucous membrane.
Here the predisposing injury is usually not a single one but a series
of long-continued mild or severe irritations. Carcinoma of the
tongue develops in a mouth with decayed, ragged teeth or at the site
of a syphilitic ulcer of the tongue. Carcinoma of the lip develops
probably more frequently in the man who has for many years
smoked a pipe and at the site of the irritation of the pipe stem.
Cancer of the breast is a hundred times more common in women than
men and much more frequently occurs in women who have nursed a
number of children or whose breasts have been subjected to preced
ing inflammatory conditions or injury. Cancer of the uterus is
RELATION OF TRAUMA TO CANCER AND TUBERCULOSIS
47
practically always seen in women who have had lacerations and
chronic inflammation of the outlet of this organ. Carcinomata of
the skin, as far as I know, never arise except at the site of a chroni
cally irritated, benign, preceding lesion. A wart, a mole, or a little
ulcer from which the crust is frequently scraped is usually the place
where skin carcinomata originates. Carcinoma of the alimentary
tract is practically always located at those areas where the contents
are mechanically arrested by the narrowness of the tube or where
chronic irritants can most favorably act. A preceding benign ulcer
ation is, in the minds of most men, a frequent antecedent of the
malignant change.
An interesting thing about the whole problem of the relation of
injury to cancer is that one very seldom sees either a sarcoma or a
carcinoma arise at the site of a severe injury. I have never seen a
sarcoma arise at the site of a fracture. I have never seen a cancer
arising at the site of an incised or a lacerated wound of a mucous
membrane, however extensive or severe. The important thing to
know is that in the case of sarcoma it is the single, mild injury; in
the case of carcinoma it is the continued small injury or irritation
which seems to predispose the setting up of the wild, morbid process.
Tuberculosis in one form or another is one of the most widespread
of diseases. A generation ago the German pathologists, who had
done more autopsies than any other set of men in the world, were
almost prepared to say that every adult showed signs some place in
his body of an active or healed tuberculosis lesion. This does not
mean, of course, that most people die of tuberculosis or that a great
majority of people are seriously incapacitated by this disease. For
our purpose to-day it has, however, this very important bearing—an
unknown number of people, but unquestionably a very large number,
harbor within their bodies foci of tuberculosis in a quiescent form.
The fundamental pathology of tuberculosis is the tubercle. This
is, in simple language, a kernel, in the center of which are groups of
tubercle bacilli lying in a nest of young connective tissue and other
cells and surrounded by a limiting capsule of scar tissue. Now when
anything disturbs the tubercle these bacilli can be let loose to enter
the blood or lymph stream and thereby wander to other places in the
body. Usually when tubercle bacilli are so loosened from their rest
ing places the great majority of them are destroyed by the defense
forces of the body and do no harm. If, however, such migrating
organisms run across a place favorable for their growth and where
the blood stream has been so slowed down that they can stop they
may set up at this site another colony of tubercles. Such, in plain
language, is our present idea of the spread of tuberculosis from one
place in the body to another. Now a very favorable state or condi
tion for the lodgment of wandering tubercle bacilli, or any other
organisms for that matter, is a mild injury; that is, an injury just
severe enough to cause some extravasation of blood into the tissues,
the presence of a certain number of injured cells in the vicinity, and
the stoppage of blood in a certain number of small blood vessels.
That tuberculosis of the bone and joints is frequently, if not usually,
brought about by the lodgment of tubercle bacilli in an already
tuberculous patient at the site of a mild injury seems to be rather
firmly established in the minds of most clinicians and pathologists.
48
MEDICAL PROBLEMS
Tuberculosis of the lungs can probably also be more or less dis
seminated by a severe blow on the chest which causes the partial
disintegration of an old tuberculous focus. It is needless to say
that any injury to an old tuberculous focus has a great tendency
to scatter the tubercle bacilli which are there present. This has
happened occasionally, I am sorry to say, during our operative or
manipulative treatment of tuberculous disease. I have recently had
this case for example. A small boy with a rapidly progressing
tuberculosis of the ankle was brought to me. The diagnosis wag
very obscure, since tuberculosis of the ankle is a rare disease in this
country. We decided to incise the wound to be sure of its nature.
On finding that it was tuberculous, I removed the tuberculous bone
and closed the wound. The boy rapidly developed the disease in a
generalized form and died within a month.
A recent decision of one of our supreme courts (Maryland) is
as follows: “ When disease or infection is so set in motion or aggra
vated by an injury that disabilities result which would not other
wise have occurred, such disabilities are to be treated as the result
of injury.” We have had a similar ruling from the supreme court
of our own State.
In the light of the above judicial sentiment and considering the
few remarks which I have made about the origin of cancer and
tuberculosis, it is rather evident that where either cancer or tubercu
losis develops at the site of and following an injury or series of in
juries these diseases must be looked upon as being set in motion or
aggravated by the trauma.
The C h a i r m a n . The discussion of this paper will be deferred to
the end of the morning program. The second paper is “ Chronic
infectious hypertrophic arthritis of the spine and its relation to
industrial accidents, by Dr. J. C. Landenberger, of Salt Lake City.
CHRONIC INFECTIOUS HYPERTROPHIC ARTHRITIS OF THE SPINE
AND ITS RELATION TO INDUSTRIAL ACCIDENTS
BY J. C. LANDENBERGER, M . D., OF SALT LAKE CITY
The subject of my paper is “ Chronic infectious hypertrophic
arthritis of the spine and its relation to industrial accidents.” In
the literature on this subject many synonyms appear, such as
spondylitis; chronic spondylitis; chronic infectious spondylitis;
chronic hypertrophic spondylitis; spondylitis deformans; spondyl
arthritis deformans; arthritis deformans; arthritis of the spine;
hypertrophic arthritis of the spine; atrophic arthritis; degenerative
arthritis; osteoarthritis of the spine; rheumatoid arthritis of the
spine; Bechterews disease.
The selection of the name, “ chronic infectious hypertrophic
arthritis of the spine,” was made because it suggests the etiology
and pathology of the disease as the medical profession of to-day
decrees.
The term “ arthritis” (arthro—a joint) is used in preference to
spondylitis (spondyl—a vertebra) because the subject matter deals
with the inflammation of the joints of the spine, which condition is
very commonly associated with joint disease elsewhere in the body,
whereas the word “ spondylitis ” does not carry in itself any sugges
tion of other pathology.
For more complete elucidation of the subject, it might be well to
take up arthritis in general. Arthritis is an inflammation of a joint.
When occurring in a single joint it is spoken of as monarthritis;
when two or more joints are involved, as polyarthritis.
When the inflammation sets in rather abruptly, associated with
fever, quickly reaching its maximum intensity and with an early end
result, it is designated as acute arthritis. Should the inflammation
come on insidiously, not associated with much, if any, fever, of
particularly slow progression and with a late end result, it is called
chronic artnritis.
According to its etiology it is sometimes spoken of as gouty
arthritis, infectious arthritis, rheumatoid arthritis, traumatic
arthritis. And depending upon its pathology the classification may
be degenerative* or hypertrophic arthritis, proliferative or atrophic
arthritis, and arthritis deformans.
Etiology: For some time sporadic opinions have here and there
appeared as to the infectious nature of chronic arthritis in general.
However, it is only during the past 10 to 12 years that study and
research work have at last developed definite and satisfactory prin
ciples to guide us in this matter. In days gone by, because of the
absence of such definite and satisfactory principles, traumatism
was blamed for an extremely large percentage o f many disabling
joint conditions which we are now rapidly learning to be actual
disease and in no way resulting from trauma, though often so
stated by the applicant to the industrial board to gain compensation.
49
50
MEDICAL PROBLEMS
None of these joint conditions have been more flagrantly pre
sented before industrial commissions and courts than chronic in
fectious hypertrophic arthritis of the spine.
During the last decade many scientific workers have thoroughly
investigated the subject of the etiology of chronic arthritis in gen
eral, reaching the unanimous conclusion that focal infection is the
important factor.
As expressed by Albee, “ The great importance of focal infection
as an etiological factor in joint disease has been repeatedly empha
sized in the past few years. And he is so impressed with the infec
tious character of, these chronic arthrites that he classifies them
all under the caption “Chronic infectious arthritis,” and states that
they are “ probably secondary to some local septic process elsewhere
in the body.”
Taylor, of Baltimore, says that “A chronic focus of infection any
where in the body may lead to joint involvement.”
Tubby, of London, speaking of arthritis of the spine, as far back
as 1912, stated that, “ If the patient shows definite signs of the dis
ease elsewhere there is no difficulty about the etiology.”
Brilliant work on the etiology of arthritis in general has been ac
complished by Rosenow, Murphy, Frank Billings, Hastings, Poynton and Paine, Smith, Rosenau, Anderson, Victor Vaughan, Nichols,
and Richardson, and many others, with the result that the theory
that joint disturbances are secondary to focal infections is depend
ably established.
By a focal infection is meant, “ any circumscribed area of tissue
which is inoculated with pathogenic bacteria.” Any focus of sup
puration is a focal infection. Study and experience have taught us
that the most common sites of focal infection are about the teeth,
tonsils, sinuses, ear, mastoid, and seminal vesicles and prostate, the
less common sites being the intestinal tract with its appendix and
gall bladder; genito-urinary tract, covering cystitis, pyelitis, ure
thritis and in the female metritis and salpingitis; the respiratory
tract, as bronchitis, bronchiectasis, empyema, and lung abscess.
Medical opinions are now practically unanimous in maintaining
the belief that a suppurating focus anywhere may produce arthritis.
So that in these enlightened days the appearance of an arthritis is
the cue to the physician to examine his patient thoroughly for some
focus of infection. These are in many instances hidden or appar
ently quiescent and at times may be especially difficult to discover.
However, when, in one’s experience, the extraction of a diseased
tooth quickly relieves pain in a couple of elbow joints, or the removal
of old infected tonsils promptly cures a long-continued polyarthritis,
the practitioner of medicine becomes convinced of the correctness
of the view that a focal infection may readily cause arthritis. And
all medical men agree on this proposition to-day.
In discussing the etiology of arthritis some mention must be made
of trauma, but this part of the subject should, in my judgment, be
discussed with great care and explicit rhetoric so that there can be
no misunderstanding.
Far too many verdicts have already been allowed for cases of
chronic infectious arthritis which were designated in the court room
as traumatic arthritis, when, in my opinion, the traumatic part was
an absolute nonentity.
HYPERTROPHIC ARTHRITIS OF TH E SPINE
51
You will agree that it is a very significant situation when doctors
who are engaged largely in industrial practice always obtain a his
tory of injury with every case of chronic arthritis which they may
see, while those doctors who have little or no industrial practice never
obtain a history of injury with their cases of arthritis, and yet they
may have as many, or more, cases of arthritis as the industrial sur
geon.
In the event of a wound of a joint, a gunshot wound, an explosion
wound, a stab wound, or any other kind of a wound where bacteria
may be directly carried into the joint, infection ensue and arthritis
develop, we may all fairly and properly call this a traumatic arthri
tis. Or in the event of a severe contusion of a joint, with or with
out a wound, and with or without a fracture, such as might occur
from the kick of a horse or from being run over by a heavy vehicle
or struck by a heavy moving object, and followed by a definite
arthritis in the joint involved, we would all fairly and properly
agree that this was a traumatic arthritis. However, in such cases
as these there is never any dispute for the simple reason that trauma
has left its mark which is visible.
In distinct contrast to such cases comes an industrial worker with
a painful joint and the history of an injury a month previously. The
injury was not severe enough to cause him to stop his work, and
there are no visible or other signs of an injury, but his teeth and
gums are literally rotten. The condition ox the joint is not acute
but is that of a chronic infectious arthritis with slow progression
and is possibly associated with involvement of other joints.
How can we fairly and properly speak of such a case as this as
traumatic arthritis? And yet the industrial boards and courts are
granting favorable verdicts in just such cases.
The sense of corporation liability for injury, with its monetary
remuneration, together with compensation laws which pay indem
nity for injury, present a lure to the industrial worker which it
is difficult for him to resist. And this is undoubtedly the reason
why cases of chronic infectious arthritis in industrial workers are
always connected with the history of an injury, whereas the same
pathological conditions occurring in individuals in other positions
in life seldom or never are accompanied by a history of injury, and
so far as the relative incidence of the occurrence of chronic arthritis
in industrial workers is concerned we have no information that they
are attacked with any more frequency than other people, even in
spite of the fact that they are more exposed to traumatisms.
Traumatic arthritis is a comparatively rare condition and when it
does occur it is a monarthritis and an acute arthritis.
Now, as to the pathology of chronic infectious arthritis, and by
this we mean the study of the diseased tissues, the changes that occur
in the tissues, etc.
Returning to the theory of focal infection as playing the dominant
role in the causation of chronic arthritis, it must be considered that
the infectious agent or its toxines may be carried from their original
source to the joint involved either through the blood or lymph
streams. That they make their way usually through the blood
stream and lodge in the joint or tissues about the joint is the com
mon and accepted theory of the manner of dissemination. Thus
52
MEDICAL PROBLEMS
any joint, large or small, may become affected. The distribution is
usually polyarticular.
The spinal condition may occur independently of any other joint
involvement, or it may be associated with one or more joint dis
turbances. It may be limited to a few vertebrae or include the whole
spine. The joints most commonly involved are the fingers, hip,
knee, spine, elbow, and feet. It is a disease chiefly of middle life and
old age.
Following lodgment of the infectious embolus or toxine the type
and extent of the disease in the joint will, of course, depend upon
the age of the individual, the general vital resistance, the local re
sistance, and the degree or virulence of the offending agent.
According to Nichols and Richardson there are two pathological
types of chronic infectious arthritis, namely, the proliferative or
atrophic type and the degenerative or hypertrophic type.
In the proliferative or atrophic type is seen a proliferation of
the synovial membrane, disintegration and dissolution of the articu
lar cartilages, atrophy of the bone and an absence of bony forma
tion about the joint. In the degenerative or hypertrophic type is
seen a softening and erosion of the cartilage, with hypertrophy
of the bone in and about the joint.
As to chronic arthritis in general, its nomenclature, etiology,
and pathology, this short discussion will at least picture to you
the fundamental principles. Having thus taken up the matter of
general arthritis for the express purpose of giving you a basic
knowledge of the subject, the following remarks will be confined
strictly to the title of this paper, namely, “ Chronic infectious hyper
trophic arthritis of the spine.”
At the outset and speaking generally, it may be said that so far
as etiology and pathology are concerned there is no essential dif
ference in chronic arthritis of the spine and chronic arthritis of
any other joint, so that the previous remarks of general arthritis
apply more or less equally as well to the spine.
It must be remembered, however, that between every vertebra
is situated a fibrocartilaginous disk called the intervertebral disk.
Your imagination will readily suggest that these disks may be placed
there for the purpose of relieving shocks and jars to that part of
the skeleton which supports and protects most of the vital organs
and, secondarily, they add thereby a protection to the joint from
injury.
Furthermore, you are seriously reminded that the joints of the
spine are not as superficial and vulnerable as are the joints of the
extremities. As Kidner aptly says, “All the joints of the spine are
subject to various forms of disease which affect joints elsewhere.”
By chronic infectious hypertrophic arthritis of the spine we mean
that it is a chronic arthritis of the spine of slow progression, caused
by an infectious agent and showing hypertrophic changes, which
latter, by some authorities, is spoken ox as a deposit of calcium
salts, rather than a true growth of bone.
The study of these hypertrophic changes in the spine has made
wonderful progress in late years, due to the observations with the X
ray. Rontgenologists have had the advantage of observing the
spine, secondarily, during special studies of any or all of the thoracic
or abdominal organs, so that a vast number of spinal columns have
HYPEBTROPHIC AttMERlTlS OF THE SPINE
53
thereby been closely studied although the complaint of the patient
had no reference to the spine nor was a picture of the spine the
original purpose.
Through mis wonderful opportunity the rontgenologists are able
to give us very dependable and indisputable facts in relation to the
spine, and it is probably appropriate at this time to take up the
X-ray study of the vertebral column.
Arial W. George and D. Leonard, of Boston, who during the
past 11 years have acted as impartial physicians to the Industrial
Accident Board of the State of Massachusetts, have made a very
exhaustive study of the spine, including over 10,000 cases—normal
and abnormal. In view of such voluminous experience, it would
seem ridiculous to controvert their opinions.
They “ found very early in this study that theoretical diagnoses
which were not based upon known facts, or facts mat were not
easily demonstrable by the X ray, led into difficulties; and they
early realized the absolute necessity of giving opinions based on
the X-ray studies which were accurate and which could be proven
and substantiated by facts and which were not theoretical.”
They emphasize the importance of recognition of congenital varia
tions, that these conditions as they appear in the X ray may be
entirely segregated from injury. They stress the importance of
chronological, occupational, and postural changes. “ Vertebrae
change in appearance just as other parts of the human anatomy may
change; just as an individual grows older in general appearance, so
do the vertebrae.”
The laboring man who has done heavy lifting and pushing of heavy objects
throughout the period of his working life, who is muscular and of large
physique, will in almost every instance have changes which differ from the
individual who has occupied a desk position or led a sedentary life. There
will be structural changes in the spine such as varying degrees of scoliosis, and
due to this structural scoliosis there will be found changes of individual bodies
or of all the bodies. More important perhaps is the fact that with these
changes will also be found hypertrophic changes on the margins of the verte
brae. These changes are many times confused with the changes due to injury
or disease.
To them, “ the most important phase of the entire subject is to
understand and recognize the above changes.” They say that “ in
variably individuals over 40 years of age are going to show hyper
trophic changes to a greater or less extent,” and they wish to empha
size that such changes can be proven as not the result of one alleged
injury.
It is their opinion that such hypertrophic changes “ have no im
portance whatsoever as indicating the result of an injury,” and that
they are as “ natural to this type of individual as any of the various
changes due to age.”
One must always be on guard for these changes and consider them normal
in relation to the age, occupation, and posture of the individual.
In speaking of arthritis they say that “ the changes which appear
as the end result are so much within the normal limits that they
prefer to speak of these changes as hypertrophic changes and elim
inate the word arthritis.”
Unless they find morphological changes of the body or parts of the body
which indicate tearing, fracture of a portion of the body or parts of a vertebra,
they do not consider these hypertrophic changes the result of injury.
54
MEDICAL PROBLEMS
W. H. Wallace, of New York, thinks the exostoses are probably
calcified fragments of the ligaments and believes that this condition
of the spine is much more Frequent than most of us have been led
to suppose. He quotes Silver as having 86 cases all following acute
infections, and that it is probably a definite disease and terminates
in many cases by spontaneous cure.
Howard Doub, of the Henry Ford Hospital, of Detroit, in a large
number of cases of infectious arthritis of the spine, has found
roughening of the crest of the ilium and partial calcification of the
iliolumbar ligaments. It is his opinion that this is another mani
festation of infectious hypertrophic arthritis of the spine.
The majority of his cases of this condition have shown evidences
of infectious arthritis varying from slight spur formation to those
showing calcification of all the ligaments of the spine.
Henry K. Pancoast, of Philadelphia, states that “ It must be borne
in mind that hypertrophic changes, when found as they are in spines
of individuals of advancing years, are not strictly pathological.”
You now have a general outline of the subject matter of this paper,
which has been gone into carefully though briefly. The basic
etiology and pathology and the rontgenology of the subject have
been taken up, together with the comparative study of chronic arthri
tis in general.
Going now into these subdivisions separately and from the view
point of facts, and taking up the rontgenology first, it must be
apparent to you just what X-ray authorities think of chronic
arthritis of the spine. They have all seen so many hypertrophic
spines in people without injury that they will not tolerate that
the condition be in any way attributed to trauma unless there are
definite traumatic signs. Furthermore, the condition of hyper
trophy, or calcification of the ligaments, is observed by them so
frequently that they are even disposed to believe that it is a result
of age and occupation and not even connected with disease.
There is plenty of evidence that focal infections may produce
hardening of the arteries, calcification of the ligaments, hyper
trophy of joints, and in many other ways bring about premature
old age, so that from this point of view one might classify senility
as being the chronological result of focal infections.
At any rate the hypertrophy shown in cases giving history of
trauma is in no way different from that shown in cases without
trauma.
With no reason for believing that focal infections might produce
hypertrophies of all the other joints and exempt the spine, and
having convincing evidence that focal infections do produce hyper
trophy in other joints, it must be logical to assume that focal in
fections can similarly affect the spinal joints. Therefore, it must
be reasonably considered that although age and occupation may be
a factor in the production of hypertrophy of the spine, yet in all
probability focal infection plays the most important part.
To sum up the rontgenologists’ opinions on this matter, espe
cially in its connection with trauma, the quotation, already referred
to, from George and Leonard most reasonably meets the situation,
namely:
HYPERTROPHIC ARTHRITIS OF THE SPINE
55
Unless one finds morphological changes of the body or parts of the body,
which indicate tearing, fracture of a portion of the body or parts of a verte
bra, these hypertrophic changes should not be considered the result of injury.
In discussing the subject of chronic infectious hypertrophic ar
thritis of the spine from the etiologic and pathologic points of view,
and in its relation to trauma, several things should stand out before
you quite plainly, namely:
1. The common accepted theory that focal infections are the im
portant factors in the causation of chronic arthritis.
2. That the spinal joints are subject to this affection as well and
as frequently as other joints.
3. That age and occupation enter into its development.
4. That it is observed extremely frequently in people who have
not had an injury.
5. That it is very frequently associated with joint disturbances
elsewhere in the body; in other words, it is very often only a part
of an outbreak of general joint disturbance.
6. That chronic infectiousi hypertrophic arthritis of the spine is
essentially and fundamentally a disease and not an injury.
These facts, in the light of our present knowledge, are indis
putable.
In recapitulation, considering the etiologic, pathologic, and
X-ray findings, it may safely be stated that chronic infectious hy
pertrophic arthritis of the spine is a chronic pathological condition
of the spine of slow progress, resulting from age and focal infec
tions, associated with calcification of the spinal ligaments or bony
exostoses, and should not be considered as due to or aggravated by
injury unless definite objective evidences of trauma exist.
The C h a i r m a n . The third paper. “ Trauma and its results from
an administrative point of view,” is to be given by Dr. James J.
Donohue, of Connecticut.
TRAUMA AND ITS RESULTS FROM AN ADMINISTRATIVE POINT OF
VIEW
B Y JAM ES J . DONOHUE, M . D., F. A. C. S., MEMBER CONNECTICUT BOARD OF COMPEN
SATION COMMISSIONERS
In discussing the results of trauma from the viewpoint of those
intrusted with the duties of administering compensation laws, the
impressions made upon such officials are many and varied. The
things to be attained under these laws, in the order of their merit,
are: First, prevention of the accident; second, restoration of the
injured employee; and third, compensation for his disability. Time
prevents going into matters specifically or in detail, and the best
that can be done is to indulge in generalities on the subject which
has been assigned.
Compensation laws, like all others, are made for the purpose of
remedying apparent evils of society, and also for the purpose of
lifting humanity into a higher scale, so that the sufferer, whether he
be claimant or dependent, may be relieved of the burdens which
naturally result from industrial accidents.
After 12 years’ experience in administering the compensation act
in Connecticut, I find in general that the amount of good which has
accrued to the toiling masses through compensation legislation can
not be measured, with any degree of fairness, by the amount of dol
lars and cents which have been expended in compensating injured
employees. This sort of legislation has a broader significance. It
has shown that there has been an honest attempt, .demonstrated in a
practical way, to disprove the saying of the Highland Bard that,
“ Man’s inhumanity to man makes countless thousands mourn.”
For practical and beneficial legislation it is difficult to conceive of
any which has done more to alleviate human suffering than compen
sation laws, and while we are far from the millennium, so far as
perfection in operation is concerned, we have a right to make a very
satisfactory report of progress up to the present time.
In attempting to deal out justice to injured men, there is probably
no situation more difficult to handle than that of the man who comes
in with no visible physical injury, but who is suffering from sub
jective symptoms, which are always difficult definitely to diagnose.
In such cases we need to exercise all the patience and judgment with
which we are endowed in order to see that justice is done to both
sides.
However, it is not the prerogative of the commissioner to be lib
eral with other people’s money, as was suggested to me by Governor
Baldwin when I received my appointment to the first compensation
commission of Connecticut some 12 years ago; rather, it is our
duty to handle all situations in a spirit of liberality, giving the
injured man the benefit of all reasonable doubt.
Many of us, I feel sure, when we see a man coming in for about
the tenth time and claiming a back strain, wish that our prehistoric
56
TRAUMA PROM AN ADMINISTRATIVE POINT OP VIEW
57
ancestors in their progress of evolution had handed down to us an
anatomical structure devoid of any vertebrae whatever; in other
words, when the spineless vertebrate presents himself, we often wish
that heredity had dealt differently with the human race anatom
ically, and so might have eliminated many of the claims for back
strain. We have heard of railway spine, which, in the past, was the
bugbear of the railroad companies. To-day we have the sacroiliac
strain and the lumbar muscle strain, both of which are among the
most fertile sources of contention when it comes to disability dis
putes. To cull the oats from the chaff is the duty and work of no
novice, and many times the chaff has a mighty good sprinkling of
oats mixed in with it. In some of these cases it is well-nigh im
possible, by any diagnostic method existing at the present time, to
measure pain, imaginary or real, and many things have to be taken
into consideration m arriving at a conclusion.
Oftentimes the man with a back strain, though he may not be a
malingerer, still lacks that stamina and self-confidence which are
necessary to send him forward and shake off the imaginary pain
magnified by his self-consciousness and self-sympathy. The medical
man with the strongest hypnotic power and the one with the great
est ability to send home a suggestion will be the most useful in
making a cure of what, in the hands of a man lacking in these quali
ties, will often result in a confirmed neurotic. One of the most
difficult problems, if not the most difficult, which we are called upon
to deal with is the neurotic.
The neurotic is the result of a variety of causative conditions.
He may be produced by a rather trifling injury when he has the
nervous system which is a fertile soil for the production of this con
dition. Too much time for the injured man to think about himself
after a very trifling injury is very detrimental to the man himself
and also to his employer, and if employers would show more co
operation in assisting to get such men back to work quickly it would
do more than any medical treatment that could possibly be insti
tuted for the cure of this condition. The payment of a few dol
lars in compensation is a mighty small consideration compared with
the quicker recovery of the injured man, and this can best be done
by the strongest kind of cooperation between employer, insurer, and
employee. Just as quickly as an injured man is able to get around
and do work of any kind, even though it may be far from the work
which he was doing at the time of injury, the employer should fur
nish him employment; and by so doing, even though he puts this
man to work at a time when he can not earn what he actually pays
him, it will redound to his advantage by reducing his experience
rate, and it will also prevent the employee from becoming a neurotic,
which is always a possibility in certain types of individuals.
There are employers, unfortunately, who do not show the right
spirit toward the compensation laws and injured workmen. They
seem to take the attitude, “ Oh, well, I am insured; talk to the insur
ance company; I paid my premium, let them pay for it.” This is
absolutely the wrong spirit, as indirectly in the end it costs them
thousands of dollars. A worker restored is an asset to the employer,
to himself, and to the community. An idle workman is a liability.
Many days of idleness and many dollars might be saved to the em
58
MEDICAL PROBLEMS
ployee and to the employer, respectively, if there were a more judi
cious expenditure of a small amount of money in assisting the injured
man to get back to work in the way which I have suggested.
Neurotics are also produced many times by the injured workmen
getting into the hands of nerve specialists, who treat them more for
the pecuniary reward which they may themselves receive for such
treatment than with any real desire to cure their patients and get
them back to work. Unnecessary and prolonged disabilities are
oftentimes produced by poor medical treatment or medical treat
ment received at the hands of would-be neurologists. When the
patient gets into the hands of a neurologist of this type there is so
much red tape in the diagnosis and in the various examinations to
which he is subjected that it tends to exaggerate in the mind of the
injured man the condition from which he thinks he is suffering,
and he revolves it in his mind sufficiently long for it to become to
him a pronounced fact, and he thus becomes a confirmed nervous
wreck. I have seen many of such cases, and in my opinion if they
had never seen a nerve specialist they would have been very much
better off and would have resumed work much more promptly.
All of this forces me to conclude that if we have to deal with a
neurologist, the best that can possibly be secured is the one to select,
and be sure to select a man who is so busy that he will want to get
his patients off his hands quickly and back to work and not have
them as constant visitors to his office or any other place of treat
ment.
When you are really confronted with such a situation as this and
medical means fail, the cure which will probably result in the great
est number of recoveries and in the quickest return to work is the
one most used in European countries, namely, the payment of a
lump sum. This clears the mind of the injured man of all pending
litigation, and when he is assured that such a lump sum is a final
and complete settlement of his case, he almost always forgets: his
injury and attendant mental troubles and goes back to work.
In this connection I might add also that when lawyers get hold
of a man of this type another stumbling block is thrown in the way
of his recovery, for the legal profession as well as the medical can
claim its share in the production of neurotics.
My observation leads me to feel that people coming from southern
European climates—that is, the warm countries—are the ones who
are the most spineless and who have the biggest idea of the size
of their injuries, magnifying a trifling ailment out of all proportion
to the injury actually received, shouting with pain if you look at
them, and going into hysterics if you attempt to bend or exercise
an injured member in an attempt justly to estimate the amount
of specific injury. They are the ones who are apt to make the
strongest claims on the slightest provocation, and if there is such a
thing as overdoing it, I would say that this is the element which
needs our closest attention. I have likewise noticed that the people
from the colder climates are far less of a neurotic type, and in fact
it seems to me that that tendency is almost entirely absent in most
of the cases coming from the hardier climates. The emotional types
come from the warmer countries, and I believe it is because they
come from countries having a paternal government. My own experi
traum a
from
an
a d m in is t r a t iv e
p o in t
of
v ie w
59
ence has been that those who come from the countries where the
government is the most paternal are the ones with whom I have
had the most difficulty in dealing, and they are by far the most
unreasonable in their claims.
Great injury can be done an injured man by giving him too much
sympathy. While we always sympathize (for we must if we are
human) with the employee who is injured, and he of course is enti
tled to our first consideration and to the full extent of anything to
which he may be entitled, still great harm can be done him by giving
him worthless sympathy. What he needs is bracing up and manful
support rather than sympathy which makes a weakling out of him.
I am speaking now from a medical standpoint, and the men on our
boards and commissions, medical and otherwise, who will take this
attitude toward injured workmen can serve the State, the Nation,
and the employee far better than by any other attitude which they
can assume. We recognize that no injury which a workman gets
can improve him. We recognize that to break a leg or an arm
does not help that member, but for all intents and purposes, in the
multitudinous injuries which are being received every day by
employees, the recoveries are such that we could almost place them
in a 100 per cent class so far as useful restoration to society and
to the employees themselves are concerned. And while we recognize
that suggestions will not support a broken limb, after it is sup
ported and properly reduced and immobilized and recovery made,
good wholesome and supporting advice is what the patient needs
and not sympathy.
One of the most detrimental things we have to contend with in
disposing of the claims of a man entitled to compensation for injury
is the feature of overinsurance. In some of these cases it is a difficult
proposition to get the man back to work if he carries a health and
accident policy, together with a benefit insurance from his working
organization or some fraternal organization. In such cases the man
can make more money in idleness than he caji by resuming work,
and this naturally greatly increases the incentive to prolong dis
ability. It is not the easiest thing in the world to disprove dis
abilities which depend largely on subjective symptoms, for medicine
is not an exact science by any means.
Neither is it well to have the maximum amount of weekly compen
sation increased by our legislatures without giving due consideration
to the question of raising the minimum as well. I think the ques
tion of the maximum has been played too strongly, while the mini
mum has been pretty well forgotten. My own feeling is that it
would not be a bad idea to raise the minimum amount of weekly
compensation in almost every State in the Union, while the maxi
mum is more nearly able to take care of itself.
The policy tried by some employers of examining all employees
seeking employment has, of course, been brought about in an effort
on the part of employers to eliminate the defectives, but that is
almost an impossibility. When a claim can be made and based
entirely upon the far-reaching words, “ contributing cause,” it im
presses me that almost anything can come within the scope of com
pensation laws to-day, so long as the incident occurs within the
73891°—26----- 5
60
MEDICAL PROBLEMS
scope of the employment. Some who have conducted this system of
examinations in their factories feel they are able to take the selec
tive men and eliminate the defectives, and by this means reduce their
compensation costs. Were it not for the fact that it throws a great
many men out of employment, men oftentimes more skilled in their
special lines than those who may be hired to take their places be
cause of their physical fitness, such a series of examinations might be
useful in bringing to the attention of workmen certain conditions
from which they may be suffering, so that proper steps might be
taken by them ror the correction of ailments and conditions which
otherwise might not be made known to them until such diseases or
conditions become acute and result in disability to work. Some of
the large insurance companies to-day allow their policyholders to
have physical examinations made at the company’s expense for the
purpose of enabling them to check up on their physical condition
and rectify weaknesses or defects found to exist, so that this course
must unquestionably be a means of preventing illness and disability
to a certain extent, because the large insurance companies are doing
it not alone from a humanitarian standpoint but because it is a cold
blooded business proposition.
Since the passage of compensation laws the number and variety
of diseases and conditions attributed to injury or trauma has become
legion. The authors of textbooks written even a short time ago
must necessarily completely rewrite or revise their books when it
comes to the question of etiology. It often raises doubt in the mind
of a medical man whether or not the question of causation has not
been vastly overdone in the interest of proving or substantiating
claims for compensation.
Another fact that the results of trauma has brought to our atten
tion is that hospitalization can not be too good, nor medical and sur
gical services too good, and in every case there should be no limit
placed by State acts on the quantity as well as the quality of these
services. I note with considerable satisfaction that at the present
time most of the States are rapidly coming to that conclusion, and
I am sure, from the trend of legislation, that it will not be long
before every State with workmen’s compensation acts not only will
pay the weekly compensation to which injured workmen are entitled
but also will grant them unlimited medical, surgical, and hospital
services.
To summarize briefly, the subjects which have afforded the great
est sources of possible conflict of opinion are such as hernia; specific
loss of vision; occupational diseases, due either to injury or to latent
conditions; conflicting reports and testimony of examining physi
cians and surgeons; and the question as to who should have the
selection of the medical attendant, the employee or the employer.
While there are many others, these are the most common sources of
trouble with which administrators of the compensation laws are con
fronted. But while these specific factors cause many disputes, they
are rapidly becoming adjusted so that they are less fertile sources
of controversy than they were a few years ago. It is impossible for
any compensation law, any more than any other law, to be so shaped
that it will operate automatically, but I believe t^ 1 compensation
laws arrive at justice in a more direct and simple way than the old
TRAUMA FROM AN ADMINISTRATIVE POINT OF VIEW
6 1
complicated system of common law, and while they are not perfect
we believe we have made a closer approach to that state in aiding
injured workmen than any other system which has yet been devised.
In closing I might say that the best way to alleviate the results
of trauma is to give the injured workman full and unlimited medi
cal, surgical, and hospital services. Do not encourage the fellow
who seeks a few dollars’ compensation to the detriment of his own
physical and mental well-being when he ought to be working and
rehabilitating himself. In this respect I agree with Doctor Albee,
who said that the best way to rehabilitate an injured man and to
bring about his recovery (and that is the chief aim of all compensa
tion laws) is to get him into a proper state of mind and have him
resume work as quickly as possible, and then we will be rendering
the greatest service to the employee, who is our first consideration,
and to society in general.
The C h a ir m a n . The fourth and last paper this morning is “ Phos
phorus necrosis of the jaw,” by Dr. Robert P. Bay, of the State
Industrial Accident Commission of Maryland.
Doctor B a y . In Maryland we have had several cases of phosphorus
poisoning which have caused quite a little notoriety. We had one
case in which the lower court decided that it did not come under the
compensation commission, but this decision was later reversed by the
court of appeals. I will read you just one paragraph, which I
believe covers the subject:
The phosphorus poisoning of the girl was contracted in the course of and
arising out of a hazardous employment, at a particular place and within a
known and definite particular period of time.
That was enough for the court of appeals to rule that it was an
accident and did come under the accident commission.
PHOSPHORUS NECROSIS OF THE JAW
B Y ROBERT P. BAY, M. D., CHIEF MEDICAL EXAMINER, MARYLAND STATE INDUSTRIAL
ACCIDENT COMMISSION
In presenting this short paper, it is my desire not to convey any
new ideas, but chiefly to refresh your memory with certain wellknown facts which we feel to be of special interest. Phosphorus
necrosis of the jaw, occurring mostly in the manufacture of matches,
has been described by writers in other countries. Its occurrence was
first observed by Lorinser, of Vienna, who published a paper upon
the subject in 1845, recording cases which occurred as early as 1839.
In 1846 Doctor Wilks, of London, published a paper upon the sub
ject in Guy’s Hospital Report. Later on cases were reported by
both English and continental surgeons between 1862 and 1865.
Cases were reported at this time in which the entire lower jaw, or
portions of it, were removed by Drs. William Hunt and C. S.
Boker, of Philadelphia, and one notable case by Dr. J. C. Hutchison,
of Brooklyn, in which the entire upper jaw, with the malar bone,
was excised. There has been considerable literature written on
the subject, and all textbooks on surgery contain a rather full account
of the disease.
According to some writers, phosphorus necrosis of the jaw is due
to the constant exposure of the periosteum of the upper or lower
jaw to the phosphorus vapors. Others say that phosphorus poison
is not a local condition of the jaw but is a systemic disease affecting
the whole skeletal system, with predilection for the jawbones. Mar
shall states^ however, that there seems to be no fact in pathology
better established than that the disease is the result of local poison
ing produced through some break in the continuity of the structure
of the mouth which permits the poisonous fumes to come in contact
with the periosteum. Most writers say that five years is the average
time before the first symptoms of phosphorus necrosis become mani
fest. However, the symptoms may make their appearance a few
months after the patient engages in his work or they may not appear
tor 10 to 15 years or more. Many workers who have given up their
positions and taken some other work showed evidence of the disease
later on in life
The preexisting condition seems to be morbid state pi the peri
osteum, which under an exciting cause readily inflames/ The excit
ing causes are found in the teeth—a carious tooth with the pulp
exposed, which structure by some of its tissues is continuous with
the peridental and perialveolar membranes, and tartar accumula
tions may give rise to an irritated and sensitive condition of the
borders of the reflected periosteum. It is a matter of observation
that the periostitis, which develops in connection with other causes,
with the exception possibly of syphilis and mercurial poisoning, is
in many cases of a*local character, whereas that which precedes phos62
PHOSPHORUS NECROSIS OF TH E JA W
63
phorus necrosis is, as a rule, general, passing rapidly, unless inter
fered with, to involvement of the entire bone.
Phosphorus necrosis presents anatomically all the typical changes
leading to the death of the part en masse. The process is more rapid
than ordinary necrosis. After the specific inflammation is excited
in the periosteum there is formed laminated layers of new bone
which envelope the jaw, stopping at the borders of the alveolar
process in front and behind, but completely surrounding the angle,
ramus, and processes. Osteophytes form both upon the outer sur
face of the bone and within its substance. The affected bones un
dergo a process of drying, or sclerosis, on account of interference
with their nutrition by the newly formed structure. The bone may
become rarefied, due to reabsorption of the osteophytes. Thus the
bone may become very dry, thin, and brittle. The periosteum peels
easily. Suppuration finally sets in, due to some infection carried
down into the deeper structures by way of a pulpless tooth. The
suppurative process spreads until it may involve the entire bone. In
75 per cent of the cases there is complete necrosis of the bone; in the
remainder the necrosis is partial. The pus burrows its way between
the bone surface and its periosteum, and escapes, usually through a
sinus in the neighborhood of the lateral or first molar tooth. The
muscles attach themselves to the periosteum covering the new bone
and are lifted off, as it were, with that membrane. The sequestrum
(is inclosed by this newly formed bone. The mandible is affected
more than the maxilla—5 to 3 according to Hirt, and 9 to 1 according
to Thiersch. Out of 16 cases Mears reported 11 in the lower jaw
and 5 in the upper jaw. In 3 cases both upper and lower jaw were
affected.
Symptoms of phosphorus necrosis differ from those of ordinary
necrosis mainly in intensity. The odontalgia, which is one of the
early symptoms, is at first intermittent but in time becomes continu
ous. It is also more diffuse, from the first involving the entire bone.
Swelling and tenderness are found in the regions of the alveolar
processes. A tooth or teeth may be removed, but the pain does not
cease. Very soon suppurative periostitis manifests itself in the peri
alveolar and peridental membranes, causing the teeth to become
loose and pus to exude from the alveoli. The inflammation quickly
extends, involving the structures of the gums and detaching them so
as to expose the alveolar border. The surrounding soft parts swell,
become tender, pus and saliva dribble over the inflamed lower lip,
and there is an odor like garlic. The face becomes swollen, reaching
to the lower lip, and mild inflammatory symptoms are present over
the skin of the face, resembling erysipelas. The jaws become par
tially ankylosed. Numerous small abscesses may form on the jaw
margin. The gingiva is separated from the teeth, the bone is de
nuded of its periosteum and is covered with a greenish yellow putrid
material. Large sequestra of bone may be expelled, occasionally the
whole mandible may be cast off. The process lasts from a few
months to a few years, the average duration being three years.
When the inflammation reaches the condyle of the lower jaw great
pain is experienced in the ear of the affected side. The occlusion
of the jaws, which before may have been partial, now becomes com
plete. The interference with the ingestion of proper food, owing
64
MEDICAL PROBLEMS
to the condition of the mouth, the suffering endured by the patient
associated with the constant presence in the mouth and the swallow
ing of the offensive discharges from the dead bone, all combine to
deteriorate in a marked degree the general health of the patient.
I f the maxilla is involved, necrosis is more dangerous than in the
mandible, because meningitis or brain abscess may ensue. Unless
proper remedial measures are resorted to death may ensue from ex
haustion, or, in very severe cases, from gangrene of the overlying
soft structures.
Prevention of the disease consists of thorough ventilation of the
rooms in which the phosphorus is handled, cleanliness of the fac
tories, with the proper care and treatment of the teeth of the op
erators, and teaching them habits of personal cleanliness. Factory
employees should not eat or drink in their workrooms, and by at
tention to their hands and to their finger nails should avoid carrying
any phosphorus into their mouths. Where proper precautions are
observed phosphorus necrosis is rarely seen. Experience has provei
the value of turpentine in neutralizing the toxic effects of the pho? •
phorus fumes. Wide-mouthed bottles containing this agent are woi n
strapped around the neck and resting on the chest ready for the
inhalation of the vapor.
Treatment may be divided into three stages—primary, inter
mediate, and secondary. The primary stage may be described as
that in which the periosteum in its morbid condition manifests
the results of beginning irritation. The workmen rarely present
themselves for treatment in this stage. Pain in the bone of a
diffuse character, intermittent in occurrence, with the sensation of
protrusion of the teeth, soreness in the gums, with hemorrhagic
transudations during mastication, or upon the use of a toothpick,
are the chief symptoms present in this stage. I f the teeth are exam
ined tartar may be found collected around the gum margins, while a
softened condition of these structures, with a discoloration of a pur
plish hue, may be present. The teeth should be carefully looked at
and those that are too far gone should be extracted. Tartar should
be carefully and thoroughly removed. Astringent solutions such
as alcohol, tincture of myrrn, etc., should be used to bath the teeth.
Constitutional treatment should consist in the administration of
anodyne remedies to relieve the pain and soothe the general system.
In the stage which is designated as intermediate, in which the
inflammation of the periosteum is well established, the plan of treat
ment should be such as to arrest, as far as possible, the inflammatory
action and thus limit the destruction of bone. Free incision of the
periosteum to the bone should be employed, using internal and exter
nal remedies to assist in combating the inflammation. Effort to
arrest the progress of the disease in this stage is usually without
avail, the condition seeming to resist any successful interference.
When the inflammation has passed to the suppurative stage and the
death of the bone accomplished, the treatment should be as fol
lows: Cleanse the mouth with warm water, after which dilute
solutions of carbolic acid, iodine, or KMn04 should be applied
around the exposed bone with a syringe to disinfect the parts and
remove the collection of pus. A layer of iodoform gauze should be
packed around the exposed bone to receive the secretions and pre
PHOSPHORUS NECROSIS OF THE JA W
65
vent as far as possible their escape into the mouth and mixture with
the food. If sinuses are formed they should be cleansed by injec
tions of medicated solutions and dressings be put on. Use no poul
tices or warm applications in this stage, as it simply increases puru
lent formation, produces sinuses, and consequent disfigurement.
Many surgeons still believe that we should wait until the seques
trum has formed before interfering surgically. It was discovered,
however, that many patients do not survive long enough for the
sequestrum to form, so early resection has been practiced lately, the
excision of the bone being carried into the healthy bone tissue as far
as possible. Even though the early resection is done, the disease may
still go on, and in the end deformity may be greater than if complete
sequestration had been waited for. If early resection is done, it
should be done subperiosteally and in the intraoral route. This will
be found practical in nearly all instances. The process of regenera
tion of the removed bone, where the periosteum is in healthy condi
tion, continues for a long time after the operation. Even the maxilla
may regenerate, though not as completely nor as perfectly as the
mandible. Should complete necrosis of the mandible occur, the
sequestrum should be permitted to remain so as to prevent recession
of the chin. This forms a framework about which new bone may
develop, and thereby the contour of the face is preserved. When
sufficient lamina and new bone have developed, the sequestrum is
removed through the mouth, care being taken not to fracture the
new bone. When the disease has invaded the condyloid and caronoid processes of the lower jaw, the disarticulation is easily affected
after incision of the structures in front of the ramus. It may be
well sometimes, when the entire jaw is involved, to remove only half
of the lower jaw at a time, and then later on, in about eight weeks,
to remove the other half. When the sequestrum has been removed,
iodoform should be packed between the two lamina of new bone, and
each time the amount of gauze should be lessened so as to permit
approximation and consolidation of the bone plated. After removal
of the sequestrum in the lower jaw a bandage should be applied so
as to support the new jaw. After removal o f same in upper jaw, the
same form of dressing should be used until the cavity is closed by
the fibrous tissue which forms, as a rule, in place of bone. I f the
sequestrum is expelled before new bone forms, a prosthesis should
be employed. Along with this surgical treatment preparations of
iron and quinine, concentrated food, open air, and other hygienic
surroundings should form an important part of treatment.
In conclusion, the cases occurring in Maryland have all developed
in one plant. They had been exposed for xrom one month to three
years before the symptoms occurred, and the original symptoms
were all local and not constitutional. In every case necrosis devel
oped following some open lesion, such as a bad tooth or a cavity, the
result of an extracted tooth. I believe that certain precautions
should be used to prevent the direct introduction of phosphorus into
the tissues, such as inspection of the mouth and nose, with special
care of the teeth, which should be cleansed before and after eating.
The signs at present posted around the plant apply to the swallow
ing of this poison rather than to the inoculation. I also believe
that operation should be performed at once and the diseased bone
66
MEDICAL PROBLEMS
removed and the cavity drained. Needless to say the patient should
not be allowed to come into contact with phosphorus until he is
entirely healed. The process as a rule is very gradual, due to the
slow action of the phosphorus fumes and the quantity which attacks
the exposed bone.
Treatment of the disease in the primary stage is efficient and pre
vents its progress. In the intermediate and secondary stages the
treatment lies within the judgment of the individual surgeon as to
whether conservative or radical measures should be employed.
[On motion duly made, seconded, and carried the privileges of
the floor were extended to Walter H. Monroe, of Alabama, although
Alabama is not a member of the association.]
DISCUSSION
The C h a i r m a n . These papers are open for general discussion.
At the conclusion of the general discussion the readers of the papers
will be called on to close the discussion. As Doctor Bay’s paper
is to be discussed this evening, the discussion will be on the first
three papers read.
Doctor M c B r id e . I would like-to ask Doctor Bay whether or not
in the cases of phosphorus poisoning occurring in his State, and
with which he is familiar, blood examinations were made; and if so,
what the blood pictures showed ?
Doctor B a y . Unfortunately, these cases occurred in a small town
where the hospital facilities were not sufficiently great, and my con
nection with them was simply in consultation. A blood picture
was made in two of them, however, but it did not show anything
but secondary anemia. The culture was not made. The leucocyte
count, if I remember correctly, in the highest was 12,000, with mild
secondary anemia.
The C h a i r m a n . Inasmuch as Doctor Bay will not be here this
evening, are there any questions that you wish to ask him at this
time before we go on with the general discussion ?
Mr. W i l c o x . I would like to ask Doctor Bay the nature of the
industry in which these cases occur. I do not care to have the name
of the industry.
Doctor B a y . Mr. Stewart, who is down for discussion of this sub
ject, will cover that much more thoroughly in his discussion than I
am capable of doing.
Mr. S t e w a r t . I recognize my incompetency to discuss the papers
that have been read this morning from the viewpoint of the gentle
men who read them. I understand the meaning of only about one
word out of five that has been used in the papers, and all I want to
do is to call attention in a general way to the medical aspect of com
pensation work as it has revealed itself in the meetings of this asso
ciation.
Year after year we sit through the medical sessions of the conven
tions hearing the workingmen denounced as frauds—not universally,
it is true, perhaps not even in a majority of the papers read, though
I think it would figure more than a majority, particularly when
hernia or back strain comes up for discussion. Of course we all know
DISCUSSION
67
that, back and spine troubles are our greatest difficulties. They are
the things upon which we most need information and enlighten
ment from the doctors, but do we not need to be schooled in broad,
general principles, particularly in the matter of back strain?
I am neither a scientist nor a physician, but let us assume, what
most of us who have studied the matter at all believe to be true, that
man is a man by virtue of the fact that in some distant past the
creature from which he has grown learned to stand on its hind legs,
thus freeing its arms, so that instead of trying to butt with its head
it could throw stones at its enemy or at the animal it needed for
food but could not otherwise catch or kill. This freeing of its hands
was the beginning of its use of the bow and arrow, and of all those
other methods of attack and defense which differentiate man from
other forms of life.
With the use of the hind legs for standing and the freer use of the
hands began the development of an entirely artificial animal, by
virtue of which the back became his weakest part. By the use of
his hands, guided by his brain, man developed from an inferior and
inconsequential part of the animal world to that position about
which he spends most of his time nowadays bragging, and in the
process put a strain on his back. I f that is true, and I think the more
we study it the more we will believe it is true, there is a natural
weakness in the spine, not because of our work but because we are
men, and I wonder if, after all and particularly in these special
studies of individual cases, we ought not to consider that an artificial
animal in an artificial job, in an artificial world which he has created
with his hands, guided by his brain, and at the expense of his back
may not produce a condition of the spine which is largely, if not
entirely, the result of his occupation—of the posture he must assume
during his working hours.
The real difficulty, as I see it, is that the physician studies an
abstract condition as it exists in an individual case at the time he
makes his examination. He finds a condition that could and in many
cases does develop by reason of age, and with which occupation seems
to have nothing to do.
We give all the glory of this artificial thing we are and the arti
ficial things we do to the brain and the hand, while the fact that the
bony conformation of the spine has been trying to adjust itself to a
new position has been given no recognition. Everything upon
this globe which has been built by human hands, guided by human
brains, is at the expense of the human back. To begin with, the
very fact that we are bipeds throws all the bodily strain, or most
of it, upon the back. We go into the mines and quarries, and with
bent, cramped, distorted backs we free the ores, the marble, and the
granite, from which later on, wrought by the hands or by machinery
built by human hands and tools constructed by human hands, are
erected the buildings and the statuary which we call our wealth.
The hand, guided by the brain, constructs the tools to make the ma
chinery, and builds the machinery that creates and distributes our
billions of dollars of wealth. We can do these things because we
stand erect, but we stand erect at the expense of the back. Let us
not forget that every dollar of wealth, everything of joy or of
artificial beauty, comes from the toil of the hands and the pain of the
back.
68
MEDICAL PROBLEMS
The story and pictures of Atlas bearing the world upon his back
is to the workingman not mythology, but truth. Crouched upon his
knees, his head erect, his hands free, his face writhing, he shows the
awful anguish of bearing the world upon his back. Not only that,
but if it is true, and we believe it is, that man began to be a man—
as we understand the term “ man ”—when he first learned to stand
on his hind legs and free his hands, then consider what he has done
to himself at the expense of his back.
The marrow of the human spine must build and maintain a brain
five times the size of that with which it started. From a general
stature of two and a half feet man has grown to a race size, par
ticularly among the Nordic races, of twice that stature, and no
where to-day, except among the Pygmies of Africa, are there crea
tures which we would be willing to call men who are anywhere near
the size man started with, and all this at the expense of the back.
I grant you all you may say—that there are no outward evidences;
that there are no bruises, no lesions; that “ all the symptoms are
subjective ” ; that only his face writhes, only his nerves twitch, and
that “ these symptoms may be easily simulated by anyone.”
There is not a day but tfiat thousands of men appear before State
compensation commissions asking for medical aid or money com
pensation for back strain. The physicians are called in and two
or three hundred out of every thousand such men are turned away as
frauds. I do not believe they are frauds.
A condition arises which may not be the result of a single blow,
an immediate accident, but in which there is a continuous, an un
natural, abnormal hammering, blow upon blow, upon that point
that ought to have rest. Is not that a situation growing out of
the man’s occupation? Is it not a condition which, while common
to all, is made infinitely worse by a man having to work in a
coal mine, especially a thin-seam mine, by a man having to shove
a wheelbarrow loaded to the limit, for 8 or 10 hours a day? Do not
these occupations produce a condition of the spine at 35 or 40 years
of age that would not ordinarily have arisen before 60 or 70 years,
and were not the compensation laws designed originally and in
tended to take some cognizance of this very fact? Some of these
claimants may, of course, be frauds.
I am past 68 years old and I do not remember a day nor an hour
when I did not have the backache. But, you say, that was not the
result of trauma. I grant you that, except the trauma that comes
to every back because of the fact that we stand upon our hind legs;
but suppose I was a hod carrier or a ditch digger, would not the
greater pain be the result of occupation?
Certainly with all the billions upon billions of wealth the hands
have created we can afford to be reasonably liberal when the shouts
of pain come up from the back which sustains it all. Somehow or
other, it seems to me some of the doctors do not quite get the view
of the compensation laws which I have been forced to take as I
have studied the whole situation.
Mr. C l a r k . The reading of these papers has brought to my mind
something I had very forcibly impressed upon me at San Francisco,
namely, the lack in our commissions of an accumulation of medical
knowledge. We as commissioners know that three-fourths of all
DISCUSSION
69
the problems we have to meet are legal or medical and much more
medical than legal. We also know, and some of us have learned
by experience that only the best physicians are of much help to us.
We are hindered and hampered more by physicians than from any
other source I think, and at the same time we are helped more from
that same source than from any other.
In our departments we publish bulletins (at least, we do in Ohio,
and I presume most of the jurisdictions do the same) giving the
decisions of the commissioner. Some of them are written up in
great detail, and some of them are short, but I have never yet seen
any separate volumes devoted to medical questions, all of which are
live questions, and mean so much to the medical departments we
maintain.
In our department we have seven or eight physicians, who have
their suites of rooms and their clerical forces and their reviewers
and all the equipment we can give them to reach medical conclusions
for our assistance, and yet when the report of this convention or
this association is published, it will probably be sent to the commis
sioners. In it will be all the discussions of all the subjects that
have been discussed at this meeting. What could be of more value
to our commission than to have the marvelous papers which have
been read here this morning taken into our medical departments,
with instructions that each one of our physicians make a careful
study of such papers. They would be glad to do it, because there
has not been a paper read this morning that has not dealt with one
of the most live and most difficult questions we have to consider.
Our doctors do not get that discussion from the outside; they do not
have the value of such papers as the one read here on back injuries,
a subject which has troubled commissioners more than any other,
and the ones on traumatism, in which there is more fraud per
petrated than in any other branch of compensation administration.
What this association is for, I take it, is to get information and
assistance to those administering the law. I should like to have
these papers printed so that I can take them in to our physicians
and say, “ I f you are not interested enough to make a careful study
of that little volume containing the medical part of the program
at Salt Lake City, you ought not to be in this department.” I
would like to be in a position to say that to every physician I have
in my department.
I am connected with three or four national conventions and have
a bushel basket full of annual reports that I have merely scanned,
because I am not interested in the bulk of the matter after it is
in print, but I would be intensely interested as a commissioner, and
my physicians I am certain would be much more interested, if the
medical part of this program could be printed in a separate volume
for the benefit of the medical departments of our commissions.
Mr. S t e w a r t . I want to say that it seems to me to be asking a
good deal, in view of the fight that the Bureau of Labor Statistics
has to get an appropriation to print anything at all, to ask us to
separate these subjects and get out separate bulletins on each. If
the physicians of the compensation commissions do not know what
is in these, proceedings, they have not taken sufficient interest to
find out, We can not go on increasing our printing expense, which
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MEDICAL PROBLEMS
is borne by the Bureau of Labor Statistics alone, in this manner.
We supply as many copies of these proceedings as are requested.
M r . M c S h a n e . I want to call attention to the resolution of the
Halifax convention dealing with medical problems—the problems
which were made the heart of this convention and given expression
in the splendid papers you have heard here. We have called the
attention of the various physicians and surgeons with whom we
have come in contact to the reports of our proceedings, and we
will be glad to furnish copies to any who inquire. All you have
to do is to apply to the secretary-treasurer and they will be fur
nished. We have an index, and you can send and get what bulle
tins you please.
Mr. K i n g s t o n . With reference to what Mr. Stewart has said and
the importance of the matter that we hear at these conventions, I
wish to say how much I have appreciated, during these past 10
years of attending these conventions, getting the stuff across that
we hear. I have gone to the trouble of taking the proceedings of
these last 11 years and binding them in two separate volumes, and
have prepared an analytical index of my own (it was done before
this printed index came out), so that I am now in a position when
at home to refer in an instant to discussions such as we have had
this morning that have occurred at the conventions during the past
years. I commend that to the commissioners here; I am sure you
will find it a very helpful plan.
I wish to ask a question of Doctor Landenberger with reference to
sacroiliac cases. We have a large number of back cases and some of
them come to us diagnosed as sacroiliac trouble. That is the term;
possibly that does not mean a great deal, or the doctor in saying that
does not know exactly what he means to convey, but at all events
it is suggested that this man has sacroiliac trouble. The X ray
may be negative so far as any disturbance of the joints is concerned,
but the pain is in the region of the sacroiliac joint, and so it comes
to us as a sacroiliac trouble.
I wonder if the doctor, in referring to infective diseases of the
spine, had also in mind that a large number of these troubles which
come to us diagnosed as sacroiliac-joint troubles are probably in
fective diseases of that joint as well. In other words, Doctor, do
the remarks which you have made regarding spine troubles apply
with equal strength to the sacroiliac joints?
Mr. B r o w n . Referring to the matter of the publication of these
papers, I realize the wisdom of the suggestion of Brother Stewart
concerning the publication of them in our proceedings. On the other
hand, considering the suggestion made by Mr. Clark, of Ohio, that
each particular profession has its particular literature, I wonder if
we could not prevail upon these able physicians who have given us
such excellent papers to have these papers appear in the medical
journals which circulate among the physicians who ought to have
such papers. My idea is to get them into the hands of the doctors
who will not, perhaps, get them from our proceedings. Might not
that answer the question?
Doctor B a y . It does not seem to me that the last suggestion is
quite feasible. The papers read here are put in the simplest form
DISCUSSION
71
for both the layman and the physician, and they probably would not
be accepted as highly scientific medical papers.
What Mr. Stewart has said is very true, I believe, in so far as
the men connected with accident commissions and boards are con
cerned. I do feel, however, that each doctor presenting papers here
should have a certain number of these reprints for himself to send
to the physicians in his State and in other States doing that line
of work. In that way it may help at least to spread the gospel of
this industrial surgery. That is the only way I can see to meet the
situation in a practical way.
Mr. S t e w a r t . Within reasonable limits we can handle the reprint
situation. I believe the Halifax convention asked that two or three
or possibly four of the medical papers be printed separately and
sent out. After your report is in type ready to print, the expense
of taking out a few pages and printing two or three thousand extra
copies is not great, and within limits I am perfectly willing to do it,
and do do it right along.
Mr. W a l n u t . The first question I want to ask of Doctor Tyree in
reference to cancer is how he would apply his information on the
subject to a typical case; for example, the case of a woman who has
cancer of the breast, and who, before the board, attributes it to a
fall of some sort and a blow, followed by a bruise, with subsequent
pain, and an ultimate diagnosis of cancer of the breast. I would
like to know what period of time he thinks should elapse between
the date of the alleged injury and the development of the cancer,
and what emphasis he would put upon the various phases of her
story. In the same way, I would appreciate learning the emphasis
he would put upon the development of tuberculosis from an injury.
For example, take a young man in his twenties who meets with an
accident in a coal mine, due to an explosion, and the obvious in
juries are to his leg and his arm, but he also testifies that he had pain
in his chest. He is disabled about four weeks, then goes back to
work, and within six months has developed a case of tuberculosis.
Then as to the question of back injuries we have case after case,
of course, of back injuries in which doctors testify on both sides,
those on one side attributing the condition entirely to the man’s
physical condition and some infection and those on the other side
saying, “ Yes; that is probably true; but the particular strain or
twist that the man was subjected to and which he alleges to have
been the source of his trouble had an exciting effect upon the pre
existing conditions.” Under our statute we sometimes grant com
pensation. As I understood Doctor Landenberger, he would not
attribute any importance at all, or very little, to the exciting cause
of this aggravation.
Then, in connection with Doctor Donohue’s paper, we have cases
of men who have been injured—probably a spinal injury or some
other rather severe injury—and never go back to work again. We
have them examined fully and completely by physicians. I had a
case of a man who has not been at work lor three or four years. I
brought him from the western end of the State, where he had been
examined by many doctors, to the eastern end, where they did
nothing at all about him. We had him in a hospital under examina
tion, and the doctors reported negatively on any possible obvious
72
MEDICAL PROBLEMS
disability. Yet the man has not worked for three or four years,
and so far as I know has not since gone back to work. That man
had been a good workman for maybe 20 years. Is that a com
pensable disability? That is a question that has frequently occurred
to me.
Those three questions are the kind of questions we face and, I
presume, the kind of questions that other board members also face.
The C h a i r m a n . I f there is further discussion we will be glad to
hear it. I f not, we will call upon the readers of the paper to con
clude the program. Doctor Tyree.
Doctor T y r e e . I realized when I had finished my paper that I
had not said all I wanted to say or could say on this subject.
In answer to the gentleman’s questions about cancer of the breast
and its relationship to injury, I have, in my experience as a surgeon,
seen quite a few times that very condition which he mentioned, and
the answer to it is this: The woman gets a blow on her breast and a
short time afterwards, or maybe immediately afterwards, she dis
covers that she has a lump in her breast. She goes to her doctor and
he makes his diagnosis. For the sake of argument we will say it
is a cancer, and that she is operated on and either gets well or dies
from it. Then it comes up as a compensable case. We all know that
people have many benign lesions or even beginning or far-advanced
cancers of one sort or the other which are more or less painless.
Many times, for instance, we have had patients in our office with
far-advanced carcinoma of the stomach or of the large intestines,
which we saw were inoperable. Just so with the case in question.
The woman may have either a benign tumor or a carcinoma in the
breast. An injury which she received may either just call attention
to the fact of this trouble, or it may, as I noted in my paper, set up
the really wild character of this formerly benign tumor and cause
it to become carcinomatous.
One has to go into the history of such a case as that very carefully
to know, and sometimes it is indeterminable. A patient you have
never seen before comes to you a week or 10 days after a blow on the
breast and gives evidence of the trauma already there. I f the
tumor is then a carcinoma you can be very sure that it was a car
cinoma before she was hurt. If she does not come to you for, say,
three, four, or six months after she had this injury and then the
tumor is a carcinoma, you can not say which one of three things
this woman had before she was hurt—a perfectly normal breast, a
breast with a benign tumor in it, or one with a beginning carcinoma.
It would be impossible really to say in that case.
That is one of the things to which I tried to draw attention in my
paper. Sometimes we are up against insoluble propositions in these
cases of injury, particularly in those which come to us a long time
after the injury is done.
In the case of tuberculosis, it is a rather common story too—not
so much in our part of the country as in parts where there is more
tuberculosis of the joints—to have a man who is more or less below
par receive an injury to his knee and then after three or four weeks,
or maybe a longer time than that, develop tuberculosis in that knee.
It is beyond any doubt that this man was tubercular before he re
ceived his injury.
DISCUSSION
73
Mr. W a l n u t . In the particular case I had in mind, the man
had tuberculosis of the brain; would you connect that with any
trauma ?
Doctor T y r e e . Well, it is a pretty hard thing to say. Tubercu
losis primarily in the body is certainly not a traumatic disease, but
that tuberculosis almost anywhere in the body, even tuberculosis of
the lungs, can be lighted up by the scattering of the tubercle bacilli
from their insistent situations we must all admit.
That subject has been rather widely discussed by Doctor Morehead, of New York City, who has written a large volume on trau
matic surgery, which ought to be in the hands of the physicians at
tached to all of your offices. He cites a case or two which has come
under his observation that looks very much like a spreading of
tuberculosis in the lungs by an injury.
As I indicated in my paper, I should think that in order to start
tuberculosis of the lungs from injuries, such injuries would always
have to be injuries of the chest, but that there is always some tuber
culous focus in the body before there is a lighting up of acute tuber
culosis following a trauma is, I think, indisputable. Tuberculosis
does not follow an injury without an already existing tuberculous
state.
There is just one other thing I would like to say. I have been
writing and talking about sacroiliac troubles now for quite a long
time, and I see a lot of such cases. I am pretty sure in my own
mind that the majority of the sacroiliac cases, as I see the non
industrial, are traumatic, and I want to say that the X-ray picture
of the sacroiliac slip, or sacroiliac subluxation as it is called, is
almost worthless from a diagnostic standpoint. The sacroiliac joint
is the poorest joint in the body. Instead of it being the arch that
it should be, apparently, as our friend on the right [Mr. Stewart]
here explained, when man assumed the upright position his sacroiliac
joint was the big thing that suffered. It is the joint which joins
the spine to the pelvis. Formerly it was jointed at right angles.
Now it is supposed to fit into the upright procedure, and the sacroil
iac joint, instead of being the arch that we find in architecture,
is just the reverse; it is an inverted arch and the sacroiliac joint is
held rigid by the ligaments which grow over it and not at all by its
construction, and it is subject, I think, to as much trauma as any
other joint in the body. I think that the great majority of the peo
ple that I see complaining of sacroiliac troubles have their troubles
brought on by injury, and I think that because of the great success
which I have had in treating those cases by the system of manipu
lating them. There is no question but what there is inflammatory
trouble of the sacroiliac joint.
Doctor L a n d e n b e r g e r . In regard to Mr. Kingston’s question rela
tive to sacroiliac injuries and diseases, I was given as a title to my
paper in your program, “ Trauma as a causative factor or aggra
vating factor in diseases of the spine.” This was such an exten
sive subject that, of course, justice could not be done it in 20 or 30
minutes, and so I changed that title to “ Chronic infectious hyper
trophic arthritis of the spine,” giving only a monograph. I did not
mean to take up the subject of the sacroiliac joint in it.
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MEDICAL PROBLEMS
Doctor Tyree has given you a discussion on the sacroiliac joint.
In the reading of articles "for the preparation of my paper, Mr.
Kingston, I ran across a very clever X-ray article on sacroiliac joint
disturbances which I will be glad to give you before you go. The
author, who has taken many pictures of sacroiliac joints, has come to
the conclusion that the slip or the separation, so-called, of the
sacroiliac joints is a myth, that it does not exist. In his X-ray pic
ture he can apparently produce at will, by direction of his X ray,
the condition that we all read of as a separation or a slip.
Relative to the question as to the hypertrophic rigidity of the
lower spine and involvement thereby of the sacroiliac joints, I do
not think there is any question that the hypertrophic condition of
the spine, when it goes on to a complete rigidity, not only involves
the bone, the vertebra, but also includes a calcification of the liga
ments all about the spinal column. Those ligaments run over to the
sacroiliac joints, and I think the sacroiliac joints may easily be
involved.
Mr. Walnut’s question is as to the exciting or aggravating effect
of trauma upon a chronic infectious hypertrophic arthritis of the
spine. I did not have so very much time in which to prepare my
paper, but I did a great deai of reading for it and I have had a
lot of experience with bone accidents and so forth. The ordinary
man who sustains a sprain to the back from lifting, or a contusion
of the back from a blow upon the back, and who has no definite
signs of trauma recovers from that acute condition in a month or
two or three.
I do not want to be unfair to the workman, but nevertheless it
constantly occurs with us that the man who has trouble with his
back and complains of a traumatism is, 99 times out of 100, an
industrial worker, and if he is an industrial worker, 99 times out
of 100 when he comes to a physician with back trouble he connects
it with the history of an injury. I do not know just why that is,
but I think it is because of the lure of the compensation, the insur
ance and the continuation of pay. The workman in this country
has a mighty hard time to get along, no matter what his occupation
may be he is making only enough to support his family, and when
he lays off because of injury or illness, and especially illness, he gets
no compensation and he wants it.
There is no question in my mind but that the industrial worker
does give a history very much more frequently, a hundred times
more frequently, in connection with back trouble when there is no
injury, than other people do.
Mr. W a l n u t . Do you think it possible, Doctor, than an injury
can be an exciting cause?
Doctor L a n d e n b e r g e r . If the injury is an exciting cause, if the
examination of the particular case of chronic infectious hypertrophic
arthritis of the spine with the history of an injury shows in any
possible way a connection with traumatism different from the fellow
who has the exact condition of the spine without the history of an
injury, then I say he ought to receive compensation. If the man
who gives the history of an injury has no different pathological find
ings or X ray findings than the man who does not have the history
of an injury, and you do not find that the man who gives the his
DISCUSSION
75
tory of an injury has any traumatic signs or evidence, I do not
believe he is entitled to compensation under traumatism.
Doctor D o n o h u e . I think the question which the gentleman from
Pennsylvania asked was whether or not a neurosis traceable to
trauma would be classified as a compensable condition or injury.
Is that the point?
Mr. W a l n u t . That was the point.
Doctor D o n o h u e . As to our State, I can answer that briefly by
saying, “ Yes.” Of course a trauma that causes a neurosis is un
questionably compensable.
M r . M c S h a n e . I should like to see hands f r o m all the States
where that is the law, where it is clearly and definitely established.
[Seven hands were raised.]
Mr. W a l n u t . Let us understand just what is meant by the ques
tion.
Doctor D o n o h u e . Maybe I do not get what you are after.
Mr. W a l n u t . In one place you have a man who has worked 20
years; he gets hurt and is knocked out for maybe a year from some
injury or other. He does not then go back to work, but insists
he has had trouble in his back or trouble somewhere. The doctor,
however, can find no reason for it and says he is a malingerer. He
has had a history of 20 years of industry and then he quits and
says he can not work any more. The doctor says that is an attitude
of mind and not physical, but is that attitude of mind a compensable
matter ?
Doctor D o n o h u e . I should say that that is a question of fact
and then a question of diagnosis on the part of the medical man.
If you believe the medical men whom you are employing, there is
no question about it at all; that is not a compensable condition.
In that connection I might cite an instance I ran up against, as prac
tical lessons are probably the most useful. I had a man of that
type who received what he claimed to be a strain; he was from the
southern European countries which I spoke about in my paper.
Every time that man came into my ofiice he would tell me he could
not work, that his back was no good. I tried to offer suggestions
to him to see if he would not go to work. He would say, “ No good;
can’t do anything.” That is all I could get out of him. I was not
satisfied. I sent him to the best orthopedic man and he found no
pathology. I also sent him to a neurologist, a nerve specialist—a
psychiatrist, I should call it—and he said the man was disabled. I
was not very well satisfied with the diagnosis; I thought the man
ought to work. He continued that performance for two years,
dropping into the office probably once or twice in two weeks. I got
so disgusted with him that I said to him, “ Now, my friend, I think
you have gone far enough. There is nothing the matter with your
back; you are in a condition where I think you ought to be working,
and I am going to see that your compensation is ended if you do
not go to work within the next two weeks.”
Because of that strong suggestion made by me to him, that man
went to work within the next two weeks and has worked, continu
ously for five years and there has been no trouble with him,
73891°—26------ 6
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MEDICAL PROBLEMS
I think false sympathy is the poorest thing that can be given an
injured employee. Muscular soreness should not stop a man from
working. A muscular pain in the back should not prevent a man
from working. I think that there are none of us 100 per cent
perfect. I quite sympathize with Brother Stewart’s ideas on our
prehistoric ancestors and the way we have evolved, but I am afraid
he feels that we doctors are inclined to be hardhearted toward the
fellow who is hurt. That is far from the fact. The doctor will
go farther than anybody else to compensate the fellow who is
actually injured, but he will resist attempts of the fellow who thinks
he is injured and does not want to go to work to draw compensation,
because that man is no good to his fellow workmen; he has a bad
effect upon the rest of his fellow employees. Those fellow employees
will come and tell you that he is putting it over on you. After
you have watched these men for a dozen years, you find that there
are quite a few of them who put it over on the commissioner.
The tendency of the lay commissioner is to be very sympathetic.
It is natural; we should be and we want to be; we want to give
the fellow who is hurt everything; but I tell you it is false sympathy
to be giving him money when he ought to be working. I find very
few of us who do not have lame backs; I have one myself, but I
should not like to sit down and loaf with it, and I find it not to
the best interest of the fellow with that lame back to keep those
muscles stiff. Such men can walk around the streets and do every
thing else they want to, but when you ask some of them to go to
work they say, “ I can’t work, I am no good.” I think if you give
them a strong suggestion it will help. I am a little inclined to favor
mental science; I think mental therapeutics pretty valuable at times,
and if it is given in the right dose and to the right case, it does a
lot more good than erroneous payments of compensation.
M r . M c G i l v r a y . Out in California we have a new trouble to us;
probably it is an old trouble with a new name, but inasmuch as
you have been discussing neurosis, I want to bring this to your
attention. We are troubled mainly out there with what we have
designated physician’s neurosis—a fellow goes around to half a
dozen doctors and when he gets through he doesn’t know anything
about it at all.
[Meeting adjourned.]
,
TUESDAY AUGUST 18—EVENING SESSION
CHAIRMAN, ANDREW F. McBRIDE, M. D., COMMISSIONER NEW JERSEY DEPARTMENT
OF LABOR
MEDICAL PROBLEMS (concluded)
The C h a ir m a n . The first order of business to-night will be the
report of the committee on preparation of a medical work bearing on
the etiological relation between trauma and the various known dis
eases, by G. N. Livdahl. Mr. Baldwin will read this report.
COMMITTEE ON PREPARATION OF MEDICAL WORK BEARING ON
THE ETIOLOGICAL RELATION BETWEEN TRAUMA AND THE
VARIOUS KNOWN DISEASES
BY
G.
N.
LIVDAHL,
COMMISSIONER
NORTH DAKOTA
BUREAU
W ORKMEN’ S
COMPENSATION
[Read by Charles E. Baldwin]
At the eleventh annual convention of the International Association
of Industrial Accident Boards and Commissions, held at Halifax,
Nova Scotia, August, 1924, the following resolution was adopted:
Inasmuch as numerous diseases following trauma have to be dealt with by
the various accident boards and commissions of this association; and whereas
up to the present time no authoritative work has been published bearing upon
the etiological relation between trauma and the various known diseases which
follow : Therefore be it
Resolved, That a committee be appointed to consider the question of the
preparation of a medical work bearing upon the etiological relation between
trauma and the various known diseases.
Such a work to be written or compiled by recognized medical and surgical
authorities in collaboration.
The chief purpose of such a work to be a comprehensive and adequate recog
nition of trauma as a causative factor in relation to all disease or pathological
conditions.
The executive committee appointed the following members to serve
on said committee: G. N. Livdahl, Bismarck, N. Dak., chairman;
George A. Kingston, Toronto, Ontario; Dr. Robert P. Bay, Balti
more, Md.; Dr. James J. Donohue, Norwich, Conn.; Ethelbert
Stewart, Washington, D. C.
This committee has not held any meeting, but has conducted its
work wholly by correspondence. The chairman first addressed to
each member of the committee a letter stating the proposition quite
fully and asking numerous questions covering various phases of the
matter, asking every member to give them serious study and investi
gation, and then to write the chairman fully in reply. The replies
received were then compiled and forwarded to all the members, thus
giving all the benefit of the information given by the others. The
members were again requested to forward to the chairman their com
ments and to make their suggestions for a report to the association.
77
78
MEDICAL PROBLEMS
Your committee therefore submits the following for your consid
eration and approval:
1. While at present there does not exist any medical work dealing
directly with the question under consideration (at least not comply
ing with the resolution adopted by the association nor supplying the
information that would be the most practical for those admin
istering compensation laws), there are, however, a few recognized
works closely approaching the subject and which may be used to
great benefit. In order to make the contemplated work the most
useful and practical, it should no doubt be in the form of a com
pendium or a work of an abridged character, something which might
be used as a quick and ready reference.
2. Such a work would entail a tremendous amount of labor, of
research, and preparation and would have to be produced by some
one purely out of love for the cause. The committee can not suggest
any such person, and it is hardly possible that the association can
draft any capable persons into such work.
3. While the committee can not in advance calculate the amount,
the cost of producing and publishing such a work would no doubt be
of considerable magnitude and far beyond the reach of the associa
tion’s present treasury. The possibility of the sale of such a work
is so very limited as to make the returns from this source practically
negligible.
4. The medical journals of this country have already published
valuable articles on various phases of the subject here under con
sideration, but it is possible that they might secure still more of
such material if their attention was called to it. If this was done
it would soon be possible for someone, whether attached to any of
these journals or not, to produce a compendium as herein contem
plated and recommended.
5. It is possible that if the attention of the American Medical As
sociation was brought to this particular question more general inter
est would attach to it, more direct statistics might be obtained and
compiled, and more papers on the subject be produced.
6. It is recommended that the medical committee of this associa
tion be given this question for its careful consideration and report
to the 1926 convention; that nothing further be done in the matter
until such a report is received; and that this temporary committee
be discharged.
Respectfully submitted.
G . N . L i v d a h l , Chairman,}
G eorge A. K i n g s t o n ,
R o b e rt P. B a y ,
J am es J . D on oh u e,
E thelbert S tew art,
Committee.
[A motion was made, seconded, and carried that the report be
accepted and the committee discharged, and that the subject be
turned over to the medical committee to handle.]
The C h a i r m a n . We will now have the report of the committee on
compensation for eye injuries, by the chairman, Mr. Hatch, of New
York.
REPORTS
of
c o m m it t e e s
79
REPORT OF COMMITTEE ON COMPENSATION FOR EYE INJURIES
BY L. W . HATCH , DIRECTOR OF THE BUREAU OF STATISTICS AND INFORMATION, NEW
YORK DEPARTMENT OF LABOR
This committee was appointed subsequent to the last convention.
I shall present its report in an informal fashion, because, as you
will, see, it finally seemed to the committee that its problem was only
one of getting the facts straight as to just where this association
already stood and stands now with regard to the subject which came
up at Halifax and was referred to the committee.
The matter which was referred to this special committee for con
sideration was a suggestion at the close of Doctor Black’s report
presented at Halifax. His report presented a careful plan, from
the medical point of view, for measuring the extent of loss of in
dustrial visual efficiency in the case of eye injuries. Doctor Black
suggested that if his report for the special committee of the Oph
thalmic Section of the American Medical Association should be
adopted, it would be a wise thing to consider in connection with its
application the factors of age and occupation in the case of perma
nent eye injuries. To consider and report on this suggestion was
the purpose of this committee.
When this special committee began to look into the matter, it
seemed to its members pretty clear that Doctor Black had overlooked
the fact that this association had previously considered the matter
of age and the occupation factor in its standard schedule for perma
nent disabilities. No doubt that was due to the fact that no one had
had occasion to bring the matter to Doctor Black’s attention or to
the attention of his committee.
If you will recall, the committee on statistics of this association
presented a preliminary report at the Baltimore convention, and
then a final report at the St. Paul convention, on a permanent dis
ability schedule of benefits. In that report the committee took ac
count of both age and occupation factors, and the recommendation
of the committee was that an age variation factor should be em
ployed in a standard permanent disability schedule, and a schedule
with such a factor was presented. As far as the occupation factor
was concerned, the committee reported that it was not prepared with
the resources at its command, nor with the available material that
could be found, to work up such a schedule. The committee there
fore recommended that the occupation factor should be left out of
the standard schedule for permanent disabilities, but that there
should be in each State discretionary authority to take account of
that factor in the case of any permanent injury where the occupa
tion factor introduced a peculiar and exceptional effect: That is, in
cases where it proved to be an exceptionally serious item in the ex
tent of the injury, the accident board or commission should have
authority to consider such cases on their merits as they came up and
vary awards from the standard schedule accordingly.
That report of the committee on statistics was adopted by this
association at the St. Paul convention. Comparing the report of
that committee and Doctor Black’s suggestion, you will see that
Doctor Black v»ras proposing that something should be done in the
case of eye injuries which had previously been quite thoroughly con
80
MEDICAL PROBLEMS
sidered and decided with reference to all permanent injuries, includ
ing eye injuries.
Now, with a little thought, I think you will all agree that there
is no reason why the occupation factor should be considered in eye
injuries any more than in other permanent injuries of which you
can easily think. For example, the loss of a man’s right hand may
have a more serious effect in throwing him out of an occupation
than the loss of one eye; that would clearly be the case with a
common laborer.
So our report is that age and occupation factors have already
been provided for in the association’s standard schedule for per
manent disabilities, and that we see no reason why they require any
different treatment from the point of view of eye injuries alone.
Our recommendation is that this situation be reported to Doctor
Black, together with the suggestion to his committee that it is not
necessary for the completion of their schedule and for its applica
tion and use by the various jurisdictions to introduce into it age
and occupation factors. In other words, the task of that committee
will be complete when it makes final report on its schedule for
measuring loss of visual efficiency in eye injuries.
‘That is the committee report as formulated up to 10 minutes ago*
Since the session began, I have had handed to me a copy of the
final report of Doctor Black’s committee. This is designated as the
final report of the committee on compensation for eye injuries of the
Section of Ophthalmology of the American Medical Association.
This report has been accepted and adopted by the Section of Oph
thalmology and has also been accepted and adopted by the legisla
tive body of the American Medical Association. In other words,
they have gone on and completed the big, constructive job which
their committee had to do.
With this report before it, this association has something of very
large and important significance to consider. In a letter addressed
to Commissioner Tarrell, Doctor Black says, “ I hope you will be
able to obtain favorable comment on this report, and, if possible,
have the committee on eye compensation of this association accept
and adopt same.”
This report has been in the hands of the chairman of this special
committee about 15 minutes. We can hardly recommend its adop
tion offhand, although my personal impression of the work of that
committee has been very favorable indeed.
Probably the best thing to do with this report is to refer it to a
committee for consideration and report at the next meeting. It
certainly is too big and important a thing, and the whole subject
is too complex and technical for any quick action.
DISCUSSION
Mr. S t e w a r t . H o w long is that report?
Mr. H a t c h . It is eight 8-point-type pages, with tables and dia
grams that are very complicated.
Mr. S t e w a r t . It is apparent that that can not be digested at this
convention so that we can act intelligently upon it. I wonder if
there would be any objection on the part of Doctor Black to hav«
DISCUSSION
81
ing that put into our proceedings, so that we can have the matter
handled by our next convention.
Mr. H a t c h . I imagine there can be no objection to that.
[The report referred to is as follows:]
APPRAISAL OF LOSS OF VISUAL EFFICIENCY—STANDARD METHOD
APPROVED BY THE HOUSE OF DELEGATES OF THE AMERICAN
MEDICAL ASSOCIATION, MAY 26, 1925
R
eport
of
C o m m it t e e
on
C o m p e n s a t io n
for
E
ye
I
n j u r ie s
The committee on compensation for eye injuries was appointed by the Sec
tion on Ophthalmology of the American Medical Association in 1919. It has
submitted several reports. These have been accepted but not adopted, as
more time was deemed necessary for further research. Herewith we submit
a final report based on the results of our investigations, both experimental and
clinical.
scope
The aim of the committee is to establish a method of determining the loss
of visual efficiency of a person who has suffered any degree of impairment of
vision as the result of occupational disease or injury. Such loss is to be the
basis on which the amount of compensation shall be determined.
s e c t io n
i
.
c o m p e n s a t io n
based
on
the
v is u a l
e f f ic ie n c y
of
the
in d iv id u a l
Compensation for loss of vision should be that proportional part of the
compensation provided by law for total permanent disability which expresses
the percentage loss of visual efficiency of the individual in pursuing a gainful
occupation.
Total permanent disability of both eyes is identical with total permanent
disability of the mdwidual.
It will be noted that this method of determining compensation makes un
necessary the separate provisions for computing compensation for disability
of one eye and for disability of both eyes.
At present the compensation laws of most States contain provisions that
base awards on disability of one eye only, and some statutes provide separate
schedules for one eye and for both eyes. In the interest of uniformity, definite
ness, and justice it is urged that compensation statutes be so changed that
awards for ocular disability shall be based on the percentage of permanent
disability only.
s e c t io n
n.
t h r e e p r im a r y a n d c o o r d in a t e f a c t o r s
o f v is io n
There are three elements of vision, each of which has an interdependent
and coordinate relation to full visual efficiency. These coordinate factors are
(a) acuteness of vision (central visual acuity) ,* (b) field of vision, and (c)
muscle function. Although these factors do not possess an equal degree of
importance, no act of vision is perfect without the coordinate action of all.
Other functions, though secondary^and dependent, are recognized as im
portant, such as depth perception, stereoscopic vision, fusion sense, color per
ception, adaptation to light and dark, and accommodation. These functions
are inherently dependent on the status of the three coordinating functions of
vision, and they also depend on central nervous function.
SECTION III. M A XIM U M AND M IN IM U M LIM ITS OF TH E PRIM ARY COORDINATE
FACTORS OF VISION
In order to determine the various degrees of visual efficiency, (A) normal
or maximum, and (B) minimum limits for each coordinate function must be
established; i. e., the 100 per cent point and the 0 per cent point.
A.
Maximum limits.—The maximum efficiency for each of these is estab
lished by existing and accepted standards.
1The report of the committee was unanimously adopted by the Section on Ophthal
mology.
82
MEDICAL PROBLEMS
(a) Central visual acuity: The ability to recognize letters or character
which subtend an angle of 5 minutes, each unit part of which subtends a .
minute angle, is accepted as standard. Therefore, a 20/20 Snellen is employed
as the maximum acuity of central vision, or 100 per cent acuity.
(&) Field vision: A visual field having an area which extends from the
point of fixation outward 65°, down and out 65°, down 55°, down and in 45°,
inward 45°, in and up 45°, upward 45°, and up and out 55° is accepted as
100 per cent industrial visual field efficiency.
(c) Muscle function: A maximum normal muscle function is present when
there is absence of diplopia in all parts of the field of binocular fixation.
B.
Minimum limits.—The minimum limit, or the 0 per cent of the coordinate
functions of vision, is established at that degree of deficiency which reduces
vision to a state of uselessness.
(а) Central visual acuity: The minimum limit of this function is established
as the loss of light perception, light perception being qualitative vision. The
practical minimum limit of quantitative visual acuity is established as the
ability to distinguish form. Experience, experiment, and authoritative opinion
show 20/200 Snellen as 80 per cent loss of visual efficiency, 20/380 as 96 per cent
loss, and 20/800 as 99.9 per cent loss. Table 1 and Chart 1 show the percentage
loss of visual efficiency corresponding to the Snellen notations for distant
and for near vision, for the measurable range of quantitative visual acuity.
(б) Field vision: The minimum limit for this function is established as a
concentric central contraction of the visual field to 5°. This degree of contrac
tion of the visual field reduces the visual efficiency to zero.
T able 1.—P E R C E N T A G E LOSS OF V ISU A L E F F IC IE N C Y C O R R E S P O N D IN G T O T H E
S N E L L E N N O T A T IO N S F O R D IS T A N T A N D F O R N E A R V IS IO N F O R T H E M E A S U R A
B L E R A N G E OF Q U A N T IT A T IV E V IS U A L A C U IT Y
Snellen nota
tion for dis
tance
Snellen nota
tion for near
Percentage of
visual effi
ciency
Percentage
loss of vision
20/20
20/25
20/30
20/35
20/40
20/45
20/50
20/60
20/70
20/80
20/90
20/100
20/120
20/140
20/160
20/180
20/200
20/220
20/240
20/260
20/280
20/300
20/320
20/340
20/360
20/380
20/400
20/450
20/500
20/600
20/700
20/800
14/14
14/17.5
14/21
14/24.5
14/28
14/31.5
14/35
14/42
14/49
14/56
14/63
14/70
14/84
14/98
14/112
14/126
14/140
14/154
14/168
14/182
14/196
14/210
14/224
14/238
14/252
14/266
14/280
14/315
14/350
14/420
14/490
14/560
100.0
95.7
91.5
87.5
83.6
80.0
76.5
69.9
64.0
58.5
53.4
48.9
40.9
34.2
28.6
23.9
20.0
16.7
14.0
11.7
9.7
8.2
6.8
5.7
4.8
4.0
3.3
2.1
1.4
0.6
0.3
0.1
0.0
4.3
8.5
12.5
16.4
20.0
23.5
30.1
36.0
41.5
46.6
51.1
59.1
65.8
71.4
76.1
80.0
83.3
86.0
88.3
90.3
91.8
93.2
94.3
95.2
96.0
96.7
97.9
98.6
99.4
99.7
99.9
(c) Muscle function: The minimum limit for this function is established by
the presence of diplopia in all parts of the motor field. This condition consti
tutes zero visual efficiency.
SECTION IV.
MEASUREMENT
OF COORDINATE FACTORS AND
THEIR PARTIAL LOSS
THE
COMPUTATION
OF
A.
Central visual acuity.—Visual acuity shall be measured both for distance
and for near, using the Snellen notation, each eye being measured separately.
83
DISCUSSION
Central visual acuity for distance shall be measured at a test distance of 20
feet. Central visual acuity for near shall be measured at a test distance of
14 inches.
The quantity that determines the visual acuity efficiency of one eye shall be
the result of the weighted values assigned to these two measurements for dis
tance and for near. A onefold value is given to the former and a twofold
1 .— P E R C E N T A G E L O S S O P V IS U A L E F F IC IE N C Y
C O R R E S P O N D IN G T O T H E S N E L L E N N O T A T IO N S F O R
D IS T A N T A N D F O R N E A R V IS IO N , F O R T H E M E A S
U R A B L E R A N G E O F Q U A N T IT A T IV E V IS U A L A C U IT Y
C hart
m m H
5
SNELLEN ACUITY NOTATIONS FOR 14* READING DISTANCE : :
10
15
20
25
>
v- 30
zw
V 35
tZ
iSm
w
-J 40
<
CO 45
>
O 50
55
60
65
70
75
B0
85
SO
SNELLEN ACUITY NOTATION FOR 20 FOOT EXAMINING DISTANCE
value to the latter. Thus, if the visual efficiency for near is 40 per cent and the
visual efficiency for distance is 70 per cent, the central visual acuity efficiency
for the eye in question would be:
(40 X 2) + (70 X I )
--------------3
or a 50 per cent visual acuity efficiency.
80 + 70 _ 150 _ ^
3
3
84
MEDICAL PROBLEMS
The best central visual acuity obtainable with correcting glasses shall be used
In determining the degree of visual efficiency.
If there exists a difference of more than 4 diopters of spherical correction
between the two eyes, the best possible vision of the injured eye without glasses
or with lenses of not more than 4 diopters spherical difference from the fellow
eye shall be the acuity on which subsequent rating is to be computed for this
injured eye.
The Snellen test letters or characters as published by the committee and
designated “ Industrial vision test charts ” subtend a 5-minute angle, and
their component parts a 1-minute angle. These test letters are to be used at
an examining distance of 20 feet for distant vision and 14 inches for near
vision from the patient. The illumination is to be not less than 8-foot candles,
nor more than 10-foot candles on the surface of the chart.
Table 1 and Chart 1 show the visual acuity and the percentage of loss of
efficiency, both for distance and for near, for partial loss between 100 per cent
and zero vision for one eye.
B. Field vision,—The extent of the field of vision shall be determined by the
use of the usual perimetric test methods, a white target being employed which
subtends a 1° angle under illumination of not less than 3-foot candles, and
the result plotted on the industrial visual field chart.
The amount of radial contraction in the eight principal meridians shall be
determined. The sum of these eight, divided by 420 (the sum of the eight
principal radii of the industrial visual field) will give the visual field efficiency
of one eye in per cent.
C. Muscle function.—Muscle function shall be measured in all parts of the
motor field, recognized methods being used for testing.
Diplopia may involve the field of binocular fixation entirely or partially.
When diplopia is present, this shall be platted on the industrial motor field
chart. This chart is divided into 20 rectangles, 4 by 5° in size. The partial
loss to muscle function due to diplopia is that proportional area which shows
diplopia as indicated on the platted chart compared with the entire motor field
area (Table 2 and Chart 4).
When diplopia involves the entire motor field, causing an irremediable
diplopia, the loss in coordinate visual efficiency is equal to the loss of use of
one eye; and when the diplopia is partial, the loss in visual efficiency shall be
proportional and based on the efficiency factor value of one eye.
SECTION V. INDUSTRIAL VISUAL EFFICIENCY OF ONE EYE
The industrial visual efficiency of one eye is determined by obtaining the
product of the computed coordinate efficiency values of central visual acuity,
of field vision, and of muscle function. Thus, if central visual acuity efficiency
is 40 per cent, visual field efficiency is 81 per cent, and the muscle function
efficiency is 100 per cent, the resultant visual efficiency of the eye will be
0.40 X 0.81 X 1.00=32.4 per cent. Should diplopia be present in part of the motor
field so that the motor efficiency is reduced 50 per cent, the visual efficiency
would be 0.40X0.81X0.50=16.2 per cent.
T able 3 .- L O S S IN M U S C L E F U N C T IO N
M otor
field
efficiency
M otor
field
efficiency
Per cent
N o loss equals_____________ ______ ______
1/20 equals_______ ____________ _________
2/20 equals______________________________
3/20 equals ............. ............. .......... ............
4/20 equals. ........... ............................. - ........
5/20 equals _ . ________________________
6/20 equals.......................................................
7/20 equals...... ................................................
8/20 equals _____________________________
9/20 equals______________________________
10/20 e q u a ls ......................... ............ ............
100
98
95
92
89
87
84
81
77
74
71
11/20 equals.......................... .................
12/20 equals...................................................
13/20 equals....................................................
14/20 equals.......... .......................................
15/20 equals........ ............................. ............
16/20 equals............................. .......... ..........
17/20 equals...................................................
18/20 equals. __........................ ........... .........
19/20 equals................... ............. _________
20/20 equals.......... ..................... ...................
Per cent
67
63
59
55
50
45
39
32
22
0
DISCUSSION
85
SECTION VI. INDUSTRIAL VISUAL EFFICIENCY OF THE INDIVIDUAL
It is a fact well established by common experience that the visual efficiency
of the individual is by no means reduced to one-half (50 per cent) by the
complete loss of one eye, vision in the fellow eye remaining normal. Hence
the necessity for a weighted average. The researches of the committee show
rating of the individual
in substantial agreement Ch a r t 2 .— C U R V E F O R L O S S O F E F F IC IE N C Y IN
D IP L O P IA
with the consensus of tech
nical judgment, such judg
ment being based on actual
reproduction, comparison,
and relative evaluation of
various specific conditions
of visual efficiency.
The industrial efficiency
of the individual is com
puted as follows: To the
percentage figure which
has been determined as the
industrial visual efficiency
of the less efficient of the
two eyes, 3 times the per
centage figure that has
been determined similarly
for the more efficient eye
is added, and the result is
divided by 4. The quo
tient will be the percent
age figure that expresses
the industrial visual effi
ciency of the individual.
Thus, if the individual
efficiency rating of the in
jured eye is 40 per cent and that of the fellow eye is 100 per cent the visual
efficiency of the individual will be found by the following formula:
(40X 1) + (100 X 3) __ 340
4
“
4
Individual industrial efficiency, and compensation should be 15 per cent of
the amount awarded for total permanent disability.
SECTION V II. TYPES OF OCULAR IN JU R Y NOT INCLUDED IN THE DISTURBANCE OF THE
COORDINATE FACTORS
Certain types of ocular disturbance are not included in the foregoing com
putations and these may result in disabilities, the value of which can not be
computed by any scale as yet scientifically possible of deduction. Such are
disturbances of accommodation, of color vision, of adaptation to light and
dark, metamorphopsia, entropion, ectropion, lagophthalmos, epiphora, and mus
cle disturbances not included under diplopia. For such disabilities additional
compensation shall be awarded, but in no case shall such additional award
make the total compensation for loss in industrial visual efficiency greater
than that provided by law for total permanent disability.
Compensation for loss in industrial visual efficiency, as provided for above,
does not include compensation for any cosmetic defect, for mental or phy
sical suffering, for cost of medical attention, or for time lost from gainful
occupation during the period of treatment previous to final computation of
compensation as provided for below. Additional compensation should be
awarded for the various losses here enumerated when not specifically pro
vided for by statute.
SECTION V III. REGULATIONS FOR COMPUTING COMPENSATION
Compensation shall not be computed until all adequate and reasonable opera
tions and treatment known to medical science have been attempted to correct
86
MEDICAL PROBLEMS
the defect. Further, before there shall be made the final examination on
which compensation is to be computed, at least 3 months shall have elapsed
after the last trace of visible inflammation has disappeared, except in cases
C h a r t 3 .— IN D U S T R IA L V IS U A L F I E L D C H A R T
;7o°
of disturbance of extrinsic ocular muscles, optic nerve atrophy, sympathetic
ophthalmia, and traumatic cataract; in such eases, at least 12 months and
preferably not more than 16 months shall intervene before the examination
shall be made on which final compensation is to be computed.
In cases of additional
C h a r t 4 .— I N D U S T R IA L M O T O R F I E L D C H A R T
loss in visual efficiency,
when it is known that
there was present a preex
isting subnormal vision,
compensation
shall
be
based on the loss incurred
as a result of eye injury or
occupational condition spe
cifically responsible for the
additional loss. In case
there exists no record or
4h
no adequate and positive
evidence of preexisting
subnormal vision, it shall
be assumed that the visual
efficiency prior to any in
jury was 100 per cent.
N e ls o n M . B la c k .
A l b e r t C. S n e l l .
Jam es P a tto n .
H a r r y S . G r a d le .
Mr. T arrell . Doctor
Black has been work
ing on this proposition
for the last 10 years,
and he is very anxious to have some action taken by this association.
I move that this matter be referred to the medical committee to
report later on in the session as to what it thinks advisable.
DISCUSSION
87
Doctor D o n o h u e . That is a pretty complicated report. I must
confess that I do not feel capable of digesting it, and I am satisfied
that there is nobody here, except some medical men and specialists
who can comprehend it. I think if you are going to pass that on to
any committee of this body, you can act just as intelligently right
now as you can by waiting longer. If you will refer it to the medi
cal committee, or any other committee you see fit, to report on at
the next meeting, by that time those on the committee will have
plenty of time to look the report over, and I want to tell you they
will have to study it pretty carefully to comprehend it.
Mr. K i n g s t o n . I was going to suggest that possibly it might be
well to refer this matter temporarily to a special committee, with
the suggestion to that committee that it make a recommendation,
say, day after to-morrow, as to what action should be taken. My
feeling is, as Doctor Donohue has said, that the thing to do at this
convention is to refer the matter to a special committee or to the
medical committee, to bring in a special report at the next conven
tion. If it can be referred to-night to a special committee, which
might be asked to bring in a resolution on Thursday morning as to
what should be done with the report, either present or deferred
action, I will make such a motion.
Mr. T a r r e l l . That was the intention of my motion. I did not
mean that the committee should report at this evening’s session, but
at some time during this convention—Thursday, probably—with its
recommendation as to what should be done. I f the committee is
unable to agree, well and good; let it make such recommendation
as it sees fit.
[The motion was seconded.]
Mr. S t e w a r t . Remember, Doctor Black is a member of the medi
cal committee of this association.
The C h a i r m a n . The motion is that this matter be referred to the
medical committee to report back to this convention as to what ac
tion should be taken.
Mr. K i n g s t o n . One important member of the medical committee
has gone.
Mr. H a t c h . I agree with Doctor Donohue that this is a very
meaty document and a highly technical one. I do not believe that
we can consider anything here except how the report shall be con
sidered and acted upon by this association. I am against voting on
it at this convention; I would not vote on it,
The C h a i r m a n . I do not think it is anybody’s intention to have
it voted on at this session. The committee is to study it and then
report back as to what action should be taken. I think it will go
over until next year.
Mr. H a t c h . I am in favor of that motion with that understand
ing.
[The motion was carried.]
The C h a i r m a n . First on the program this evening is discussion
of Doctor Bay’s paper, Mr. Kingston being the first one up.
Mr. K i n g s t o n . My idea was that I was to discuss the report of
the committee on eye injuries. Perhaps in order to get it into the
record there is just one feature that I might mention. I did not
88
MEDICAL PROBLEMS
feel myself capable of going into that report technically. In the
first place, I had nothing except the paper presented by Doctor;
Black at the Halifax convention on which to base any consideration,
and that as you will remember was rather technical.
What our various boards and commissions are doing and how
we are treating eye injuries have been discussed at the various meet
ings, so I need not go into that. Nearly all of you have your
schedule of so many weeks that you pay for the loss of an eye.
The problem that presents itself is how much shall we pay for
partial loss of vision, and that is the great purpose intended to be
served by this paper.
In considering the subject of Doctor Black’s report, “ Compen
sation for eye injuries, a resume of work done by committee on
compensation for ocular injuries, Ophthalmic Section, American
Medical Association,” I realized the difficulty a layman faces in
dealing with such a highly technical subject. I felt that unless
I could say something of practical value, it were better not to say
anything. I decided, therefore, to consult my good friend, Doctor
Trebilcock, an eye specialist of high standing in our city (Toronto).
Reference to a paper on eye injuries by Doctor Trebilcock in the
report of the proceedings of the Toronto convention in 1919 will
be found of much interest even though it is six years since it was
given.
Doctor Trebilcock is the referee to whom many of our difficult
eye cases are submitted for examination and report. He did not
have time to make an exhaustive study of the report, but he gave
me a short statement relative to one paragraph which I think
might be incorporated in the proceedings of the convention, as
follows:
Doctor T r e b il c o c k (in statement to Mr. Kingston). Referring
to the paragraph on the second page of the report (page 69 of Bul
letin No. 385 of the United States Bureau of Labor Statistics)
headed, “ Value of important but nonessential factors of vision,”
Doctor Black limits this paragraph to cases where the diplopia is
irremediable; he might have omitted the limiting clause “ unless,
as in many instances, the individual learns to suppress the vision
of the deviating eye,” because if the individual learns to sup
press the image in the deviating eye the diplopia disappears and
becomes remediable or absent ; in either case it is then beside the
question. This does not mean that the eyes again have parallel
axes, but annoyance disappears, and it becomes safe again to leave
both eyes uncovered.
He then suggests that he, with a majority of the committee, would
set the compensation at a lesser sum than would be paid if the
vision of the eye were completely lost. If full consideration be
given to this particular phase of the question, I consider there is
reason for thinking that the economic disturbance associated with
an incurable diplopia is often greater than it would be if the sight
of one eye were entirely lost, and that the deserved compensation
should be correspondingly higher instead of lower.
Loss of vision in one eye resulting from an injury which does
not disfigure the globe, or does so only in a slight degree, is as
we all know not always a hindrance of much degree from the earn-
Discussion
89
ing standpoint; indeed, occasionally, after a variable period of
time (sufficient for certain readjustments to be made by the work
man) it is really no hindrance at all; and in a narrow sense all com
pensation might then be cut off until such time as the remaining
eye, for any cause whatsoever, suffers a loss of visual acuity.
Even if the injured eye be so badly damaged that it come to eneucleation, the artificial eye may be so accurately matched and fitted
that the remarks in the last paragraph would apply.
Surely such a man is left in a happier state of mind and alto
gether better fitted to approach his daily toil than one who has an
incurable double vision, and is compelled to wear some kind of obscurator or to keep one eye closed all the rest of his natural life.
His mental annoyance is to be permanent, and who will say that
the effect upon his ability for work may not be noticeable to him
self as well as to his employer and be reflected in his earnings.
Yet when his check is cut below that of his companion who per
chance carries a sightless eye following a traumatic detachment of
the retina (also irremediable), his chagrin is supposed to be ap
peased by the assurance that his deflected eye may be at some future
date a priceless asset to him. I am sure he will be unconvinced by
the argument, and be inclined to reply as any bachelor, absolutely
without kith or kin or friend, might reply to an insurance agent
who would take premiums from him every remaining year of his
life to purchase a policy payable at death.
Perhaps Doctor Black would say that this contingency is well
taken care of in the following paragraph (page 74 of Bulletin No.
385 of the United States Bureau of Labor Statistics):
Compensation for loss in industrial visual efficiency, as above provided for,
does not include compensation for any cosmetic defect incident to eye injuries
or to ocular affection due to adverse occupational conditions; for mental
or physical suffering; or for cost of medical attention or for time lost from
gainful occupation during period of treatment previous to final computation
of compensation as provided for below. Additional compensation should be
awarded for the various losses here enumerated.
Still it might be better if the statement regarding such cases were
not made so baldly that it had to be modified by a sort of codicil
appended afterward.
No one recognizes more than myself how impossible it is perfectly
to solve these questions by a set of formulae; neither can I, as an
eye surgeon, look forward with pleasure to a day ever coming when
this may be done. The new problem presented by each new case
is what keeps our work from becoming humdrum, stimulates a flag
ging interest, and keeps the doctor not only happy in his work but
perennially young.
The C h a ir m a n . The first name on the program to discuss the
paper read by Doctor Bay this morning is Dr. Arthur L. Murray
of the United States Bureau of Mines, Salt Lake City, Utah.
Doctor M urray . Before proceeding with the discussion, I would
like to pay tribute to the excellent paper presented by Doctor Bay.
I think all who heard it this morning will agree with me that he
presented his subject in the most interesting and instructive manner.
In fact, he covered the ground of phosphorus poisoning so well that
I hardly find it necessary to extend my observations to find sufficient
material for discussion.
90
3VLEDICAL PROBLEMS
Phosphorus, or compounds of phosphorus, is employed in a num
ber of industries, viz, the making and using of acetylene; the mak
ing of bone black; the making of certain kinds of brass; the making
of ferrosilicon, especially in certain steel manufacturing; the making
of fertilizers; the making of fireworks; the making of certain acetic
acids; phosphate mills; the making of phosphor bronze; the making
of phosphor compounds; extraction of phosphorus; the making of
red phosphorus.
Fortunately, in most of these industries the compounds of phos
phorus used or the conditions under which phosphorus is used and
handled give rise to very slight opportunity for poisoning. The
principal sources of phosphorus poisoning are white phosphorus and
its fumes and phosphoretic hydrogen.
Time will not permit my going into the details of the relative dan
gers of phosphorus poisoning of the several industries before men
tioned, so I will dwell upon those most likely to contribute indus
trial cases.
The making of matches with white phosphorus was, until July 1,
1913, a fertile source of phosphorus poisoning in the United States
as well as abroad. The literature bearing on industrial medicine
prior to that date was rich in references to cases of phosphorus poi
soning among match-factory workers. Intensive investigations con
ducted about this time led Congress to pass an act, effective July 1,
1913, placing a prohibitory tax on all matches made from white
phosphorus, and further forbidding importation or exportation
of such matches after January 1, 1913, and January 1, 1924,
respectively.
The heavy penalties for violation attached to this enactment,
$5,000, or imprisonment for three years, together with the prohibi
tive tax on production, had the desired effect of eliminating white
phosphorus from the match industry. Since the above accomplish
ment, writers on industrial diseases seem to have forgotten that there
is such a thing as phosphorus poisoning.
Passing on to the other industries where phosphorus poisoning
may occur, we may consider reduction works where phosphorus is
produced in an elemental state from the mineral phosphates. This
process, although dealing with white phosphorus, a very poisonous
substance, is carried on in such a manner that there is relatively
no danger; the phosphorus is collected under water and therefore is
not subject to volitation or fumes. Phosphor bronze is an alloy of
tin and copper with a small amount of phosphorus, not more than
three per cent, and usually less. It is usually made in hearths that
are well ventilated and in a semiopen condition, and very seldom are
the fumes from the phosphorus really dangerous to the workmen.
The use of ferrosilicon, which contains phosphorus, in the mak
ing of steel, very much like phosphor bronze, is of very little danger
to the workmen. The fumes are carried off so that they are dis
pensed with in the air and the dangers to the men are relatively
negligible.
As to the manufacture and use of acetylene, we have in acetylene
the calcium carbide when it is acted upon by water, and a small
amount of phosphorated hydrogen given off. If large amounts of
acetylene are burned in confined spaces, it is possible the content of
DISCUSSION
91
the atmosphere may be great enough to effect poisoning, but as
acetylene requires a fair amount of oxygen it is usually burned in
the open. It is burned in our miners’ lamps, it is true. There the
amount of ventilation is sufficient to prevent poisoning.
The manufacture of bone black is another source of phosphorus
poisoning. In this country bone black is manufactured only to a
limited extent, and then under hygienic conditions which almost
preclude phosphorus poisoning.
Coming to the question of fireworks, to my mind, from what
information I could gather from the literature available, fireworks
are probably the chief source of phosphorus poisoning to-day. Dur
ing recent years there has developed an increasing use of white
phosphorus in the manufacture of certain types of pyrotechnics.
In reviewing the more recent literature, one is struck not only by
the references to the fireworks industry as being a very likely field
for phosphorus poisoning, but also by the fact that most of the
cases cited are found to be of employees in such factories. I am
sorry Doctor Bay is not here to-night; I think he might elucidate
those cases that he mentioned to-day, but he stated to me that in
the past two years five authentic cases of phosphorus poisoning have
come to his attention from fireworks manufacturing plants located
in the State of Maryland. Miss Lillian Erskine, of the New Jersey
Department of Health, has called attention to the fact that in her
State a case of the use of white phosphorus has been found in a
fireworks plant, causing exposure of men and girls to the fumes of
phosphorus and direct contact with the paste.
From my knowledge of the use of phosphorus in industry, it
strikes me that the greatest danger of such poisoning presented
to-day is in the manufacture of certain types of pyrotechnics—
those in which phosphorus must be used are small in proportion to
those manufactured. The nonphosphorus type of fireworks is the
small sparklers which children are now permitted to use in a great
many cities on the Fourth of July.
I appreciate that the exposure to phosphorus in fireworks manu
facture is comparatively small to that which was present prior to the
prohibitive act of Congress as to the match industry. Such being
the fact, it occurs to me that an investigation of all fireworks manu
facturing plants should be instituted, and if the use of white phos
phorus in quantities and under conditions exposing workers to phos
phorus poisoning is found, steps should be taken to secure an enact
ment by Congress similar to that made as to the use of white phos
phorus in the manufacture of matches. Fireworks are by no means
an essential commodity, and as such an enactment would affect but
a few types of pyrotechnics, I see no reason why an enactment cov
ering the use of white phosphorus in the manufacture of fireworks
should meet very much opposition.
Your organization can accomplish a great and most lasting good
in fathering a movement absolutely to prevent phosphorus poison
ing among employees of fireworks manufacturing plants; much
more could be accomplished in this way than by paying for years
compensation for disabilities arising out of such poisoning.
73891°—26----- %
92
MEDICAL PROBLEMS
The C h a ir m a n . Mr. Stewart is also down to discuss Doctor Bay
paper.
Mr. S tew art . It is certainly not my intention to discuss either
the medical or the legal aspects of Doctor Bay’s paper. As far as
the legal aspects are concerned, we find not only the courts of vari
ous States, but very often the courts within the same State on both
sides of the proposition, and this is exactly what happened in the
Francks case. Catherine Francks was given a judgment under the
old liability law of $22,500. The Court of Appeals of Maryland
ruled that phosphorus necrosis was an accidental, personal injury
compensable under the workmen’s compensation act, or, if it was
not, the members of the compensation commission ought to be good,
kindly, Christian people and make it so. Catherine Francks found
that the courts decided that the compensation commission had no
power to grant compensation for occupational diseases.
In Virginia, Roxana Fultz found that the courts of Virginia
held that phosphorus necrosis was an occupational disease and that
the law of Virginia did not provide for any compensation for occu
pational diseases. In Pennsylvania, Gladxelter got up against the
same thing.
The difficulty in trying to guess which shell the pea is under is
that the operatives have become so skilled that they slip the pea
between their fingers and you are beaten before you start to guess.
The fact of the matter is that the pea is not under either shell.
For that reason, of course, we are all trying to make the compensa
tion laws as broad as possible, and to take everything out from
under the old liability law that we reasonably can.
The thing in Doctor Bay’s paper which disturbs me most is that
of practically limiting the field of occupational diseases to the sin
gle question as to how the poison enters the system. I am not at
all sure that in every case of phossy jaw which was found by the
Bureau of Labor Statistics in its investigation, the phosphorus had
entered through a decayed tooth or as the result of a recently ex
tracted tooth. My impression is that there were cases where these
conditions were not shown, though I frankly concede that probably
99 per cent of the cases of phossy jaw were preceded by a condition
of bad teeth. Cases of phosphorus necrosis in the fingers and hands
were, I believe, generally speaking, preceded by a cut which per
mitted the phosphorus to secure access to the bone.
The startling thing to me about this paper is that it brings up
a new factor, that is to say, the mode of entrance of poison into the
body, and makes it the deciding one in occupational diseases.
I believe every country in the world which specifically names
occupational diseases in its workmen’s compensation act names
phosphorus. Every State in the Union which has an occupational
disease clause in its laws and specifically names the occupational
diseases names phosphorus. The same may be said of anthrax, but
in anthrax, as in phosphorus necrosis, there must be an abrasion of
the skin before the anthrax germ can proceed with its deadly work.
There must be a cut, a sore, or a bruise which gives the germ im
mediate access to the blood; it does not burrow through healthy
skin tissues. Yet every country and State having a specific occupa
tional disease law names anthrax. I have not taken time to go
through the whole list of recognized industrial poisons to determine
DISCUSSION
93
whether others than the two here named fall into this same cate*
gory, though my impression is that it will be found that radium
necrosis acts in the same way.
We must not forget, however, that in the case of both phosphorus
and radium it is not only necrosis with which the workers are
affected. Anemia of an incurable and deadly type is often more
frequent in both phosphorus and radium plants than is necrosis, and
to produce this effect no defective teeth or abraded skin are neces
sary. The Bureau of Labor Statistics is carrying on at this time
two investigations. One is of phosphorus poisoning in the manufac
ture of a certain type of fireworks, such as the spit devil, devil-onthe-walk, son-of-a-gun, etc. Not only are we finding cases of necrosis
as severe as were ever found in match factories, but we are finding
anemic conditions which, according to my recollection, were not
studied in the investigation of the match industry at all.
When I took the figures from our record for the report to-day we
had found 14 cases of phosphorus necrosis, some of them very, very
bad cases, and we had found 2 deaths. Since this record was made
another death has, I think, been reported. The investigation so far
has covered four States, and I may say that we have secured in
advance of our report a practical agreement from the manufacturers
to stop making this class of fireworks.
We have not yet secured such an agreement from the rat-poison
manufacturers, although I think it is very clear that a substitute
for phosphorus is readily obtainable. The Department of Agricul
ture, which is probably more interested in rat poisoning than any
other of the Government departments, has come out very strongly
against the use of phosphorus in the manufacture of such poisons.
In the investigation of radium necrosis and other occupational
diseases in connection with luminous paints the investigation has
already covered five States. We have found 13 cases of necrosis of
the jaw and 1 of the toes. There are numerous cases of anemia in
violent form, several deaths, and recently the death of the superin
tendent of the plant under circumstances showing it to be due
unmistakably to occupational conditions.
I can urge only that this association be very cautious how it
handles the subject of the method of entrance into the body as a test
of industrial poisons or occupational diseases arising therefrom.
The C h a i r m a n . Y ou have heard the very able discussion offered
by Doctor Murray and Mr. Stewart on this subject. The meeting is
now open for general discussion.
Mr. W i l l i a m s . I have nothing to suggest about phosphorus poi
soning specifically, but I would like to suggest to the members of
this convention that personally I have found a good deal of assist
ance in my work from the book of Kober & Hayhurst on Indus
trial Health. I do not mean it is a perfect book—a perfect book
hardly exists—but it is the best book on the subject. All the articles
were not written by the authors, but they are all written by special
ists. There is an interesting article there by Dr. Alice Hamilton
on phosphorus poisoning. Those of you who are interested in the
general question of industrial hazards would, I feel sure, be well
pleased if you purchased a copy of this book. It is really a second
edition of an older book written by Kober & Hayhurst*
94
MEDICAL PROBLEMS
Mr. E ppler . The Francks case in Maryland was more or less a
shock to all of us who have made any study of occupational diseases.
Our law provides for accidental personal injury. It has always
been my impression and the impression of the Maryland commission
that phosphorus poisoning was an occupational disease.
As Mr. Stewart has so well stated in his paper, the suit of this
young girl, who had been working in a fireworks factory, was
brought under the old common law on the theory that it was not
covered by the Maryland compensation statute, but that on account
of the negligence of the employer she still had her right at common
law, and on that basis the case was tried. The jury rendered a ver
dict of $22,500.
It is thought more or less among the lawyers in Maryland (with
all due respect to our court of appeals) that the court of appeals
felt that was rather a large verdict under the circumstances. There
was nothing technically or legally wrong in the trial of the case.
It seems that the evidence was properly admitted and that the case
was in every way properly and legally presented to the court.
I have here the official opinion in that case, and what that case
decides, as far as we can get at it in Maryland, is that phosphorus
poisoning is no longer an occupational disease, although in one
sentence or so of the opinion, to which I think our secretary re
ferred, it does make a statement as to the entrance of the poison.
That is the only place in the opinion where I can find anything
along that line, but there are several other places to which I would
like to call your attention:
If, therefore, a disease is not a customary or natural result of the profes
sion or industry per se, but is the consequence of some extrinsic condition or
independent agency, the disease or injury can not be imputed to the occu
pation or industry, and is in no accurate sense an occupation or industry
disease. In this case the occupation of the girl as an employee in a depart
ment of a manufactory of fireworks was simply a condition of her injury
whose cause was the definite negligence charged against the employer. The
most that is warranted to be inferred from the allegations of fact in the
declaration is that the phosphorus poisoning alleged was the gradual result of
the negligence of the employer. As this negligence was a breach of duty to
her, it was not to be foreseen or expected by the worker.
Then further on in this opinion our court of appeals attempts to
define what is the meaning of accidental personal injury in the
immediate statute.
It was by chance that employer did not use due care, and by chance that
the vapor of phosphorus was where its noxious foreign particles could be
inhaled by the girl. It was by chance that the inspired air carried these par
ticles into her system, sickening her and causing a necrosis of the jaw after
fortuitously finding a lesion.
That is the point I think Mr. Stewart particularly dwells on, but
farther on our court of appeals makes this statement:
The injury thus inflicted upon her body was accidental by every test of the
word, and its accidental nature is not lost by calling the consequential results
a disease.
There was a succession or series of accidental injuries culminating in the
same consequential results. The introduction of phosphorus into the human
body is none the less accidental if through the medium of a pimple point, an
unsound tooth, a scratch, or a lesion, or of ingestion or inbreathing.
As I read this opinion, our court of appeals has done this much:
It has legislated phosphorus poisoning out of the class of occu
DISCUSSION
95
pational disease into the class of personal accidental injury; I can
not see any other way you can construe that. It does seem to say,
however, that there must be the unforeseen element.
Just at present we have a case in Maryland that is giving us
a great deal of trouble. Something has developed there known as
benzol poisoning. We have had two or three very serious cases
among girls working in can factories. The following case was
presented to us just last week, before I came away. A girl who
had been working in a factory that had the proper ventilation, all the
up-to-date equipment to carry off the poisonous fumes, left that
factory and went to another where the equipment for ventilation
was not so up to date and worked under conditions where she would
naturally inhale these fumes. The poor girl did inhale them and
subsequently died.
As a commissioner of Maryland I feel that that case of benzol
poisoning is pretty nearly the same as phosphorus poisoning. When
I come to cast my vote I am going to say I do not see much dif
ference between benzol poisoning and phosphorus poisoning. It
looks to me as if our court of appeals has more or less legislated
phosphorus poisoning out of occupational disease into accidental
injury, and I for one am willing to go ahead on the benzol propo
sition and legislate that out also.
In a little talk with Mr. Stewart along that line the other day,
he said this was the opening wedge; it showed the tendency and the
drift of our court of appeals. I can not see any reason at all why
ordinary occupational disease such as this phosphorus and benzol
poisoning should not come under our statute. Some of the lawj^ers
of Maryland think that the court of appeals felt that this verdict
was a little too large for this girl and so started out with the idea
that it had to find some way to get rid of this verdict; it put the
cart before the horse, perhaps.
I do not say I am willing to stand on the opinion because the
Court of Appeals of Maryland in taking that position on phosphorus
poisoning mentions not only the jaw but also, as I read to you, a
pimple or scratch, which could be on the hand, foot, or any part
of the body, as I see it. Therefore I say that the court of appeals
has done this much to help our statute: It has told us that phos
phorus poisoning is a personal accidental injury.
Mr. C l a r k . What occupational disease is left under that decision?
Mr. E ppler. That decision says that phosphorus poisoning is not;
all the others I suppose are. I cited the benzol case merely to show
my feelings in the matter.
Mr. S t e w a r t . Let us get down to brass tacks as to what that
court of appeals did. This Catherine Francks, being told that there
was no occupational-disease clause in the Maryland law, which is
true, went to court under the liability law. In the trial court she
got a decision of $22,500. What the court of appeals did was to
say this was not an occupational disease; and if it was not, that the
compensation commission ought to be good and put this girl under
the compensation law of Maryland whether or not her case was
covered by the law, and therefore it reversed the decision of the
court below and threw the girl onto the mercy of the compensation
commission again.
96
MEDICAL PROBLEMS
M r. T a r r e l l . H ow m uch did she collect as com pensation?
Mr. S t e w a r t . Hold on. She does what the court of appeals says,
conies to the compensation commission for compensation, and then
the court says, “ Why, that is not covered under your law.” In
other words, they simply juggle the girl out of any possibility of
getting anything. It is true that the court of appeals told the com
pensation commission it ought to be good when it knew it could not
be good. Suppose the compensation commission had given Catherine
Francks compensation under the law, and the employer had ap
pealed—gone up to this same court of appeals; there was only one
thing it could do, and that was to say that occupational diseases
were not covered under that law and she could not be paid. That
girl was simply juggled out of any possibility of getting a cent.
Mr. E p p l e r . I can not go quite that far, because as a matter of
fact, the case is still standing in the court of appeals. It has not
come to the compensation commission. This decision has been ren
dered. As I read this decision, the court of appeals—the highest
court, the supreme court, of our State—has never definitely said
that in this case this girl did suffer a personal accidental injury
covered by the compensation law of Maryland.
I will leave that opinion with Mr. Stewart or with any of you
gentlemen to read. As one of the members of the Maryland com
mission, I feel that my duty under that decision is to say that phos
phorus poisoning is not an occupational disease, but a personal acci
dental injury.
Mr. S t e w a r t . And when you do, there will be an appeal from
your decision and you will find that the court of appeals can not
read into your law what the legislature did not put there.
Mr. E p p l e r . If that be so, then it puts our commission in this posi
tion, that we can go to our legislature in 1927 and put the matter
frankly and squarely up to them. I for one am willing to do that,
and I want to do that, as far as I can, with occupational disease.
M r. D
uxbury.
Y
ou
h a v e n o t d on e th a t?
Mr. E p p l e r . I was willing to do it. We got up a schedule; we
got up a list of occupational diseases that should be included. I
looked over the list. I come from a section where there are 4,000
coal miners; when I read down the list I found they had left out
miner’s asthma and I said, “ If you don’t put that it, nothing goes,”
and they dropped the whole proposition.
Mr. H a t c h . I am not at all sure, from New York’s experience,
that it may not prove to be possible to give that girl compensation
under that decision, and when the matter comes up to the court of
appeals it will hold that it was an accidental injury. In the State
of New York anthrax was compensated as an accidental injury
before anthrax was ever mentioned in the compensation law as a
compensable occupational disease, and several other diseases have
been compensated under conditions which the court held made
them accidental injuries within the usual sense of the term. So
there is a big possibility of compensating occupational diseases as
industrial accidents, aside from compensating them under what the
courts may hold to be occupational disease.
DISCUSSION
97
Mr. D u x b u r y . In our experience w e have had many instances
where we could compensate such diseases as industrial accidents;
afterwards, when the law was revised in 1921, those same things
were denominated occupational diseases, but it did not make any
difference as to whether we called them occupational diseases or in
dustrial accidents; they were entitled to compensation just the same,
Of course, there are many circumstances where acquiring an occu
pational disease probably would not come under the definition in the
compensation laws of accidental injury, but if they do not want to
call it an occupational disease, why it is an accidental injury—if
you do not get them coming, you will get them going.
Mr. G l e a s o n . The Doctor covered just what I was going to say.
There is benzol poisoning, copper poisoning, brass poisoning, and
poisoning from gilt on Christmas cards—in fact, I had two of those
cases a month before I came away. All of them come under the act.
Mr. W i l c o x . Your law uses the word “ injury” and does not use
the word 64accident ” ?
Mr. G l e a s o n . Yes.
Mr. W a l n u t . We have that distinction in Pennsylvania, and as I
understand that opinion, it would be somewhat in line with the
opinions we have in Pennsylvania, and I presume in a good many
other States—where the disease or the condition arises from a par
ticular event, occurring in the course of employment, it is com
pensable as an accident. It may be a disease that arises in this
way, for instance. If a man contracts a disease through breathing
gas in a garage over a period of a month, under our decisions that
is not compensable, but if he can relate that disease to the breathing
of the gas on a particular date, then it is compensable. As I gather
from this opinion, the court related the phosphorus poisoning in
this case to a particular event, and therefore it was an accident. If
it had been something that had gradually accumulated over a period
of months it might not be considered an accident.
The C h a i r m a n . It is just the opposite.
Mr. W a l n u t . We compensate anthrax just as they do in New
York.
Mr. H a t c h . Our law says “ accidental injury,” and yet a lot of
those cases are compensated as accidental injuries. Do not any of
you get the impression that I am not for covering occupational
diseases as such in compensation laws. I am; I am for putting all
occupational diseases arising out of the employment under the com
pensation system.
Mr. K y a n . The labor element of Nevada tried to get an occupa
tional disease law passed by the legislature. It failed. The em
ployers of the State objected, and as a compromise the legislature
passed a law that the Industrial Commission of Nevada make a sur
vey of occupational disease in Nevada and report at the next session
of the legislature two years hence. We came here to get all the
information we could upon occupational diseases. The Nevada law
says that an injured workman shall receive compensation for acci
dent by injury arising out of and in the course of employment. Dif
ferent States have it “ by injury,” but our State says that it has to
be an accident.
98
MEDICAL PROBLEMS
The principal occupational disease which we have in Nevada is,
I think, pneumonoconiosis; that is what the doctors call it but
we call it, in simple terms, miner’s consumption. Seventy-five per
cent of the premiums paid into the Nevada Industrial Commission
come from the mining industry. We are the fifth largest State in
the Union in area, but we have over a square mile for every inhabi
tant in the State, as we have a population of only 75,000 people.
We came here to get all the information we can on occupational
diseases. Of course you gentlemen come from the States of the
East, which have large industries which we do not have in Nevada.
In all the books we have read we have not seen anything about
miner’s consumption as an occupational disease. If we can get any
information from this intelligent body, it will be welcomed by the
Nevada Industrial Commission.
Mr. S t e w a r t . If the gentleman will write to me after I get
back to Washington, I will send him all the evidence he needs on the
question of miner’s asthma.
Mr. W i l c o x . I think a few words will clarify the situation with
regard to this. It is the general holding of commissions and of
courts that where the thing that causes the disease is a single germ
or a sudden onset, then it may be compensated as an accident under
compensation laws which provide covering for accidental injuries,
and because of that we compensate for anthrax, for carbon monoxide
poisoning, for typhoid fever, possibly for phosphorus poisoning
in a case like that of which Mr. Eppler speaks, and for some other
types of injuries; but it is my understanding that we always hang
to that one thing, that the onset of the disease must come from
some single instance, which distinguishes it from the pneumono
coniosis the Nevada member here speaks of, which is a disability
coming from frequent and continuous insults to the system.
Mr. W i l l i a m s . I will read two or three sentences from the Con
necticut law which may possibly assist my friend from Nevada.
When our statute was first passed we did not put “ accident ” into it,
but our courts did, and at the next session of the legislature some of
us drew up two or three little simple phrases which are now in the
act. One of them says, “ If an injury arises out of and in the course
of the employment, it shall be no bar to a claim for compensation
that it can not be traced to a definite occurrence which can be located
in point of time and place.”
Then we put another little sentence in our definition section.
“ The word ‘ injury* as the same is used in said chapter shall be
construed to include any disease which is due to causes peculiar to
the occupation and which is not of a contagious, communicable, or
mental nature.”
Mr. I n g r a m . We have been struggling with this subject for the
last eight years in the State of Nevada, and if we could take out
of our law the word “ accident ” we would have all the law we
wanted. That is all we need. By the way, Mr. Stewart, for your
information, the Bureau of Mines has made a careful investigation
of pneumonoconiosis in Tonopah, which is our largest section sub
ject to this disease. We have been unable to get the figures from this
bureau, and if you can get them for us or give us the results of this
PREEXISTING DISEASE
99
general survey, that will be very helpful to the commission in getting
this survey in shape.
Mr. M c S h a n e . A s k Doctor Murray; he w i l l get them for you.
Mr. W i l c o x . I have a copy of the Wisconsin compensation act in
my hand and there are four lines that cover every injury that grows
out of occupation.
Mr. M c G i l v r a y . Why not use the California law, Mr. Wilcox ?
The C h a i r m a n . We have had a very free and open discussion on
this very important question, and have had some very excellent
papers on it. We have all been enlightened and I hope something
may result from this free discussion. I hope we will get a clarifica
tion of the various acts where clarification is needed.
Mr. W i l c o x . In that connection, may I suggest that Doctor Angel,
of the American Association for Labor Legislation, is now prepar
ing for distribution among the States a form of an amendment to
the present laws which will have the effect of covering this type
of injury. I know he is on that work at the present time.
The C h a i r m a n . The next paper was to have been presented by
Dr. Ralph Lewy, of New York, but as he is not here, the subject
“ Preexisting disease—Its relation to workmen’s compensation,” will
be presented by R. E. Wenzel.
PREEXISTING DISEASE—ITS RELATION TO WORKMEN’S COMPEN
SATION
B Y B. E. WENZEL, COMMISSIONER NORTH DAKOTA W ORKMEN’ S COMPENSATION
BUREAU
This subject has been placed under the general heading of “ Med
ical problems,” hence it might reasonably be expected that it would
be treated, in the first instance, from the medical standpoint and by a
representative of that profession. That was the original program.
The enforced change or person to present the subject for your con
sideration has made it impossible to accommodate in that regard.
First consideration of the subject must now be from the layman’s
or administrator’s standpoint, except as such consideration may and
must enter the field of my profession, the law.
As I deem it of some importance to make reference to legal phases
of the subject, permit me, as a starting point, to quote from one of
our recognized legal encyclopedias, to wit:
Acceleration of a diseased bodily condition may constitute a personal injury,
and an injury may be by accident, although it would not have been sustained
by a perfectly healthy individual.—Corpus Juris Pamphlet on Workmen's
Compensation, p. 69.
Attached to this paper you will find a review of a number of
cases, decided by courts of last resort, supporting this general state
ment of the law on this particular subject. In that review I have
given the citation, a brief statement of the facts, and a short sum
mary of the decision of the court. I shall not burden you with a
recital of these cases, but shall refer to them, as occasion may re
quire, to support the conclusions that have forced themselves upon
me in the practical work of administering compensation legislation.
If it is the law that a person whose intemperate habits have so
weakened his powers of resistance that the shock of receiving a
100
MEDICAL PROBLEMS
broken leg brings on delirium tremens and death (158 N. W. 1027,
Michigan), or that a person who has a constitutional disease known
as syphilis, and as the result of what is commonly known as a minor
injury suffers a shock sufficient to bring on paralysis and insanity
(111 N. E. 786, Massachusetts), or that a person who was previously
suffering from an acute impairment of the heart, and through the
medium of just ordinary exertion is disabled and subsequently dies
(108 N. E. 361, Massachusetts)—is entitled to compensation, then
it becomes a matter of immediate and considerable concern to every
bureau or commission having in charge the administration of a
workmen’s compensation law. It becomes a matter of sufficient
concern, to my mind, that the bureau or commission may well ask
itself the question, “ Are the practical results of the application of
this rule of law fair to all the parties concerned?” And if the
answer should be in the negative, then, it appears, another question
would immediately become pertinent, viz: “ What can we, individ
ually and collectively, do or suggest that will tend toward prac
tical results that are fair to all the parties concerned?”
My legal experience and research directs the statement that this
is the law, notwithstanding the fact that a number of jurisdictions
have inclined toward a contrary view. The trend of the great
majority of legal decisions is toward a very broad construction of
the terms “ personal injury” and “ injury by accident.” And it is
not very difficult to understand how the courts, which had long had
before them the words “ tort,” “ negligence,” “ fault,” “ wrong,”
“ damages,” etc., in connection with cases of personal injury, came
to apply those same words, with their legal connotations and con
structions, inferences and interpretations, to the problems that arose
out of an entirely new method of dealing with these cases of personal
injury; and once having applied them, or more particularly having
applied the theories about them, they became precedent, and having
become precedent the old theories in new and strange settings became
more susceptible to growth and development than to any possible
change. But if it is now the law, should it not be uniformly ac
cepted as such and as uniformly followed ?
Eight there my practical experience as an administrator of work
men’s compensation legislation, together with a sense of what I
should modestly identify as discernment and discrimination, enters
a protest. It enters a protest sufficiently strong to cause me to de
liberate, ponder over, and then carefully weigh the various answers
which might be made to my first question. Yes, it enters a rather
vigorous protest, and finally insists that my answer should be that
the application of this rule of law is not fair, at least in a great
many instances; and it goes over the records that have received my
personal consideration and points out specific cases to substantiate
the correctness of the answer.
It points, for example, to the case of a man who presented a claim
for compensation because of an injury to his back—one of those
“ didn’t-amount-to-much,” “ just-a-kink-in-the-back,” “ slipped-on-abanana-peel ” cases—and apparently it was just that; for m 10 days
or so the claimant was back to work as usual. A thorough examina
tion and an X ray at the time of the first treatment by his physician
PREEXISTING DISEASE
101
revealed the fact that this man had a chronic arthritis, with partial
destruction of one of the lumbar vertebrae. This the physician
reported, together with the information that it was in no wise re
lated to the injury. The man went back to his work, that of a
clerk and handy man in a combination butcher shop and grocery
store. About a year later he showed up in the hospital, with every
indication pointing to an extended disability. Supposing, as has
not yet developed, that some simple act of lifting or straining
brought on the collapse the second time, unbiased consideration of
the matter raises the question at least, “ Is it fair to charge the occu
pation with the cost of the disability now in waiting?”
It points again to the case of a man who was injured about 22
years ago, and 2 years later was taken to a hospital for a bone opera
tion on the leg. Released from the hospital (and this was prior to
the day of compensation laws in this country), he continued to work,
doing as much as any ordinary man over a period of years, experi
encing only the inconvenience of having a periodic discharge three
or four times a year from the outside and upper part of the injured
leg. A year or so ago the man received a slight blow on the inside of
the same leg—a blow that he described as very slight, leaving no mark
or abrasion and causing no stoppage of work for weeks afterwards.
But the blow did light up the tubercular infection that was only
smoldering before, and in three months from the time of his second
injury his was a case of permanent partial disability; and, so, again,
the question presents itself, “ Is it fair to charge the occupation in
which he was last engaged with the full cost of this disability?”
It directs attention, once more, to the case of a man whose foot
slipped on some cinders or was caught in some wav, so that his knee
was wrenched. In any event, the incident was of such a character
that when the claimant came to report the matter two weeks later
he could not tell just what had happened, when it happened, or ex
actly where it happened; and 99 out of 100 persons brought into
personal physical contact with the same kind and type of occurrence
would have paid no attention to it whatsoever. But again the pres
ence of a preexisting disease overthrew all the calculations and tech
nical skill of several experts in medicine and surgery, bringing as
a final result almost complete destruction of the hip joint, and hos
pital, medical, and pension expenditures of more than $10,000, to
gether with a renewal of the query, “ Is it fair to charge all of this
to the industry and to the individual employer concerned?”
It brings to mind a group of similar cases, one of which will un
doubtedly include report of the death of the injured person before
the close of the present year.
It brings to mind as a final illustration the case of a man who
suffered a fracture of the forearm, an injury that, according to our
own records, ordinarily represents a charge of $250 to $300 placed
against the occupation and the employer involved. But union re
fused to take place at the point of fracture, not even the sign of a
callus appearing until the expiration of more than 14 months after
injury, during which time two or three open-bone operations had
to be performed. It was not the nature of the occupation, nor its
peculiar hazards, nor the character of the injury, nor any lack of
skill on the part of the surgeons, but the presence of syphilis in the
102
MEDICAL PROBLEMS
body of the claimant that resulted in a charge of around $3,6CR
against the industry and the individual employer involved. Anc
so, again, the question, “ Is that fair?”
Workmen’s compensation legislation has eliminated the element of
fault ” from every case of injury in the course of employment. It
holds liable every occupation covered by the law, through the indi
vidual employer, for the accidental injuries inflicted upon the people
employed in such occupation. That is the proper responsibility of
the occupation. This may not represent the full responsibility, for
there is considerable sound argument for the extension of that
responsibility so as to include occupational diseases. There does not
appear to me to be anything of fairness, however, in the contention
that the logical sequence of the course of reasoning that worked
out the compensation insurance plan contemplated or contemplates
burdening a particular occupation or individual with the cost of
alleviating or relieving entirely those afflicted with other and com
mon human ills and ailments, just because those afflicted with them
happen to be employed by an individual engaged in business in that
occupation. If it should be conceded, even, that society as a whole
should assume that burden, then society as a whole should bear
the financial cost, not a particular individual known as an employer
or a particular occupation known as one coming within the terms of
a compensation act.
But suppose that we all agree that a negative answer should be
given to the question, and that we are here in complete agreement
along that line. This body of representatives is then confronted
with the more difficult task of answering the other question, “ What
can we, individually and collectively, do or suggest that will tend
toward practical results that are fair and equitable to all the parties
concerned? ”
Before attempting to make my suggestion for your consideration,
permit me to refer to one or two of the decisions hereinafter
summarized.
The Supreme Court of Illinois, for instance, in Springfield Coal
Mining Co. v. Industrial Commission, 132 N. E. 752, said this:
If there is a preexisting disease, the employee is entitled for all the conse
quences attributable to the injury in the acceleration or aggravation of the
disease, but he can recover compensation only to the extent and in the propor
tion in which the preexisting disease is increased or aggravated. Under these
rules the previous condition of the applicant was a material circumstance to
be considered in ascertaining whether his condition of total and permanent
disability resulted from the accident or from the disease, and if from both,
the proportion in which the accident contributed.
That decision was handed down in 1921, and it is rather difficult
for a frontier lawyer to tell just to what extent the Supreme Court
of Illinois now accepts that statement as precedent; but it represents,
so far as I am able to find, one of the first attempts—if not the
first—to give consideration to the practical difficulties and inequities
involved in a strict adherence to the general rule laid down in
Corpus Juris Pamphlet on Workmen’s Compensation, and herein
before quoted.
The Supreme Court of Minnesota, in Hogan v. Twin City Amuse
ment Trust Estate, 193 N. W. 122, although confronted with the
opportunity to express itself on the subject in 1923, failed to accept
PREEXISTING DISEASE
103
that opportunity, much less to embrace it, remanding the case to the
Minnesota Industrial Commission on procedural grounds.
The Supreme Court of Utah, in a case almost identical with the
one cited from our own records, Pinyon Queen Mining Co. v. In
dustrial Commission, 204 Pac. 323, presented as a reason for its
failure to follow the California decisions the fact that California
had dealt with the matter through legislation that was controlling.
The court quoted from the California statute as follows:
The term “ injury” as used in this act shall include any injury or disease
arising out of the employment. In case of aggravation of any disease existing
prior to such injury the compensation shall be allowed only for such propor
tion of the disability due to the aggravation of such prior disease as may rea
sonably be attributable to the injury.
It would appear to be a reasonable conclusion to say that the
remedy for the solution of the difficulties or inequities that confront
the bureaus and commissions in the administration of compensation
legislation by reason of the preexisting disease question must come
through the medium of rules by such bureaus or commissions, where
they have the power, and elsewhere through legislative amendment
or enactment.
The judicial interpretation of Illinois and the legislative enact
ment of California constitute what appears to me to be the correct
basis for handling these preexisting disease cases. Just how many
representatives at this convention are in accord with that opinion I
have no means of knowing, as yet. If a reasonably large majority
is found to share that opinion, then I would suggest that the time
for some definite action looking toward the acceptance of this new
rule and the adaptation of practice to it is in order. If opinion on
the subject is fairly well divided, or the majority shares the con
trary view, then I would suggest that the subject is of such impor
tance, at least, that a further survey and study should be made dur
ing the coming year by a special committee, such committee to report
its findings and recommendations to the next annual meeting.
It is with no hesitancy that I assume that most of those present
have had far more experience with preexisting disease cases than
we have had in North Dakota; and that by reason thereof they are
in position to discuss the matter more constructively and more intelli
gently. It is with the view, therefore, of bringing the informational
value of that experience to this gathering through discussion, and not
with the view of anticipating your concurrence in my opinions and
conclusions, that I have framed a resolution for the consideration
and action of this convention whenever the same may be deemed to
be in order. The resolution is as follows:
Whereas it is one of the aims of the International Association of Industrial
Accident Boards and Commissions to bring about equity and uniformity in the
administration of workmen’s compensation legislation; and
Whereas it is the opinion of the representatives of --------- industrial acci
dent boards and commissions fro m ------Provinces of the Dominion of Canada
and ------ States of the United States assembled at this, the twelfth annual
meeting of said association, held in this year 1925 in the city of Salt Lake City,
Utah, that equitable administration of such workmen’s compensation legislation
will be furthered by and through the uniform adoption and adaptation of the
following basis for the handling of preexisting disease cases arising in the
course of industrial employment, to w it:
That in case of aggravation of any disease existing prior to such injury the
compensation shall be allowed only for such proportion of the disability due to
104
MEDICAL tROBLEMS
the aggravation of such prior disease as may reasonably be attributable to the
injury; and
Whereas it is the further opinion of such representatives that it may reason
ably be expected that definite and proper expression and publication of such
opinion will hasten the uniform adoption and adaptation of such basis for the
handling of preexisting disease cases: Now, therefore, be it
Resolved, That the various industrial accident boards and commissions of the
Provinces of Canada and the States of the United States be, and they hereby
are, urged to accept, adopt, and adapt the foregoing basis in the handling of
preexisting disease cases; that the same be done as speedily as possible through
the adoption and publication of rules by such bureaus or commissions, wherever
they possess the power; and that wherever such power is not now possessed
such bureaus, boards, or commissions sponsor the necessary legislative amend
ments to make this resolution effective. Be it further
Resolved, That due and proper publicity be given the passage of this reso
lution.
REVIEW OF DECISIONS
1. Miami Coal Co. v. Luce, 181 N. E. 824 (Ind.).
F a c t s . —In this case the workman was a miner, 48 years of age, in good
health; he had worked almost every day for 25 years, and was engaged in
firing shots in the mine, being injured as the result of an explosion. The doctor
described the condition as showing scalp wounds and several fractures as well
as burns. He was unconscious and delirious when examined. When the in
quest was held, however, the coroner determined that the man died from
mechanical obstruction of the bowels. Another doctor testified that there
was no evidence of any abdominal injury to account for the obstruction, and
that he died from the obstruction and independent of injuries which he had
received.
D e c i s i o n . —It was the duty of the members of the board to bring to bear
their experience and knowledge, and to exercise their reasoning powers, and,
moreover, it is sufficient if there be a causal connection between the injury and
death. The injury need not be the sole cause.
2. Indian Creek Coal & Mining Co. v. Calver't, 119 N. E. 519 (Ind.).
F a c t s . —A miner, working regularly when the mine was running, and at the
blacksmith’s trade and as a section hand on the railroad when the mine was
not running, and who was known to his friends as a strong, healthy man, not
having required the services of a physician, but occasionally indulging in
intoxicating liquors excessively, and complaining that his side hurt when he
coughed, was working in a room in the mine with his son. The two went into
another room and attempted to push a car over a slight grade, but found it
too heavy. Two other men were then called, and after pushing the car over
the grade, the first two continued to move the car down grade into their own
room. One of the men who was called to assist testified that the deceased was
talking and “ cutting up ” the same as usual, but after they pushed the car onto
the switch he was heard to remark, “ Oh, my side.” This was before the
deceased and his son pushed the car down grade into room 12, and commenced
to load it. While loading, the deceased suddenly called out, “ Oh,” and when
asked what was the matter, he said, “ I don’t know.” The son helped him
around the corner of the car, laid him down on the slack pile, and gave him
a drink of water. The son then went for help. When he returned his father
was lying on the slack pile holding his hand over his hearj:. He was taken to
the company’s office, where he died two hours later. An autospy disclosed
a rupture of the aorta on the right side, about 2 inches below the arch, and that
a diseased condition existed at the point of rupture. The cause for this was
given as chronic alcoholism or tubercular focus, probably the latter; and
with this condition existing any exertion or excitement making the heart beat
more rapidly might produce a rupture.
D e c i s i o n . —Assuming that the decedent was afflicted with a fatal malady
which was certain to result in his decease sooner or later, and that such malady
was the cause of decedent’s death, these facts alone are not sufficient to dafeat
the claim. As there was an injury, and it concurred with the ailment in hasten
ing the latter to a fatal termination, the right to an award exists. The
court adopted the definition of an accident as being any unlooked for mishap
or untoward event not expected or designed, and under and in accordance
with that definition held the injury to be an accident arising out of the em
ployment.
PREEXISTING DISEASE
105
3. Hogan v. Twin City Amusement Trust Estate, 193 N. W. 122 (Minn.)
F a c t s . —Claimant, while carrying a bundle of music rolls down a stairway
fell and injured herself. She laid off the second day after this, returned to
work, and then laid off from time to time during the next month a total of
several days. About the third week after the injury a physician was con
sulted. His finding was that she was suffering from inflammation of the Fal
lopian tubes, inflammation of the right ovary, and a small fibroid tumor.
Medical experts disagreed as to whether or not the fall aggravated the pre
vious acute condition of the claimant. The referee allowed the claim, but
the industrial commission reversed that decision.
D e c is io n . —Even though the accident would have caused no injury to a
perfectly normal person, it is a well-known principle that “ an actual aggra
vation of an existing infirmity by an accident occurring in the course of em
ployment is compensable.” The case was merely remanded to the commis
sion, however, as ther determination of issues of fact were held to be for
the commission. The case was really disposed of by the court on the question
of whether or not the commission had applied a too stringent rule of proof
in requiring the claim to be established by “ clear and satisfactory evidence99;
it held that the commission had done so, and laid down the rule that only a
preponderance of the evidence was necessary to establish a causal relation
between an injury and a subsequent ailment.
4. Jones Foundry d Machine Co. v. Industrial Commission, 185 N. E. 754 {III*)
F a c t s . —The claimant was working in a foundry and had been engaged
in such work for a period of 12 years. He was 39 years old, a steady worker,
but addicted to the excessive use of intoxicating liquors. He had had de
lirium tremens. He had arterial sclerosis and high blood pressure. On No
vember 1, 1917, he was carrying molten metal and pouring it into flasks.
The molten metal was carried by two men in a ladle weighing about 65
pounds when empty and 175 pounds when filled. The temperature of the
room was 80°, while the weather outside was cold enough to require an over
coat. A few minutes after claimant was last seen at work, he was found
standing leaning against a flask, apparently unconscious. He was taken to
a hospital, and in April following was found to be insane. A physician, in
answer to a hypothetical question, testified that heavy exertion in a heated
atmosphere might contribute toward the occurrence of a cerebral hemorrhage
in a man whose condition was that of the claimant; that it might cause a
hemorrhage and paralysis; and that a hemorrhage which produces paralysis
might interfere with his mental condition. He further testified that the
high tension and excessive exertion in a heated room would have a tendency
to raise the blood pressure, and when the blood pressure reaches a certain
point some of the blood vessels of the body would give way, causing hemor
rhage; and that heavy drinking would make a man more susceptible to just
what occurred. It was also found that the claimant had had a similar attack
during the previous year, which disabled him for about two weeks.
D e c i s i o n . —It is true that an injury of a similar character might have hap
pened by reason of moderate exertion in a moderate temperature, or that he
might have received a similar stroke in the absence of any exertion at all
while sitting in his home or lying in his bed, and the result perhaps would have
been the same. He might have suffered this stroke in the same way if he had
stayed at home and not worked at all that day, but he did not, and he did
suffer this stroke as a combined result of the disease and his work. It was
therefore the result of an accidental injury.
5. Peoria, Railway Terminal Co. v. Industrial Board, 116 N. E. 651 (III.).
F a c t s .— A fireman, working for the plaintiff, was firing a switch engine, and
while so doing fell from the engine, death resulting. The deceased had been,
during his lifetime, a machinist, a concrete construction foreman, a switchman,
and a fireman. His last employment had existed for only one day prior
to his death. It was his first trip over the particular road covered. There
were four persons in the cab. The deceased was last seen by any of his com
panions engaged in firing while the switch engine was going between 8 and 12
miles an hour. The roadbed was practically level. As soon § ls the deceased’s
absence was discovered, the engine was run back, and the fireman was found
on the side of the embankment, which at that point was about 12 feet high.
Some scalp wounds were found on the back of his head. An autopsy was
held under the direction of the coroner, and it was found that the deceased
died from hemorrhage of the brain, but whether caused by the fracture the
106
MEDICAL PROBLEMS
physician could not say. A portion of the brain was found to be soft, and the
hemorrhage was from the soft portion. It was testified also that the fall
could not have produced the condition found, but that the cause was syphilis,
which was indicated by scars on other parts of the body. It was also testified
that the exercise of shoveling could cause blood pressure and might result in
the ruptured blood vessel.
D e c i s i o n . —The burden rests upon the claimant to show by competent testi
mony that he was injured in the course of employment, and such proof must
be based on something more than a mere guess. Such proof, however, may be
circumstantial evidence. If the facts proved give rise to conflicting inferences
of equal degrees of probability, so that the point between them .is a mere
matter of conjecture, then the applicant fails to prove his case; but where
the known facts are not equally competent, where there is ground for compar
ing and balancing probabilities at their respective values, and where the more
probable conclusion is that for which the applicant contends, an inference in
his favor is justified.
Even where a workman dies from a preexisting disease, if the disease is
aggravated or accelerated under circumstances which can be said to be acci
dental, his death results from injury by accident. We think it is clear that the
conclusion necessarily follows that death was accelerated by the fall from the
engine, and therefore the injury resulted from an accident. The proximate
cause of death was the fall from the engine and not the disease. This infer
ence, from the facts, is more reasonable than any other inference that can
fairly be drawn therefrom.
6. Springfield Coal Mining Co. v. Industrial Commission, 132 N. E. 752 (III.).
F a c t s . —Tlie applicant was 50 years old and before the accident had worked
on a farm and for four or five months prior to the accident had worked in this
coal mine. He had always been able to do such work, and testified that he
had never had any kind of heart trouble nor internal trouble before this
injury; that at the time of the accident he did not think that he was hurt and
went back to his work, but not being able to get his work done he was sent
home in a buggy; that the doctor bandaged him, and that he had been under
the care of that doctor and another since his injury; that his heart ached;
that his head felt as if it were going to burst; that his heart felt filled up and
heavy. The doctor who treated him at the time of his injury and bandaged
him, and also treated him at different times afterwards, testified that claimant
was suffering from myocarditis, an organic disease of the heart, caused by
infection and degeneration of the heart muscles; that the disease is never the
result of an outside injury or force applied to the body; that he had examined
the applicant twice after the injury and found him in a bad condition, weak
and emaciated, but that there were no results from the injury which could
possibly have caused myocarditis; and that he had a temporary disability only
from the injury. The claimant was injured while he was getting dut of an
empty car, when the mule started up and caught him between two cars, he
being caught in the region of the left lower ribs. Another doctor who treated
claimant testified to the injury and that the squeezing which claimant had be
tween the cars could have aggravated the condition which was already there,
but that the heart condition or disease was present before the time of the
injury.
D e c i s i o n . —An employee is entitled to compensation for every accidental
injury suffered in the course of his employment. That is the measure and the
limit of his right. If the injury is the proximate cause of the incapacity, the
previous physical condition is unimportant, and he may recover for his perma
nent incapacity which results from the accident, independent of preexisting
disease. If there is a preexisting disease, the employee is entitled for all the
consequences attributable to the injury in the acceleration or aggravation of
the disease, but he can recover compensation only to the extent and in the pro
portion in which the preexisting disease is increased or aggravated. Under
these rules the previous condition of the applicant was a material circumstance
to be considered in ascertaining whether his condition of total and permanent
disability resulted from the accident or from the disease, and if from both,
the proportion in which the accident contributed.
T. Pinyon Queen Mining Co. v. Industrial Commission, 20Jf Pac. 823 (Utah).
F a c t s . —Claimant was a miner, and while engaged in his regular work in
jured his arm. At the time of this accident* and for some time prior, he had
PREEXISTIN G DISEASE
107
been afflicted with an organic disease, but it had not interfered with his work
ing; that unaccompanied by the disease the applicant would have recovered
from his accident within six weeks; that by reason of the failure to treat the
disease the disability continued for a considerably longer period; and that as
soon as the doctors began treating the disease the arm trouble cleared up.
D e c i s i o n .—The court quotes the Corpus Juris Pamphlet on Workmen’s Com
pensation (p. 69, sec. 59) as follows: “Acceleration of the diseased body con
dition may constitute a personal injury, and an injury may be by accident al
though it would not have been sustained by a perfectly healthy individual.”
So death may be regarded as having been caused by an injury although there
was a diseased condition prior to the injury without which death would not
have ensued, and partial or total incapacity may spring from and be attribut
able to the injury where undeveloped and dangerous physical conditions are
set in motion producing such a result as well as where there is a dislocation
or dismemberment or internal organic change capable of being exactly located.
The court stated that California had a different rule, and, in explanation
thereof, quoted from the California statute as follows: “ The term ‘ injury’
as used in this act shall include any injury or disease arising out of the em
ployment. In case of aggravation of any disease existing prior to such injury
the compensation shall be allowed only for such proportion of the disability
due to the aggravation of such prior disease as may reasonably be attributable
to the injury.”
8. Tintic Milling Co. v. Industrial Commission, 206 Pac. 278 (Utah).
F a c t s .—The applicant was assisting in putting a “ pug-head” in the flue
that carries fumes from the roaster. At the time the roasters were not entirely
dead, and were throwing off fumes. Claimant was gassed, causing bronchial
irritation, followed by nausea and vomiting. He became ill, but continued
work for several days. The irritation kept up and about six weeks later a
hemorrhage resulted from the lungs. Two months after that an examination
of the sputum showed active tuberculosis. It was testified that the gassing
was either the direct cause of the tuberculosis or lighted up a dormant condi
tion which existed previously; that he was wearing a respirator at the time
and when he first entered the flue gases were so dangerous that he had to
wait about 30 minutes. There was also evidence that the claimant, prior to
the date of the alleged injury, was afflicted with pulmonary tuberculosis and
that the occurrence of January, 1921 (the date of the injury) might have
accelerated or aggravated the disease.
D e c i s i o n .— There is ample evidence in the record to sustain the findings of
the commission either that the injury was caused by the occurrence of Janu
ary 17, 1921, or that said occurrence lighted up a dormant condition which
previously existed. The disease of pulmonary tuberculosis, with which claim
ant was afflicted, would not seriously interfere with his regular employment,
for it appears that during the year previous the claimant worked 356 eighthour shifts out of a possible 384, but that within five days after this occur
rence he was unable to work, and continued to be disabled. We have already
stated that under our statute no compensation can be allowed for a disease
except where the disease is a result of an accident. The word “ accident ”
refers to the cause of the injury and it is here used in the ordinary and popu
lar sense as denoting an unlooked for mishap or an untoward event which is
not expected or designed by the workman himself. As a physiological injury,
as a result of the work he is engaged in, an unusual effect of a known cause,
a casualty, it implies that there was an external act or occurrence which
caused the injury or death. It contemplates an event not within human fore
sight and expectation. If the injury is incurred gradually in the course of the
employment and there is not any specific event or occurrence known as the
starting point, it is held to be an occupational disease and not an injury.
[The resolution proposed by Mr. Wenzel in his paper was, on
motion duly made, seconded, and carried, referred to the resolutions
committee for its recommendation, with the provision that “ full,
free, and intelligent discussion ” be had when the committee reports
on said resolution. Meeting adjourned.]
73891°—26----- 3
WEDNESDAY, AUGUST 19— MORNING SESSION
CHAIRMAN, MRS. P. L. ROBLIN, CHAIRMAN OKLAHOMA INDUSTRIAL COMMISSION
The C h a i r m a n . This association has given me and my State much
valuable information. The Legislature of Oklahoma knows all about
the workings of this association, and is so well pleased with what you
have done that it has made a special appropriation for the dues to
this association and the expenses of the commissioner in attending.
The subject to be discussed in the first two papers I confess I
know nothing about. Oklahoma is the only State which has a com
pensation law that does not provide death benefits. Fearing that
some of you may not know the reason, I want to say that at the time
the constitution was drawn, the members of the convention, feeling
that some of the States were attempting to limit the amount recov
erable for death, provided specifically in our constitution that no
amount could be fixed, no limit could be placed, on the recovery for
death. The 1921 session of the legislature passed a resolution to
submit to the people of Oklahoma an amendment to this section.
Unfortunately, when it was submitted it was at a time when there
were two very unpopular measures to be submitted and all three
were lost.
We need all the valuable information we will get this morning on
this remarriage table, because one of these days we are going to
cover death in Oklahoma.
At the St. Paul convention last year, it appears, this association
realized that the Dutch remarriage table, which is in most general
use, did not truly represent American conditions and a committee
was appointed to compile material for a remarriage table based on
the American experience. We shall have the pleasure now of listen
ing to the report of the committee on statistics atfd compensation
insurance costs on American Eemarriage Table, by the chairman,
L. W. Hatch, of the Department of Labor of New York.
REPORT OF COMMITTEE ON STATISTICS AND COMPENSATION
INSURANCE COSTS ON AMERICAN REMARRIAGE TABLE
BY L. W . H ATCH , DIRECTOR BUREAU OF STATISTICS AND INFORMATION, NEW YORK
DEPARTMENT OF LABOR
The assignment of this matter to the committee on statistics and
compensation insurance costs grew out of a consideration of the
subject at the St. Paul convention.
I am going to indicate how the committee became active on the
matter this year, by reading part of a letter of the secretary-treasurer to me last January, bringing up the subject. He makes some
characteristic, pungent comments on the situation. This is from
Commissioner Stewart, January, 1925:
Ever since the International Association of Industrial Accident Boards and
Commissions was organized, little shots of steam have been thrown off from
108
REPORT OS' COM M ITTEE O tf STATISTICS
109
various boilers of various sizes in the conventions on the subject of the remar
riage of widows.
At the St. Paul convention the matter was taken up seriously. I have
circularized the various State commissions and with one or two exceptions
have gotten less than nothing from them.
I believe you will agree with me that the Dutch remarriage table was never
worth a “cuss” even on its face, and its applications to the American conditions
are a little less than absurd.
I am writing to ask you if in your judgment the committee on statistics
and compensation insurance ought not to go into the subject of remarriage
of widows in such a way as ultimately to develop a table that will be worth
something.
That started the ball rolling.
I am sorry that the committee is not prepared to report a full
and final plan for the preparation of American statistics of remar
riage which might form the basis for an American table in the
course of time. I can, however, report progress, and that is what
this report is, a report of progress and some indication of where
the thing now stands with the committee.
This progress report will really cover what the chairman of the
committee has undertaken to do in preparation for submission of
something concrete to the whole committee, so please understand
that I am reporting only preliminary work of the chairman toward
getting down to something concrete and constructive in this line.
It happened that the assignment of this matter to this committee
occurred just about the time we had started in New York to make a
tabulation of New York experience—that is, to collate the data
preparatory to putting it in the form of a table. In New York we
now have 11 years’ experience under unlimited death benefits with 2
years’ compensation in case of remarriage, and we are in a position
where the records should be fairly complete on the subject.
I thought the best thing that 1 could do as chairman of the com
mittee would be to go ahead and work some distance into our New
York handling of the problem and then take the matter up with the
committee in the light of the experience we had gained in New
York. We have not yet completed the New York tabulation. We
have collated the data for the entire 11 years and are now about
ready to put it in the form of a table. Here are some of the points
we have developed so far in this work:
What you have to find out about each case is a fairly simple
matter. Briefly enumerated, what you have to dig out of your
records, if you are going to tabulate your remarriage experience,
includes, first, a case number for identification, then the date of
death of the injured employee, the date of birth of the widow, the
date of her death if she has died, the date of remarriage of the
widow if she has remarried, the date of any commutation of com
pensation which might have occurred, the date of any other with
drawal of the widow from the usual status, and then the date of
observation—that is, the date when the data are compiled. It is just
a series of dates, all of which ought to be normally in the records if
your law is like the New York law, and it simply requires clerical
work to bring them together.
When you have gotten this material together, however, and you
set out to prepare a table by which to test the data in the ‘Dutch
remarriage table, which we are using now in this country and which,
no
AM ERIC AN REMARRIAGE T A B lJi
as h a s b e e n in d ic a t e d , e v e r y b o d y is s u s p ic io u s o f , th e t h in g is n o t
q u it e so s im p le .
Mr. M c S h a n e . Mr. Hatch, can you give to the convention the
date of the compilation of the Dutch remarriage table ?
Mr. H a t c h . I do not believe I can. Mr. Leslie, do you know what
the date of that table is?
Mr. L e s l ie . I do not, Mr. Hatch, offhand.
Mr. H a t c h . It is an old table.
Mr. McShane. Social practices change; if nothing else, that is
why it is not very valuable.
Mr. H a t c h . A s to the validity of the Dutch table, it is, of course,
Dutch and not American experience. It is experience running back
a good many years and it is not experience under a compensation
law. However, this matter was like a great many others in the com
pensation laws of this country. When we started out we had to take
what was available and do the best we could with it. So the Ameri
can laws (that is, those like the New York law) provided that in
computing present values in death cases the Dutch remarriage table
should be used; although we now find that was a pretty poor basis,
we do not want to be too critical of what was done at that time. It
was all that could be done. But now our problem is to accumulate
American experience, having found from various bits of evidence
that have been developed that the Dutch table does not reflect Ameri
can conditions. Pennsylvania has, for example, compiled some data
which rather jar the Dutch table, and the United States Employees’
Compensation Commission has also compiled some remarriage data
which tend in the same direction.
We will have to continue a long time under compensation laws
before we will get a thoroughly dependable basis for an American
table, but it is a question whether, if we had all the American ex
perience that might be compiled right now, so that Commissioner
Stewart, for example, could put it together in the form of a national
table, we might not be pretty nearly ready to do business with that
as saxely as we are doing it with the Dutch table. That is a pretty
technical matter and wThen we get some actual data we can tell a lot
better about it than we can now. Commissioner Stewart has tried
to get some data and reports he got less than nothing from most
jurisdictions.
Going on to the technical matter of tabulation, my report is here
still more one of progress only. I think, however, that we are on
the road in our New York tabulation, as we are going to use a form
that is a little different from any other that has been used in this
country, to get a standard form that will be the right thing. I am
not prepared to say it is the right thing yet until we go through the
process of actually putting the figures together under this table
form. I have confidence in it, not because it is New York’s or be
cause I had a hand in it, but because I have been able to get advice
from one of the best actuaries in the country on a table of this kind,
namely, Joseph H. Woodward, formerly actuary of the New York
Department of Labor and now a consulting actuary in New York
City, who has done a great deal of work on the general problem of
computing values in death cases. He has kindly given me his ad
vice so that we might lay out something that not only would insure
REPORT OP CO M M ITTEE ON STATISTICS
111
a sound statistical compilation but would be in a form to be most
valuable and practicable for the actuaries who will have the job of
testing the Dutch table on the basis of the compiled statistics.
In making the tabulation there is only one feature which pre
sents much difficulty. This has to do with calculation of the ex
posure to remarriage. It does not sound complicated, but—well,
marriage is a complicated matter anyway.
Mr. McShane. Just what do you mean by “ exposure to remar
riage ” ?
Mr. H a t c h . What I mean is this: It is necessary in order to get
“ exposure ” to compute the total time in which widows of a given
status (attained age, year of widowhood, number of children, etc.)
might have remarried or actually did remarry. That would be the
exposure to remarriage. Now, the time in each case varies. For
example, for those in a given year of widowhood, those that remarry
do not all remarry at the beginning of the year—they remarry at
dates all the way through a given year; so you have the question of
fractional years to deal with. Another element to take account of
is the dropping out of some of them by death. Then, under the New
York law there are withdrawals from the status of a widow by com
mutation of the widow’s compensation to a lump sum, in which case
she relinquishes the right to two years’ compensation if she remar
ries. There are a number of complications of this kind, and it is a
complicated, technical problem to arrive at the correct method of
measuring total exposure.
I am reporting, then, that the chairman of the committee is trying
to evolve out of our New York experience a concrete plan for collat
ing the data and tabulating it, which, after submission of course to
the other members of the committee, I hope by the next meeting of
the association can take form in a formal, detailed plan for compil
ing American remarriage experience.
I hope that our report will cover not only the matter of what any
one State should do, but, in cooperation with Commissioner Stewart,
some kind of a plan for a combination of it in a national experience.
That is a very important matter, because the conditions in the
different States as to the scope of the data will vary considerably,
and it is to be hoped that we can work out some plan so that we
can get all the value there is out of all the data, even with varia
tions in its scope.
So much for the purely technical side of this subject. I want to
say just one thing more. This plan for remarriage tabulation we
hope to make just as detailed and practical as the other statistical
plans for statistical tabulations that the committee on statistics has
in past years presented and which have been applied in many of
the States. But just where does this piece of statistical work belong
in the statistical program of any industrial accident board or com
mission ? I think it is rather important that we consider that.
What is the purpose of a remarriage table anyway? Its chief
value is as a means of computing probability of remarriage as a
factor in computing present value of the total compensation which
will be payable to a widow of an injured workman, Such present
value is the measure of reserves necessary to pay her compensation:
In other words, it is essential for insurance purposes. It is not a
112
AM ERICAN REMARRIAGE TABLE
minor matter from that point of view. I have heard estimates of the
possible effect of an American table on the reserves which are re
quired under workmen’s compensation laws put in pretty large
figures; unquestionably it might make a very great difference in
the necessary reserves, and that, of course, is a matter of great im
portance. If the reserves are not large enough, the security of com
pensation of the widow is jeopardized. If the reserves are too high,
then industry and society are being required to pay more than they
should. It is important that we get the thing right. However, I
think this piece of work in any program of statistical work of a
commission should be labeled No. 2 and not No. 1. No. 1 should be
the compilation of your experience along lines which have been
previously recommended by the committee, which will afford you,
first, information of practical value on the problem of accident pre
vention, because, after all, preventing accidents is more worth while
than compensating them; and second, dependable data as to the cost
of your laws and of the various features of your laws, so that you
will be in a position to speak with some authority when questions of
changes in law, or debates about the cost of compensation generally,
come up in your legislatures or before the public.
In other words, the previously established and recommended pro
gram of accident statistics of the committee is of major importance
as compared with this remarriage experience. If you can also com
pile your remarriage experience, it is a desirable thing to do.
I have given you on behalf of the committee only an interim
report and the prospect of a definite report next year. May I add
to that, as chairman of the committee and on behalf of the com
mittee, this proposal, that if any of you can take up this work and
are disposed to do so, the chairman of the committee would be glad
to give you the benefit, on any point of detail, of our New York
experience so far, and our further experience as we go through the
tabulation in the next few months.
DISCUSSION
Mr. I n g r a m . In the proposed card for gathering the data, as I
understand it, you include the factor of children in the possibility
of remarriage; that is, one, two, three, four, five?
Mr. H a t c h . That is a matter that can be included. Thus far,
however (I think I am right in this), the experience that has been
tabulated in this country seems to indicate that that is a minor mat
ter in remarriage experience. A widow with several children remar
ries as easily and promptly as a widow without children. How long
the period of widowhood has continued and the age of the widow
at the time of the death of her husband are the two prime factors.
Furthermore, so far as testing the Dutch table is concerned, the
number of children cuts no figure whatever. That is a table based
on the attained age of the widow.
Mr. I n g r a m . We make a set-up this year for the reserves and two
years from now we find we are “ in the red ” on the set-up on that
very thing. The older the widow gets, the more money she gets, the
^loser she gets to death, the more money seems to be required to
protect the reserves, up to the peak. There is a peak, of course^ but
ONTARIO , S M O R T A LITY AN D REMARRIAGE EXPERIENCE
113
we have not had the experience to be able to find where that peak
is, and we are very much interested in the table in order to get
proper reserves to protect these widows. As in our State we have
unlimited compensation for widows until death, we will have to
determine that matter if we are going to have ample reserves.
Mr. S t e w a r t . I consider this work the biggest work we have on
hand now. All the boards set up a reserve; it is just like the catas
trophe fund. You keep a catastrophe fund. Suppose some catas
trophe happens that blows the top off of your catastrophe fund;
you have not half enough money to meet it. The boards keep up a
remarriage reserve fund. About half of such funds are ridicuously
small; they fail to meet the need, nine times out of ten. Others have
reserves which in my opinion are ridiculously high. It is up to us
to know what we are doing.
This has nothing to do with the widow; it is simply a matter of
regulating our money reserves, and it seems to me that the quicker
we get down to business and get up such a table, the better it will
be for us. I am satisfied that that Dutch table is not worth the
paper it is written on, so far as our purpose is concerned.
[The report of the committee was, on motion, duly made, seconded,
and carried, received with thanks, and the committee was continued
to make further report at the next meeting.]
The C h a i r m a n . Mr. Kingston will give us his experience on the
mortality and remarriage experience of Ontario.
Mr. K i n g s t o n . Mr. Dean was on the program to prepare a paper
on this subject of Ontario’s remarriage experience and also its mor
tality experience, and I am sorry he is not able to be here to pre
sent this paper and to discuss it, possibly somewhat along the same
lines as Mr. Hatch has discussed it. I can not go into the matter
with as much detail as that and will simply read the short paper
Mr. Dean has prepared.
ONTARIO’S MORTALITY AND REMARRIAGE EXPERIENCE
BY T. NORMAN DEAN, STATISTICIAN ONTARIO WORKMEN’ S COMPENSATION BOARD
[Read by George A. Kingston]
Pension requirements under the workmen’s compensation act of
Ontario, in addition to the ordinary interest, present value, and
annuity tables, necessitate three life annuity tables: 1. Value of
a monthly pension to a child to death or age 16; 2. Value of a
monthly pension to a workman to death; 3. Value of a monthly
pension to a widow to death or remarriage with two years’ com
pensation in a lump sum in lieu of subsequent pension payments.
In 1915, on inception of the act, the following standards were
incorporated into actuarial tables:
1. Mortality.— {a) Children: A table said to be used by Canadian
insurance companies.
(b)
Workmen: The American experience table to age 56, and for
subsequent years a modification of the healthy male table on the
assumption that industrial life is not coterminous with, but some
what less than, actual life, and in the case of permanent injury,
114
ONTARIO *S M O RTALITY AND REMARRIAGE EXPERIENCE
social rehabilitation is not so easily attained at an advanced age as
it is at a younger age.
(c)
Widows: The widows’ life table (pages 68 and 69, supplement
to the Seventy-Fifth Annual Report of the Registrar-General of
Births, Deaths and Marriages in England and Wales).
2. Remarriages of widows.—The Dutch State Insurance Fund
(Rejksverzekeringsbank) remarriage table as introduced into Amer
ica by Messrs. Olifiers and Dawson, modified by the assumption,
more or less arbitrary, that the remarriage element disappears after
age 55.
^Fhe Ontario table differed from preexisting tables in the use of
the English life table for widows5 mortality instead of the Danish
survivorship female annuitants table.
In 1919 the Associated Workmen’s Compensation Boards of Can
ada had prepared new tables substituting for mortality the United
States life tables, census of 1910, and retaining the Dutch standard
for remarriage of widows. These tables in 1920 were adopted by
Ontario.
In 1924 an examination was made of the actuarial bases upon
which the board was operating. This entailed a study of Ontario’s
remarriage and mortality experience for the nine years ending De
cember 31, 1923.
During this period pensions were awarded to 2,458 male workmen,
of which number 2,144 were still upon the list at the end of 1923;
76 pensions expired by death of pensioner, 139 by commutation, and
63, being temporary pensions, by lapsation. In addition 36 stood
suspended, generally by reason of lack of address.
Pensions during like period were awarded to 926 widows. Of this
number 727 were still upon the list, 37 had expired by death of pen
sioner, 4 by commutation, and 145 by remarriage, 13 standing sus
pended.
At the end of 1923 there were continuing 261 cases of pensions to
children without parents and 400 children with widowed mothers,
as well as 41 to disabled female workers and 60 to other dependents.
The number of cases of pensions to other dependents and to dis
abled female workers was considered too small to permit of actuarial
survey. Children’s rates were found to approximate very closely
the United States life rates, so no table was constructed. New
tables for mortality of male workmen and of widows and for remar
riage of widows were made, and these tables compared with other
tables as follows:
1. Mortality.— (a) Workmen: 1. Ontario experience tables; 2.
United States life tables, 1910; 3. English life table No. 8, census of
1911; 4. English Government annuitants’ tables, 1900-1920, neglect
ing year of selection.
(b)
Widows: 1. Ontario experience tables; 2. United States life
tables, 1910 (females); 3. English life table No. 8, census of 1911
(widows); 4. Danish survivorship female annuitants.
2. Remarriage.—1. Ontario experience tables; 2. Dutch State In
surance Fund.
Compilation of mortality rates for workmen disclosed the fact
that the Ontario experience rates are more closely paralleled by the
English Government annuitants’ rates than by either the United
O N TA R IO 'S M O RTALITY AN D REMARRIAGE EXPERIENCE
115
States or English life rates. The English life rate shows a smaller
mortality than the United States life rate to age 65, and a greater
jiortality after age 65. The English Government annuitants’ rate to
age 87 is lower than the United States life rate and after age 87
it is higher. The Ontario experience rate is the same as the English
Government annuitants’ rate from ages 10 to 14, higher for ages
15 to 30, equal for age 32, and lower to the end of the table, age 94.
Compared with the United States life rate, the Ontario experience
rate discloses a lower mortality for ages 10 to 16, equal for ages
16 to 17, and lower for ages 18 to 94.
The United States life table for white males covered a population
homogeneous with that of Ontario, or as nearly the same racial mix
ture as it was possible to find, and it is a matter of some astonish
ment that the Ontario experience rate of mortality not only is much
lower, when general population is considered, but is somewhat
lower than the mortality rate of a select life table. For the causa
tive factors of difference, the following is offered:
1. There is a tendency, commonly enough admitted, to overstate
age.
2. Workmen injured severely enough to necessitate pension, when
hospitalized are relieved of ancillary conditions as well as traumatic
disability, and after dehospitalization get beneficient regimen. It
is suggested that as time goes on, this, like medical selection of insur
ance risks, will wear off.
3. The quality of medical aid.
4. Less likelihood to fatal accident.
5. Comfort of a life pension.
From ages 20 to 86 the Ontario experience rate of mortality for
widows is higher than the Danish experience; subsequent to age 86
it is lower.
The English table begins with age 25 and shows a lower death
rate than the Ontario experience rate to age 63, from which age to
the end of the table, age 93, the mortality rate is higher. In the
United States table the expressed death rates, commencing age 16,
are lower than the Ontario experience rates to age 52; at age 53
they are the same, continuing equal for each age to age 99, the end
of the table.
Remarriage rates from the Ontario experience are comparable
with those from the Dutch State remarriage table. Commencing
age 20, Ontario rates are lower; ages 21 to 32, higher; ages 33 to
36, the same; ages 37 to 62, end of the table, they are higher.
In connection with the remarriage table the influence of the Great
War, marriageable men being overseas from 1915 to 1919, and their
return in 1919, plus the generous gratuity on disestablishment, and
the heavy “ bonusing” on remarriage under the Ontario compensa
tion act are; perhaps, causative factors.
In American and Canadian remarriage tables it has been cus
tomary to disregard the remarriage factor after age 65. Ontario's
experience shows that the remarriage factor for age 66 is. precisely
the same as the figure used for age 54 in the modified Dutch table,
and that the remarriage factor persists to age 70.
Combining the United States life table rate for mortality and the
Dutch State Fund remarriage table remarriage rate an interesting
116
O N TA R IO 'S M O RTALITY AND REMARRIAGE EXPERIENCE
comparison with the combination mortality and remarriage rate of
Ontario is obtained: Commencing age 20, the experience rate is
0.085 as against 0.1115; at age 30 it is 0.0819 compared with 0.07503;
at age 40, 0.0399 instead of 0.03603; at age 50, 0.0266 to 0.01959; at
age 60, 0.0328 to 0.01592; at age 70, 0.0576 to 0.0566; and from age 71
on, age for age, they are the same (the remarriage factor having
dropped out).
Summing up the results of the study of Ontario’s experience, it is
manifest that although the Ontario experience tables, in general,
show higher mortality and remarriage rates, substantially, having
speculated as to factors affecting differences, the general population
tables for whites, expressed in the United States life tables, census
of 1910, and the Dutch State Fund remarriage table as first used in
New York State, with, perhaps, a less declivitous graduation for
remarriage, are safe and proper bases for construction of actuarial
tables in compensation jurisdictions.
Canadian experience has been combined and the unified experience
as well as that of each of the six compensation Provinces confirms
the trend of results of the Ontario study.
DISCUSSION
Mr. K i n g s t o n . That is the contribution Mr. Dean has made to
the subject. I merely wish to say that we found a year ago, after
this survey of our reserves was made, that as a result of the tables
we had used during the nine years, on a pension-reserve fund of
something like $11,000,000, we had gathered about $1,000,000 too
much. We at once turned back from the reserve fund to the gen
eral fund that amount of money, so that we not only started then
on the new basis—tables adopted to meet what we saw to be the
true condition and the real need—but we also restored the condi
tions resulting from the old rates to as nearly as possible the posi
tion in which they would have been had we adopted the more
modern rates from the outset. But I feel that we are very fortu
nate in Ontario in that we guessed as we did. It is very much
easier to give the million dollars back to the accident fund than to
have to go to the accident fund and collect another million dollars.
When the employers paid the money in the first place, they consid
ered it was gone, but to come back for a million dollars 10 years
afterwards would be a sore touch. It was a very comfortable
thing to be able to turn that million dollars back to the accident
fund and restore conditions to what they really ought to be.
I do not know that there is anything more I can contribute to the
subject. I do wish to express the hope that in the not distant future
we will be able, by collaboration with New York and all the other
jurisdictions which are making a study of this subject, to get to
gether a combined experience table of the Canadian Provinces and
the American jurisdictions which will be a real, sound basis upon
which all of the jurisdictions can with absolute safety determine
their rates for these cases.
The C h a i r m a n . This is a subject in which we are all interested.
The discussion of this paper will be led by R. E. Wenzel, commis
sioner of the Workmen’s Compensation Bureau of North £)akota.
NECESSITY FOB N A T IO N A L ACCIDENT HATES
117
Mr. W e n z e l . It was my understanding that I was to take up some
of the experiences of North Dakota. On looking into the matter
I discovered that our experience was so slight that any attempt at
discussion from our experience would be of very little value to this
gathering; and so while we have prepared some tables upon the mat
ter, I do not think that I can add anything here this morning with
respect to it that would be of any value.
The C h a i r m a n . We will proceed with the next number on our
program, “ Necessity for national accident rates,” by Lucian W.
Chaney.
NECESSITY FOR NATIONAL ACCIDENT RATES
BY LUCIAN W . CHANEY, OF THE UNITED STATES BUREAU OF LABOR STATISTICS
Three organizations are now and have been for some time gather
ing, statistics of accidents on a national scale, ^hese are the Inter
state Commerce Commission, the Bureau of Mines, and the Bureau
of Labor Statistics. The last-named has up to the present time con
fined itself to the iron and steel industry.
It is the present purpose to inquire whether theoretical considera
tions and the experience of the above organizations justify the use
of the word “ necessity ” in the title of this paper.
First, it is desirable to inquire regarding the nature of rates and
the steps by which the practice of the Bureau of Labor Statistics
has come to be regarded as in some degree standard.
The two elements which make up an accident rate are the amount
of exposure and the casualties which occur in connection with that ex
posure. In vital statistics it has long been the practice to express
the rates as the number of cases per 1,000 population of the town,
State, or country under consideration. It was natural to endeavor to
use a similar form of expression in treating accidents. Accordingly,
the early accident rates were “ number of cases per 1,000 employed.”
Almost immediately it became evident that this did not take into
account the fact that exposure to the hazards of industry is limited
to the time in which persons are actually engaged in industrial pro
cesses. The man who works eight hours* per day at a task has evi
dently a shorter exposure than the man who works 10 hours. In
order to take into account this time element the schem?, was devised
of transforming the time worked and the number employed into an
equivalent in terms of workers for 300 days of 10 hours each. These
theoretical people were termed “ 300-day workers” or “ full-year
workers” and rates became “ number of cases per 1,000 300-day
workers.”
Several objections to this formula were urged, into the details of
which it is not necessary to go. As a result the matter was referred
to the committee on statistics of your organization. After prolonged
and careful consideration it decided that the wise procedure was to
break away from the idea of representing people and consider only
the working time expressed in hours. The Bureau of Labor Statis
tics accepted this conclusion and its frequency rates have since been
“ number of cases per 1,000,000 hours’ exposure.”
Along with this development went another which was finally re
ferred to your committee on statistics and by it elaborated and in-
118
N ECESSITY FOR N A T ION AL ACCIDENT RATES
clorsed. This pertained to what are called “ severity rates.” They
are formulated on the same basic exposure as the frequency rates but
differ in that the casualties, instead of being treated as single events,
are translated into terms of loss expressed in days. Temporary dis
abilities are given their actual time loss, while fatalities and per
manent disabilities have fixed time allowances ranging downward
from 6,000 days allowance for fatalities. After the application of
these constants, rates are computed and expressed in terms of daj's
lost. A severity rate is days lost per 1,000 hours’ exposure.”
It may be remarked in passing that insurance companies formu
late their rates in terms of u money cost per $100 of pay roll.” This
is beyond question the most convenient procedure for the purposes
which they have in view. For serious and accurate study of acci
dent prevention problems it has one fault so serious as to render
it wholly unacceptable. Pay roll fluctuates with the wages paid.
Evidently, then, an increase in wages would cause an apparent fall
in the accident rat^when in fact the rate might be stationary or
even rising. Of course, the converse would be true and falling wage
rates would be accompanied by an entirely illusory appearance of
increasing accident rates.
The above outline gives an idea of the development of the stand
ard method of preparing accident rates. It is now possible to in
quire regarding their necessity on a national scale.
There are six things which properly prepared accident rates will
show. They will—
(1)
Provide standards by which success in accident prevention
may be judged; (2) indicate whether the conditions are improving,
retrograding, or simply marking time; (3) identify those industrial
departments and occupations whose conditions demand the most
serious attention; (4) define accurately the importance and relation
to each other of accident causes; (5) give an exact indication of the
relation of causes to nature and location of injury; (6) furnish
material which may be used in that process of education of the
worker upon which safety effort must largely rely for further
progress.
To many other phases of the intricate accident problem the rate
method is applicable, but these do not concern so directly the pre
vention of accidents as the six specified. Do these six items need
to be projected on a national background in order to be of the
greatest utility?
STANDARDS OF PERFORMANCE
The importance of standards is so apparent that it scarcely re
quires emphasis. A given concern needs two such standards, one
giving the average experience of that particular industry and the
other the record of the most successful plants. Such standards, to
be satisfactory, must be derived from a sufficiently wide experience
that they may be trusted not to be unduly influenced by local and
temporary conditions. The concerns of a single jurisdiction, even
if it be one of the larger industrial States, do not afford a sufficient
“ coverage ” to permit their being used as a general standard.
Small groups are apt to fluctuate violently and thus give different
indications from period to period. I f the cause of such fluctuation
NECESSITY FOR N ATIO N AL ACCIDENT RATES
119
is some nonessential temporary influence, increasing the volume of
data will usually smooth out the trend and afford a reliable indica
tion. It is interesting to observe how as smaller units are combined
the progressively larger groups show greater regularity until at
length a condition is reached which may properly be regarded as
standard.
It may be urged therefore that for setting up reliable standards
of performances national accident rates are necessary.
d e t e r m in a t io n
of p r o g r ess
Without satisfactory rates, both general and for his own works,
it is impossible for an industrial manager to determine what his
accident status really is. There may be improvement as compared
with previous periods in his own experience. This may be very
much less than it fairly ought to be when considered in relation with
the general trend of that industry. One responsible for the promo
tion of safety in a given plant or company can not too often check
up his results and test them both by previous records of his own and
by the experience of others such as may be available to him.
No plant management nor association of industrial plants can
possibly assemble and analyze the facts in the case in a completely
satisfactory manner. If such assembly and analysis is to be made
it must be done by some public authority of sufficiently wide scope
to render its work dependable. Regarding each of the three agen
cies collecting accident data it is freely acknowledged that their
efforts have been a large factor in such success as has been secured
in accident reduction. Therefore for checking up the course of
accident experience national accident rates are necessary.
DEPARTMENTS AND OCCUPATIONS REQUIRING SPECIAL ATTENTION
It may happen, in fact does frequently happen, that a group
having a particularly unfortunate experience is completely obscured
by being considered in combination with other groups whose record
is better. On analysis this undesirable condition becomes apparent
and suitable remedial measures can be taken. It is highly desirable
that it be possible to determine whether this condition is one due
to inherently hazardous characteristics or comes about from some
local condition. The remedial measures will naturally be of a differ
ent sort in one case than in the other.
Not very much has been done so far in the way of occupational
rates. The difficulties which have beset the attainment of a satisfactory exposure in the case of industries and departments are
multiplied and accentuated when an effort is made to secure occupa
tional rates. It is evident, however, that some problems will remain
quite insoluble until this field is covered. It has been noted earlier
that any extended analysis at once tends to reduce the size of the
groups to a point where they are not a reliable index of conditions.
It will be easily seen that this would be particularly true when an
effort was made to consider the exceedingly numerous occupations
which the subdivision of modern labor has brought about.
For the purpose, therefore, of dealing with departmental and
occupational conditions national accident rates are necessary.
120
NECESSITY FOB N A T IO N A L ACCIDENT RATES
THE STUDY OF CAUSES
A good deal has been said about causes and their importance in
accident prevention but not much has been done. It has for the
most part been thought sufficient to classify causes in a more or less
detailed fashion. It has not been recognized that a modification of
the rate method mentioned under preceding heads is applicable
to the treatment of causes.
To consider a concrete case: In the admirable presentation of
compensation statistics in Wisconsin Labor Statistics, March-April,
1925 (page 3), there is a table classifying the cases closed in 1924
according to causes. Column 5 of this table is the total days lost
determined according to the schedule recommended by your com
mittee on statistics and approved by your association. The losses
there specified aggregate 845,525 days. It is manifestly impossible
to determine an exposure for each item of the classification, but
the total exposure oi the year should be an ascertainable number of
hours. With such an exposure rates could be computed which would
be much more readily compared with each other than the recorded
figures can be. It may be urged with entire propriety that this con
venience is gained at a cost in securing the exposure and applying
it to the losses which is greater than the advantage resulting. This
would be true in a measure if Wisconsin was the only jurisdiction
to be considered. Suppose, however, another State uses the same
classification and has 1,000,000 days of loss. This greater loss may
signify a greater volume of industry; it may mean a higher indus
trial hazard; it is compatible with a lower hazard. In short, as
between the jurisdictions it has no meaning. It may fairly be in
sisted that a method permitting both comparison within a State
and between States is superior to one whose significance is entirely
within the State.
The Wisconsin report (pp. 8-10 et seq.) further shows the desira
bility of national rates in its very extensive classification of causes
by industries and by nature of injury. Wisconsin has a very con
siderable volume of accident occurrences, but not enough to serve
as a basis for general conclusions when attenuated to the degree
that it must be when distributed into so elaborate a classification.
The study of causes by means of rates supplements the study of
departments and occupations which any safety organization must
undertake if it is to deal intelligently with accident prevention.
For the study of causes, therefore, national rates are a necessity.
CAUSES AND LOCATION AND NATURE OF INJURY
None of these items relate so closely to accident prevention as
do causes. They are not without importance, however. To illus
trate, a very high proportion of injuries occur to the eye. It is diffi
cult and in many cases impossible to obtain protection by modifying
the machine or changing the process. The only adequate protection
is some form of transparent shield—a goggle, a helmet, or a mask.
The lack of national rates has for a long time handicapped efforts
at prevention and made necessary extensive statistical studies by
private agencies which work might much better have been done by
some public agency.
NECESSITY FOR N A T ION AL ACCIDENT RATES
121
EDUCATION OF THE WORKER
Under primitive conditions of warfare with the elements, with the
beasts of the forest, and with his fellow men, it was essential to sur
vival that man should possess a certain degree of indifference to
danger. The fact that he survived was necessarily associated with
an attitude of mind quite unsuited to the different and more com
plex dangers of modern life. To create a different attitude and
relate this attitude to the prevention problem is a large part of the.
duty of the safety inquirer. In this effort nothing is more im
portant than the facts, clearly understood and pungently presented.
If the facts presented are ox a national character and can be con
trasted with those of the worker’s own environment, they have a
powerful appeal.
Therefore as a factor in the education of the body of workers
national accident rates are a necessity.
NEED OF COOPERATION
It remains to suggest the relation of this organization to the devel
opment of a system of national accident rates. The Bureau of Labor
Statistics now receives reports of employment monthly from a large
number of industrial concerns. From this list the division of indus
trial accidents of the bureau has selected 2,500 concerns engaged in
26 industries and located in 13 of the more important industrial
States. From these reports, supplemented by correspondence, it will
be possible to determine the exposure incident to operation of these
concerns. If, now, there can be obtained from the concerns or from
the records of the States a simple classification of the accidents, it
will be possible to make a beginning in the preparation of those
national accident rates whose necessity has been the subject of this
paper.
It is natural and proper that this organization should actively
interest itself in the development of such rates for two reasons:
(1) Such standardization as has been already accomplished has been
done by or under the direction of your committee on statistics;
(2) the State boards and commissions which make up your associa
tion have control of the statistical data.
It may finally be stated that if we are ever to have helpful national
accident rates such as some other industrial countries have it must
be brought about by cooperation of the members of your association
and the Federal Bureau of Labor Statistics.
Mr. W e n z e l . May I ask a question, please? How could you pos
sibly apply national rates to a State fund, particularly where that
fund is exclusive ?
Mr. C h a n e y . I have not been talking about State funds at all.
You can not apply them to State funds. They are intended to be
applied in the prevention of accidents in the State and by the appro
priate group of people who are concerned in the prevention of acci
dents.
The C h a i r m a n . It occurs to me in regard to the next number on
the program, “ Jurisdictional problems arising out of shifting
labor,” that the State which can give us the most information is
122
JU R ISD ICTIO N AL PROBLEMS— S H IF T IN G OP LABOR
California, and I have the pleasure at this time of introducing Johi
A. McGilvray, chairman of the Industrial Commission of California
JURISDICTIONAL PROBLEMS ARISING OUT OF SHIFTING LABOR
BY JOH N A . M ’GILVRAY, CHAIRMAN CALIFORNIA INDUSTRIAL ACCIDENT COMMISSION
The subject assigned me, “ Jurisdictional problems arising out of
shifting labor,” impresses me at once with its importance and mag
nitude. In the short space of time allotted to me it will be possible
merely to skim the surface, as I believe the subject one that could
well be emploved as a thesis for a master’s degree.
Preliminarily, let me state that in California the question of the
industrial accident commission’s jurisdiction in extraterritorial
matters has been settled to all practical purposes, so far as the com
mission and the employees are concerned, as will appear further on.
There is, however, a sharp conflict of authority in various other
States of the Union as to the jurisdiction of the different accident
boards and commissions in controversies involving the extraterri
torial scope of the acts under which they operate. There is a mani
fest difference between a compulsory act (such as the California
workmen’s compensation, insurance, and safety act) and the statutes
of several of the other States, where the compensation provisions
are dependent upon the election or consent of the employer and
employee.
The rights declared by an elective statute have their origin and
sanction in the agreement of the parties to be bound by the statute.
Under a compulsory statute, however, the correlative rights and
obligations are not founded upon contract nor do they correspond
with the legal conception of a tort, since a liability is imposed with
out regard to the element of wrongdoing on the part of the person
charged. The obligation should be defined as a statutory one
attached by law to a given status. (North California Salmon Co. v.
Pillsbury, 174 Cal. 1.)
Because of my recent connection with compensation work and my
unfamiliarity with the manner in which problems such as this are
discussed in your international body, I trust that I will be pardoned
if I approach this subject from the California viewpoint. As I
see it, the jurisdictional problems before accident boards and com
missions arising out of shifting labor usually present themselves
when employers have manufacturing plants in several States and
shift their employees from one State to another; when workmen are
hired in one State to perform work in another State for a contrac
tor doing business in several States; and when employees on the
boundaries of States occasionally cross the line from one State to
another for the purpose of performing work therein.
The seasonal nature of employment in agriculture and in the
lumber, canning, and construction industries imposes upon the
Pacific coast, and on California particularly, a migratory labor pro
blem of no small magnitude. The men who flock to the coast
cities with their accumulated savings from their summer’s work are
the prey of the unscrupulous and the victims of their own improvi
dence. This is the source from which is drawn the seasonal labor
JU RISD ICTIO N AL PROBLEMS— S H IF T IN G OF LABOR
123
in the coastal employments as far north as white men go and as far
south as the Equator.
The salmon canning industry in Alaskan waters derives its labor
chiefly from this group; they are generally ignorant of their con
tractual rights and sometimes, it has been asserted, greatly imposed
upon. In this industry, the question of the jurisdiction of the
California Industrial Accident Commission over this class of labor,
where the employee was hired within the State for work outside
its exterior boundaries, was finally settled.
By the act of the legislature of 1917, the workmen’s compensa
tion, insurance and safety act of California was amended by adding
section 58 thereto, which provides that the commission shall have
jurisdiction over controversies arising out of injuries suffered with
out the limits of the State, where the injured employee is a resident
of the State and the contract of hire is made within the State.
The constitutionality of this provision was upheld by the supreme
court of that State in the case of Quong Ham Wah Co. v. Industrial
Accident Commission of California (192 Pac. 1021), decided in
October, 1920, and writ of error in the United States Supreme Court
was dismissed in March, 1921 (255 U. S. 445).
This was the case of a machinist in a salmon cannery in Alaska,
who was a resident of California and who was hired in that State
to perform work in Alaska. The court held “ that the legislature
has power to provide for the creation of a compulsory obligation
to compensate for injury suffered elsewhere as a regulation of con
tracts subject to the sovereignty of the State, whether the contracting
employee be domiciled in this State or not.” In a concurring opin
ion signed by the chief justice of the Supreme Court of California
and by one of the associate justices it was said that inasmuch as the
provisions of section 58 of the workmen’s compensation, insurance,
and safety act conferred upon employees residing in the State the
privilege of resorting to the workmen’s compensation, insurance, and
safety act of said State to obtain compensation for injuries received
while in the course of their employment, in all cases where the
contract of employment was made in this State whether the injury
was received within or without the boundaries of the State, the pro
vision of the Constitution of the United States ipso facto carries
this privilege to and confers it upon every citizen ox any other State
whose contract of employment is made in California, thus preventing
the California statute from being discriminatory in effect and in
contravention of the provision of section 2 of article 4 of the Con
stitution of the United States.
In other words, notwithstanding the language of section 58 of
the workmen’s compensation, insurance, and safety act of Cali
fornia, with reference to residents, by virtue of the Federal Consti
tution a nonresident of California, it a citizen of the United States,
is entitled to the same redress as a resident, and for that reason the
industrial accident commission has jurisdiction over the complaint
of a resident of California and also over the complaint of a non
resident who is a citizen of the United States, where the contract of
hire is entered into in the State.
73891°—26----- 9
124
JU R ISD IC T IO N A L PROBLEM S— SH IF T IN G OF LABOR
The history of that portion of the California statute, so far as
it relates to the extraterritorial effect of the act, may be of interest.
In December, 1916, the Supreme Court of California held in the
case of North Alaska Salmon Co. v. Industrial Accident Commis
sion (174 Cal. 1) that the workmen’s compensation act (Stats. 1913,
ch. 176) as it existed prior to the taking effect of the amendments
of 1915 did not have extraterritorial effect. This decision was based
in part upon the decision of the Supreme Court of Massachusetts
in In re Gould (102 N. E. 693), holding that the compensation act
of that State would not be given extraterritorial effect unless such
intention was expressly indicated by its language.
The California act was amended in 1915 by inserting section 75a,
expressly conferring extraterritorial scope upon the California law.
This amendment was carried over without change when the act was
reenacted in 1917 and became section 58 of the present act.
At this point I believe a word should be said as to the economic
side of the question—why there should be extraterritorial scope to
workmen’s compensation acts. It may be well to illustrate some of
the effects of injuries arising out of shifting labor. Take the salmon
canning industry. Labor is recruited in California during the late
winter and early spring for work in the Alaska fisheries during the
canning season. Workmen who are crippled in the course of their
work in Alaska are returned to California either on the next vessel
after the injury or when the uninjured workmen return, and affect
the interests of California from and after their return to as great
an extent as if they had been injured within the State.
I f a workman is killed in Alaska in the course of the fishing
season he may leave a widow and orphans in California, in which
case the interests of California are as much affected as though the
fatal injury occurred within that State. If such workmen, although
not killed, had families in California, and are prevented by their
injuries, either for a temporary period or permanently, from sup
porting their dependents, the burden upon the State is greater for
the period of their incapacity than if they had been killed.
Another illustration: Many traveling salesmen are hired in Cali
fornia, reside in California, and have their families in California,
but travel through a number of the Western States in the course
of their work. An injury to such a salesman in another State affects
the welfare of the State of California, its citizens and residents, to
just as great an extent as if the injury occurred in California.
Again, men are frequently recruited in California for large con
struction jobs such as building railroads, electric power plants, etc.,
carried on in other Western States. These men have their homes
in California and frequently have families or other dependents per
manently residing in California. Injuries to such workmen abroad
affect the interests of citizens and residents of the State and the
welfare of the community in which they reside as much as if such
injuries occurred within the confines of the State of California.
The rule as enunciated in the Quong Ham Wah Co. case, as I
have said before, has been followed in California and is the settled
law. In other jurisdictions, however, I find some deviation, although
in States having the compulsory statutes the doctrine of that case has
been pretty generally followed. As illustrative of the deviation the
following cases are cited:
JU R ISD IC T IO N A L PROBLEM S— S H IF T IN G OF LABOR
125
In the case of Hagenback v. Leppert (117 N. E. 531), which is an
Indiana case (the Indiana law being elective mainly), we find the
court to hold that the right to compensation is contractual and fol
lows the employee if he is injured in employment in another State.
In Holmes’ case (Holmes v. C. Steel Co., 174 N. Y. Supp. 772),
which was a New York case (the New York law being partly com
pulsory and partly optional), the court said:
The workmen’s compensation act is so far a part of every contract of em
ployment that the rights and liabilities of the parties thereto in case of injury
to the employee must be determined in accordance with its provisions whether
such injury occurs within or without the State.
In Barnhart v. American Concrete Steel Co. (125 N. E. 675),
also a New York case, a slight difference is to be observed. There it
was held that the right of the employee under the New Jersey act
(where acceptance is optional) is contractual, not merely quasi
contractual, as in New York, where the scheme of compensation is
mandatory, and the agreement for compensation under the New
Jersey act was held to be enforceable in New York unless contrary
to the public policy of the State.
A further deviation is observed in Smith’s case (Smith v. Heine
Safety Boiler Co. (1921), 112 Atl. Rep. 516), a Maine case (the
Maine statute being elective), where the employee, a resident of New
York, was killed in Maine while working for a New York corpora
tion. It was held his widow was entitled to compensation under the
Maine act, although the contract of employment was made in
Massachusetts.
Again, in the case of Donohue v. Robertson (199 N. Y. Supp. 470),
the New York court held that when the contract of employment
was entered into in New York and the injury occurred outside the
State, the contract was not necessarily controlling. This case was
decided in 1923, the court holding that in such a case it must be
shown that the employee was conducting a hazardous employment
within the State and that claimant suffered an injury incidental to
that employment.
Again, in Indiana, in Johns-Manville v. Thrane (141 N. E. 229),
the court held that a contract of employment which was made in
Illinois (which State has an elective statute), to be performed in
Indiana (where the statute also is elective), is in effect an Indiana
contract, and an employee under such contract is an Indiana em
ployee, although his permanent residence is elsewhere.
In Texas, where the statute is partly elective but compulsory as to
certain enumerated employments under the act, the relation of em
ployer and employee is contractual and the terms of the act are to
be read as part of every contract of service between those subject to
its provisions. This applies to injuries occurring out of the State
as well as to those arising within. (Smith v. Yan Nuy Interstate
Co., 262 S. W. 1048.)
The case of Darsch v. Thearle Duffield Fireworks Display Co.
(133 N. E. 525), decided in 1922, is distinguished in the Johns-Manville case above noted. The Darsch case held that no award could
be made under the Indiana compensation act for an injury which
occurred in Indiana, where the contract of employment was made
in Illinois, the employer and employee were residents of that State,
126
JU RISD ICTIO N AL PROBLEM S— S H IF T IN G OF LABOR
the firm had no place of business in Indiana, and the employee was
there only temporarily, it being held that a section of the Indiana
compensation act provided that every employer and employee should
be presumed to have accepted the provisions of the act, and that
every contract made subsequent to the taking effect of the act should
be presumed to have been made subject to the provisions of the act,
and was binding upon such persons only as were residents of the
State of Indiana and made their contracts of employment there or
maintained an office and place for doing business within that State.
In the case of Altman v. North Dakota Workmen’s Compensation
Bureau (195 N. W. 287, July, 1923), it was held that the North
Dakota compensation act, which is compulsory, does not have extra
territorial effect so as to render the compensation fund liable for in
juries sustained in the course of employment in another State, al
though the contract of employment was entered into in North
Dakota, the court taking this view of the matter even in the face of
the decisions in a great number of States that have held that a com
pulsory act has extraterritorial operation.
In Anderson v. Jerrett-Chambers Co. (Inc.) et al. (206 N. Y.
Supp. 458, Nov., 1924), the New York court held that where hazard
ous business is being carried on in New York by a resident employer
and a New York employee is doing work incidental thereto in an
other State, the employer must insure the employee in New York,
and under the workmen’s compensation law of New York the em*
ployee is bound to his remedy in that State and can not waive it by
electing to take compensation in another State.
This last case logically brings us to a consideration of some of
the problems arising from a lack of uniformity of the provisions
of the various workmen’s compensation acts relative to the extra
territorial scope of said acts. As I have said before, in California
it is not a problem so far as the injured workmen or the commis
sion are concerned, but there are certain problems that confront
the employer as well in California as in other States. The major
ones are:
First, lack of adequate insurance or the danger of duplication of
insurance, where the employer has failed to make provision for
the liability that may attach by reason of injuries arising in States
which assume jurisdiction under their workmen’s compensation acts,
or where a common-law remedy is available to the injured workman.
Second, and closely following the first, the necessity of the em
ployer’s paying a double premium; that is, his liability to carry
several coverages with no apportionment of the premium.
Third, the danger of double recovery, as indicated in the Ander
son case above cited, wherein the claimant was paid New Jersey
compensation, but was not prevented thereby from obtaining com
pensation in the State of New York, where he was entitled to it
under the facts of the case, and could not waive the benefits in New
York by reason of the provisions of section 32 of the workmen’s
compensation law of New York, the court saying:
Whatever rule may be permissible in the case of a nonresident employee and
employer in relation to a hazardous employment principally carried on in
another State and only incidentally carried on in this State, and leading to
injuries suffered in this State, no such rule * * *
(waiver) is applicable
by election of remedies or estoppel in a case where the State has jurisdiction
DISCUSSION*
127
of both the parties and the subject matter. Our statute was primarily for
the protection of the residents of this State in the conduct of New York
business.
This brings us to the question of what remedies there may be to
effect more uniformity as to the extraterritorial scope of workmen’s
compensation laws in the United States. It naturally follows, I think,
that some sort of comity between the States is necessary, and if the
doctrine of comity could be adopted in its entirety it would probably
prevent the double recovery. As an analogy, we have the seamen’s
acts of the various countries. It is well known, I take it, that the
courts of the United States as a rule will not entertain jurisdiction
in controversies arising where seamen are involved when the laws of
the country of which such seaman is a national make adequate pro
vision for redress, leaving the matter to be determined when the ves
sel arrives at a port within the jurisdiction of the country under
whose flag it is registered.
But under our constitutional form of government—a federation
of States—it is a little more difficult to apply the doctrine of comity
to the various workmen’s compensation acts as such doctrine is
understood and applied between foreign States. I believe the best
solution of the problem can be obtained by the uniformity of State
laws; if it is not possible to make the workmen’s compensation laws
of the various States uniform, it certainly should be possible to
make certain provisions uniform, those provisions particularly
which define the extraterritorial scope of the acts. Also, a uniform
provision should be adopted that would permit private insurance
under compulsory State funds for interstate business. I believe
that it would be well for this body to undertake the study of a plan
whereby uniformity of the extraterritorial scope of the various acts
may be obtained.
DISCUSSION
The C h a ir m a n . Discussion on this paper will be by our most
esteemed president, Mr. McShane.
Mr. M c S h a n e . It has indeed been interesting to follow Mr. McGilvray in his very able paper on “ Jurisdictional problems arising out
of shifting labor.” Not only has he very plainly pointed out many
problems which do arise as a result of shifting labor, but he has also
briefed the causes and legal aspects thereof and made valuable
recommendations looking to their solution. Upon the matters dis
cussed by him he has left me nothing to say. Having very gra
ciously been furnished with an advance copy of his paper I had an
opportunity to give some thought to the subject, and I have been
led to conclude that there is another angle from which this subject
may be profitably approached.
Mr. McGilvray has dwelt almost entirely upon the sharp conflicts
of authority in the various States of the Union as to the jurisdiction
of different accident boards and commissions in controversies arising
out of the extraterritorial scope of the acts under which they operate,
and the resulting confusion as to rights and remedies of employer
and employees which result therefrom. I shall dwell for a few min
utes upon problems arising out of shifting labor in the same shop,
plant, or employment, and shall use examples and illustrations from
128
JU R ISD IC T IO N A L PROBLEM S— S H IF T IN G OF LABOR
the workshops of steam and electric railways engaged in interstate
commerce.
Two brothers may be employed here in the Oregon Short Line
shops; one is called to work upon an engine withdrawn from service
for general repairs; his brother at the same hour may be called upon
to make temporary repairs upon an engine of the same class and in the
same shop. The fact that the first engine has been withdrawn from
service for general overhauling places the mechanic working upon it
in intrastate employment, while the fact that the second engine has
not been withdrawn from service and is in the shop for temporary
repairs only places the mechanic assigned to it in interstate com
merce. Let us assume that each of the two brothers sustains a serious
injury in which the right arm is lost, and that both were negligent.
The first would come within the protection of the workmen’s
compensation law and receive benefits in accordance with the provi
sions of such law without any litigation. The second brother is
out; he can not get compensation because of the nature of his em
ployment at the instant of his injury, and he can not recover dam
ages because of the doctrine of negligence which has been ingrafted
upon the common law.
This question or illustration can be juggled about in many ways
to make many different cases. For example, let us suppose that the
injury sustained is as at first set out except that negligence is plainly
evident upon the part of the employer instead of the employee.
Here again the first brother must accept the benefits as set out in
the compensation law, while the second brother is permitted to go
into court and successfully press his claim for damages, which
amounts to many times the compensation benefits.
Thousands of employees in the United States are thus situated,
notwithstanding the fact that they are engaged in the same shop doing
the same class of work, receiving the same pay, and sustain the same
kind of an injury. The remedies available, as well as the recoveries,
are entirely different, thus giving cause for just complaint, and very
frequently resulting in a miscarriage of moral justice.
It has occurred to me that there is a method available whereby
the benefits and the remedies available to all injured workmen can
be made uniform in the same place of employment. In order to do
so certain legal obstacles have to be overcome. It might be interest
ing for you to know that an effort has already been made along this
line.
Before proceeding with a discussion of the legal obstacles to be
overcome, I desire to make plain the point I have in mind and shall
restate it as the problem of unifying remedies applicable to the
employees working in the same shop or plant, irrespective of
whether they are engaged in interstate or intrastate commerce.
The shops of our interstate railways give the best mental picture
of this problem, for there the same employee may be switched
from interstate to intrastate employment and vice versa several
times during one eight-hour shift. Because of the peculiar provi
sions of the maritime clause of our Federal Constitution, you have
a somewhat similar condition, though much more difficult of solu
tion, in the case of longshoremen who pass back and forth over a
gang plank from the wharf to a ship resting in navigable waters,
DISCUSSION
129
while loading or unloading the cargo. Thousands of men thus em
ployed find themselves unfortunately situated in case of injury.
They are not advised as to the proper forum before which they
should press their claims. They are confused as to procedure and
they are very uncertain about benefits.
Congress has already entertained a bill providing for the enact
ment of a Federal compensation law covering employees engaged in
interstate commerce. The bill was presented by the Employers’
Liability and Workmen’s Compensation Commission, pursuant to
joint resolution No. 41, approved June 25, 1910 (36 Stat. at L. 884),
proposing a Federal workmen’s compensation law which reads:
A bill to provide an exclusive remedy and compensation for accidental in
juries resulting in disability or death to employees of common carriers by
railroad engaged in interstate or foreign commerce within the District of
Columbia and for other purposes. (S. Doc. No. 338,, 62d Cong., 2d sess., p.
107.)
It may be assumed that the power of Congress to do this was
thoroughly gone into by this commission appointed by Congress
before such a bill was drafted.
Even though Congress enacted such a law you would have much
the same situation in a different form; that is to say, two employees
injured in the same shop, one in interstate and the other in intra
state commerce, would get a different weekly compensation; they
would have to follow different procedure and would have to press
their claims in different forms.
In view of this situation congressional enactment of a Federal
compensation act covering all employees engaged in interstate com
merce does not seem desirable. It appears that the real remedy lies
in inducing Congress to pass a law making available to workmen
engaged in interstate commerce the benefits of the compensation law
of the particular State wherein the injury occurs. It is thought by
some men of recognized legal ability that such a law is constitu
tional. While our Supreme Court has not spoken on this question,
there are certain decisions from the text of which encouragement
may be drawn. The Webb-Kenyon Act, you will recall, was an
act of Congress designed to protect a State with the prohibition law
against shipments of liquor into it from wet territory. In other
words, it#was a law which permitted the State prohibition laws to
apply to movements of liquor from one State to another, Congress
saying in effect: “ If the State law prohibits the possession of intoxi
cating liquors, we by this act will allow that State law to become
effective as the expression of our congressional will and in that way
prohibit the entrance into that State of intoxicating liquors.”
As the Supreme Court upheld the constitutionality of this law, one
may be led to believe at first blush that this case is directly in point
with our situation, but we must remember that the opinion written
by Mr. Justice McReynolds was based on the rather narrow ground
that the Webb-Kenyon Act dealt with a peculiar commodity, to wit,
intoxicants. It states that Congress could have prevented intoxi
cants from being shipped in interstate commerce altogether, and that
therefore, if they could forbid the movement of intoxicants alto
gether, they could, of course, do less by forbidding it in certain
localities where the law of that locality itself prohibited the pos
session of it. It must not, however, be overlooked that in the Jen
130
W H A T T H E SOUTH IS U P AGAIN ST
sen case the court was construing the powers of Congress under the
maritime clause of the Federal Constitution while in construing the
Webb-Kenyon Act it was a test of the commerce clause. And there
fore, while we may feel ourselves out of the timber on the commerce
clause, there is still grave doubt about the power of Congress to
make applicable the benefits of the local compensation act in case
of longshoremen because of the peculiar provisions of the maritime
clause of the Federal Constitution as heretofore stated.
We do, however, find some comfort in the'fact that the Jensen
case was a five to four decision, as was the Knickerbocker case, and
the dissenting opinion of Mr. Justice Pitney bristles with logic in
support of the power of Congress to deal with the subject in the
manner it intended to do by the amendments to the judiciary act of
1789, which were passed for the express purpose of permitting the
States to deal with the subject.
At present, time will not permit an analysis of the various deci
sions relating to the question but it does appear that it would be
profitable to have a law drafted, and carefully briefed as to its
constitutionality for presentation to Congress, giving to working
men engaged in interstate commerce the benefits of the compensation
law of the State in which the injury occurs.
The C h a ir m a n . The next number on the program is “ What the
South is up against (or the purpose of the proposed Richmond con
vention)”. I have the pleasure of introducing Walter H. Monroe,
of the workmen’s compensation division of the Bureau of Insurance
of Alabama.
M r. M onroe . First of all I want to express my appreciation for
the assistance the Bureau of Labor Statistics has given to the State
of Alabama since I first became associated with the workmen’s com
pensation administration in that State, and to pay a debt of grati
tude to the late Carl Hookstadt, though it was never my pleasure
to know him personally.
WHAT THE SOUTH IS UP AGAINST (OR THE PURPOSE OF THE
PROPOSED RICHMOND CONVENTION)
B Y WALTER H . MONROE, OF TH E W ORKMEN’ S COMPENSATION DIVISION, *BTJREAU OB'
INSURANCE OF ALABAMA
I once knew four brothers of differing ages, possessed of varying
degrees of personal ability and temperament. At times these boys
would disagree violently among themselves and actually come to
blows. But in spite of these personal differences an outsider who
offended one of those brothers would meet with coordinated violence
from the entire quartet. It was simply a matter of family pride.
Each of those boys had his own individual responsibilities, his
habits and peculiarities, and his own destiny to shape. Each had
personal problems to solve without assistance from the others.
Our national spirit is identical with the cooperative attitude of
these brothers. Sectionally we may differ, but our spirit as a mighty
Nation is undoubtedly unimpaired.
Geographical boundaries not only limit land and water but mold
public opinion, create customs, and sometimes take a hand in fashion
ing our legislation. This is especially true of the South. Legisla
W H A T T H E SOUTH IS U P AGAINST
131
tion of a certain kind which might appear progressive and radical
to our conservatism would doubtless receive more favorable con
sideration in other sections of the country.
As major divisions of a powerful unit we should be deeply im
pressed with the responsibility of working out our own legislative
salvation, but as officials we should not withdraw, ostrichlike, within
our own borders and thus miss many worth-while things happening
all around us. There is not a single one of us who would not render
assistance to a neighbor in time of distress, yet, as commonwealths,
we reside next door to other States wherein injured and maimed
workmen and their dependents are forced to common-law damage
suits.
PROPOSED RICHMOND CONVENTION
For the purposes of bringing into line those Southern States
without compensation laws, acquainting those States having the
court administrative system with the advantages of the commission
method, and formulating and recommending to southern compensa
tion officials more uniform legislation and procedure, there is being
agitated a proposed convention of southern compensation officials
(as well as other interested individuals) to be held in Richmond, Va.y
at an early date.
This idea of a periodical sectional conference could, I believe, be
used to advantage all over the country. Forms and procedure
could be simplified, certain features of the laws could be univer
salized, thus enabling one commission to cooperate with another
in the matter of conducting investigations, and assistance and infor
mation could be rendered to all interested in these problems.
In this connection one of the most important subjects that could
possibly be discussed would be the question of urging southern com
pensation officials to compile their statistics in line with the recom
mendations of the committee of statistics and compensation insur
ance cost of this association. In Alabama I have attempted to see
that these minimum requirements were adhered to. This was neces
sary on account of our extremely limited personnel. Along these
lines I can see no valid reason why statistical tables can not be com
piled reflecting the industrial accident experience of the North,
South, East, and West, and this can be done if the reporting fea
tures of the different laws are universalized and the recommendations
of your committee strictly adhered to.
While I can see no hope for a national compensation act and per
sonally question the advisability of such a statute, certainly there
are features of all laws that can be made more similar; for example,
the different methods of reporting accidents, commission procedure
contrasted with court procedure, and finally the scope of the differ
ent statutes (with special reference to numerical exemptions). Some
of us require the reporting of all accidents resulting in time loss
or medical expenditure, some require the reporting of those injuries
resulting in a disability period exceeding the waiting period (these
varying from three days to two weeks), and some require the report
ing of only those accidents in which compensation is paid or claimed.
Even the forms used vary in size and requirements. Why not use
the model reproduced on page 30 of Bulletin 301 of the United
132
W H A T T H E SOUTH IS U P AGAINST
States Bureau of Labor Statistics as a basis, adding thereto those
questions covering conditions of a local nature arising out of the
individual statute’s requirements?
All of these varying features of southern compensation laws must
appear most confusing to a foreign corporation entering the southern
industrial field for the first time.
STATES WITHOUT ACTS
In a consideration of the compensation outlook in the South we
have to deal first with five States having no compensation laws.
These five States (Arkansas, Florida, Mississippi, North Carolina,
and South Carolina) are the only ones in the Union remaining with
out this legislation, excluding, of course, the District of Columbia.
I have noted the passage of an excellent law in Missouri and she
should be accordingly felicitated, but cautioned to keep her new
born babe away from the fires of the referendum.
It is most fitting, I believe, that their sister Southern States render
these States, backward in compensation legislation, first aid and
interest their lawmaking bodies in this important question. I do
not wish to imply that assistance emanating outside of the South
would be unwelcome, but I am of the firm belief that these States
are more liable to hearken to the voices of neighbors, for, after all,
the State is but an expansion of the neighborhood idea. These
five States deserve paramount consideration and immediate atten
tion, and I suggest the assigning of each of these States to a southern
compensation State to be “ worked” as a salesman does a prospect.
As soon as this has been done the compensation State’s officials
should procure a list of the members of the legislature, as well as all
others interested, of the State assigned it. Each of these individuals
should be acquainted, through circular letters, with the benefits
obtained from compensation legislation.
I have already communicated with insurance officials in each of
these five States and without a single exception they have displayed
hearty interest and a personal desire to secure for their State also
a compensation act. In fact, bills have been unsuccessfully intro
duced at various times in at least four of these States.
In this connection a short review of the legislation attempted in
these five States may be of interest.
Arkansas.—In 1919 a compensation act was introduced in the
Arkansas lower house, but it proved to be unsatisfactorily drawn
and was ultimately withdrawn from committee by its proponents.
However, this bill’s introduction so stimulated the interest of the
legislature that a committee was later appointed by the governor to
draw up a suitable act. This committee did not meet after the legis
lature adjourned, having never been provided with expense money,
but its chairman personally undertook the compilation of a bill on
behalf of the committee. This bill, introduced in 1921, was modeled
after the Virginia law, provided commission administration, a 7-day
waiting period, and benefits of 50 per cent of the weekly wages, sub
ject to a weekly maximum of $15 and a minimum of $5. This bill was
referred to the judiciary committee, but as all of the lawyers in that
session were violently opposed to the measure it died in committee.
W H A T T H E SOUTH IS U P AGAINST
133
There has been no compensation legislation offered in Arkansas
since 1921.
Florida.—In 1919 two compensation bills were introduced in the
Florida Legislature. The first, written by the president of John B.
Stetson University, provided commission administration, but I have
not been advised as to its benefits. The other bill provided court
administration and benefits ranging from 60 to 65 per cent of the
weekly wages, subject to a weekly maximum of $18, a minimum of
$5, and a 7-day waiting period. No reason has been given me for
the failure of either of these bills.
In 1921 another act was introduced proposing commission admin
istration, a T-day waiting period, an extraordinary 2-week retroac
tive feature, and 50 per cent of the weekly wages, subject to a
weekly maximum of $20 and a minimum of $6. Neither have I
been advised of the reasons for this bill’s failure.
In 1923 a bill was drawn by the insurance commissioner of Florida
which received favorable consideration from a lower house com
mittee. It was, however, finally and adversely reported in both
houses after violent opposition by certain employees and attorneys.
In 1925 two bills were introduced; one, based on the Wyoming
act, provided a competitive State fund and an initial appropriation
of $50,000, and the other, based on the Louisiana law, provided
optional insurance and court administration. The first was favor
ably reported by its committee, but the appropriation was cut to
$5,000, which would have been fatal had the bill become a law. The
second bill was adversely reported by its committee. Neither came
to a vote. I am advised that the insurance companies actively op
posed the bill proposing a State fund.
Mississippi.—There have been only three efforts to pass a com
pensation act in Mississippi. I have been unable to secure informa
tion relative to the exact dates on which these bills were introduced,
but have been advised that at either the 1912 or 1916 session of
the legislature a bill was introduced providing a State fund, com
mission administration, extremely liberal benefits, and so liberal a
tax for its upkeep that it was bitterly fought by both employers
and insurance carriers. The author of the bill finally admitted that
he had been convinced of its impracticability and withdrew it.
During the 1920 session a bill was introduced and sanctioned by
all parties in interest. Its rejection has been charged to a failure
of the parties to agree at the last moment.
In 1924 an act providing very liberal benefits and commission
administration was introduced. This bill also failed of passage
because of the failure of representatives of capital and labor to agree
on certain points.
It appears that the damage-suit lawyer is the principal foe of
compensation legislation in Mississippi.
North Carolina.—Speaking industrially, I believe the Carolinas
stand in greater need of a compensation act than any of the other
States. I have been unable, on account of shortness of time, to pro
cure information relative to the bills introduced in North Carolina
prior to 1925. During this year’s session, however, a bill was
offered creating a commission administration, providing benefits of
50 per cent of the weekly wages, with a weekly maximum of $15
and a minimum of) $5, and a 7-day waiting period with a 6-week
134
W H A T T H E SOUTH IS U P AGAINST
retroactive feature. Although this bill was exceptionally well drawn
it failed on account of lack of interest on the part of the legislators,
so I am advised. Two other bills, copies of which I have been un
able to procure, were also introduced at this session and met a
similar fate.
South Carolina.—The only response to letters of inquiry addressed
to officials in this State indicate that the voters and legislators simply
will not actively interest themselves and that contingent-fee attor
neys promptly oppose any proposed legislation.
The attitude of officials in these five States is very encouraging,
and I believe the southern legislative fields are ripe and that these
States will pass appropriate laws if the benefits to be derived are
properly placed before the interested parties.
Although it may appear to you a paradox, it is my personal belief
that most of the bills offered in these States have failed because of
too progressive features embodied in them, a lack of interest and in
formation on the part of all parties interested, and the activities of
damage-suit attorneys.
The wiser course, I believe, is to adopt a milder act at the outset
and to graduate to more liberal benefits and expansive administrative
machinery when conditions justify. In the light of experience the
inching-along process is the safest after all.
PUBLICITY
Absence of information usually denotes absence of interest. One
of the greatest needs of the South in the field of workmen’s compen
sation is the dissemination in simple, understandable, and nontech
nical language of its principles and advantages to employee and em
ployer alike.
Five years ago I had never heard of the compensation principle,
was not aware that a compensation law had replaced the old damagesuit system in 1920, and would probably have gone to a lawyer had
anything happened to me. I seriously doubt that at that time I was
more ignorant than the average run of southern citizens are now.
The average citizen and quite a number of politicians (I believe the
proper term is “ statesmen ” ) have passed up this question as one
involving much personal “ boning ” and intensive research. The
simple fact of the matter is that the entire principle is accurately
reflected in the modified biblical quotation “ The injured laborer is
worthy of a portion of his hire.”
So tar as I am aware Virginia and Tennessee are the only South
ern States making definite moves to acquaint their citizens with
compensation facts. There is absolutely no valid reason why stat
utes so far-reaching in their personal application should be hid
under a bushel and not placed before the public in simplified form.
One of the greatest foes of compensation is its technical verbiage.
While this may be a necessary evil for actuaries it should be assidu
ously avoided by officials administering these laws.
The necessity for publicity is especially acute in the South on
account of our negro population. These people expect their “ white
folks ” to look out for their interests when in trouble. When the
white folks” are themselves unacquainted with the proper pro
W H A T T H E SOUTH IS U P AGAINST
135
cedure the laborer is totally at sea and doubtless winds up in the
office of an “ ambulance chaser ” and his last state is worse than
his first. It has been my personal observation that in only the more
intensely industrial districts is labor at all familiar with its* com
pensation rights. The smaller the employer’s operations the greater
the need for compensation coverage. For this very reason it be
hooves Southern States to reduce numerical exemptions and to
broaden the scope of their laws.
After personally reviewing approximately 25,000 settlements in
Alabama I have come to the conclusion that employees of our cor
porations meet with the most liberal treatment.
C0ITRT-ADMINISTERED LAWS
From many quarters there have come to rme expressions leading
me to believe there is a widespread belief that the South is the
stronghold of the court system. However, the facts are that we
claim only 3 of the 10 States utilizing this method of administra
tion. These three are Alabama, Louisiana, and Tennessee. The
other seven represent New England, the West, and a Territory
(Alaska, Arizona, Kansas, New Hampshire, New Mexico, Rhode
Island, and Wyoming). It should also be borne in mind that four
Southern States already have commission administration (Georgia,
Oklahoma, Virginia, and Texas). At least eight bills offered in
noncompensation Southern States in the past have proposed indus
trial commissions. Also, bills proposing a change to the commis
sion idea have been offered at almost every session recently of the
legislatures of Alabama, Louisiana, and Tennessee.
A comparison of the merits and demerits of these two systems
of administration has not been assigned me as a subject, but I
wish to observe (and I believe you will bear me out) that a court,
or self-administered, act is a great deal better than no compensation
act at all.
A comparative investigation of the court docket of Jefferson
County, Ala. (in which Birmingham is located), has revealed the
fact that injured workmen and their dependents receive under
our present compensation law six times the benefits awarded under
the old system.
Another comparison of two Alabama mine disasters (Virginia,
1905, and Dolomite, 1922) has demonstrated that more than 500
dependents in the 1905 disaster placed their hopes for recovery in a
single test case that ran the gamut of the courts for six long years
before it finally, in 1911, reached the Supreme Court of Alabama,
where it was dismissed on the ground of multiplicity of suits. To
lend color to the situation the employer thoughtfully bankrupted
in 1907. The 1922 disaster occurred after our present compensation
act was passed, and the numerous dependents of the 97 asphyxiated
miners received the benefits provided by law, their cases being given
paramount consideration in the circuit courts of Jefferson County.
I often wonder if our Southern spirit of conservatism is not, after
all, the actual, typical attitude of America as a nation. We admit
it is sound business judgment to give any proposed policy a thorough
trial before permanently adopting it. Witness Minnesota experi
menting with the court system for eight years before finally adopt
136
W H A T T H E SOUTH IS U P AGAINST
ing an industrial commission. Minnesota’s legislature meets bien
nially. Alabama has had its court law only five years and its legis
lature meets at intervals of four years.
have safely progressed from common law to a compensation
act and I feel safe in saying that our legislatures will, at the proper
time and in the light of mature experience, adopt more expansive
machinery for the enforcement of their compensation statutes.
Let us all meet in Richmond, fixed in our determination to wipe
five inky blots from the face of America’s compensation map, to
broadcast among our own people the simple principles of workmen’s
compensation, to open our eyes that we may see what is going on
around us, and finally to disillusion ourselves of the erroneous im
pression that individually we have the best compensation laws in
this wide, wide world.
DISCUSSION
The C h a ir m a n . Mr. Monroe, your State has certainly entered
upon a real mission, and I hope the members of this association, in
dividually and collectively, will be able to render you some assist
ance. We are especially glad, Mr. Monroe, to have heard from you
to-day, as I am informed that this is the first time that Alabama has
been represented at a meeting of this association.
Mr. M onroe. It has been a privilege for me to attend this meeting.
I am in much the same position as Mr. McGilvray; it is my first
experience at a session of this association. I hope the powers that
be back home will some day make a similar appropriation to that
which Oklahoma has made.
The C h a ir m a n . The next is the discussion of Mr. Monroe’s paper
by Bolling H. Handy, chairman of the Industrial Commission of
Virginia, which will be read by Charles E. Baldwin.
Mr. H a n d y . On December 9, 1924, I addressed a letter to the
chairman or official at the head of the compensation department of
the States of Georgia, Kentucky, Maryland, Tennessee, West Vir
ginia, and Alabama. In this letter I stated that the members of the
Virginia Industrial Commission had for some time felt that a con
ference of officials administering compensation laws in the Southern
and South Atlantic group of States would be advisable, as their
problems are largely the same. I asked the opinion of the different
officials addressed as to the wisdom of such a meeting.
At that time I had no idea of the formation of any association in
the Southern States, nor have I since become convinced that such an
association would be advisable. No suggestion of this sort was con
tained in the letter above referred to. Rather, my idea was that a
conference of this sort would probably be beneficial in a group of
States confronted with the same conditions. It seems to me that it
would probably be unwise to attempt the formation of any southern
association of industrial commissioners. The international associa
tion that has been in existence a number of years entirely covers
the field.
In this day of multiplicity of organizations I am inclined to
believe that it is much wiser to avoid the effort of establishing any
organizations when well-established organizations are already in
DISCUSSION
137
existence. I firmly believe, however, that so far as the South is
concerned it would be of material benefit to have such a conference.
It is my idea that if the proposed southern conference develops, it
would be wise to invite the commissions which have been appointed
to study compensation legislation in Southern States not having
compensation laws, where such commissions have been appointed,
or certain officials of such States to be present.
Another feature which is worth mentioning is the fact that such a
conference in all probability would assist in securing uniformity in
the administrative features of the compensation laws of the States
in the same group. The Virginia commission has frequently con
ducted hearings in Virginia for commissions of other States, and
has also frequently had occasion to call upon other commissions for
the same service. This has occurred recently in reference to a hear
ing in Georgia. The compensation law of Georgia is practically the
same in its administrative features as that of Virginia. It was
simpler for the Georgia commission to understand just what we
desired brought out in the testimony, and it was also much simpler
for the attorneys who appeared in the case, as the laws of the two
States were so similar.
Mr. Monroe has very forcefully presented the argument in favor
of cooperation among the Southern States in reference to compen
sation matters.
The C h a ir m a n . Is Mr. Wood here?
Mr. S tew art . I want to say just a word about the Missouri situa
tion. That law was passed some weeks ago, and it was understood
and so stated in the papers that both sides had agreed that no
referendum would occur. I wrote the governor, therefore, asking
him to have a representative at this association. Several letters
passed between myself and the governor, and he stated that as soon
as he could get his commission organized it would of course join this
association, and that in the meantime, he would send a representa
tive here of his own; he named Mr. Wood, whom I put on the pro
gram. Since then the opposition has been able to get up a petition
of sufficient length to put the matter up to referendum again in the
hope that the people will do just what they have done two or three
times before. I have here a letter from the commissioner of labor
of Missouri, part of which is as follows:
In regards to referendum petition being sufficiently signed to keep the com
pensation act from going into effect in Missouri, I regret very much to say
that this is true. It having been secured through the efforts of the ambulancechasing lawyers by paying from 10 to 50 cents a name in securing them. There
were many untrue statements made in regards to this act. However, I feel
as though, when it is properly explained to the people and comes to a vote, we
will not have any trouble in passing it. This will come up at the next general
election, which will be November, 1926.
I just want you to know that the legislature really did the very best
it could, but the law is being held up by the game that has been
played there four or five times before, and we are going to do the
best we can to help them.
The C h a i r m a n . Oklahoma attempted to do something along the
line Mr. Monroe has suggested, in trying to get Missouri interested
in the compensation law. Our insurance company and safety de
partment and my associate on the industrial commission have all
138
W H A T T H E SOUTH IS U P AGAINST
been in Missouri, in several of the counties, on different occasions,
and we are very much interested. Perhaps the Industrial Commis
sion of Oklahoma is interested in the Missouri law from a selfish
standpoint. You know we have been getting all of those weak backs
and hernias and trachomas over in Oklahoma that they get nothing
for in Missouri.
[It was moved, seconded, and carried that the discussion of the
preceding papers be taken up in the first half hour of the afternoon
session. Meeting adjourned.]
WEDNESDAY, AUGUST 19— AFTERNOON SESSION
CHAIRMAN, MRS. F. L. ROBLIN, CHAIRMAN OKLAHOMA INDUSTRIAL COMMISSION
DISCUSSION (concluded)
The C h a ir m a n . We are to devote the first half hour of this after
noon to a discussion of the papers given this morning. If there is
no objection, we will discuss each paper separately. Is there any
one who wishes to discuss the report given by Mr. Hatch? There
seems to be no further discussion on that paper. We will proceed
to the paper of Mr. Kingston. It is practically the same question,
but are there any questions you wish to ask Mr. Kingston or any
remarks you care to make in discussing this subject? We will then
go on to the discussion on the paper of Doctor Chaney.
Mr. L a n s b t jk g h . Of course there are very few of us who have
gotten to the point of having very much data along the lines sug
gested by Doctor Chaney with reference either to the exposure
hazard or to severity rates; nevertheless it seems to me that when
we consider the collection of such data we' should also consider its
utilization in order that we may insure that the data collected will
be in such form that it may be properly utilized in comparing the
experience of the various States and that we may be sure that in
utilizing it we are not making some very grave errors.
Pennsylvania has more industrial accidents than any other State in
the Union. All accidents causing absence from work of two days
or more are reportable, and that is what we base our figures on. Last
year we had 2,209 fatal accidents and 175,330 nonfatal accidents.
That is more than any of you have, regardless of the size of your
State, and it may be that our accident experience in Pennsylvania is
very bad. I do not know whether it is or not. That was brought out
in some of the discussions last week in the convention of the Associa
tion of Governmental Labor Officials, particularly by Mr. Hatch in
his paper.
We have developed exposure hazards in certain industries, such
as the cement industry and the iron and steel industry. We can
compare our plants in the iron and steel industry, plant for plant,
and tell them whether they are good or bad in relation to each other.
The cement industry has done the same thing. We have no means
of collecting our exposure hazards in other industries nor do we at
the present time know how we are going to do it. But I am not sure
that if we had statistics of our exposure hazard, and if every one of
the other States here represented had similar statistics, we would have
anything unless we went a great deal further than that. Although we
might compare the iron and steel accident rates of Pennsylvania
with those of Illinois, or of Ohio, or of any other State having such
industries, and compare our textile rates with the textile rates
of Massachusetts, Rhode Island, or any other textile State, and
73891°—26----- 10
139
140
DISCUSSION
compare our coal mining rates in the same way, nevertheless, unless
we subdivided our statistics very carefully, we would have a lot of
crude figures bearing no relationship whatsoever to each other, be
cause Pennsylvania, with its iron and steel industries, with more coal
mines than any other State, with more machine-shop products than
any other State, would be likely to have a very much higher acci
dent rate than a State which was primarily, we will say, a textile
State or a State which had a very much larger percentage of cloth
ing manufacture. If you go into a single industry you have ex
actly the same thing.
We have been mining coal in Pennsylvania for many years. As
compared with Utah, our mining conditions are entirely different.
We have mining seams which are 2 feet 6 inches high, and a large
percentage of bituminous coal mining is of that character because of
the fact that we have exhausted many of the better seams. Natur
ally, you are going to get a very much higher accident rate under
those conditions than you are under mining conditions such as you
have in your States.
At the present time we are having an enormous number of accidents
in our anthracite mines which would have been utterly impossible 20
years ago, for the simple reason that mining conditions have entirely
changed. Whereas a couple a years ago certain conditions were
existent which made for safety, to-day those conditions are absent,
regardless of what any of us may do. So if, as an association, we
are going into a program of development of exposure hazards, let
us make sure that we go far enough in the collection of our data
and in the utilization of it to insure that after we get it we will
have something which is comparable.
The C h a ir m a n . Is there anyone else who wishes to say a few
words in discussing this paper ?
Mr. S tew art . As far as statistics of accidents are concerned, after
you have gotten these statistics you certainly can not know any less
than you know now, and there will be a chance to subdivide and
segregate those figures, particularly if they are compiled, as we
have requested, by departments and occupation. The Bureau of
Labor Statistics will do the rest. Of course, in a coal mine we should
take the thickness of the seam. Now a thick seam stripped is all
right, but in a shaft or a slope, if you are going to take your coal
all out, you have a blamed sight more dangerous mine with a 35-foot
seam of coal than you have with a two and a half foot seam. Of
course, those facts would all have to appear.
As I said before, if you get us those figures, the number of acci
dents and the conditions under which they occurred, I promise you
that we will so classify, subdivide, and tabulate them that you will
be satisfied you have something to work on in Pennsylvania.
The C h a ir m a n . Is there anyone else? This will close the discus
sion of this paper. President McShane has a question he wishes to
ask Mr. Lucas.
Mr. McShane. Yesterday I asked Mr. Lucas, who represents the
largest self-insurer in LTtah, a very pertinent question. You all
have your problems with the self-insurers—you have some of the
finest people on earth to deal with and you have some of the mean
DISCUSSION
141
est. I am going to ask him to answer in public the question I asked
him in private.
Mr. L u c a s . Mr. McShane asked me what I thought the reason
was why some self-insurers are willing to deal with their men on
a liberal basis, whereas others seek every avenue of escape from
liability. In some instances perhaps that applies also to private
insurance carriers. I told him that I had, as a practicing attorney,
represented both classes.
Take the self-insurer which has a law department of its own,
with a position such as I occupy to-day. The man filling such a
position has a direct interest in preserving a friendly feeling among
the employees of that industry for the management. In other
words, while he is not expected to steal money of his company in
the sense of giving it away when it is not justly due, neither does
the management, if it is what it ought to be and I believe most of
such managements are, expect you to squeeze and steal from the
men. I am honest about that. That man is there for the purpose
of doing justice as far as he can do it, and that man’s job depends
just as much upon having the men in that industry think he is
square as it does on having the management think he is square,
because if a kick comes from either side he is out of luck. That is
one attitude.
On the other hand, take a situation like that if I were in general
practice and a client walked into my office and said, “ Here is a
certain state of facts. Am I liable? Have I got to pay anything?’*
Of course I would know that the reason that man has come to me as
a lawyer is that he does not want to pay. I am glad he came because
I want to get paid, and if I can save him paying that money, I can
get some more money. Everything'in life depends on the point of
view, that is all. If you look at a thing through the inverted end
of the opera glass, you will get a different view. So when the selfinsurer goes to counsel in general practice for advice, that lawyer
has not the slightest interest in his client’s relations with his men or
any other factor in the problem. He looks at the case from the cold
blooded, legal standpoint—“ Is this man liable or isn’t he?” If he
sees a chance of escape, he tells his client so, and they go to bat
and he wins or loses. In either event he pockets his money.
Mr. D u x b u h y . I may not have fully understood just what the
last speaker meant, but if I did, I do not quite agree with him. I
think that the last case he cited would be governed by exactly the
same rules as the first one. If a lawyer is going to serve his em
ployer, he serves such employer so that he holds his job and de
serves to hold his job. When his client comes to him with reference
to the client’s legal rights in a certain matter, he will advise his
client according to what he believes is the legal liability, and the legal
rights, because that is the kind of advice that people want from
lawyers.
It is a popular impression, I know, that people go to lawyers for
the purpose of escaping their legal liability. There may be such
lawyers, and there may be clients who want that kind of lawyers,
but I feel that the lawyer who is successful and deserves to succeed
gives the same kind of service to his employer that he would give in
the other relation. He wants to do exact justice, and that is what
142
DISCUSSION
the man wants, and if he gives his client such advice as “Well, we
may get out of this and we may not,” he will involve his client in
litigation, with, possibly, adverse verdicts and judgments, and he
will soon lose his job with that client because he deserves to lose it.
That may be the conception of some people with reference to the
different lawyers, but it is not the conception which lawyers who
deserve to be lawyers have of their job. It is not the conception
which you will find among members of the American Bar Associa
tion when discussing their duties and obligations, and it is not the
conception which you will find in any association of decent ant*
respectable lawyers.
The C h a i r m a n . We will proceed with our discussion of the
paper which was read this morning by Mr. McGilvray.
Mr. B r o w n . I did not arise to discuss the paper, but to express
a feeling of thankfulness for the most excellent discussion by Mr.
McShane of Mr. McGilvray’s paper. Personally, I am connected
with a few men in the Northwest—Idaho, especially—in attempting
to put before Congress a proposition for just such a law as Mr. Mc
Shane outlined. In talking with our most excellent Representative,
Burton L. French, he said, “You compensation people know better
just what kind of a bill you would like to have introduced, and I
promise you that if you .will arrange such a bill, so that I can have it
by the time or a little before the next Congress convenes, I will do
all in my power to have it taken under consideration, considered, and
indorsed, if it is possible to do so constitutionally.” I want to make
it known, especially to our worthy secretary, that that gentleman is
at the service of this association in carrying out the plan recom
mended by Mr. McShane.
Mr. W i l c o x . I do not think I quite understand the plan that Mr.
McShane suggested this morning. I am in doubt as to whether
he means to make it optional with the railway employee, who would
otherwise have to bring his case under the common law, to elect com
pensation as a remedy.
Mr. M c S h a n e . Mr. McGilvray drove me into a corner and left me
to find something to present to the convention, which I did. I think
that the convention should not, at this time, however, take my sug
gestion too seriously, but I do place it before the convention as a mat
ter for consideration and such action as might be indicated after a
thorough examination of the subject has been made.
There is no doubt that such a law at the present time would meet
a lot of obstacles. There are constitutional provisions in the States
which vary, and you will have a lot of difficulty in the States as
well as in the Nation. That is my thought, and I simply proposed
it for you to consider. I have not thought it out very well myself;
I am willing to admit that.
The C h a i r m a n . Mr. McShane, have you any suggestions as to
how this association shall consider these questions ?
Mr. M c S h a n e . It is in the record. There are a lot of fellows who
know more about this than I do, and I rather think if they con
sider it important they will give it some thought and bring it up.
I f not, they will let it go.
DISCUSSION
143
Mr. W i l c o x . This question has been thrashed out over and over
again, and we have been trying to devise ways and means to provide
protection for railway employees injured in interstate commerce.
Not all the obstacles are in the matter of legislating; a great part
of the obstacles in practically every State is in the attitude of the
railway employees themselves. I think they are openly opposed to
any tinkering with the law so far as they are concerned. They
want to take their chance under the Federal employers’ liability
act.
I am not very much in favor of laws which give you a right to
select your remedy at common law if you think you can establish
your liabilities at common law, but if you know you have not a good
case at common law, then you can take a sure shot at compensation.
1 do not like that kind of a law.
Mr. McShane. That was my intention, to make it optional.
Mr. W i l c o x . The biggest problem of all, so far as we are con
cerned as administrators of law, is to know whether or not the case
that occurs right in our own jurisdiction is in fact one cognizable
under the compensation law of our State, or whether it is a case
that should be disposed of under the Federal employers’ liability act.
A railway company, if it thinks it has a genuine defense under the
Federal employers’ liability act, or the common law of the States,
is likely to insist that the case arose in interstate commerce, and, vice
versa; if it is a case where there* is no defense, where negligence of
the company is easily established, then it will submit to the injured
party or the dependent that it is a case that really ought to be dis
posed of under the compensation law. That will be found to be
the situation you will have to meet, and whether a case is in inter
state commerce or in intrastate commerce is a mighty close proposi
tion. This question of whether or not even temporary repairs carry
that instrumentality, that car, that engine, into the realms of intra
state commerce is another question. Some courts hold that you can
not take the car, if it is not loaded, or the engine inside the shop for
these repairs and continue it as temporary repair work and keep it
in interstate commerce, and vice versa. I have not seen any light
on the matter so far, and I do not know that I do now.
Mr. I n g r a m . We have discussed this matter at other conventions.
The railroad transportation brotherhoods were the principal ob
jectors to a Federal compensation law which was proposed by a
Federal compensation commission created at their request during
the Taft administration.
In Nevada, this is the situation with reference to railroad em
ployees. The compensation provisions are used in the settlement of
such cases. In every one of our cases in the Federal Court, the sug
gestion is made that under the compensation law of the State of
Nevada the injured man would be entitled to a maximum of $7,200,
and of course, that affects the jury in its settlement. In Nevada, as
far as the employee is concerned, you will find very few juries who
have given a larger compensation award than the employee would
be entitled to under the State compensation act.
Mr. W i l c o x . Do you mean at common law ?
144
DISCUSSION*
Mr, I n g r a m . That is the amount which the employee himself re
ceives. You will find some $10,000 verdicts, but when you go int<
the matter you will find that the attorney has gotten 33£ per cent
of it and the employee has paid his costs, so that gets it down pretty
close to our compensation figures.
Every one of our compensation amendments in the past six or
seven years has been formulated and passed on the strength of rep
resentations made by the railway employees, because they are the
only active labor lobbyists in Nevada. What was their object ? Their
object was that they expected that at some future time there was
going to be a national compensation act to take the place of the
employers’ liability legislation and when this time came they wanted
to have the figures of the compensation benefits in the State of
Nevada such that it would help them in the national compensation
law- They are not going to have their congressional Representatives
agree that $5,000 as a maximum is a sufficient sum to pay for the
loss of a life when in the State of Nevada the widow and orphans
can get as high as $25,000. That is why compensation laws are
being built up in these various States.
I might remark that I have been the active legislative represent
ative for the train-service organization of the State of Nevada for
a good many years, and I do not, at this time, find that objection
to a Federal compensation law among the train-service employees.
There was a time when in their conventions they opposed such a
law, but if you look in the proceedings of the convention of last
year you will find every one had something favorable to say about
the compensation principle as distinguished from the employers’
liability act and the recoveries possible thereunder.
Some education may be needed in some of your States, but let
me tell you that the Federal courts are not giving any very large
decisions.
Mr. W a l n u t . I am going to add some of our experience to this
discussion. In Pennsylvania our principal carriers are the Phila
delphia & Reading and the Pennsylvania Railroads. The Philadel
phia & Reading always insists on this interstate provision in order
to avoid liability wherever it can, but the Pennsylvania Railroad for
some years has adopted the practice of recognizing all of its accidents
as coming within the compensation law, regardless as to whether or
not they may be interstate or intrastate accidents, and the system has
worked fairly well. Sometimes the railroad gets burned, because
when a man has a very good case he refuses to accept compensation
under our law and proceeds under the provisions of the Federal
employers’ liability act, but for the most part it operates on that
basis and has operated that way for a number of years. As far as I
know, there is no organized complaint from their employees.
Mr. B r o w n . Did I understand you to say that it is the custom
of that railroad now to bring its accidents under the scope of the
compensation law, regardless as to whether they were intrastate or
interstate?
Mr. W a l n u t . Oh, yes. When an accident occurs the railroad
enters into an agreement with the injured man just as though the
accident occurred right there. It may be an accident to a brakeman
on a through train. The railroad will enter into an agreement with
DISCUSSION
145
that man for the payment of compensation and that agreement is
approved in the regular way by the board. I f there is any serious
contest over it, you will find the claimant coming before the board
on petition in what is clearly an interstate case and the railroad
making no defense on that ground but merely raising other questions,
mainly the medical significance of the relation between the alleged
accident and the condition, just as if it was liable under our com
pensation law.
Mr. B r o w n . The question in my mind was the practicability of
any State attempting to change a law. I am at a loss to see how
it would be possible for us to legislate as a board or to agree
with the men that they could change a matter that is interstate into
intrastate. I do not understand how that can be done.
Mr. M c S h a n e . What Mr. Walnut said, as I understood him, was
this: Where it is plainly an interstate case the man still has his
rights, but if he is willing to settle on the basis of intrastate
employment the railroad company accepts it; it is a matter of agree
ment, and the man certainly has a right under the common law to
enter into an agreement for settlement.
Mr. D u x b u r y . But your agreement is not within the province of
the industrial commission. It is a private agreement.
Mr. M c S h a n e . We do not, in Utah, approve such agreements.
We tell the parties to go their own way.
Mr. D u x b u r y . Minnesota does not have the best law in the world,
but it has a good many commendable features. One of them is that
we do not restrict its provisions to an employer who has? a certain
number of employees. We have 7,500 indemnity claims. We limit
all permanent total disability to $10,000, which is a little less lib
eral than some others which have no limitation whatever. We
have a $20 weekly maximum. We have unlimited medical benefits.
We have many good features, but our law provides that employees of
steam railroads are not under the compensation law, so we do not
have the trouble that you have been talking about. If the injured
men are employees of the steam railroads, the compensation law of
the State of Minnesota has no relation to their employment and their
rights are under the Federal employers’ liability act or the common
law of the State with reference to negligence or whatever the juris
diction may rest upon. In that particular, I think Minnesota is
lagging behind the procession, because there is no fundamental
reason that I can imagine why steam railroads should not be subject
to the same rules of liability as other employers. Thisi exemption
resulted from the attitude of the Federation of Labor; it did not
want such employees included, and when the men do not want to be
blessed, why you can not bless them, that is all.
Mr. C l a r k . I would like to ask by what authority you in Pennsyl
vania take jurisdiction in that sort of a case?
Mr. W a l n u t . I do not see that there is any objection to the taking
of jurisdiction. You see what really happens is this: The Pennsyl
vania Railroad says, “We will not raise the question. This is an
interstate accident. We will pay this man on the same basis as if he
were under the compensation law, and we will follow the same prac
tice that would be followed if it were a compensable case,” and we
146
DISCUSSION
assist them in that practice. Of course neither side is bound. The
employee can, if he chooses, refuse to accept payment on a compensa
tion basis, and say, “ I can get a whole lot more under the accident
liability law.” He is at liberty to do that if he chooses, but if he does^
not choose that proceeding, the Pennsylvania Railroad will fix the
amount of money he is to receive by our compensation rates, asking
the board to assist in determining what those rates should be.
Mr. C l a r k . It amounts, then, to your board becoming an arbiter
instead of a commission.
Mr. W a l n u t . Y ou see, the question of interstate commerce never
being raised, we would have jurisdiction, prima facie jurisdiction
at least, until that question was raised. It does not follow merely
because a man' is employed by the Pennsylvania Railroad that he
is in interstate commerce. The case comes before us as an intra
state commerce case and nobody raises the* question that it is inter
state. We treat it as an intrastate case.
Mr. C l a r k . Is not your commission bound to take judicial notice
of the fact that the Pennsylvania Railroad is an interstate corpora
tion?
Mr. W a l n u t . We are not bound to take judicial notice that every
employee who is injured is injured in an interstate commerce acci
dent ; we could not take such judicial notice because that is not true.
What percentage of accidents are interstate and what percentage are
intrastate, I do not know, but I know that you could not assume
they are all interstate accidents.
Mr. C la r k . The courts have held the same as in maritime law,
that any railroad corporation whose lines run over more than one
State is an interstate corporation and is under congressional and not
State regulation.
Mr. W a l n u t . Remember, there is a very marked distinction be
tween the interstate character of the carrier and the interstate char
acter of the employment of the employee. Your carrier may be en
gaged in interstate business, but your employee is not necessarily
engaged in interstate business.
Mr. D u x b u r y . I wanted to suggest that if one of these railroad
cases came before the Industrial Commission of Minnesota upon
agreement that the parties would adjust their differences by applying
the schedules of the compensation law, I would hold immediately
that the Industrial Commission of Minnesota had nothing to do with
that case, just as I would if a case of domestic discord in which both
parties were willing to be divorced came up; of course, that would
not be a case that would appeal very strongly, but if the parties
came in and wanted to submit their contention to the right of di
vorce to the Industrial Commission of Minnesota, I would say they
had better go to a court which had jurisdiction of that question.
I do not think this question of jurisdiction has been properly
expressed. If you take over something, give your approval to plac
ing the jurisdiction of the subject matter in your commissions, your
act is of just as much importance as it would be if a convention of
tramps had performed that same function. I think we ought to be
carexul as regards our jurisdiction. We have troubles enough with
DISCUSSION
147
out hunting for domestic troubles or going outside the jurisdiction
of the subject matter.
Mr. W a l n u t . The commission of Pennsylvania has taken a dif
ferent attitude. We have a very high regard for the compensation
law and we would like to see it extended. We want to see it ex
tended to cover all the accidents in the State that it can possibly
cover. We think it is better thafi the old precarious gambling of
the common law. For that reason, when these parties come before
us and undertake to have this compensation system applied to their
differences, we are perfectly willing to accept the opportunity of
extending the act that far.
Mr. H orner. In order that you may get a clear understanding
with reference to this intrastate and interstate proposition, the
Pennsylvania Railroad Co. as a rule holds that all its train-service
accidents are interstate accidents. The men who are injured in the
shops are as a rule assumed to be in intrastate employment, and in
those cases the Pennsylvania Railroad Co. enters into agreements
and pays compensation the same as any other employer does; but
when it comes to a question of interstate employment, the railroad
company notifies the bureau that the case is an interstate case and
that settlement is made on the basis of the workmen’s compensation
law of the State of Pennsylvania. In that case no agreement is
entered into. The railroad company simply notifies the bureau that
that case has been settled on the basis of the workmen’s compensa
tion law of the State of Pennsylvania and that it was an interstate
case.
To cite a case in point to show that the courts of Pennsylvania
recognize the distinction between the interstate and intrastate case,
recently we had a case with the Philadelphia & Reading Railroad Co.
I know of this case personally because I handled it. A man was killed.
The widow filed a claim under our compensation law, but before that
case was finally adjudicated, some “ ambulance chaser” in New York
got hold of the widow and insisted that she drop her claim against
the railroad and proceed under the Federal liability law, which
against her will, she did, with the result that she lost out in
the courts. The courts did not sustain the case; it was an intrastate
case, and the case went before the referee and the referee awarded
the compensation. The attorney who represented the widow in the
suit against the railroad company under the Federal liability law
(after he lost the case and the widow was granted compensation
under the compensation law of the State of Pennsylvania) tried to
get the Philadelphia & Reading Railroad Co. to commute the amount
in order that he might get a fat fee. The widow lived in Harris
burg. She came into our office, and we told her not to pay any
attention whatever to this attorney; that she owed him nothing.
There was accrued compensation due amounting to something like
$1,800. The widow was in bad shape financially. She was notified
that she would have to move out of the house in which she lived
unless she paid her rent. We interceded with the landlord, saying
that an award had been made but that there was some delay in
paying the compensation because of the fact that she had been
induced to bring suit under the liability law. I immediately com
municated with the Philadelphia & Reading Railroad Co., with the
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DISCUSSION
result that it sent us a check for $1,800 and some odd dollars, ac
crued compensation that was due at that time, and we turned it over
to the widow.
Mr. D u x b u r y . That was interstate or intrastate?
Mr. H orner. It was an intrastrate case.
Mr. D u x b u r y . It seems to me that it is bad practice and almost
unjustified for an industrial commission to assume jurisdiction of
a subject matter over which it has no jurisdiction, because there
are lots of cases where it has no jurisdiction, the subject matter
arising in interstate commerce. If it adopts the practice of assum
ing jurisdiction—and I doubt if that word is the proper one;
I think it would be better to use “ usurp ”—it is putting into
the hands of the railroad adjuster an advantage by which it can
settle cases where the liability would amount to a great deal more
and a great deal more ought to be paid. It gives that impression
and puts that advantage into'the hands of those fellows.
I f you can make the man believe, by a little reflection on his
lawyer, who advises him otherwise and who may have an interest
in it, that the lawyer is deluding him, he is mighty glad to settle
that kind of a case according to a schedule that does not apply.
The industrial commissioner, by usurping jurisdiction in such a case
as that, is putting in the hands of the adjusters an advantage which
they ought not to possess.
I do not want to lend the good name and reputation of the In
dustrial Commission of Minnesota to purposes that can not be
commended. Industrial commissions ought to have a definite idea
of what their jurisdiction is, and they ought not by their influence
and their zeal for a law which applies well in some cases to give
wrong impressions with reference to the rights of other parties
whose rights come under a different set of laws, and by that means
induce settlements that are absolutely contrary to the rights of
property. There are cases where the legal rights of the parties
entitle them to more, and they ought to have it.
Mr. W ilcox . Mr. Stewart tells me that there has been a very
apparent change in the attitude of the railroad brotherhoods with
regard to this whole problem. I remember the history back to the
Columbus meeting, I believe it was. Mr. Pillsbury. former chairman
of the California commission, had prepared a bill for introduction
into Congress. It was the plan of that bill that in the various States
having compensation laws, the compensation law of the State in
which the accident occurred should be the measure of recovery
for that particular accident in interstate commerce, assuming, of
course, that accidents in intrastate commerce were already covered
within those States. That brought out very sharp opposition from
the railway brotherhoods. I think that the bill was introduced in
Congress and met their opposition; at least it was smothered.
There, were different views at that time, one of them supporting
the Pillsbury plan and another the plan of a Federal compensation
act covering benefits for railway employees generally throughout
the United States who might be injured in interstate commerce,
leaving the States to take care of those in intrastate commerce. It
was the hope that that character of legislation might develop on
DISCUSSION
149
the part of the States a tendency toward uniformity in their acts,
the objection to the Pillsbury plan being that it was unfair to
compensate one injured railway engineer on the basis of the law
in New York and* another on the basis of the law of some other
State where benefits might be very different.
We can not settle this matter here to-day by any manner of means,
and it occurs to me that perhaps this association ought to name a
committee to give the question careful consideration, and in coopera
tion with the railway brotherhoods, perhaps, work out some sort
of a scheme that as an association we can get back of and further.
Mr. D u x bu ry . It occurs to me that the suggestion that Congress
provide that the laws of the States may govern the extent of lia
bility in interstate commerce can not be done constitutionally. That
is the exact point which was held to be unconstitutional in the last
act of Congress attempting to bring maritime injuries under com
pensation laws. The point was that Congress had the power to pass
a compensation law for maritime employees or any other employees,
but that Congress did not have the constitutional right to adopt the
law of a State as its act, and if it is going to give compensation for
interstate commerce it will have to provide a uniform compensation
law for the United States, because it has jurisdiction of that par
ticular field, and can not adopt the various plans of the States. It
has to be its law, and not the law of the State.
Mr. H a t c h . The situation as to the maritime jurisdiction problem,
which is very much akin to that with regard to interstate commerce,
does lend weight, of course, to what Senator Duxbury has said,
that, in the lignt of the Knickerbocker and other decisions, it would
be a very hard proposition to draw an act which would be regarded
as constitutional providing that the railroad men in one State re
cover under one benefit schedule and in another State under another
benefit schedule.
In the maritime cases the main point of the whole thing was that
the law must be uniform everywhere, and to attempt to apply State
compensation laws to seamen or to longshoremen would be to say
that a vessel in one port would have one kind of law, in another port
another kind, and so on; that is what the Supreme Court said you
can not do constitutionally. Although I am not a constitutional law
yer, I should think that the same rule of uniformity of law would
apply in your interstate commerce proposition. I am in favor of
Mr. Wilcox’s suggestion that this matter be given study, to see if
some remedy can not be found.
The C h a ir m a n . Mr. Wilcox has suggested that a committee might
be appointed at this session to make a study of this problem.
Mr. D u x bu ry . Why not make it in the form of a motion ?
Mr. W ilcox . I move that this organization appoint a committee
of five to confer with the railway brotherhoods and other organiza
tions—such other groups as it may see fit—to the end that some uni
form type of legislation be provided covering injuries in interstate
commerce.
[The motion was seconded. At the suggestion of Mr. Duxbury and
accepted by Mr. Wilcox the motion was amended to provide that the
committee be appointed by the incoming president.]
150
DISCUSSION
Mr. B row n . Mr. Wilcox spoke about the body with whom this
committee should confer.
The C h a ir m a n . I think the motion is liberal enough to cover all
agencies which may be of any assistance.
Mr. B row n . A s a body representing the commissions of the
United States of America and Canada we are expected to be fair
with all parties, and in this resolution we put first that this body
confer with the railway workmen. We do not say anything about
the railroads. It occurs to me that the railroads should be included,
and if we name anybody they should be named also.
Mr. D u x b u r y . I think it would be a bad idea to put in details.
Mr. W ilco x . I had a reason for saying it just as I did. The Fed
eral employers’ liability act was accomplished after a lot of work. It
took a long, long time to write that into the Federal statutes, and it
was put there at the instance of the railway brotherhoods. I think
that our first duty is to confer with the railway brotherhoods with
regard to this type of legislation, because the present law was en
acted at their instance and for their protection. I am not quite
ready to force on them some different scheme against their will.
Mr. D u x b u r y . We ought to assume that this committee will have
wisdom enough to consult with the railroad brotherhoods and with
all other interests. I would much prefer that we leave out those
details.
Mr. W il l ia m s . The amendment I am about to suggest would
meet the objection of the gentleman, that is, that a commitee of
this association be appointed to confer with parties interested and
take such steps as in its judgment might seem wise in order to
bring about a remedial condition for the employees of railroad
companies engaged in interstate commerce.
[The substitute motion was accepted by Mr. Wilcox, seconded,
and carried.]
The C h a ir m a n . The committee will be appointed by the incoming
president.
Mr. R y a n . I would like to ask one more question on this subject.
Mr. McGilvray, in his excellent paper this morning, stated that
if a resident of California, whose contract of hire was in California,
went to another State, the California commission would have juris
diction over that employee if he was injured in another State.
We took this matter up with the California commission. A num
ber of mining companies in Nevada contracted to hire their men in
California, running them by bus from Sacramento to Tonopah and
the mines of Nevada. The California commission assumed it had
jurisdiction over the accidents in Nevada. The Nevada Industrial
Commission claimed and held that it had jurisdiction over these
men when they were injured in Nevada. I would like some infor
mation from Mr. McGilvray on that point—whether he still holds
that.
M r. M cG ilvr ay . That is, that we assume jurisdiction? Oh, yes;
that is the case of the double jurisdiction that I spoke of. Under
your law you probably can maintain jurisdiction over those men
while they are employed there. That case is a double burden on the
employer.
A DM IN ISTRATIV E COST
151
The C h a ir m a n . Next is the plea of Mr. Monroe as to how we
are going to help the South. Have you any suggestions to offer
as to the way this association can help Mr. Monroe in his problems ?
Mr. S tew art . I think Mr. Monroe is thoroughly satisfied with
what has been done through the committees already.
CHAIRMAN, FRED M. WILLIAMS, CHAIRMAN CONNECTICUT BOARD OF COMPEN
SATION COMMISSIONERS
The C h a ir m a n . The first item on the regular program is a paper
by Mr. Kingston, of Ontario.
ADMINISTRATIVE COST—WHAT ITEMS SHOULD CONSTITUTE AND
ENTER INTO SUCH COST
BY
GEORGE
A.
KINGSTON,
COMMISSIONER
ONTARIO
WORKMEN’ S
COMPENSATION
BOARD
This is the first occasion during the 10 years I have been attending
the conventions of the association where the question of admin
istrative cost has been considered a subject worthy of discussion
and of a place on the convention program.
In the very nature of the subject, in what I have to say I must
have in mind our administration of the law in Ontario and our ex
perience there regarding this subject.
I should explain first that when the law was first proposed in
1913 in the draft bill submitted to the Government the following
section was included:
S e c t i o n 68. To assist in defraying expenses incurred in the administration
of the act there shall be paid to the board out of the consolidated revenue fund
such annual sum not exceeding $---------as the Lieutenant Governor in Council
may direct, etc.
The Chief Justice of Ontario, reporting on the proposed law to
the Government of that day, used the following words dealing with
the question of administration expenses:
The only remaining provision of the draft bill to which I shall refer is sec
tion 68, which provides for a contribution by the Province to assist in defray
ing the expenses incurred in the administration of the act. I have not ven
tured to suggest what the contribution should be, but in my judgment it
should be a substantial one. The effect of the proposed law will be to relieve
the community of a burden of maintaining injured workmen and their de
pendents in cases in which under the operation of the existing law they are
without remedy, and by the transfer from the courts to the board of the de
termination of claims for compensation which will lessen very much the cost
of the administration of justice.
When it actually came to passing the legislation in 1914 the Gov
ernment recommended that the amount which was left blank in the
draft bill and which was the subject of the above paragraph should
be fixed at $100,000, which sum was paid by the Government for a
number of years, besides providing office accommodation and the
salaries of the members of the board.
It is not, however, so much of administration expenses in the gen
eral sense that I am asked to speak as of “ administration cost with
relation to accidents,” indicating what the different administrative
functions are costing per case and what items should enter into such
cost.
152
ADM INISTRATIVE
cost
In our Province the system is purely what has come to be known
more particularly in the United States as 46State-fund system.” No
insurance companies are permitted to operate in this field, and the
application of the act is compulsory, with a few exceptions, which
were fully set out in my paper at the Halifax convention a year ago.
We are able to state, therefore, with some degree of exactness just
what the various functions covered by our administration cost per
case.
Take the year 1923 for example, the last year of which our rec
ords are complete. We had 61,109 accidents reported, and during
that year we paid as follows:
Benefits awarded, Schedule 1___________________ $4,036,170.26
Benefits awarded, Schedule 2 and Crown_______ 1,848,785.58
Medical a id ------------------------------------------------------788,905.90
Safety associations____________________________
81,980.66
Administration expenses________________________
221, 648.34
6,477,490.74
Of the 61,109 accidents reported 51,655 were in Schedule 1, and
as medical aid and safety association work has relation only to
Schedule 1 industries, it will be apparent that the cost of these serv
ices would be as follows:
Medical aid: $788,905.90-^-51,655=$15.27 per claim.
Administration: $221,648.34-H>1,109=$3.63 per claim.
Safety associations: $81,980.66-H>1,655=$1.58 per claim.
It should be borne in mind, however, that in Ontario, as in any
State-fund system, a very substantial portion of the office adminis
tration expense has to do with the assessment or insurance side of
the work.
I have made no attempt at an accurate division of this expense
as between the assessment department on the one side and the
claims on the other, but roughly it is about fifty-fifty, so that with
us it is fair to say the administrative cost per claim is between
$1.60 and $1.75.
Otherwise if we take our whole office expense for a year and try
to make it comparable with a jurisdiction where the insurance com
panies pay the claims we should add the insurance companies’ office
expense, including the expense of getting business, to the board’s
administration expense. I do not know what such a comparison
would reveal as the figures are not available, but any of you who
have access to the data can easily make the comparison in your own
jurisdiction.
Just what portions of what we include in our administration ex
penses should, strictly speaking, be considered administrative cost
may be a matter of some controversy. Medical aid is, of course,
not administrative cost so much as it is compensation cost, yet medi
cal examinations by referees should, I think, be included in the
former. Safety work, in whatever form it may be carried on,
should not, strictly speaking, be included as administrative cost.
Whatever.its effect may be, it will go to the reduction of the ac
cident cost, so safety organization expense should be kept separate.
Rehabilitation expense is in much the same category. In so far
as an injured workman is rehabilitated to such extent is the com
pensation cost in respect of his case reduced. I am unable to give
DISCUSSION
153
any figures as to rehabilitation cost as we have practically only
started this work in Ontario and our actual office expense incident
to the organization of our rehabilitation department is as yet negli
gible.
Expense incident to the payment of compensation should of
course be considered administrative cost, so that in comparing a
jurisdiction in which the administering board actually issues the
compensation checks with one in which the State treasury uses its
machinery for the payment of compensation this should be taken
into consideration. A State or Province which makes the board
pay the claims must also require the board to collect the fund.
This, of necessity, involves the expense incident to the investment and
management of this fund. All of this should of course be properly
considered administrative cost.
The expense of the medical department of the board’s work should
be included in administrative cost, provided its functions are purely
administrative, i. e., where the department’s work is confined to the
examination of claim papers and the examination of claimants to
ascertain the extent of disability. Should a medical department of
any board depart, however, from the purely administrative field and
engage in curative practice the expense of such should come under
medical aid and not administrative cost. I should think this prac
tice would be very unwise on the part of any board unless possibly
it might be in the scientific application of physiotherapy in after
treatment of certain cases. This, properly speaking, might come
under the head of rehabilitation.
Summing it all up, therefore, we have the two functioning
groups:
1. Those the expense of which is properly considered an adminis
trative cost. Items in this group are—
(<a) Board’s salaries and traveling expenses.
(b) Office rent, stationery, postage, supplies, etc.
(c) Claims department, including claims investigation, etc.
(d) Medical department (administration).
(e) Assessment department.
(/) Finance and bookkeeping departments (including payment of
compensation, investment and management of funds, etc.).
(g) Statistical and actuarial departments.
2. Those the expense of which should be included in compensa
tion or medical cost—such items as—
Accident prevention and safety association work department.
Factory inspection.
Medical aid (treatment of claimants).
Rehabilitation.
DISCUSSION
The C h a ir m a n . This very interesting paper is to be discussed first
by Mr. Horner of Pennsylvania.
Mr. H orner. Administrative cost in handling accident and com
pensation cases is controlled largely by the different provisions of
the workmen’s compensation laws in the different States and Prov
inces and by the efficiency of administration, Mr. Kingston has given
154
AD M IN ISTRATIV E COST
us some figures on the administrative cost in an exclusive State-fund
jurisdiction, covering approximately 61,000 accidents.
Under the provisions of the Pennsylvania compensation law we
have self-insurers, stock and mutual insurance companies, and a
competitive State fund. In furnishing some data on Pennsylvania’s
experience I am not including any figures covering administrative
cost on the part of the State fund, the insurance companies, or the
self-insurers. I am basing the figures on the money expended by
the State in the administration of the compensation law and the law
requiring the reporting of accidents. These figures do not include
money expended by the department of labor and industry in inspec
tion and accident prevention work, or in the administration of the
rehabilitation law. The inspection and rehabilitation bureaus are
operated separately, although there is close cooperation between
these two bureaus and the bureau of workmen’s compensation, all
being in the department of labor and industry.
The question as to what items should enter into administrative
cost is a fertile field for discussion. A strict interpretation would
probably confine the cost to operating expenses, not including the
expense of accident prevention and rehabilitation work. However,
a more liberal interpretation would probably include these latter
activities. The Pennsylvania experience, as shown by the following
figures, include the operating cost of the workmen’s? compensation
board, referees, and bureau of workmen’s compensation, as well as
postage and traveling expenses and payment of fees of impartial
physicians and surgeons selected by the State.
During the year 1924, the total number of accidents reported to
the bureau of workmen’s compensation of the Pennsylvania Depart
ment of Labor and Industry was 177,539. The average cost of han
dling these accident and compensation cases was $1.49 per case. The
number of cases in which agreements and awards were made during
the same period was 78,774 and the average administrative cost of
handling each of these cases was $2.95. Of the 78,774 compensable
cases 73,445 were noncontested—cases in which compensation was
paid upon agreements properly executed by the parties in interest and
approved by the State. It cost the State to handle these 73,445 non
contested cases $0,917 per case. By eliminating the compensation
board and referee expense items in handling the 177,539 accident
reports, including the 73,445 noncontested compensation cases, the
actual cost is reduced to $0,474 per case.
Five thousand three hundred and twenty-nine cases were contested
before the referees at an average cost of $18.90, while 1,046 cases were
disposed of by the compensation board at an average cost of $58.14.
It must be remembered that the referees travel from place to place in
holding hearings in the districts over which they preside and that
the workmen’s compensation board travels over the entire State.
The State-fund experience shows that during the year 1924 the
average administrative cost in the handling of 28,000 accident re
ports, including approximately 8,600 compensation cases, including
every item of expense with the exception of the payment of compen
sation and medical and hospital expenses, was $16.71 per case.
These figures, of course, include the cost of contesting cases before
referees, the workmen’s compensation board, and the courts, as well
rHSctrssioN*
155
as pay-roll auditing. The actual cost of adjusting the 28,000 cases
for the purpose of paying compensation and medical and hospital
expenses was $1.97 per case. The State-fund experience also shows
that the average cost per case for medical and hospital expenses for
the last seven months of the year 1924 was $18.19, while the medical
cost for the year 1923 was $16.52 per case. In the State of Pennsyl
vania the payment of medical and hospital expenses is limited to the
first 30 days after disability begins.
The C h a ir m a n . Next in the discussion comes Mr. Wilcox, of
Wisconsin.
Mr. W ilcox . The items that form the basis of the bulk of the
expense of the administration of the compensation act must, of
course, vary from State to State. The administration of a law in
New Jersey or Connecticut, States where you are in very close con
tact with the people with whom you have to deal, must necessarily
be a very different thing from what it would be in a State like Cali
fornia where you have to take a day and a night to travel the length
of the State, and the type of law will, of course, vary the program
from State to State.
The legitimate costs of administration, of course, are such costs as
are necessary to see that the law is administered adequately, and that
an employee or his dependents gets the amount that is due and gets
it promptly and in full measure, and that the supervising body
really knows that such is the fact.
With us, we feel that our first obligation is to make certain that
we learn of all of the compensable accidents in the State by prompt
reports from the employers—not from the insurance carriers but
direct from the employers. That always involves quite a consider
able outlay, because the employers will soon fall back if you are
not everlastingly after them to see that they do make their reports.
That is not the case so much with the larger institutions as it is with
the smaller ones, and the contractors will be the slowest of all to get
the information to you.
Our next obligation, we think, is to see that we have a sufficient
force properly to file and docket those claims. So far as our de
partment is concerned, we will then have the beginning of a suffi
cient record on any particular case, and we think information
should immediately be furnished an injured employee, giving
him just an outline of his rights under the law, so that he may be
relieved as far as possible from anxiety and from the necessity of
spending money in order to learn his rights.
Then we think we should do sufficient follow-up to see that the
money goes to the injured employee promptly, and that in the case
of a contest between him and his employer' or his insurer making
it necessary for a conference or a hearing, we should hold it in a
locality where it will be possible for the parties to present the issues
as freely and quickly and completely as possible. Of course that
involves, in a State like Wisconsin or the larger States, quite a good
deal of traveling expense and a good deal of effort to make certain
that you are giving prompt service in that field.
Of course we feel that we ought to have a sufficient force to see
that the claims are disposed of after they have been submitted.
73891°—26-— 11
156
ADM INISTRATIVE COST
When the parties are depending on us for action, we ought to be in
a position where we can act.
Next, as Mr. Kingston mentioned, we ought to have sufficient
medical advice for the commission to satisfy itself that what it is doing
is the right thing, and then—the point that Miss Harrison stressed—
a follow-up at sufficient times to make certain that the compensation
estimates were, after all, decently accurate estimates.
We think we ought to maintain the highest type of statistical
department. I do not know how a department can administer work
men’s compensation without the knowledge that can be gained from
a well-ordered statistical department. The first thing we organized
in Wisconsin was our statistical department. We got it started
right at the first part of the game, and we have never let it slip for
a minute.
We think our experience ought to be tabulated and put out to
the public. We publish our experience in bulletins every month
or so. There is one on “ Promptness of compensation payments.”
Here is one on “ Place where accidents occur and the cost of acci
dents, the number of injuries that resulted in death and in per
manent total disability and in permanent impairments, according to
occupation,” and things of that sort.
We try to get that information out to all the people in the State
who are particularly interested in it. It is published in bulletin
form, and we have a very large mailing list. As soon as it is ready,
we get it to the people who are or ought to be interested in the
material we are collecting, because it should be of help to them.
And on top of it all is the publication generally of information to
apprise the whole public of what the compensation act is, its general
working, and what its benefits are—that general information, which
after all, yields material dividends..
Mr. K ingston . Mr. Wilcox speaks of publishing this bulletin. I
wish all the States that publish bulletins would adopt the practice
of putting the rest of us on their mailing list. I know I look for
ward with a great deal of interest to that bulletin which comes from
Ohio every month. It has put each member of our board on the
mailing list. I should very much like to receive the Wisconsin
bulletin and also bulletins published by other States, because they
would keep us in touch with what you are doing, and we want to
study what you are doing as well as study what we ourselves are
doing.
The C h a ir m a n . It occurs to me that it might be of great interest
in this connection if we knew the number of employees connected
with the administrative departments in the States of which you
gentlemen are speaking. Can you tell how many you have in
Ontario ?
Mr. K in g sto n . We have approximately 100 on our staff at home.
The C h a ir m a n . How many have you, Mr. Horner?
Mr. H orner. We have 121.
The C h a ir m a n . H ow many have you, Mr. Wilcox ?
Mr. W ilcox . We have about 140 employees administering all the
functions of the department in the State. That takes in the child
labor employment office.
DISCUSSION
157
Mr. K ingston . You do a lot of things in Wisconsin that we do
not.
Mr. W ilcox . We do not have an insurance fund to administer
like you do in Ontario and in Pennsylvania.
Mr. L ansburgh . The 121 in Pennsylvania does not include the
insurance fund force.
Mr. S tewart . I would like to submit a statement as to why I asked
for this subject to be put on this afternoon.
I made an effort during the year to get a line on the administrative
costs of workmen’s compensation from two points of view—first,
the cost per case; second, the percentage that the administrative
cost was of the total money handled. I am not going to discuss both
of these angles at this time because what I have to say is just as
true of one angle as of another.
The prime difficulty has been just what the Bureau of Labor
Statistics has always found, that it is impossible to get information
by correspondence because it is impossible to write a letter or draft
a schedule that can not be construed in more than one way.
The result is that I do not know what the figures mean. In
the first place it will be necessary to know just the type of the
administration, what the commission does. I received a report from
one State that its operating expense for 1924 was 64 cents per case.
Its highest operating expense was in 1922, when it cost $2.77 per
case. This was due to the fact that the compensation cases in 1922
were only about one-fourth of what they were in 1924, while their
total expenses were a little more. An average for the five-year period
1920 to 1924 inclusive gives $1.22 per case. Now just what admin
istration meant in that case I do not know. I do not know what
$3.58 per case in one State means as against $15.07 in another State,
nor $3.54 in another, $7.30 in another, $23.40 in another, and $1.93
in another.
In the case of the self-insurers many of them simply can not
separate their compensation administrative cost from their acci
dent prevention work, and some of them can not separate it from
their general welfare expense. I can not tell whether the admin
istrative cost of one self-insurer, for instance $41.85, is comparable
with another at $2.35. One self-insurer listed its plants, and the
range is from $1.31 to $32.15 for the same year. I do not know
what these administrative costs mean; neither does anybody else—
first, because we do not know what administration means; and sec
ond, because we do not know what items go into the total of admin
istrative cost as expressed in dollars and cents.
I think we have come to the place where we will have to have a
show-down as to administrative costs. I do not believe that any
body has anything to fear when it comes to a clear-cut statement
of just what administration means; that is to say, what is included in
administrative costs and what is accomplished by administration.
In order that this may be cleared up as an association matter I have
introduced a resolution, which has been turned over to the resolu
tions committee.
Mr. B y n u m . I represent a State in which there is private insur
ance, and in order that it may be made a matter of record and for
such assistance as it may be to our secretary-treasurer, I believe I
158
COM PENSATIO N IN SU RAN CE
can give offhand the cost of administration. The items that go to
make up this cost include every item of expense connected with the
compensation report or a report of accident, including some expense
for medical examinations ordered by the hearing board member or
by the full board, as the case may be. We have a right to do that
under the law. The last fiscal year there were 49,004 accidents re
ported in the State of Indiana. I do not know how many of these
cases came to agreements, but it is my recollection that we have
about 65 agreements come in each day. There were 1,498 adjudicated
claims out of these 49,000 accidents. Of these 1,498 adjudicated
claims, 437 were appeals to the full board of five members at Indian
apolis. The other cases were heard, as provided by law, at the county
seat in the county in which the accident occurred, and Indiana has
92 counties.
The average cost per accident, including the agreement cases, the
adjudication of claims by the individual member, the adjudication
by the full board, the medical examination attendant upon it, was a
shade less than 99 cents per claim or per accident.
The C h a ir m a n . The next matter on the program is “ Factors
used in rate-making for compensation—Their explanation and
illustration,” by William Leslie, general manager of the National
Council on Workmen’s Compensation Insurance.
FACTORS USED IN RATE MAKING FOR COMPENSATION INSUR
ANCE—THEIR EXPLANATION AND ILLUSTRATION
BY WILLIAM LESLIE, GENERAL MANAGER NATIONAL COUNCIL ON WORKMEN’S
COMPENSATION INSURANCE
Insurance has been defined by A. H. Willett in his classic treatise
entitled “ Economic Theory of Risk and Insurance ” as “ that social
device for making accumulations to meet uncertain losses of capital
which is carried out through the transfer of the risks of many in
dividuals to one person or to a group of persons.” While it is
uncertain what loss will be sustained by any particular individual
the amount of loss to be sustained by the group as a whole can
be determined within comparatively narrow limits if reference
can be had to the j>ast records of the losses caused by a large num
ber of similar individual risks. Each individual must pay as a
consideration for the transfer of his risk a sum which is propor
tional to the amount of risk transferred plus an equitable share
of the cost involved in rendering supplementary or incidental
service and in handling the details of the transaction. This con
sideration is what we term the premium, and from its definition we
see that it must satisfy two conditions— (1) that the combined pre
miums for all the transferred risks must be sufficient to meet the
losses and the expenses of the insurance carrier and (2) that in
respect of each individual the premium must bear a definite rela
tion to the amount of risk transferred. This relationship is ob
tained by measuring the hazard of the individual’s risk m terms
of the probability of occurrence of a loss-producing event and the
amount of resulting loss. This measure is called the “ expected
loss” because it represents the average amount of loss per risk
which we would expect among a large group of identically similar
FACTORS USED IN RATE M A K IN G
159
risks. “ Expected loss” should be carefully distinguished from
“ actual loss.” In the case of a large group, the expected loss
for the group should approximate the actual loss, but for an in
dividual within the group the two may be far apart.
Applying these elementary concepts of insurance to compensa
tion rate making, we find that we can state our problem very broadly
as involving two major processes— (1) that of estimating the actual
losses to be incurred by the entire group of insured risks and
(2) that of dividing this amount among the contributors so as to
make each bear a share proportionate to his expected risk loss.
Of course, the overhead loading for service, tax, and expense items
must be added to obtain the full premium, but as the practice is
to apply this loading as a uniform percentage of the risk premium
we can ignore it entirely in our present consideration of rate mak
ing and deal only with so-called “ pure premiums” or premiums
designed purely to meet losses. A compensation rate is simply
a statement of the amount of the premium per hundred dollars
of pay roll to be paid by the individual for insurance. When the
expense loading is removed from the rate, the remainder represents
the amount which should be contributed on each hundred dollars
of pay roll to meet losses. Hence, we always refer to the un
loaded rate as the “ pure premium,” which is merely an abbreviated
way of saying “ expected losses per hundred dollars of pay roll.”
The complications in compensation rate making are introduced
by the fact that the insurance is not against the occurrence of a
single event involving a definite monetary loss. It is true that the
event insured against is an industrial injury, but such injuries cover
a wide range of possibilities running from those involving only medi
cal attention to those resulting in fatality or in permanent total dis
ability. Furthermore, the monetary loss not only is dependent upon
the nature or extent of the injury in accordance with the benefit
schedules of the particular compensation law but also usually in
volves as additional variable wages or extent of dependency or both.
The probability of occurrence of injuries producing each of the
distinctive types of disability varies from risk to risk according
to the general hazard of the industrial process and to the particu
lar hazard of the individual risk due to its physical condition
and the attitude of the management and employees toward accident
prevention.
We have seen that equitable rates must recognize the differences
in hazard between risks and that those differences may arise from
a great variety of causes occurring singly or in combination. It is
therefore essential to reduce the problem to simpler and more defi
nite terms by classification and analysis. Hence the first step in rate
making is really embodied in the establishment of manual classifi
cations, to some one of which every risk may be assigned and for
which average rates can be determined. The classification system
which the National Council employs is one which tries to preserve
national industrial groupings. You do not want to cut across
national industries and break them into illogical and unnatural di
visions. An attempt is made to classify them either according
to the product which they turn out or according to the process em
ployed in turning out the product. It is not strictly either one or
the other; it is not strictly a product system or a process system of
160
CO M PENSATION IN SU RA N CE
classification, but it is a combination of the two. There are at the
present time some 850 classifications which are used for the purpose
of establishing rates.
Further refinement in the treatment of individual risks, through
what is equivalent to a refinement of this general classification sys
tem, then comes through the application of the plans of schedule
and experience rating which modify the average class rate up or
down according as the hazard of the individual risk, as measured
by these plans, is greater or less than the average of the class.
In the interests of space and time it is necessary to confine this
paper to an exposition of the factors employed in the establishment
of average classification rates ordinarily known as base or manual
rates. Those who desire a more complete understanding of the struc
ture and method of application of schedule and experience rating
plans will find very detailed explanations in various papers that
have appeared from time to time in the Proceedings of the Casualty
"Actuarial Society. It is merely essential to point out in this paper
that individual rating systems play a very important part in carry
ing out the true principles of loss distribution and that without
such systems the average class rates would work injustice upon
individual employers and accident prevention would be handicapped
seriously.
Having classified our risks we can now restate our rate-making
problem as being that of first estimating the actual losses to be in
curred by the entire group of insured risks and then dividing these
losses among the several manual classifications in proportion to the
expected loss cost of each. To perform the second operation we must
know the relative standing o f each classification as a producer of
losses. Because of the fact that this relativity of hazard will be dif
ferent for different types of injury, one class producing predomi
nantly severe injuries while another produces mainly minor injuries,
we have found it expedient to group losses into three divisions as
follows: 1. Serious, involving indemnity in death, permanent total
and major permanent disability cases; 2. Nonserious, involving in
demnity in minor permanent and temporary disability cases; and
3. Medical. For each of these loss divisions and for each classifica
tion a measure of relativity must be obtained which will serve as a
basis for the equitable division of the total expected losses.
These two steps in compensation rate making are ordinarily de
scribed as the “ establishment of the rate level ” and the 44determina
tion of partial classification pure premiums.” These descriptions
are readily understood if we think of pure premiums as measuring
relativity between classifications without necessarily reflecting the
absolute loss cost per hundred dollars of pay roll to be incurred in
the immediate future. If the established pure premiums are correct
measures of the relative loss cost per class, then the absolute loss
cost per class is found by dividing the total estimated future losses
among the various classifications in proportion to their pure pre
mium relativity. This method of approaching rate making is ex
tremely helpful in view of the practical limitations which delay the
reporting of classification experience and in view of the fact that a
great many classifications do not have enough experience in any
single State from which to determine their relative or absolute cost.
We can determine our pure premiums upon any level of cost we
FACTORS USED IN RATE MAKING?
161
please—State or national, present day or past—and then apply to
such pure premiums the necessary factor, known as the projection
factor, to place them upon the desired rate-level basis. Th,is projec
tion factor is the quantity by which the pure premiums or measure of
relativity must be raised or lowered in order that they may measure
the absolute loss cost per hundred dollars of pay roll to be incurred
in the future.
In. obtaining measures of classification relativity, we have avail
able the experience of the past, comprising a statement of the insured
pay rolls and the actual incurred losses. This information is re
ported by the insurance carriers on a form known as Schedule Z.
For the information of those .interested, there are available a limited
number of copies of the instructions for the preparation of Schedule
Z, as published by the National Council on Compensation Insurance.
Each carrier furnishes this schedule for each State either to the
State authorities, who make it available to the National Council,
or direct to the National Council. The experience is reported sepa
rately for each manual classification under all policies issued in a
given year. The reports of each carrier are audited and, after neces
sary corrections have been made, are combined to give the aggregate
State experience of all carriers for each classification, for each
policy year. Changes in loss cost due either to amendments in the
law or to new conditions as to medical or hospital cost are introduced
at this stage, so that the experience for each year in each State is
placed upon a common level so far as the benefit provisions of the
law and the standard of medical cost are concerned. Now, in order
to obtain dependable measures of relativity it is necessary to have a
broad exposure both in years and in volume. Experience which is
too old may be misleading because of subsequent changes in indus
trial methods or other conditions affecting relative costs. It is be
lieved that the best results can be obtained *by using the five most
recent available years. The fact that Schedule Z experience can not
be obtained until all policies issued in a given year have expired and
some additional time has elapsed for the making of pay-roll audits
and the development of outstanding losses on open cases, creates a
considerable lag between the period covered by the latest available
classification experience and the future period during which result
ing rates are to be employed.
#
But, as we have already seen, this lag is in a large degree over
come by the subsequent projection of those pure premiums to the
rate-level basis. We want measures of relativity which are as nearly
up to date as we can get them because of the necessity of distributing
the insurance burden equitably, but such changes in insurance cost
as may have occurred subsequent to the compilation of classification
data must be assumed to be uniform for all classes and, therefore,
reasonably measured in the process of establishing the rate level.
But even five years of classification experience in a single State
will not give a sufficient volume of data for establishing pure
premiums in a large number of classes. Hence it is necessary to
combine the experience of all States to obtain dependable measures
of relativity for these classes. Such combination can not, of course,
be made until the experience of each State has been converted to a
common level. Again we recognize the fact that pure premiums
162
COM PENSATION INSURANCE
derived from a combination of the experience of several States are
relatively but not absolutely correct. They are in reality a series
of index numbers which furnish valuable information for compara
tive purposes but which do not tell us anything about absolute cost.
But we can easily reconvert these so-called national pure premiums
to any individual State basis and then project them to the rate-level
basis required for the particular State with the indications of both
the State and national experience before us in the shape of pure
premiums on the rate-level basis. We can then determine which of
the two shall be used. This determination is made separately for
the serious, nonserious, and medical pure premiums respectively*
Where the State experience is sufficient to give a dependable measure
of relativity, the pure premium indicated by the State’s own experi
ence is employed. Where the State experience is insufficient to
furnish any guide to the relativity, the national pure premium is
employed. Where the State experience is insufficient to give a de
pendable measure of relativity, but is nevertheless a partial guide,
we take a weighted average of the State and national pure
premiums, assigning a weight to the State that is proportional to
the credibility of its experience. As these pure premiums, both
State and national, have already been projected to the State ratelevel basis, we have only to load our final selections for service and
overhead expenses to obtain gross rates.
Now, to run over these operations in a little more detail so as to
see what factors are applied, how they are derived, and how they
work. In the first place, the classification experience reported for
each State represents actual pay roll and actual incurred losses.
The losses are reported according to six subdivisions; namely,
death, permanent total disability, major permanent disability, minor
permanent disability, temporary disability, and medical. I f amend
ments to the law have been adopted during the experience period,
it is necessary to calculate the effect of such amendments upon com
pensation cost in each policy year. For amendments affecting in
demnity, the effect is calculated by applying the law both before
and after the adoption of the particular amendment to a standard
distribution of injuries and comparing the results. The American
Accident Table, containing a distribution of 100,000 injuries
according to the nature and severity of the resulting disability, is
used for this purpose. The valuation is first made in terms of
weeks’ wages and then reduced to monetary values based upon the
actual wage level underlying each year’s experience. The latter
step is necessary because o f the presence of the maximum and
minimum monetarv limits contained in the various laws. These
limits have the effect of making the average percentage of com
pensation actually payable different from the nominal percentage
set forth in the law. Therefore, to find how much a given amend
ment has changed compensation cost, we must know not only the
nominal effect of the change but also its actual effect when applied
to a given wage distribution. Of course there are some amend
ments affecting indemnity cost which do not involve this question
of limits, but by far the greater number do.
These amendment factors are calculated separately for each of
the indemnity loss divisions shown in Schedule Z. For example,
FACTORS USED IN RATE M A K IN G
163
if the death-benefit provisions are changed, the effect of this on
death-benefit cost is calculated and the resulting factor is applied
to the death losses reported in Schedule Z. Separate factors are
calculated for each policy year, not only because of possible varia
tions in average wages but also because the earlier years of the
experience may be affected by more than one amendment and it is
most satisfactory to bring each year’s indemnity losses to the present
law level by its own appropriate amendment factors. In Exhibit A
there are shown typical amendment factor calculations for different
types of losses. These may be of interest to those who care to go
more deeply into the actual mechanics of the matter.
While medical losses may be affected by actual law changes, they
are also affected by other conditions which can not be measured
theoretically as can indemnity amendments. Changes in fee sched
ules, hospital charges, methods of medical practice, requirements
of injured employees, and the attitude of the medical profession in
charging for compensation work, all have their effect upon medical
cost. A comparison of medical costs recently made tor the five
years covered by policies issued from 1918 to 1922, inclusive, shows
that all over the country the medical cost has risen steadily and in
some cases by astounding amounts. The comparison was made by
computing the ratio of medical losses to premiums for each policy
year for each State. In order to make the comparison valid, the
premiums for each year were computed upon a common basis by
applying the then present prevailing manual rates to the individual
classification pay rolls. Exhibit B contains the comparison as it was
worked out in terms of medical loss ratios. From a study of this ex
hibit it was concluded that for rate-making purposes the medical
losses of the earlier years should be converted to the level of medical
cost indicated by the latest available year of Schedule Z experience.
Accordingly by dividing each year’s medical loss ratio into that of
the most; recent year, we obtain a series of medical conversion factors
respectively applicable to the medical losses of each such year.
When indemnity losses have been modified for amendments by
application of the respective amendment factors they are combined
for each year into two groups, serious and nonserious, as previously
defined. The entire State experience of each classification is then
ready to exhibit upon what we call the “present-law basis,” which,
as we have just seen, includes medical loss adjusted to the latest
year’s level of cost. The form used for this purpose by the National
Council is shown as Exhibit C, upon which there has been posted a
typical class experience.
As we have emphasized in the preceding general remarks, the pure
premiums indicated by the State experience upon the present-law
basis are primarily for the purpose of determining relativity and
have not yet been projected to the rate-level basis. To anyone
familiar with compensation, it will be apparent at once that the law
amendment and medical adjustments that have been made do not
cover all of the possible influences that may affect the experience of
the past in its relation to present or future conditions. Variations
from year to year in the rate at which accidents occur, in the
severity of accidents, in the average wages paid in different in
dustries. as well as changes in economic conditions and social policies,
exert an influence, direct or indirect, upon compensation costs. It
164
CO M PENSATION IN SU RAN CE
has thus far been impossible to find any satisfactory manner of
separating permanent from cyclic or change variations in all these
items or of determining the conditions that will prevail in the future
with respect to these variables.
For these reasons we have come to believe that the most satis
factory method of rate making is one which utilizes the experience
of the past without introducing conjectural factors based upon pre
dictions as to the future. In taking this course we tacitly assume
that there is no substantial permanent trend in cost, either upward
or downward, and that if we adjust compensation rates annually
upon the basis of a fixed number of years of past experience, these
rates will on the average over a considerable period of years be
neither excessive nor inadequate. Admittedly, they will not neces
sarily fit the particular years in which they are applied. It is ex
pected that there will be lean years and fat years, but that by
husbanding the excesses of the fat years to meet the deficiencies of
the lean years, the average will be generally satisfactory. Now it
must be admitted that it is not desirable to place too great a strain
upon insurance carriers either in meeting several years of excessive
losses or in holding on to the profit of several good years. On the other
hand, it is equally bad from the public point of view to have rates
fluctuate too widely from year to year, so that if possible we should
find a way to adjust rate levels each year upon a basis which, if
consistently followed year after year, not only will yield adequate
and reasonable rates in the long run and on the average, but also
will be nicely balanced between the two conflicting desires of a
minimum of strain upon the carriers and a minimum of variations
from year to year.
If we use too long a period of the past for the annual determina
tion of rate levels we are quite apt to create a heavy strain because
of the slowness with which resulting rates will respond to changes
in current cost levels. On the other hand, if we use too short a
period of the past we are just as apt to produce violent fluctuations
in rate level from year to year. Our problem is, therefore, to select
that particular period of years which will produce the happy mean.
This we have decided, after considerable study of past records,
should be the three most recent completed policy years of experience
available for the State at the time of the annual rate revision.
It is possible to obtain the aggregate experience of the carriers
showing total premiums and total incurred losses much sooner after
the close of the policy year than the detailed classification ex
perience contained in Schedule Z can be obtained. Consequently,
we usually find that in addition to the five years of Schedule Z ex
perience which we compile for determining classification pure pre
miums, there is available aggregate loss experience for an additional
and more recent policy year. When this is the case, we take the two
most recent years of Schedule Z and this still more recent year of
aggregate experience as the basis for establishing the rate level.
The aggregate losses of these three years are converted to the present-law basis just as were the classification losses of the five years
of Schedule Z experience. In addition, the premiums at existing
manual rates are computed both for the three years of experience
and for the five years of Schedule Z experience. The ratio of losses
FACTORS USED IN RATE M A K IN G
165
on the present-law basis to premiums at existing manual rates is
then computed for both the three-year rate-level period and the
five-year classification pure-premium period. The loss ratio for the
three-year period divided by the loss ratio for the five-year period
gives the factor to apply to the losses of the five-year period to
place them upon what we have defined to be the rate-level basis.
As a matter of fact, however, the medical losses do not require any
projection as both for the three-year and for the five-year period
they have been converted to the same level of cost; namely, that
represented by the latest available year of Schedule Z experience.
Consequently in practice we compare the indemnity-loss ratio of the
three-year period with that of the five-year period and thus obtain
an indemnity-projection factor which is applied to the indemnity
losses (serious and nonserious) of the five-year period to put them
on the rate-level basis. A typical indemnity-projection fac
tor calculation is shown in Exhibit D.
I f the classification experience were sufficient in each State to
give dependable pure premiums in each classification, our ratemaking task would now be practically finished. For the application
of the projection factor to the pure premiums would put them on
a basis where, if applied to the pay rolls of the rate-level period,
they would yield an amount just equal to the actual losses of that
period upon the present-law basis. We then would have to add only
the loading for service and overhead costs to obtain gross rates.
But, unfortunately, the great majority of classifications do not con
tain enough experience within a single State to furnish a dependable
pure premium. We are thus forced to have recourse to national pure
premiums for the purpose of equitably distributing the cost of
insurance between classifications. This brings us to a consideration
of the methods employed in establishing national pure premiums
and in fitting them to the rate-level basis of a particular State.
By the same methods employed in calculating amendment factors
it is possible to compute theoretical factors, generally called law
differentials, which measure the difference between the theoretical
cost of the laws in any two States. These factors are computed
separately for each principal type of injury, and if it is desired to
have a single factor to express the theoretical cost relationship as
a whole it is obtained by weighting the factor for each type of injury
by the volume of losses shown in Schedule Z for such injury. Ex
hibit E contains figures worked out on this basis for each State in
which the council is interested in the rate-making procedure. From
these figures comparisons can be made as to the theoretical level of
benefits in the various States. Undoubtedly such figures would be
of some interest in comparing the adequacy of the benefit provisions
in various laws, but they do not yield the most suitable factors for
converting the experience of all States to a common level. Just as
was pointed out in connection with rates for a single State, there
are many things other than the law itself that affect compensation
cost. Wage levels, accident and severity rates, methods of admin
istration, medical and hospital conditions, and all the other related
subjects are more apt to be sources of disturbance between States
than they are between the experience of different years within a
single State. Consequently, so-called experience differentials seem
166
COM PENSATIO N IN SU RA N CE
the most desirable measures to use in converting the experience of
several States to a common level. There are a great variety of ways
in which such differentials may be computed and it would be out of
place to attempt to discuss the relative merits of the various methods
at this time. A brief description of a very simple form of experience
differentials will suffice to show wherein they differ from theoretical
differentials. Let us take the rates that are in effect for State A
and by applying them to the pay rolls of the State experience obtain
premiums at manual rates. Let us also put the State losses for the
experience period upon the present-law basis and then ascertain the
ratio of such losses to the premiums. Then let us take the same rates
and apply them to the pay rolls of the experience for State B, thus
obtaining premiums for State B upon the level of rates in effect in
State A. We then "ascertain the ratio of losses in State B, upon its
present-law level, to these premiums. The division of this ratio for
State B by the loss ratio obtained for State A gives the factor to
apply to the losses of State A to place them upon the same level
ox cost as State B. By breaking the rate for State A up into its
component elements (serious, nonserious, and medical) and compar
ing partial loss ratio a set of partial experience differentials can be
obtained in exactly the same manner. The essential feature of such
differentials is that they measure by a single factor all of the dif
ferences in cost conditions between States, whereas theoretical law
differentials measure only differences in the laws.
If we assume that the experience of all States has been combined
by some such experience differential method and the indications of
the combined experience have been used to give what we call national
pure premiums, we next have the problem of reversing the process
and in turn putting the national pure premiums upon the basis of
each individual State. This is done by a wholly analogous method.
The national pure premiums are multiplied into the pay rolls of the
five years of Schedule Z experience that have been compiled upon
the present-law basis, and the resulting expected losses are compared
with the total State losses. The ratio of actual losses to expected
losses gives the factor to apply to the national pure premium to
put it upon the State present-law basis. Separate factors are com
puted for serious, nonserious, and medical. From the manner in
which the factors are computed it will be seen that the national pure
premiums, when placed upon the State present-law basis and applied
to the State pay rolls, will exactly reproduce the State’s actual losses
upon the present-law basis. Therefore, if the indemnity projection
factor is now applied, thus putting the national pure premiums upon
the State rate-level basis, such pure premiums, if applied to the State
pay rolls, will yield the same identical sum in the aggregate as will
the pure premiums indicated by the State’s own experience if sim
ilarly applied. In both instances the sum will exactly reproduce the
State’s total losses upon the rate-level basis. Hence the question of
whether to follow in their entirety the rate-level pure premiums in
dictated by the State or national experience is one affecting rela
tivity but not general level.
In the final step of our rate-making procedure, we endeavor to
solve the problem of when to use State and when to use national pure
premiums in a rational and systematic manner. We know that
167
FACTORS USED IN RATE M A K IN G
State experience should be used wherever adequate and therefore
we establish a criterion of adequacy of exposure in terms of ex
pected losses for each of the pure-premium divisions. These criteria
are:
Serious: Expected State losses equal in amount to 25 times the
average State cost of serious cases.
Nonserious: Expected State losses equal in amount to 300 times
the average State cost of nonserious cases.
Medical: Eighty per cent of the nonserious criterion.
Wherever the expected State losses for any classification equal or
exceed the criterion, the pure-premium indication of the State ex
perience is taken without reference to the national pure premium.
I f the expected State losses fall below the criterion, a weighted
average of the State and national pure premiums is taken. In get
ting these averages the weights assigned to the State and national
pure premiums, respectively, vary with the volume of expected State
losses. The following table shows the manner in which these weights
vary:
W E IG H T S U SE D IN C A L C U L A T IN G W E IG H T E D A V E R A G E S OF S T A T E A N D N A T IO N A L
P U R E P R E M IU M S
W eight asjsigned to—
Volum e of expected State losses
Equal to
Between
Between
Between
Between
100 per cent or more of State criterion............................................................
75 and 100 per cent of State criterion___ _____ ___________ ____________
50 and 75 per cent of State criterion___ ______ ___ _________ _________
25 and 50 per cent of State criterion________ __ _ _ ________ _____
0 and 25 per cent of State criterion____________________________ ____
State
pure
premiums
National
pure
premiums
Per cent
Per cent
100
75
50
25
0
0
25
50
75
100
The final pure premium selections resulting from the application
of this formula, when loaded for expenses, should give rates which
are as nearly relatively right for each classification as the compli
cated aspects of compensation rate making will permit, and which
will furnish just the desired volume of premiums as measured by
the rate-level procedure. In order to be sure on this latter point a
further and final check is made on these rates. The loss ratio
of the three rate-level years, upon the basis of the present-law and
existing manual rates, is divided by what is called the “ permissible ”
loss ratio. The permissible loss ratio is the percentage of the pre
mium available for losses after deducting the amount required for
service and expense costs. The result of the division indicates the
average percentage increase or decrease that should be made in the
existing rates to put them on the rate-level basis. The pay rolls
of the latest available Schedule Z policy year are then multiplied
by the existing rates and the resulting aggregate premium is in
creased or decreased by the above percentage to give premiums
upon the desired rate-level basis. The same pay rolls are then mul
tiplied by the new rates resulting from our rate-making procedure
and the aggregate premium so obtained must balance with that
above.
168
COM PENSATION IN SU RAN CE
This in a general way touches the high spots of compensation
rate making as at present developed and practiced by the National
Council on Workmen’s Compensation Insurance.
E
x h ib it
A.—TYPICAL AMENDMENT FACTOR CALCULATION
PREPARED BY K . C. STOKE, OF NATIONAL COUNCIL ACTUARIAL STAFF
State “ X ” has amended the benefit provisions of its compensation law as
follows:
1. The maximum weekly compensation payable has been increased from $10
to $12.
2. The jvaiting period has been changed from 2 weeks not retroactive to 10
days retroactive at 6 weeks.
In order to estimate the increased compensation cost we must have four
things; namely, a copy of the law before the amendment, a copy of the amend
ment, tables showing the distribution of accidents by kind, degree, etc., and
finally the average wage which obtains in State X, as of the latest available
date. Everything is at hand except the wage, and this is readily determined
from the data on the reports of individual accidents which are filed with the
National Council by its memb’er companies.
Formerly the procedure called for wage data in the form of a distribution
showing the number of employees by successive wage groups. This distribu
tion was considered essential in order to calculate limit factors. The method
then employed may be illustrated by the following simplified calculation,
assuming limits of $5 minimum and $10 maximum:
W eekly wage groups
$0 to $10......... ..................................................................................
$10 to $20-...........................................................- ................. ........
$20 to $ 3 0 „ ___ _____ __________ ____ ____ _______________
$30 to $40___ ____ ______________ ____ _____________________
$40 to $50— .......................... ..........................................................
Average $25________________ ____ ___________ _______
ozouu
Number
of em
ployees
Total
weekly
wages
(col. IX
col. 2)
%
3
Nominal
Effective
compensa compensa
tion (50 per tion (col. 4
cent of
modified
col. 3)
b y limits.!)
4
5
100
1,000
2,000
1,000
100
$500
15.000
50.000
35.000
4,500
$250
7,500
25,000
17,500
2,250
$500
7,500
20,000
10,000
1,000
4,200
105,000
52,500
39,000
0.7429, ratio of effective compensation to nominal compensation. This is called the lim it factor or
the factor (due to the effect of limits) applicable to nominal compensation to produce effective
compensation.
This method has been materially simplified in practice by the construction
of a set of tables based upon a standard wage distribution. These tables
obviate the necessity of knowing the actual wage distribution in each case,
as the limit factor is now obtained upon the basis of the average wage and
this standard distribution. The full details and the mathematical basis of
the new method can be obtained from papers presented to the Casualty Ac
tuarial Society.1
In the example which we are considering the average wage has been found
to be $23 and using this wage, together with the standard distribution men
tioned in the preceding paragraph, we find the limit factors to b e :
(а) For the old law (50 per cent compensation rate, $5 minimum and $10
maximum limits), 0.79S5.
(б) For the law as amended (50 per cent compensation rate, $5 minimum
and $12 maximum limits), 0.8859.
1 Proceedings of the Casualty Actuarial Society, Vol. IX, p. 208: “ Legal limits of
weekly compensation, in their bearing on rate making for workmen’s compensation insur
ance,” by A. H. Mowbray.
FACTORS USED
m
RATE M A K IN G
169
These are reduction factors and indicate that the 50 per cent compensation
rate provided in the law is not realized. The ratio of these two limit factors
(0.8859-MX7985=1.109) shows that, everything else remaining constant, the
increase in compensation cost would be 10.9 per cent. This condition is an
ideal one and is never met with in practice. The increase in fatal cost will
be a little less than 10.9 per cent because the burial portion is unaffected by
compensation limits; that for permanent total disability will be less than
10.9 per cent also because of a limiting amount on total compensation pay
able. Major and minor permanent partial and temporary total disability cost
will increase more than the amount here indicated because of the change in
waiting period (it is obvious that waiting periods do not affect fatal or per
manent total disability).
We must go into more detailed calculations because of the aforementioned
facts. The American Accident Table is of great value from now on.
The American Accident Table—General distribution of accidents
Fatal_________________________________________________
762
Permanent total_______________________________________
62
Permanent partial:
Major----------------------------------------------------------924
Minor_______________________________________ 2,864
--------- 3,788
Temporary total______________________________________ 95,388
Grand total___________________________ __________ 100,000
Old law
A. Fatal.—The 762 fatal cases are split into numerous minor subdivisions,
each of which must be valued separately. An example follows:
Widow alone, 177 cases—average age 47. Present value of an annuity for
300 weeks ceasing upon death or remarriage, 258.63 weeks.
177X258.63=45,777 weeks’ wages.
A similar procedure having been followed for every kind of beneficiary we
obtain a total of 155,917 weeks’ wages at 100 per cent compensation rate, or
77,959 at the legal rate of 50 per cent. But, as we have said before, the
nominal rate of 50 per cent is not realized because of the limits imposed.
Hence 77,959X0.7985 (limit factor) =62,250 actual cost in weeks’ wages with
limits.
62,250X $23=
$1,431,750, monetary cost of compensation,
762 (cases) X $100 (burial) =
76,200, monetary cost of burial.
1, 507,950, total cost in fatal cases.
B.
Permanent disabilities.—“ Every workman who is permanently and to
tally disabled will receive 50 per cent of his average weekly earnings (subject
to the $10 maximum) for 500 weeks. In no case, however, shall the total
amount of compensation exceed $4,000.” This latter provision is a very im
portant one because the duration (500 weeks) multiplied by the maximum per
week ($10) gives $5,000. A rather involved calculation is necessary for this
reason and the work will not be reproduced here.
62 permanent total cases cost $200,790.
170
COM PENSATION INSURANCE
C and D. Permanent partial disabilities.—The calculation of major per
manent partial disabilities is here reproduced:
Loss of—
Duration
of pay
Number ments pro
of cases
vided in
the law
(weeks)
1
%
A rm ........ ..................................... ........ .......................................
H and__ .
. ___ ____. ___ _____ _______ ____________
Lee........... . _ _ ......................................... ..... .......... ............
F oot.................... ........................ ..............................................
E ye............................................... ................... ............. ..............
61
86
62
43
290
T otal_______ _________ ___________________________
Cost at 50 per cent_________ ___________________________
542
200
150
175
125
100
Present
value of
durations
at ZlA per
cent
Cost (col.
lX c o l. 3)
3
4
187.27
142.75
165.19
119. 93
96.73
11,424
12,277
10,242
5,157
28,052
67,152
33,576
The 382 cases which do not qualify for specific durations as those above do
are “ related to ” the latter. From our statistics we find that, on the average,
each of these cases costs 90 per cent as much as does the average dismember
ment case. Hence:
33,576^-542=61.948, average cost of 1 dismemberment case.
61.948X0.90X382=21,298 weeks’ wages.
This represents the total cost of the “ all other ” cases.
We have found many major permanent partial cases which were preceded
by a period of temporary total disability. This period averages around 20
weeks, and subtracting the 2 weeks’ waiting period we find that there will
be on the average 18 weeks’ wages paid for total disability before major per
manent partial disability begins.
924(cases) X 18(weeks) =16,632 weeks’ wages at 100 per cent.
or
8,316 weeks’ wages at 50 per cent.
Summarizing:
Major permanent partial disabilities:
Weeks’ wages
Dismemberment___________________________________ 33, 576
All other__________________________________________ 21,298
Temporary total___________________________________ 8,316
Total___________________________________________ 63,190
63,190X0.7985(limit factor) =50,457 weeks’ wages with limits.
50,457 X$23=$l,160,511, monetary cost.
By similar procedure we find minor permanent partial disability costs to
be $1,022,005.
E. Temporary total disability.—The 95.388 temporary cases in the American
Accident Table are arranged in a distribution showing the number of cases
having various durations of disability. From this table we can determine the
number of weeks’ wages involved in any sort of a condition as to waiting
period. As this law has a two-weeks waiting period, we find involved a
cost of—
123,437 weeks’ wages at 100 per cent compensation.
123,437X0.50X0.7985=49,283 at 50 per cent compensation.
49,283 X$23=$l,133,509, monetary cost.
Summary of the cost of the old law :
Fatal_____________________________________________ $1, 507,950
Permanent total----------------------------------------------------200, 790
Major permanent partial----------------------------------------- 1,160, 511
Minor permanent partial----------------------------------------- 1,022,005
Temporary total----------------------------------------------------- 1? 133, 509
171
FACTORS USED IN RATE M A K IN G
Amended law
The cost under the amended law will be:
A. Fatah— Same as previous law up to the application of the limit factor.
77,959 X 0.8859=69,064 weeks’ wages with limits.
69,064 X $23=$1,588,472, monetary cost of compensation.
76,200, monetary cost of burials.
1,664,672, monetary cost of fatal cases.
B. Permanent total disabilities.—The new permanent total cost will be
$221,076.
C. and D. Permanent partial disabilities.—The waiting period is not to be
deducted now because the new retroactive feature, coupled with the length
of duration in permanent partial makes the waiting period inoperative.
Major cost:
33,576+21,298+9,240=64,114 weeks’ wages.
64,114 X 0.8859 X $23=$1,306,377 monetary cost.
Minor cost:
39,637+11,715+7,160=58,512 weeks’ wages.
58,512 X 0.8859 X$23=$l,192,228 monetary cost.
E. Temporary total disability.—The waiting period is now 10 days.
145,232 weeks’ wages at 100 per cent compensation.
145,232 X 0.50=72,616 weeks’ wages at 50 per cent compensation.
But there is now a retroactive feature which means that all those cases
which last 43 days or more must be reimbursed for the wage loss during the
first 10 days. Of the 95,388 temporary cases 8,580 cases last 43 days or more.
8,580X10 (days waiting period), =
weekg,
7 (days per week)
12,257 X0.50=6,129 weeks’ wages.
(72,616+6,129) X 0.8859X$23=$l,604,480 monetary cost.
Summarizing:
K ind of injury
1
M onetary
cost of
prior law
M onetary
cost of
amended
law
Amend
ment
values (col.
3-s-col. 2)
%
3
4
Death______________________________________i _____________________ $1,507,950
200,790
Permanent total disability_________________________________________
Major permanent partial disability........................................................... 1,160,511
1,022,005
Minor permanent partial d isability.........................................................
1,133,509
Temporary total disability________________________________________
$1,664,672
221,076
1,306,377
1,192,228
1,604,480
1.104
1.101
1.126
1.167
1.415
N o t e —In connection with the above the reader is referred to Proceedings of the Casualty Actuarial
Society, V ol. I X , p. 208: “ Legal limits of weekly compensation in their bearing on rate making for w ork
men’s compensation insurance,” b y A . H . M ow bray; Vol. X , p 163: “ The compensation rate-making
problem in the light of the 1923-24 revision/’ b y W . W . Greene.
73891°—26----- 12
172
COM PENSATION INSURANCE
E x h ib it
B.~MEDICAL LOSS RATIOS—“ PRESENT-LAW ” BASIS
(Actual medical losses; premiums based on present manual rates)
P olicy year
State
1918
1919
1920
1921
1922
Alabama.
C aliforn ia--........................................ ................... ............
Colorado.................................................... ........................
Connecticut...... ....................... . .............................. ..........
Georgia___________________________________ ______ _
16.9
9.0
14.9
18.3
11.8
17.1
14.5
19.2
12.9
18.6
20.2
21.7
14.3
23.9
19.8
20.1
21.7
15.2
25.2
24.9
Idaho....... ................... ................................................. .......
Illinois_______________ _______________ _____________
In d ia n a .................................................................. ..........
Iow a_________ ________________________ __________
Kansas.................. . . ...........................................................
8.0
13.4
9.4
10.2
9.3
12.4
14.6
11.1
11.9
9.4
10.8
16.6
11.5
13.2
11.6
15.8
19.1
14.6
16.8
13.9
14.7
18.5
21.2
20.4
14.7
Kentucky........ ............................. ................... ................
Louisiana____________ ______ ______________________
M aine............... ........ ................................................ ..........
M aryland............... ................... ......... ............................
Massachusetts.....................................................................
9.6
9.0
9.1
6.3
11.2
11.0
9.8
10.7
8.0
13.3
11.2
10.1
11.9
10.5
14.1
14.0
14.0
15.2
15.6
17.0
17.4
14.8
18.6
17.2
18.0
Michigan_______ ____________ __________ ___________
Minnesota............................................................... ............
N ebraska.................................................... ................... .
New Hampshire.................... ............................................
New Jersey. .........................................................................
9.5
10.0
11.2
10.8
8.4
12.6
12.0
12.9
6.0
11.0
13.0
14.8
12.8
5.3
12.2
16.7
18.0
17.4
8.6
15.1
17.0
19.0
21.3
11.0
16.8
New Y ork............................................................................
Oklahoma...................... .....................................................
Rhode Island........................................................ ..............
Tennessee ________________________________________
Texas.................................................. .................. ......... .
8.2
9.5
15.2
9.5
12.7
18.0
14.8
12.7
10.2
14.4
19.0
16.5
14.0
12.8
23.3
24.4
20.6
17.0
14.1
25.0
27.5
23.3
18.2
U tah................................................................ .......... .........
Verm ont__________ ________ ________ ____ _________
Virginia______ ____ _____________ ____ __________ __
Wisconsin............................................................................
8.3
11.0
11.5
12.1
10.1
12.0
13.8
13.3
14.3
13.1
19.7
16.3
17.8
16.6
22.8
19.4
23.6
18.7
11.3
11.1
E x h ib it
C.—STATE EXPERIENCE CLASSIFICATION ON PRESENT-LAW BASIS
State, Maine
Date, 6I27/25
Nat’l R e v ’n N o. 1
Local R e v ’n N o. 1
9 N a t i o n a l C o u n c i l o n C o m p e n s a t io n I n s u r a n c e
Sch., 5.
Gr., 111.
Policy
year
N o. Am ount P.P N o Amount P .P
998, 464
639,864
784,555
i,4 8 6 ,r -
T o ta l,
present
law__
Nonserious, I V
P ay roll
846,214
8
9
0
1
2
Class, Canneries— Fruit preserving.
Serious
6,190
1,865
1,128
2,084
8,417
8,758
2,178
P . p .: Indications on rate level_____
P . p .: National on rate level ( East
.21
152
P.P Total P .p .
12,088 0.26
88,252
.26
.68 P. p .:
.17
P . p .:
P . p.:
P . p.:
P . p .:
P . p.:
P .p .:
68,282,867
8
1—
15,980
82
76,820 0.11
Indications on rate level..........
National on rate level..............
Derived b y formula..................
Underlying present rate..........
Proposed................... .............
A d o p te d ................................
85
77,957 0.14 1,156
18,208
P.P Total P .p .
58,686
21,859
68,070
48,844
64,087
14,788
8,918
12,441
22,404
18,218
17, (
20,789
14,845
19,579
87,293 0.16
201
227
295
858
467
15.147
15.147
21,809
28,798
22,186
Medical.
I
18,999
18,085
27,962
21,882
19,
0.16
Cot-
0.64
23
10,584 0.14 245,784
.48
.48
Underlying present rate____
• 47
.17
.89
.47
Sch., 84. Qt.,809. Cod e, 2584, 8017,8090. Class, Store risks— retail (n .o.c.).
Auctioneers—
Towel Supply Co. _____________
P.P Total P .p .
Policy
year
1918..
1919..
1920..
1921..
1922..
45,865
48,474
79,749
57,625
105,887 0.17 280,689
*
.44
.54
.48
.46
.48
Nonserious
N o. Am ount P .p N o. Am ount P .p
1, 640,1
672
474
1,638
786
2,569
1,794,918
2,219,818
2,880,504
2,285, r "
T o ta l,
present
law.......
P .p .:
P. p.:
P. p.:
P .p .:
P .p .:
P .p .:
Serious
Pay roll
10,171,242
Indications on rate level...........
National on rate level.............
Derived b y formula..................
Underlying present rate.........
P ro p o se d ..................................
A d opted ......................................
__
__
---
6,089 0.06
Medical,
IV
P .p
1,270
1,270
1,877
1,257
1,480
Total P .p .
1,94* 0.18
1,744
8,015 .14
1,
.09
.17
.10
MAKING
T o ta l,
present
law ____
Nonserious I
N o. A m ount P .p N o. Amount P .p
11,219
10,292
29,978
166
189
281
288
887
I
P. p.: A d opted ................................... .
P a y roll
11, *16,608
12,049,268
15,144,492
12,491,863
12,880,7
55,687,544
20,590
22,458
10,807
28,719
Medical,
RATE
1918.
1919.
1920.
19211922.
N o . Am ount P.P N o. Amount P .p
.78 P. p .: Proposed...................................
Or., 122. Code, 2220,2222,2320,225*. Class, Cotton spinning— Yarn mfg.
ton—-flax spinning— Twine mfg .____________________________
P olicy
year
P ay roll
9,965,186
'9,829,730
12,896,
11,816,,
12,129,768
T o ta l,
present
law ___
Nonserious, I
.78 P. p .: Derived b y formula...................
Sch., 6.
Serious I
Serious, I I
IN
Derived b y formula..................
Underlying present ra te ...
Proposed.................................
A dopted..................................
.72
Class, Wool spinning— Yarn mfg.— Wool7 n
Code, 2286,2291.
.78 P. p .: Indications on rate level..........
.76 P p . : National on rate level................
ern States, except New York).
P . p .:
P . p .:
P .p .:
P . p .:
Gr., 181.
P olicy
year
1918..
1919..
1920..
1921..
1922-
10,028
2,098
7,176
9,882
4,581
1,091
2,681
8,645
2,858
11,715 0.25
Sch., 6.
USED
0.21
IV
2,468
1,002
9,449
4,650,811
Medical
FACTORS
191
191
192
192
192
Code, 2111,2112.
State, Maine
Date, 5/27/25
N at’l R e v’n N o. 1
N a t i o n a l C o u n c i l o n C o m p e n s a t io n I n s u r a n c e
8,
0.06
12,698
.12
0.06
.18
.28
'.06
.07
.06
.22
.88
.22
00
174
COM PENSATION IN SU RA N CE
E x h i b i t D .— IN D E M N IT Y P R O J E C T IO N F A C T O R
Indem nity
losses on
presentPremiums
at present law level;
manual
medical on
rates
level of 1922
medical
cost
Policy year
$2,823,173
3,355,341
3,112, 512
2,338,355
2,853,893
i 3,555,158
14,483,274
8,747,406
191 8
191 9
192 0
192 1
192 2
192 3
1918-1922
1921-1923
Loss
ratio
Per cent
$1,657,732
1,955,099
1,847,817
1,479,479
1,768,027
l 2,421,689
8,708,154
5,669,195
60.1
64.8
1 Based upon aggregate data as distinguished from Schedule Z data.
Indemnity projection factor equals 1921-1923 indemnity loss ratio divided by
1918-1922 indemnity loss ratio.
64. 8—225. 2_39. 6 - 1or
60. I - 2 25. 2 34.9
6b
Medical projection factor=l,000
720,371
oc 0
M 53T893==25- 2 perCent
E x h ib it
E.—COMPARATIVE BENEFIT COST OF VARIOUS WORKMEN’S
COMPENSATION LAWS AS OF JULY 1, 1925
Permanent
partial
Death
Perma
nent
total
1
2
3
$1,000
294
645
679
393
265
539
487
311
328
338
350
388
377
321
276
378
565
615
378
711
232
930
455
309
292
367
753
209
270
741
$1,000
454
667
565
616
514
581
629
624
546
457
468
697
819
715
597
503
904
701
500
768
448
689
674
667
427
600
636
531
500
1,136
State
Tem
porary
M ed
ical
and
hos
pital
All
bene
fits
I
5
6
7
$1,000
593
758
384
712
686
493
952
706
566
565
625
651
1,259
770
469
657
941
968
420
791
294
875
793
406
541
758
547
498
618
806
$1,000
644
958
569
851
720
813
842
714
679
796
821
953
912
1,123
947
806
1,053
1,208
636
873
944
933
1,015
810
683
893
1,005
722
619
1,037
$1,000
821
1,000
877
1,000
772
1,000
935
877
784
833
877
944
784
969
772
957
864
1,000
963
1,000
735
762
938
877
772
883
969
679
926
969
M ajor ® M inor &
N ew Y ork............................................................... $1,000
Alabama.................................................................
359
California. ................................. ............................
496
427
Colorado................... ............ ................................ .
492
Connecticut............... ........... ...............................
385
Georgia....................................................................
549
Idaho................................................ . .................
Ulinos................. .....................................................
486
Indiana_________________________ ___________
437
504
I o w a ..................... ................................................
469
Kansas.............................................................. .......
K entucky................................................... ...........
478
Louisiana......................................................... .......
435
M aine......................................................................
476
M aryland............................................ ...................
606
549
Massachusetts............. ..........................................
M ichigan.................. .......... ...................................
497
795
M innesota.............................. .......... .....................
Missouri..................................................................
644
594
M ontana....................................................... ..........
Nebraska.................................... ...........................
597
383
N ew Hampshire......... - .........................................
475
N ew Jersey.............................................................
Oklahoma...............................................................
451
352
Rhode Island..........................................................
510
Tennessee................... ............................................
652
Texas..... ..................................................................
U t a h ..,..................................................................
568
289
Verm ont. ..............................................................
411
Virginia..................................................................
Wisconsin................................................................
715
$1,000
553
767
587
711
585
692
736
643
599
609
635
696
782
803
652
665
882
878
623
800
555
748
760
613
570
730
760
521
591
918
i
a Major permanent partial disability is defined as the loss, or loss of use, of a hand,
arm, foot, leg, or eye, and the loss of hearing in both ears. Also partial loss of use is
related to the benefits for total loss of use.
b Minor permanent partial is defined as loss, or loss of use, of thumb, finger, toe, etc.
2 1922 medical manual loss ratio equals 1922 medical losses divided by 1922 premiums
at present manual rates.
d is c u s s io n
175
Explanation.—The object of the above table is to afford a convenient com
parison of the benefit scales of the several workmen’s compensation laws, both
for each kind of benefit and in total, taking the New York law as the basis of
comparison.
Examples.—The figures shown in column 2 for Colorado and Montana are
respectively, $679 and $378. This implies that, on the average, for permanent
total disability the Montana benefit is i r i of the Colorado benefit.
The figures shown in column 7 are, for Illinois and New York $735 and
$1,000, respectively. This indicates that, for all kinds of injury, the Illinois
benefits average
the New York benefits.
N o t e .— T h is com p a rison o f co s t fo r “ a ll benefits ” is based u p o n
p e n sa tion in su ra n ce exp erien ce.
S in ce th e d istrib u tio n o f a ccid e n ts
v a rie s betw een S ta tes a n d th e re fo re is in ea ch case som ew h a t d iffe re n t
d istrib u tio n , th e com p a rison o f co s t fo r “ a ll in ju rie s ” is co r re ct o n ly
th e n a tio n a l co m
b y ty p e o f in ju r y
fr o m th e n a tio n a l
in a g e n e ra l w a y .
DISCUSSION
The C h a i r m a n . May I ask you a question, Mr. Leslie? Assume
that you have two plants engaged in the same line of work, that the
number of employees is substantially the same, and that at the in
ception of your policy the premium is substantially the same; as
sume also that the number of injuries is substantially the same.
A man at each plant is hurt so that he can not do anything except
the sort of a job he is familiar with, but one plant takes him back
and puts him to work, perhaps at a lower rate than he got before,
the insurance company having to pay half the difference perhaps,
while the other fellow says, “ I don’t want a cripple around me,” and
will not hire him. How do you adjust those two sets of premiums
the next year?
Mr, L eslie . Of course, in establishing these base rates we do not
go into the question of individual rating as you do, but I will be
glad to answer to the best of my ability.
The base rate is purely the rate for the classification. The rate
for the individual risk is adjusted by application either of a schedule
or an experience-rating plan. The schedule-rating plan applies
to only a limited number of risks, those which are engaged in opera
tions which are subject to inspection and rating according to the
schedule—primarily manufacturing risks. The experience-rating
plan is more universal, so far as application to different types of
risk is concerned, but it is still limited in its application to risks
which have a certain premium volume.
The schedule varies the rate according to the physical hazard as
revealed upon inspection. The experience-rating plan varies the
rate according to the actual loss cost as indicated by the past records
of the employer, and in that connection deaths, as well as disabilities,
are always included at a fixed average value so as not to discriminate
where there are dependents, thus preventing undue fluctuation in
rates through mere chance occurrences.
The particular circumstances which you cite might not fit. The
variation is produced by either of those plans. I am not sure I
got the exact point, but if there was a difference in cost which was
produced by the one employer being willing to hire the semicrippled
man and the other employer refusing to hire him, it might not be
adequate for the card in the rating system, but do you not think
that if one employer had a sufficient interest in his employees to hire
those who were crippled, take them back into his establishment, he
176
COM PENSATION IN SU RA N CE
would also be the one who would be primarily interested in prevent
ing accidents, and consequently, as a matter of fact, he would get, as
the result of his actual experience, the lower rate of the two ?
The C h a ir m a n . The discussion of this paper is to be given by
Mr. Clark, of Ohio.
Mr. C la r k . In Ohio we do not have to deal with facts as extensive
and as varied as we have heard discussed so well in the last few min
utes. I can not quite see how a State that has a compulsory act and
an exclusive State fund can consider intelligently the problems that
have to be met by States or commissions which have self-carriers,
which have insurance companies, and which have the State fund or
any two of these three.
In our State, as you all know, for some six or seven years there
has been no reinsurance of risks. When I went on the commission
about eight years ago, a great many of the risks were carried by the
insurance companies. Some 1,100 companies exercised their option,
gave bond, and carried their own insurance under what we call sec
tion 22 of our act, and the remainder paid into the State fund.
The very best witness to our system of rate making and the fac
tors that we employ, I think, is simply to state that the self-insuring
group has been reduced from 1,100 some eight years ago to a little
less than 400, and it is still gradually diminishing. I think the time
is not far away when there will be very few employers in Ohio who
will not be in the State fund.
Somebody said to me to-day that the rates in Ohio were higher
than those of the insurance companies.
If that statement were true, the larger employers of Ohio would
be giving bonds and carrying their own insurance but they are
not doing it. They are doing the opposite—they are cooperating
as never before; tliey are lending their assistance as never before;
they have fought every effort—and there has been one in every ses
sion of the legislature since I have been on the commission—to break
down the present system of rate making of the Ohio Industrial
Commission, and every one has failed, and failed by reason of the
support of the men who put the money into the department—the
employers of Ohio. There is no State in the Union organized
more splendidly by the employing group than the State of Ohio.
Kate making in Ohio, due' to Ohio having an exclusive State
fund, eliminates the necessity of considering factors which must
be considered by the National Council on Workmen’s Compensa
tion Insurance in developing rates for various States. I think that
is self-evident and needs no explanation. You have already heard
that some 800 classifications had to be considered by the National
Council, that being the natural consequence of having to take into
account the varied conditions, the varied localities, and the varied
industries of all the States, or practically all of them, in making
up the factors that go to establish the rates.
The exclusive State-Fund plan makes it possible to obtain prac
tically the entire workmen’s compensation experience of the State.
This experience is all compiled and developed by the commission,
thereby eliminating any variation in the developing of same, while
the National Council is unable to obtain the entire experience of
any given State. Also, the data it receives is compiled from many
DISCUSSION
177
different sources, which results in more or less variation in the
same. Because of this condition the council* has to obtain a much
broader experience, necessitating including data from many States.
This, then, necessitates the allowance for variation in the laws of
the various States, which is done by using a certain State as a
unit or base, then analyzing the laws of other States used and
developing a modification factor or differential for these States,
which differential is applied to the experience of such State to
bring the same to a comparative level with the State used as the
base.
For illustration, using the compensation law of New York State
as the base and desiring to include the experience of the State of
Pennsylvania, it would be necessary first to consider the benefits
under the two* State laws. It would be found that the benefits in the
State of Pennsylvania are considerably lower than those in .the
State of New York, therefore the experience of the State of Pennsyl
vania would be lifted up to a point where it would be considered on
a level with that of*New York, and then the experience of Pennsyl
vania and New York combined.
In using the experience of a large number of States in developing
the basic rate, it becomes necessary to consider the variation in the
conditions between States due to geographical location, which would
be a factor in the frequency as well as the severity of accidents. For
illustration, outside construction work in northern Michigan in
winter months would be much more hazardous than construction
work in a Southern State with a warmer climate; there must also
be considered the development within the State of various regula
tory laws, such as sanitary and health regulations and competent
hospital and medical services.
I might add, a factor which it seems to me is one that can
never be better than a guess, namely, the various conditions of the
State as to safety and educational effort along that line. Take it in
my own State, tor example; we are just now setting up a new de
partment known as a safety department—one unlike any that any of
the commissions have, I think. This department was created by
a special act of the legislature, which provided that 1 per cent of
the premium paid in to the commission, or so much of it as the com
mission may deem necessary, may be set aside. The commission has
absolute control over that 1 per cent in the developing of a safety
department which will be over and above our shop inspection depart
ment, our mine inspection department, our boiler inspection depart
ment, our engineer inspection department, and all the others ordi
narily found in the commissions or labor bureaus of other States.
We have appointed as the head of that department a, man who
has been 14 years at the head of our shop inspection, and an assistant
who has been 14 years in the service of one of our largest corpora
tions; we took from Pennsylvania at a very much increased salary
one whom we learned was me finest statistician there was anywhere;
and we have appointed his assistant. By the time this convention
meets again, Mr. Secretary-Treasurer, there will be some 20 or 25
technical men in the State of Ohio who will have devoted a year to
the collection of statistics along many of the lines that have been
discussed at this meeting and which will be helpful to you in your
department. That will, perhaps, benefit many other commissions.
178
COMPENSATION INSURANCE
Some one suggested they would like to have such helps. We pro
posed, and our law provides, that we may spend any part of this
money that we want, and we are going to be mighty liberal in the
publication of statistics, of bulletins, of anything and everything
which will educate employers to a higher degree of safety and em
ployees to a higher degree of care. That is a factor* that must of
necessity enter into the rates of any State, at least any single State
where that kind of work is scientifically and splendidly done, as we
propose to do it.
A serious accident requiring special medical attention would be
less liable to cause further complication in the State of New York,
where competent medical and hospital services would be available,
than a similar injury occurring in the State of Arizona where such
medical services could not be as readily obtained.
It might be said that the degree of advancement in civilization is a
factor in the consideration of rates, in that it affects the frequency
as well as the severity of accidents. It must be apparent that any
State which employs a larger group, proportionally, of the foreign
type of civilization has a very different problem than the State
which employs in the major part the high-grade American employee.
Some one said when we went out to the mines yesterday, “ You can
find people here from every country on God’s earth, I don’t care
where it is.” A condition like that is not comparable at all, in
the matter of the risk under any workmen’s compensation law, with
one of the high-grade factories of the East or the Middle West, or
in the West, where a very different type of men and women are
employed.
Wage scales, which are the base on which rates are applied as
well as the base on which compensation is based, become a factor
for consideration in rate making, this being due to the fact that all
compensation laws have a maximum and a minimum limit for the
computation of benefits, while the premium rate is applied against
the total aggregate pay roll with no upper or lower limitation. This,
then, means that the variation in such level in various States becomes
a factor for consideration. It would not be expected that the
average wage level in the State of New York would be comparable
to the wage level of a Southern, a Central, or a Western State; there
fore, modification of factors must be provided for the experience
of these States if used with the experience of the State of New
York.
The Ohio plan provides for the assessing of a premium on the
industry sufficient only to provide funds for the payment of com
pensation to the injured worker or his dependents and medical
and hospital services. The entire administration of the law is
borne by the taxpayers of the State out of the general revenue
fund. This, therefore, eliminates the necessity in Ohio for pro
viding factors for the administrative expense in the operation of the
Ohio act. Ohio also, by using the experience for the last five years,
eliminates the necessity of providing modification factors for old
experience developed under different benefit levels and different wage
levels than those for which rates are to be computed.
We have also adopted the merit-rating system, and we make a
finding on the first day of July of every year now on the merit
rating of the employer. Those that are penalized, and there are
DISCUSSION
179
not many, are penalized on the first day of January. Our actuarial
department, consisting of some 40 people, reports those employers
who are entitled to the better credit, by individuals and by classes,
and they are notified that they have a credit for the next premium
of such and such a percentage. That becomes a very important
factor, but could not be considered as a general factor, it seems to
me, where many of the States are combined in order to get the ex
perience.
In rate making it is always to be desired that the necessity of
applying modification factors to the statistical data to be used be
eliminated as much as possible.
All the factors noted above are to a large extent eliminated under
the exclusive State-fund plan, making for a much more dependable
rate development. Especially is this true when it is considered
that all modification factors must be first applied to the State’s
statistical data before it is consolidated with other data in develop
ing the national basic rate, and then must be again applied to this
national basic rate to develop the rate for such State; that is, taking
the State of Pennsylvania, the statistical data for Pennsylvania
would be raised in order to bring the same on a level with the New
York statistical data when considering the level of law benefits
between the two States. Then, after the classification rate has been
developed from the consolidated experience, it would be necessary
to take this rate and reduce the same on account of the lower law
benefits prevailing in Pennsylvania as compared with the State of
New York.
The C h a ir m a n . This concludes the formal program. The paper
is now open for general discussion.
Mr. C h a n e y . The rates you have been discussing this afternoon
are not the same rates that were discussed in my paper. The rates
which are now under consideration are premium rates and the rates
which we were discussing this morning were accident rates, consid
ered for the purpose of their application to accident prevention. I
have found that even in this convention there were several people
who did not know that there was a difference.
Mr. L ansburgh . I feel that Mr. Clark has given us a real contri
bution in his discussion of this paper, but I want to point out that in
using Pennsylvania as one of his illustrations he used a State which
is not in any way connected with the National Council of Work
men’s Compensation Insurance and which makes its own rates, not
State rates but within the State, and has its own rating bureau,
which will be noticed in the fact that Pennsylvania and Ohio have
been left out of the table.
Mr. C l a r k . I knew that, Mr. Lansburgh.
Mr. W ilco x . Wisconsin is one of the States which has no State
fund and which has to make rates for insurance companies, and while
we elect to make our own rates, we do not do quite what Mr. Lans
burgh does in Pennsylvania, but advise and counsel with the Na
tional Council.
I do not think that Mr. Clark means to say that they in Ohio do
not have to do the same thing that the National Council has to do.
After all, the National Council is doing this service for a large group
of States, and because of the fact that the insurance companies which
180
CO M PENSATION IN SU RAN CE
are writing business in Wisconsin are writing business also in Con
necticut, in New York, in Minnesota, and in a large percentage of the
States of the United States, it is necessary that Wisconsin shall know
that the rates that are being charged in Minnesota, in Connecticut,
and in New York are adequate to take care of the obligation of those
companies in those other States in exact proportion as they are ade
quate to take care of the liabilities in Wisconsin.
Eate making, after all, is a determination of the liability of the
various classifications and the amount that the insurers in those
classifications are required to contribute to a general fund in order
to take care of the liability, but Ohio must do exactly what the
National Council does; it must know that one concern in Ohio pays
a certain relative proportion to its fund, just exactly the same as
an employer must know that he must pay a right amount to the
insurance carrier. The processes to be used by the council must
be a very much more elaborate affair, because it must dispose of the
matter not only for the States individually, but also for the States
as a group, because of the overlapping of the insurance companies.
Ohio must know that the amount it is collecting from each indi
vidual is a sufficient amount to carry that liability. The National
Council has to do one thing more, and that is to make certain,
absolutely certain, that the rates are relatively right as between the
States. I believe that is the situation. I think Ohio must be doing
exactly the same thing.
Mr. C l a r k . I can not let that go unchallenged. I am an officer
in an insurance society, and there are about 10 States in the Union
in which we will not write a policy, and about 5 of those have
workmen’s compensation. That has been so for years. Now on
your theory, which to me is a sophistry, if you will pardon me, we
should write policies in those States irrespective of the increased
risk.
The point that it seems to me is apparent is that in any small
group of men you can get the exact experience, which gives you a
more definite basis and a purer basis on which to work than when
you have to take 50 groups in different industries, different climates,
different conditions, social and otherwise. So I do not think we
are doing what they are doing.
Mr. W ilcox . In Wisconsin, in any State, I do not care where it is,
if you have a sufficient spread of experience, you make your rates on
the basis of your own individual experience just exactly as you do
in Ohio, but there are in Ohio, as there are in Wisconsin, a large
number of classifications on which you have not sufficient experi
ence upon which to base a dependable rate, and it is then that the
National Safety Council groups its experience for the purpose of
getting a dependable rate. You can not get any more in Ohio than
we get in Wisconsin.
Mr. D u xb u r y . The State of Minnesota is one of those States
which is glad to make use of the services of the National Council,
but we have the duty of prescribing rates for the State of Minnesota.
I think anyone who listened to the discussion of Mr. Leslie must
realize that the service which Minnesota gets from the National
Council is a valuable service. It enables us to get the benefit of
high-class experts in the question of rate making. We have, of
DISCUSSION
181
course, to determine the special factors which belong to Minnesota
as the Ohio commission has to determine the special factors which
belong to Ohio. Possibly we are not as capable of doing it as the
Ohio commission is, but it is fair to presume that we would come
up to the average. As Mr. Leslie stated, we are not bound by the
rates which the National Council system indicates; we modify them
as our local conditions seem to warrant.
Of course Ohio gets a result, and collects money enough to pay its
losses and have quite a substantial fund left, according to the bulle
tins which I have read, but it does not follow that it would not profit
immensely by the refinements and the scientific rate-making system
of the National Council, resulting in a more equitable and scientific
distribution of the premium rates among the employers of Ohio. It
would collect the same amount of money that it now collects, but I
am of the opinion that the system of rate making in, Ohio or any
other State can be very much improved and made more scientific and
just to the different insurers if use is made of a high-type expert
body of rate makers such as the National Council. The council is
not serving the ends of any particular company or group of compa
nies, or anything of that kind, but is giving a service which no State,
not even Ohio, can expect to duplicate so far as the character of that
service is concerned.
Mr. C l a r k . I hope I did not leave the impression that I did
not think there was great merit in the National Council’s work. I
said that in a State such as ours I did not see how we could fit in.
Of course I recognize the technique and science of the National
Council. I did not finish what I was going to say about the bulletin
we are going to issue. We will be glad to send that bulletin to every
commissioner or to any one else whose name he may send in. If
you will send the names to me, I will see that they are put on the
mailing list.
[The president took the chair and the report of the committee on
nominations and place of meeting was presented and adopted. The
list of officers elected will be found on p. 212. Hartford, Conn., was
chosen as the place of the next meeting. The following statement
was made by the secretary-treasurer regarding the publication of
an index to the proceedings of the association:]
Mr. S tew art . I want to'call your attention to the fact that during
the last year we have made an index to all the proceedings of past
conventions of this association. It is a double index, first by sub
jects discussed, and then by the parties entering into the discussion.
In my report I said that the secretary had made the index. Of
course that had to be official, whether or not it was true. As a mat
ter of fact, my private secretary, whom you all met at Baltimore,
proposed the index herself, drafted the plan, and did all the work,
perhaps 20 per cent on her own time. This index makes the file
of the proceedings, which I suppose you all have, of very great
value, because almost any subject that comes up here has been dis
cussed at some convention by some of the very best men we have.
It makes a real library out of your proceedings, a real encyclopedia
upon compensation matters.
[Meeting adjourned.]
THURSDAY, AUGUST 20— MORNING SESSION
CHAIRMAN, FRED M. WIL€OX, CHAIRMAN WISCONSIN INDUSTRIAL COMMISSION
The C h a ir m a n . The first? number on the program is the report
of the committee on legal aid by Mr Horner, of the Pennsylvania
department.
REPORT OF JOINT COMMITTEES OF THE INTERNATIONAL ASSO
CIATION OF INDUSTRIAL ACCIDENT BOARDS AND COMMISSIONS
AND THE NATIONAL ASSOCIATION OF LEGAL AID ORGANIZA
TIONS, 1925
The committees were appointed at the 1924 annual convention of
the respective associations to consider the extent to which legal
aid organizations could assist industrial accident boards in the task
of administering workmen’s compensation laws. The two com
mittees held a meeting in Washington, D. C., on February 19, 1925,
and have been in constant correspondence.
MATTERS FOR JOINT ACTION
The committees believe, after considering the matter at length,
that legal aid organizations can render considerable assistance to
industrial accident and workmen’s compensation boards. Some of
the occasions for requiring such help are:
(a) Some persons pretending to be lawyers take cases for the
employee, and then, either because they can not proceed or because
they are working for the employer, they do nothing and the statute
of limitations runs against the claim.
(b) Some lawyers on settlement take the checks to the bank and
have the client indorse them, then take 50 per cent for fee.
(o) Some lawyers receive money to send to alien dependents in
Europe in cases where foreigners have been killed or injured here, and
because of expenses along the way only a small proportion ever
reaches its destination.
(d) Many lawyers urge a lump-sum settlement and then proceed to
use the money for investment in some kinds of real estate, or other
wise, which are wholly unsuited to the finances of the employee, who
loses all.
(e) Ignorance and suspicion by the employee prevent him from
learning about the benefits to be derived and the methods of obtain
ing them. Many accidents are not reported.
(/) The contingent fee system.
(g) The inability of the poor man to pay for a lawyer and yet
the need that he have a lawyer to prepare the evidence and the law
in certain cases.
It is likely that almost every State will have instances of some
of the above or of other similar situations where the service of a
182
REPORT OF J O IN T COM M ITTEES
183
lawyer known to be impartial and experienced in the work of ap
pearing before the industrial accident or workmen’s compensation
boards or referees will be of value.
THE MACHINERY TO ACCOMPLISH THE RESULT
The committees can not devise a universal plan which will meet
the needs of all the local organizations belonging to the respective as
sociations. Cooperation between a given legal aid society and a given
industrial accident or workmen’s compensation board is a matter
which must be worked out by those familiar with local conditions.
The committees have appended to this report a list of local organi
zations—members of the respective associations—for mutual con
venience in making contacts.
The existing situation of cooperation in Boston may well be used
as a model, with appropriate modifications necessary to fit local
conditions.
RECOMMENDATIONS
The committees recommend that the respective associations ap
prove the following resolutions:
1. Resolved, That cooperation in handling workmen’s compensa
tion problems is hereby approved by the International Association
of Industrial Accident Boards and Commissions and the National
Association of Legal Aid Organizations.
2. Resolved, That the member organizations of the International
Association of Industrial Accident Boards and Commissions and
the National Association of Legal Aid Organizations be requested
and encouraged to cooperate with each other in handling workmen’s
compensation cases.
3. Resolved, That these committees be continued by their respec
tive organizations to supply information as to methods of coopera
tion, to study the results and report from time to time on the progress
of the mutual work.
Respectfully submitted.
C ommittee of th e I n ternational A ssociation of
I ndustrial A ccident B oards and C om m issions .
W . H . H orner , Pennsylvania, Chairman.
R ichard J. C u l le n , New York.
H . R. W itter , Ohio.
E thelbert S tew art ,
Washington, D. 67., member ex officio.
C ommittee
N ation al A ssociation of
L egal A id O rganizations .
R aynor M. G ardiner , Esq., Chairman.
C laude E. C lark e , Esq.
E lm er C. J en sen , Esq.
J o h n S. B radw ay , Esq.
of t h e
in t e r n a t io n a l a s s o c ia t io n o f in d u s t r ia l a c c id e n t b o a r d s
a n d c o m m is s io n s
A
c t iv e
M em bers
United States Bureau of Labor Statistics.
United States Employers’ Compensation Commission.
Connecticut Board of Compensation Commissioners.
184
LEGAL AID
Georgia Industrial Commission.
Hawaii Industrial Accident Boards (Counties of Kauai, Maui, Hawaii and
Honolulu.)
Idaho Industrial Accident Board.
Illinois Industrial Commission.
Indiana Industrial Board.
Iowa Workmen’s Compensation Service.
Kansas Public Service Commission.
Maine Industrial Accident Commission.
Maryland State Industrial Accident Commission.
Massachusetts Industrial Accident Board.
Minnesota Industrial Commission.
Montana Industrial Accident Board.
Nevada Industrial Commission.
New Jersey Department of Labor.
New York Department of Labor.
North Dakota Workmen’s Compensation Bureau.
Ohio Industrial Commission.
Oklahoma Industrial Commission.
Oregon State Industrial Accident Commission.
Pennsylvania Department of Labor and Industry.
Utah Industrial Commission.
Virginia Industrial Commission.
Washington Department of Labor and Industries.
West Virginia State Compensation Commissioner.
Wisconsin Industrial Commission.
Wyoming Workmen’s Compensation Department.
Department of Labor of Canada.
Manitoba Workmen’s Compensation Board.
New Brunswick Workmen’s Compensation Board.
Nova Scotia Workmen’s Compensation Board.
Ontario Workmen’s Compensation Board.
A
s s o c ia t e
M em bers
Industrial Accident Prevention Associations, Toronto, Ontario.
Porto Rico Workmen’s Relief Commission.
Republic Iron and Steel Co., Youngstown, Ohio.
Leifur Magnusson, American representative of the International Labor
Office, Washington, D. C.
L E G A L A ID O R G A N IZ A T IO N S
City
Akron, O h io ...
Albany, N . Y_.
Atlanta, Ga___
Baltimore, M d.
Boston, M a ss..
Bridgeport, C on n ...
Buffalo, N . Y ...........
Cambridge, Mass._
Camden, N . J_.
Chattanooga, Tenn.
Chicago, 111...............
in
O P E R A T IO N , 1925
Address
Name of organization
Legal aid committee of the Charity Organiza
tion Society.
Legal A id Society of the C ity of Albany (I n c .)..
Atlanta Legal A id Society.. ....................................
Legal aid bureau of the Baltimore Alliance of
Charitable and Social Agencies.
Boston Legal Aid Society............. - ........................
National Association of Legal Aid Organizations;
Albert F. Bigelow, president.
Legal aid committee of the American Bar Asso
ciation; Reginald Heber Smith, chairman.
Legal aid division, Department of Public Char
ities.
Robert F. D e Forest, Esq., public defender........
Legal A id Bureau of Buffalo (Inc.)........... ...........
Legal aid committee of the New York State Bar
Association; John Alan Hamilton, E sq., chair
man.
Harvard Legal A id Bureau.....................................
Legal aid bureau, Bureau of Charities..................
Social Service Bureau............... ................................
Legal aid bureau of the United Charities.............
Jewish Social Service Bureau of Chicago, legal
aid department.
Chicago Bar Association committee on defense
of poor persons accused of crime.
Legal aid committee of the Illinois State Bar
Association; Clayton W . Mogg, Esq.
5 East Buchtel Ave.
86 State St.
R oom 922, Fulton C ounty Court
house.
830 M unsey Bldg.
16A Ashburton Place.
I l l Devonshire St.
60 State St.
P ublic Welfare Bldg.
First National Bank Bldg.
Lincoln Bldg., 327 Washington
St.
Erie C ounty Savings Bank Bldg.
Harvard Law School.
519 Arch St.
Ham. Bank Bldg.
308 N orth M ichigan A ve.
1800 Selden St.
112 W est Adams St.
140 South Dearborn St.
185
REPORT OF JOINT COMMITTEES
L E G A L A I D O R G A N IZ A T IO N S IN O P E R A T IO N , 1925—Continued
Cincinnati, Ohio—
Cleveland, Ohio—
Columbia, S. C ___
Columbus, Ohio___
Dallas, T ex___
Dayton, Ohio_.
Legal A id Society of Cincinnati............................ .
Legal A id Society of Cleveland— ........................ .
Associated Charities of Colum bia..........................
Legal aid committee of the Franklin C ounty
Bar Association.
Carl Young, Esq., public defender........................
Free Legal A id Bureau.............................................
Bureau of Legal A id ................................................ .
Denver, C olo..........
Legal A id Society of Denver...................................
Des Moines, Iow a.
Legal aid committee of the Federation of W om
en's Clubs.
Legal aid bureau of the Detroit Bar Associa
tion.
Legal aid committee of the Michigan State Bar
Association; Otto G. Wismer, Esq., chair
man.
Free legal aid bureau, Division of Public Affairs.
Legal aid bureau of the Social Welfare Associa
tion.
Committee organizing the work.............................
Detroit, M ich .........
Duluth, M in n -----G ran d R a p id s
M ich.
Greensboro, N . C_.
Grinnell, Iow a..
Harrisburg, Pa..
Hartford, C onn.
Hoboken, N . J........
Indianapolis, In d ._
Jacksonville, F la ...
Jersey C ity N . J . . .
Kansas City, M o . Knoxville, Term - - Lansing, M ich ........
Lexington, K y ........
Long Beach, Calif—
Los Angeles, Calif—
Louisville, K y ........
M emphis, Tenn_ _ _
Milwaukee, W is___
Minneapolis, M inn.
Montreal, Canada-,
Nashville, Tenn—
Newark, N . J ...........
N ew Bedford, Mass.
N ew Haven, Conn..
N ew Orleans, La___
New York C ity____
Oakland, Calif..
Omaha, N e b r...
Passaic, N. J...........
Philadelphia, Pa....
Address
Name of organization
City
Legal aid committee of the Social Service League.
Legal aid committee of the Dauphin C ounty Bar
Association.
Legal A id Bureau......................................................
John F. Forward, Esq., public defender..............
Legal aid committee of the Connecticut State
Bar Association, Thomas Hewes, Esq., chair
man.
Legal A id Society of Hoboken................................
Fam ily Welfare Society...........................................
A legal aid organization is being urged; address
communications t o .................................................
Legal A id Society of Jersey C ity............................
304 Southern Ohio Bank Bldg.
614 Fidelity Mortgage Bldg.
1123 Gervais St.
Assignment room, courthouse.
Grand Theater Bldg.
C ity Hall.
Cappel Bldg., 129 South Ludlow
St.
Care of Harry C. Green, 712 Cen
tral Savings Bank Bldg.
Care of D r. Carrie Harrison
Dickey, 621 Forty-eighth St.
71 West Warren A ve.
Do.
312 West Superior St.
404 Houseman Bldg.
Care of Samuel R . Dighton, E sq.,
1009 Jefferson Standard Bldg.
923 Broad St.
Care of George Ross Hull, 5
South Third St.
M unicipal Bldg.
720 M ain St.
18 Asylum St.
1 Newark St.
5th floor, Baldwin Block.
C. G. Daniel, 123K M ain St.
Care of John Francis Gough,
15 Exchange Place.
3d floor, C ity Hall.
Legal aid bureau, Board of Public WelfareCare of M alcolm M cDerm ott,
203 East M ain St.
Legal aid bureau of Ingham C ounty Bar Asso Care of Social Service Bureau,
303 W est Allegan St.
ciation.
Legal A id Bureau..................................................... . Care of Associated Charities.
Legal aid committee of Long Beach Bar Asso Care of Clyde D oyle, Esq., Suite
1115 Pacific-Southwest Bldg.
ciation.
Ernest R . Orfila, E sq., city police court defender. 419 Bullard Bldg., 156 Spring St.
William T . Aggeler, Esq., public defender for 906 Hall of Records.
Los Angeles County.
Legal A id Society of Louisville............. - ............... 609 Realty Bldg
Memphis Legal A id Society.................................... Room 7, basement county court
house.
Legal A id Society of M ilwaukee— ........................ 85 Oneida St.
Legal aid committee of the Wisconsin State Bar 840 Wells Bldg.
Association; W illiam Kaumheimer, chairman
Legal aid society of the Associated Charities......... 510 Tem ple Court.
L. L. Longbrake, Esq., public defender...........
801 New Y ork Life Bldg.
Montreal Legal A id Bureau.................................... 207 St. Catherine St. west.
Legal Aid Department............................................ Care of Baron de Hirsch Inst.,
410 Bleury St.
Legal Aid Bureau...................................................... Care of Nashville Chamber of
Commerce.
Essex County Legal A id Association.................... 222 Market St.
N ew Bedford Legal A id Society............................. 234 Union St.
A n organization is being established b y the Care of Miss Dorothy Ludington, Yale Law School.
students of Yale Law School; address—
Samuel E. H oyt, Esq., public defender............... . Colonial Bldg., 195 Church St.
Legal A id Society of Louisiana............................... 1406 W hitney Central Bank
Bldg.
Legal A id S o cie ty ......................... ................... ....... 239 Broadway.
Legal aid bureau of the Educational Alliance....... East Broadway and Jefferson
St.
National Desertion Bureau..................................... 799 Broadway (cor. Eleventh St.)
Voluntary defenders committee of the Legal A id 32 Franklin St.
Society.
Associated Charities of the C ity of Oakland.......... 1930 Harrison St.
Free Legal A id Bureau............................................. 403 C ity Hall.
John N . Baldwin, E sq., public defender................ 1106 First National Bank Bldg.
James H . Donnelly, Esq., Over
seer of the Poor, M unicipal
Bldg.
Bureau of legal aid, Department of Public Wel 587 C ity Hall.
fare.
186
LEGAL AID
LEGAL AID ORGANIZATIONS IN OPERATION, 192-3— Continued
City
Name of organization
Philadelphia, P a___
National Association of Legal A id Organizations,
office of the secretary.
Legal aid committee of the Pennsylvania Bar
Association; John S. Bradway, Esq., chairman.
Legal A id Society of Pittsburgh......... ....................
Associated Charities....................... ..........................
Case conference committee, Society for Organiz
ing Charity.
Social Service Bureau..............................................
Associated Charities..................................................
Legal A id Committee...............................................
Pittsburgh, P a ...
Pittsfield, Mass..
Plainfield, N . J . .
Pontiac, HI------Portland, M e ...
Portland, Oreg..
Providence, R . I .
Reading, P a ..........
Richm ond, V a ..........
Rochester, N . Y -----St. Louis, M o . .........
St. Paul, M inn.........
San Diego, Calif-----San Francisco, Calif.
Schenectady, N . Y .
Scranton, Pa______
Seattle, W ash...........
Springfield, Mass
Toledo, Ohio............
Toronto, C anada....
Washington, D . C ..
Wilkes-Barre, P a _.
W innipeg, Canada.
Worcester, Mass—
Yonkers, N . Y ........
Youngstown, Ohio.
Legal A id Society of Rhode Island........................
Legal aid committee of the Berks County Bar
Association; Harry W . Lee, Esq., chairman.
Legal A id Society of Richm ond..............................
Legal A id S ociety.................... ......... .....................
Legal aid bureau, Department of Public Welfare.
Legal aid departm ent of the United Charities...
J. A . Hahn, E sq ., attorney under the D eW itt
C. M itchell Trust.
Legal A id Society of San Fran.isco........................
Frank Egan, E sq., public defender.......................
Legal aid committee of the California State Bar
Association; O. K . Cushing, Esq., chairman.
Address
133 South Twelfth St.
D o.
1315 Union Trust Bldg.
119 Fenn St.
C ity Hall.
Pythian Bldg., H uron St., West.
15 C ity Bldg.
Care of George S. Shepard, E sq.,
Gasco Bldg.
326 Grosvenor Bldg.
Liberty Bank Bldg.
601 North Lom bardy St.
31 Exchange St.
208 Municipal Court Bldg.
203 W ilder Bldg.
548 Spreckels Bldg.
912 Hearst Bldg.
Hall of Justice.
821 First National Bank Bldg.
Allan B . M ann, American Le
gion Post N o. 21, 420 State St.
Legal aid committee, Lackawanna County Bar Connell Bldg.
Association; Walter L. Hill, Esq., chairman.
Legal service bureau, Social Welfare League.. . 243 Central Bldg.
Committee organizing the work............................. Care of Edward S. Bradford,
Esq., 359 State St.
572 Ontario St.
Social Service Federation.........................
71 Grosvenor St.
Neighborhood Workers’ Association___
1022 Eleventh St. N W .
Legal aid bureau, Associated Charities.
Care of F. Regis Noel, E sq., 408
The Barristers............................................
Fifth St. N W .
46 N orth Washington St.
United Charities.
Care of Jules Preudhomme, E sq*
city solicitor, Law Depart
ment.
Legal aid committee of the Worcester Bar Asso Care of Arthur J. Young, Esq.,
secretary Bar Association, 314
ciation.
M ain Street.
55 South Broadway.
Charity Organization Society___
Care of C. G. Crumpler, E sq.,
Committee organizing the w ork.
37 Central Square.
DISCUSSION
[A motion was mad© and seconded that the report of the com
mittee be adopted.]
T h e C h a i r m a n . It has been moved and seconded that the re
port of the committee on legal aid be adopted. I presume we had
better hear the discussion of the paper before we act on the motion.
The discussion of the report of the committee is to be by Mr. Scanlan, chairman of the Industrial Commission of Illinois.
Mr. S c a n l a n . Most of the delegates will regard this proposition,
I think, as one peculiarly up to each jurisdiction. The States, being
constituted differently, some being largely agricultural while others
are largely municipal and having large cities, will have different
phases of this problem with which to deal. I think that the com
mission of each State should devote very careful attention to the
questions involved in this matter. It behooves it to watch very
strictly the actions or conduct of lawyers representing litigants,
of physicians who may appear as witnesses for or against litigants,
and of those calling themselves agents, who are generally of the
same nationality as the injured workman and who because of that
DISCUSSION
187
come under the guise of friendship for the workman. We have that
to deal with in Illinois, particularly in Chicago; we do not have, so
much of it in other parts of the State.
In the list of organizations read by Mr. Horner, he mentioned
two in Illinois—one in Chicago and one at Pontiac. We never hear
from the Pontiac organization; as a matter of fact we rarely have
any business in Pontiac, as it is a small city in a farming region,
having no factories.
I have prepared a little paper that may be of interest. It is as
follows:
Those of us who attended the convention at Halifax, Nova Scotia,
last summer were favored with an interesting discussion by John S.
Bradway, secretary of the National Association of Legal Aid Or
ganizations. One of the results was the formation of the joint
committee to whose report and recommendations we have just lis
tened.
The object sought is to foster a closer cooperation between legal
aid organizations and industrial boards and commissions for the
better protection of the injured man who is poor and ignorant of
his rights.
In the report of the committee, as a matter for joint action, par
ticular mention is made of lawyers who may defraud injured work
men or mishandle their cases. Our experience in Chicago on the
subject of lawyers defrauding the workmen is limited to a few
lawyers of the same nationalities as the injured workmen. Often
times when a man is injured he knows some lawyer of the same
nationality living in his neighborhood and he goes to him with his
case. That lawyer may not know anything about the compensation
law, and when he appears before the arbitrator or commissioner, he
is absolutely unable properly to present the applicant’s case. Un
der such circumstances our arbitrators and commissioners have been
instructed to and actually do all they can to help the applicant pre
sent his case. Oftentimes we arouse the displeasure or the repre
sentatives of insurance companies and employers because we do
that, but we feel that the real purpose of the act is to give pro
tection to the man who is injured. I f he is unfortunate enougn to
have a lawyer who does not know how to present the case we gen
erally help him present it or grant him a continuance and tell him
to get somebody who can present it.
In Chicago we have many high-class lawyers engaged in this
business who are absolutely square and fair with the applicant, fair
with the commission, and fair with everybody concerned. When
a lawyer of that kind comes before us with a settlement contract,
because we have found that lawyer’s reputation to be good, we ap
prove the settlement contract without setting the case ior a hearing
and bringing in the applicant as we do in cases where the lawyer
representing the applicant has not that reputation. With the in
ception of compensation acts, by making the procedure simple and
summary it was believed that the services of attorneys in contested
cases would be almost, if not entirely, unnecessary. This theory has
been much discussed, but I think most of us will now agree that it
is not borne out by practice, and that the lawyer, in his proper
73891°— 26------ 13
188
LEGAL AID
sphere, is just as essential as the physician or the surgeon. However,
I .believe that the evils resulting from this source can be largely
eliminated without injustice to either the injured man or the legal
profession.
In the brief time allotted to me, I would like to convey to you
what our experience in Illinois has taught us along these lines. The
same problems are probably encountered in other jurisdictions. In
the case of Inland Rubber Co. v. Industrial Commission, appearing
in volume 309 of the Illinois Supreme Court reports, the court has
laid down the following rule: “ In proceedings under the work
men’s compensation act the rules respecting the admission of evi
dence and the burden of proof are the same as prevail in commonlaw actions for personal injury. The procedure only is different.”
Digressing for a moment, I might say that this case is one where
the court held that the injured employee had failed to make claim
for compensation within the six-months’ period provided by law,
whereas, if he had sought proper advice and made his claim before
the six months had elapsed, his award, aggregating $8,750, would
certainly not have been set aside.
Under our Illinois procedure a workman with some intelligence,
if the issue is not too involved, can and sometimes does, handle his
own case before the commission, after a study of the act, with such
advice as he can get and some assistance from the arbitrator.
But where the questions are technical and intricate, a record must
be built up in accordance with the long-established rules of evidence.
Here the layman is at sea without an oar, and the services of some
one skilled in legal procedure, who may do the questioning and
cross-questioning of witnesses and make proper objections, is abso
lutely essential.
It is at this point that we may meet or come upon the unscrupu
lous, ignorant, or too greedy lawyer. In Illinois a number of at
torneys have for many years made a specialty of compensation cases.
Most of them are capable and honest. On the other hand, and
particularly in Chicago, we have the so-called ambulance chaser,
who brings to a lawyer all sorts of personal injury cases, among
them being cases coming under the compensation act, and who
expects a generous share of the fee in case of an award. The in
jured man signs a written contract to pay the lawyer from onefourth to one-half the amount recovered; a claim is filed with the
industrial commission and an award is entered in accordance with
the law and the facts.
The industrial commission, however, does not recognize these con
tracts for attorney’s fees as being valid, nor is there such a thing
as an attorney’s lien in compensation cases. I f it is brought to our
attention that an excessive fee has been charged or if there is a com
plaint as to a fee, we direct that the matter be set for hearing and
thereupon determine and fix a reasonable fee, based upon the services
actually rendered.
Because of their exacting what we believed to be excessive fees,
we have disbarred a number of attorneys from practicing before the
commission, and the license of at least one attorney has been re
voked by the supreme court. We are in constant touch with the
grievance committee of the bar association, and whenever we find
DISCUSSION
189
a lawyer doing something objectionable, we report him to the griev
ance committee, and in a month or two the commissioners and the
grievance committee meet at a hotel and have dinner and discuss
these questions; so a lawyer can not pull very many things with the
Illinois commission until he is in trouble with the bar association.
If his conduct warrants it, the association files charges asking that
he be disbarred.
On the subject of contingent fees, most injured workmen are with
out funds, so that if it becomes necessary to employ a lawyer, the
case must be taken on a contingent basis or not at all. Oftentimes
an award is obtained* but because of the compensation being pay
able in weekly installments, the lawyer has no means of collecting
any fee whatsoever for his services.
Under our act which, unless a lump sum is awarded, requires the
payment of the award in installments, no matter how hard a fight
the lawyer may have had, no matter how far he may have gone with
the case—he may have gone to the supreme court with it—he is a
mighty long time getting his fee if the award is paid in installments.
That applies, of course, to the lawyer who put up a great fight and
won on close questioning.
We have in Chicago a lawyer, George A. Schneider, the author of
Schneider’s Compensation. I have in mind a particularly compli
cated case where a motorman on a street car ran into a truck, or a
truck ran into the car, and the motorman received an injury about
the knee. He was quite badly injured and was laid up for quite a
while at home, but he was improving, was happy, and feeling in good
shape when about five or six weeks after, all of a sudden he keeled over
at home and died. His wife filed a claim for compensation against
the street-car company; she had an ordinary lawyer whose experi
ence and whose ability in this respect were limited. He did the best
he could before the arbitrator but was unable to make a showing
which would justify the arbitrator in making an award, and so the
award was against the widow. At that time some friend of hers
advised her to see Schneider, which she did, and George took the case
and filed a petition for review. It was about five or six months
after the burial when Schneider took the case and a long record had
to be written.up. He secured a couple of professors from the Chicago
and Northwestern Universities, experts on matters of that kind, who
disinterred the body, took out the heart, the lungs, and the firmer
arteries, brought them in, and submitted them to test. The case
came up for hearing (the street-car company ably represented), and
they battled away for one day and part of the next day, when a con
tinuance was asked for.
Schneider demonstrated by these proofs of pathology secured by
the professors of these important universities that the death was
caused by the injury to the knee; that a blood clot had been formed
which had followed an artery, evidence of it being found in the
lungs. The case was continued for a week, at the end of which the
street-car company came in and said, “We are willing to pay.”
That was a case which was rescued by a good lawyer who knew
what to do. In that kind of a case, where the attorney had per
sonally obligated himself to these professors of pathology, who had
190
LEGAL AID
gone to the expense of disinterring the body and making the ex
amination, he was in a bad fix so far as his fees were concerned if he
had to get from his client so much a week as long as the compensa
tion period ran.
Lawyers of that kind are worthy of respect and confidence and
have the support, or ought to have the support, of commissions;
they have the support of our commission.
The records of the Chicago Legal Aid Society show that during
the year ending July 1, 1925, workmen’s compensation cases came
into their offices to the total number of 869. In most of these cases
adjustments were made with the employer or insurance company,
or an investigation developed that the workman had nothing com
ing. In 109 of these cases applications for adjustment of claim were
filed with the industrial commission. There were hearings before an
arbitrator in 78 cases and 38 hearings on review.
The legal aid cases tried before the commission are either handled
by attorneys on the society’s staff or referred to outside attorneys, it
being the custom in the latter instance to refer the cases to attorneys
who were formerly members of the society’s legal staff, and who
charge a fee in the event of an award.
The function of the industrial commission is administrative as well
as judicial. Since a year ago to-day, more than 60,000 accident
reports have been filed. In most of these compensation has been or
is being paid and proper receipts filed with the commission as a
matter of routine.
During the same period something like 12,000 disputed claims
were filed for arbitration Under our administrative function we have
the right to make an individual investigation in each case where
there is a dispute, but we are without facilities for doing this, except
to the extent to which an arbitrator may go when hearing a case.
Here is a domain where an organization like the legal aid society
may and does render an exclusive and useful service. Cases fre
quently arise where a workman is injured and there is some dispute
as to the extent of temporary disability or as to what he may be
entitled for specific loss, the difference in money amounting anywhere
from $10 to $100 or more. The amount involved is too trivial to
justify the services of an attorney. When these men come to the
commission for advice, we are sometimes able to take the matter
up informally with the employer or insurance company and get a
satisfactory adjustment. If not, all we can do is to advise the
man to file his claim and have the matter set for hearing before
an arbitrator. This type of case, and there are many of them, is
peculiarly one for the good offices of a legal aid society.
In Chicago the legal aid society has another important and useful
function. It has a main office and several branches in districts
where the poor and foreigners reside. An injured workman, often
ignorant of the fact that the State has provided an avenue of relief
for him in his hour of need, will seek out the local office of the organ
ization for aid and advice, where his story will be listened to
patiently, an investigation made, and proper steps taken in his
behalf.
The society is thus rendering a distinct public service, not only in
giving advice and aid, but in helping to give the compensation act
a much needed publicity among those least able to act for themselves.
DISCUSSION
191
Many times injured employees or their beneficiaries have been
denied compensation because they have learned of its benefits too
late. I recall one notable case where a widow was apprised of her
rights only by the merest coincidence. The family resided in
Chicago. The husband left home and found employment on a bridge
construction gang in one of the cities down . State. There was an
accident and he was instantly killed. There was nothing among his
effects to identify him, other than his name. The employer reported
the case to its insurance company in Chicago. The insurance com
pany upon investigation found no dependents, paid the burial ex
penses, and closed its file.
The Chicago Daily News runs a social service column, where those
in need may write and ask for such necessities as they may require.
These letters are published and those charitably inclined may re
spond. Months after her husband had been killed, the widow wrote
to the Daily News asking for cast-off clothing for her children.
The insurance adjuster who handled the case happened casually to
glance through this column in the newspaper, read the letter from
this widow, noted the similarity in names, investigated, and found
this was the widow of the man who had been killed, and compensa
tion payments, which would aggregate $3,500, were at once started.
This one insurance adjuster, at least, was honest. I believe, though,
that the old-fashioned hard-boiled claim agent is passing out of the
picture. His place is being filled^by earnest young men of high
ideals, often sympathetic.
While the measure of compensation requires considerable judg
ment, yet the amounts to be paid for injury have been fixed by legis
lative enactment and the computation has become largely a matter
of arithmetic. While there are still disputes in plenty, the personal
animosity, trickery, and bitterness of the old common-law injury
suit no longer prevail in compensation cases.
In the report of the joint committee, reference is made to lawyers
who urge a lump-sum settlement and then proceed to get the money
invested in real estate, or otherwise, where it is wholly lost. In
cases where a petition for a lump-sum settlement is filed with our
commission, proof or a showing as to what disposition is to be made
of the money is required. The commission will not approve a lump
sum where there is merely a general statement that the money will
be invested in some kina of business or in real estate. If there
is a mortgage or payment coming due on property already owned,
and no other means of meeting it, the commission will grant a
partial lump sum to meet the payment.
If it is sought to purchase real estate, we require proof as to the
specific premises to be purchased and the reason for the invest
ment, and in addition it is our practice to send our own investigator
out to inspect the premises and to make a report as to whether the
purchase is desirable from the standpoint of the petitioner and the
price reasonable.
It is our policy to discourage lump sums as far as possible, or to
approve only an amount, from the end of the payments, to cover
some pressing exigency.
Then, too, the Illinois Supreme Court has laid down rules limiting
the scope of our authority to grant lump-sum settlements. It has
192
LEGAL AID
held, for instance, that we can not grant a lump sum merely for the
purpose of paying an attorney fee. In another case recently decided
it has reiterated this in the following language: “ The State is con
cerned in preventing dissipation of the money paid and an early
recourse to that charitable aid which systematic compensation aims
to avoid.”
Reference is also made in the report of the committee to lawyers
who receive money to be sent to alien dependents, only a small pro
portion of which ever reaches them. The whole subject of alien
dependents has given our commission much concern. In Illinois
most of these cases pass through the hands of the public administra
tor. Some are handled by the local consul of the country of which
the deceased was a citizen, through his attorney. Sometimes there
is a conflict as to which has the right to represent the dependents of
the deceased.
Recently a case came before the commission where a Mexican
citizen had been killed, leaving a dependent father and mother in
Mexico. Claim was filed with the industrial commission by the
Mexican consul at Chicago, as representing the parents in Mexico.
Claim was also filed by the public administrator of Will County,
111., being the county in which the accident occurred. The oniy
issue in the case was as to who was the proper party to represent
the beneficiaries in a compensation case. By agreement, both cases
were tried at the same time. The commission held that the public
administrator was the proper party. The Mexican consul then
took an appeal to the circuit court, which confirmed the findings of
the industrial commission. The case is now, I believe, on its way
to the supreme court.
I do not know what other commissions are doing in this respect,
but we are hoping to devise a method of handling these foreign
beneficiary matters, wherever possible, through the American
consular service. This applies to the taking of depositions and also
to the payment of compensation installments, so that proper re
ceipts showing the exact amount received by the beneficiaries may
be on file in our office. This will have the result of keeping the costs
down to a minimum and prevent diversion into unscrupulous hands
of the compensation due the beneficiaries.
Lastly, I believe that the recommendations submitted by the joint
committee relative to a closer cooperation with members of the
National Association of Legal Aid Organizations are splendid and
should have the whole-hearted support of this convention.
The C h a i r m a n . Are there others here who want to discuss this
question of the relief that may be had through cooperation with
the legal aid society ?
Mr. W e n z e l . I should like, for the benefit of the committee, to
present a rather peculiar situation which exists in our State. We
have a provision in our law that in case an employer does not pay
premiums into the compensation fund, the employee who is injured
may proceed in two ways. Mind you, we have what is known as a
compulsory system and an exclusive fund, but if a man is injured
while in the employ of an employer who has not pjaid premiums, he
may proceed either under the common law in a suit against the em
ployer, or he may come to the bureau and present what we call an
DISCUSSION
193
elective claim. If he presents an elective claim, the bureau is with
out a penny of money that it can spend to investigate that claim.
In other words, the injured employee must come to Bismarck or
have his testimony taken where the injury occurred and present
it to us.
At the last legislature I drew up a bill that the State appropriate
the sum of $500 to cover expenses of the commission in investigating
such claims. That was turned down. Subsequently, we introduced
another bill giving the bureau power, in making awards in such
cases, to include expenses and attorney’s fees. So far so good, but
we are without any means whatever to disseminate that information
among the employees who may be working for employers who are
not within the fund, and it is a long and tiresome process to get all
of the employers under the act, notwithstanding the fact that there
are heavy penalties provided. So it seems to me there is a field right
there for just such an organization as this to disseminate that in
formation, and that there is also another field in cases where the
employee elects to bring suit directly under the common law against
the employer.
Mr. McShane. Under the Utah laws, attorney’s fees are fixed by
the commission. We did not go at that arbitrarily, but through a
conference with the Utah Bar Association. We have arranged a
schedule for all instances where an attorney may appear; there is al
ways an accumulated amount due, and we order paid direct to the
attorney by the employer or the insurance carrier the amount of the
fee which we fix, making certain that he will be compensated. On
the other hand, we have an agreement with the lawyers and they
thoroughly understand us and support us, on the principle that “ In
asmuch as we are going to get a fee, inasmuch as this is a humani
tarian law, we are going to catch its spirit, move along with it, and
we do not expect more than a third to half as much in this kind of
practice as we do where we pursue the remedies for our clients un
der the common law.”
Another thing with reference to the Schneider case (because I
do not know any better name), I do not believe we have an indus
trial surgeon in Utah handling a case of that kind who would not
have required an autopsy at the time that man died. We would
have been immediately notified and would have been represented
by a good physician and surgeon. Under this arrangement (and
this is a new arrangement within the last three or four years in
Utah) I do not believe it would have been necessary to disinter
that man to determine the cause of his death, and I do not believe
that under our practice it would have been necessary for a rehearing.
Mr. Scanlan. That case was more acute, Mr. McShane, than you
appreciate, because there was an inquest held on his body; the
coroner’s physician conducted an autopsy and said he died of a
cerebral hemorrhage. That was a matter of record.
Mr. M cShane. It was not a matter of putting Illinois on trial,
but I thought that perhaps the way Utah handles the cases might be
of some value to the association.
Mr. Scan^an. Schneider had to overcome the record of the coro
ner’s physician who held the autopsy and found the man had died
of cerebral hemorrhage.
194
LEGAL AID
On the attorney proposition, we have the right to fix fees for the
surgeons, but our law does not give us the right to make an order
directing the payment of any money to the attorney. There is a
large manufacturing institution in southern Illinois whose officers
attempt to keep their men from filing claims. In one case I know
of, a leading lawyer in Centralia took the case of an injured work
man out of sympathy more than anything else, and beat this com
pany, and then the assistant to the president went to the injured
workman and said, “ Don’t you pay that lawyer a cent; he is not
entitled to any money.” So here is a high-class lawyer who can not
get his fee, because we have no authority by statute to direct the
respondent to pay any money to the lawyer. We have a right to
fix his fee, but we can not issue an order directing the respondent
to pay.
Mr. B r o w n . The question I wish to ask is concerning this supreme
court decision. We had a similar case in Idaho some time ago in
which the attorneys asked us to make a lump-sum settlement in
order that they might be paid their fee, which was $900. We told
them we would not do it. Our law provides that we have a right
to control the fees of surgeons and attorneys, and we went over the
ease very carefully and determined that the lawyers were entitled
to $300 and we made partial settlement in that way. It was agreed
to between the parties and the money was paid over. The question
I wished to bring up was if your supreme court would hold a
matter of that kind unconstitutional.
Mr. S c a n l a n . I know of a case where an old lady’s son on whom
she was dependent had died after he was injured at work, and she
was entitled to compensation. She filed a petition for a lump sum.
The evidence tended to show that she owed $200 to a sister, and
$400 to merchants around town. The supreme court said that in
view of the old lady’s age, and since the compensation was all
she had in the world, a lump sum should not be allowed; that it
could not be given for the purpose of paying debts, and included
among debts attorney’s fees, so that the attorneys were in no better
position than her relatives. The court said this money was not for
that purpose but that it was supposed to be used for the benefit
and upkeep of that lady as long as she lived, and let the creditors
hold the sack.
The C h a i r m a n . Let us not stray from the question before us, the
question of the value of legal aid.
Mr. A r i z a . In the case you referred to, do you mean to say that
the Mexican consul in the United States should not take care of
the cases of Mexican citizens, but that they should be handled
through the physicians or the relatives of those Mexican citizens in
the United States by the American consul in Mexico ?
Mr. S c a n l a n . Every one of these cases comes up through peculiar
circumstances. This Mexican who was injured was the employee of
the Illinois Steel Co. of Joliet. There is where this alien, this Mexi
can subject, lived and had personal effects, which gave that court the
right to appoint a public administrator. The public administrator
filed claim for compensation. The Mexican consul in Chicago also
DISCUSSION
195
filed claim. The Illinois Steel Co. wanted to know to whom they
were to pay this money, and it was up to this commission to de
termine who should get it. We decided that the public administrator
should, for several reasons, one of which was that he is an officer of
the court; when the money is paid to him, he must make his report
to the court and it is a matter of record, and the Illinois Steel Co.
will know then that its obligation is fulfilled.
Another thing, we have an American consular service over there,
and our experience has been that we can get more correct depositions
through the American consul in foreign countries like yours than
we can through the consuls of such foreign countries in this country.
We have nothing against any of the consuls, but that is our ex
perience.
Mr. A r i z a . That is a point I wanted to make clear, because you
mentioned something about fees and costs of getting such deposi
tions.
Mr. S c a n l a n . We have no knowledge of any charge of that kind
against a Mexican consul, but we have against some consuls from
Europe.
Mr. A r i z a . As you are speaking about the Mexican consul, I
thought you meant that.
Mr. S c a n l a n . That was a case where the Mexican consul was in
volved. There are other States, I understand, that recognize the
foreign consuls and let them file claims for compensation, let the
employers pay directly to them, and let them distribute the money.
Mexico is in the favored nation class, under a treaty, and we must
recognize the Mexican consul. We recognized the public admin
istrator, and in an appeal to our circuit court we were sustained.
We let the parties thrash out the question there whether the treaty
right gave the consul the right to supplant the public administrator.
Mr. A r i z a . That was a question of supplanting the public ad
ministrator, but if the consul had filed his claim previous to the
court appointing the public administrator, in that case, under the
national law, he would have the right.
Mr. S c a n l a n . He d i d n o t.
Mr. A r i z a . During my time here, which is a little over a year, my
consulate has handled over $16,000 of compensations paid to Mexi
can citizens through the industrial commission. In only one case
have I been compelled to use an attorney; this case is still pending,
and this attorney will get the fees decided by the industrial com
mission. I have got along with insurance companies and with in
dustrial commissions, to the greatest satisfaction of my citizens, and
I think our relationship has been really an example of good rela
tions. Has it not, Mr. McShane ?
Mr. McShane. It has been very pleasant as far as the commission
is concerned.
The C h a i r m a n . We all recognize that this question of how to
handle the claim of foreign dependents is a troublesome one for any
department. It would be interesting if we had time to continue the
discussion further, but I think we ought to pass on to the next paper.
Unless there is objection, I will put this motion.
196
ADM INISTRATIVE PROBLEMS
Mr. I ngram. I want to ask one more question. What reason is
there why the claimant should have to pay for legal assistance to get
his compensation award any more than he should have to pay for
medical assistance? It seems to me that where the claimant ex
hausts all of the administrative procedure allowed by law, where he
does all the things that are required to be done to present his case
properly to the industrial commission, and then the industrial com
mission recommends or suggests that he needs an attorney, some pro
vision should be made for paying those attorney fees, not by the
claimant, but by the insurer.
It seems to me it is just as important to that man, from the com
pensation standpoint, to be able to secure legal assistance in order to
get money that is coming to him as it is to secure medical assistance,
and I think the association should go farther than we have gone this
morning on the proposition of attorney’s fees.
The C h a i r m a n . If we could always know in advance that it was
a legitimate claim, why that would be another matter, but the trouble
is that there is a dispute and it may finally be determined that he
had no claim, and to say that in that case the public shall have pre
sented his claim at public cost is another matter.
Mr. I n g r a m . As a court allows costs if you have a meritorious case,
in such a case I say he is entitled to attorney’s fees as part of the
presentation of that claim, but if he has not a meritorious case he
should pay such fees himself, as he does now.
The C h a i r m a n . That is a matter for Utah to take care of itself.
[The motion that the report of the committee on legal a,id be
adopted was carried.]
ROUND-TABLE DISCUSSION OF ADMINISTRATIVE
PROBLEMS
The C h a i r m a n . In the round-table discussion, the first matter
that of “ Compensation liabilities in bankruptcy proceedings,” to be
discussed by Commissioner Duxbury of Minnesota.
COMPENSATION LIABILITIES IN BANKRUPTCY PROCEEDINGS
BY F. A. DUXBURY, COMMISSIONER MINNESOTA INDUSTRIAL COMMISSION
The situation with reference to my being assigned the discussion
of compensation claims in bankruptcy proceedings arose from a cir
cumstance that came to my attention in the State of Minnesota.
Two different claims on awards of compensation, when our adminis
tration was vested in the court, had been presented in bankruptcy
proceedings of the employer, and it was determined by the court in
those proceedings that these claims were on the same basis as gen
eral claims against the bankrupt, having no priority.
You all know that the bankruptcy law provides for certain priori
ties, among which are wages in a limited amount and several other
matters which you probably are familiar with. It did seem that
that situation ought not to exist in the bankruptcy law, and I re
ferred the matter to Mr. Stewart and to the present president of
CO M PEN SATION CLAIM S IN B A N K R U P T C Y PROCEEDINGS
197
this association, and suggested to them that some action be taken to
correct what seemed to me to be a defect in the compensation law.
The next thing I knew about it I was informed that I was to discuss
the question here, and then I commenced to look the matter up so
as to inform myself a little fuller.
The Federal bankruptcy law was passed in 1898, in a former cen
tury and at a time when such things as compensation claims as we
know them now did not exist. The system of compensation liabili
ties was first adopted in this country about 1910, many of the laws
being adopted in 1913 and subsequent years, so there can be no
criticism of the original framers of the bankruptcy law that this
matter was not taken care of in that law.
It might be explained that there was no immediate action taken
to give priorities to compensation claims because they were regarded
as not being much different from claims for damages for personal
injury or any other claims arising out of court. But through the
development of the social idea, we now regard these claims as having
a peculiar sacredness, which is shown by the fact that in every
State, I presume, such claims were made exempt from levy or any
other proceeding by which they could be appropriated to the pay
ment of debts. Efforts are made to get compensation commissions
to violate that policy by allowing lump-sum settlements to pay cer
tain debts, but, I am glad to say this is not very popular with com
missioners generally.
In looking this matter up I found that the American Bar Associ
ation had been interesting itself for some little time in necessary
amendments of the bankruptcy law and the bankruptcy proceedings.
Its committee on trade and commerce law (I think that is the name
of the standing committee) had the matter under consideration
and made a report to the 1922 convention of the association held
at Philadelphia. In the last Congress three separate bills were in
troduced in which a great variety of amendments were proposed,
but none of these bills passed.
At that 1922 meeting the American Bar Association, because of
the interest aroused, appointed a special committee on bankruptcy
amendments and practices. That committee has been giving a great
deal of time to consideration of the work. In the program for the
annual meeting which occurs at Detroit next month there is an
analysis of the proposed amendments in the three bills which were
before the last Congress, showing where they touched upon the
same subject matter, where they disagreed, and so on. The standing
committee prepared that analysis. The special committee interested
itself in a change in the general orders. Now the general orders
in bankruptcy are promulgated by the Supreme Court of the United
States. These orders had become rather out of date; experience
had indicated where they did not work well, and the committee
succeeded in getting the Supreme Court of the United States, after
several conferences with the Chief Justice and other members of the
court, to promulgate entirely new general orders in bankruptcy.
At the meeting which is to occur next month the committee is
to report a proposed bill, including the various amendments which
it approves, as suggested by these bills in the last Congress. One
of tliese bills was sponsored by the Merchants5 Association of New;
198
AD M INISTRATIVE PROBLEMS
York, another by the National Association of Credit Men, and
another by the Commercial Law League of America, and all of
them were reviewed by a committee of the Bar Association of New
York.
In looking over this proposed bill which the committee submits for
its report to the coming meeting of the American Bar Association, I
found to my regret that this question which I have been called upon
to discuss here seems never to have been brought to its attention.
I f the subject had been brought to the committee’s attention I be
lieve that it would have appeared in the section which provides for
priorities, but there is a possibility that this might not have been
done, because in my investigation into this subject I have come to the
conclusion that it is not nearly so important as I had thought it was.
The reasons, some of which I will recite, may occur to you at once.
The general provision of compensation laws requiring employers to
insure or to show financial responsibility generally, of course, takes
care of the payment of these claims, so that they do not have to be
presented in case the employer becomes bankrupt. That is one
reason. The provisions of some of our State laws and the exclusive
State-fund system under which some States operate, furnish another
reason why these claims do not ordinarily arise in bankruptcy pro
ceedings. Another reason, which probably is not so important as it
might seem on the first suggestion, is that the bankruptcy law itself
provides, in the section on priority, second paragraph, as to the
character of debts which shall have priority. You could hardly
find any fault with the arrangement, because it is perfectly logical,
being, first, the actual necessary costs of preserving the estate;
second, the filing fees paid by creditors in involuntary cases; third,
the costs of administration; fourth, wages due workmen, clerks,
traveling or city salesmen, or servants, which have been earned
within three months before the date of the commencement of the
proceedings, not exceeding $300; fifth, debts owing to any person who
by the laws of the States or of the United States is entitled to
priority.
That last clause covers a multitude of sins with reference to this
situation, because I think in a large majority of the States, either
in their compensation law, or their insolvency laws, or in some other
way, these compensation claims are given a certain degree of pri
ority. I f the State gives them priority, they have priority under
that last clause to which I have called your attention.
The State of Minnesota, at the last session of its legislature,
amended its insolvency law. Of course the insolvency law is sort of
a dead letter; as long as the bankruptcy law prevails, it is very
seldom used, but after all it conforms to this condition in that it pro
vides that compensation claims have priority, to which they are justly
entitled. I have not made any investigation of the subject, because
that is far enough to go, but I believe it is true that that situation
exists quite generally.
Another proposition would arise if you attempted to amend this
law so as to create a classification of priority for compensation
claims. You might advance them a little bit from this firth place,
but you would land somewhere in the neighborhood of the fourth
COM PENSATIO N CLAIM S IN B A N K R U P T C Y PROCEEDINGS
199
place, which refers to wages. The more I investigate it the less im
portant I think it is that any action be taken, although I realize that
there are many instances where the laws with reference to securing
claims have not been complied with. The whole liability is against
the fellow who is a bad business man; that is, he is not systematic
in his methods; there may.be a larger number of that class of claims
than I imagine, and it may be a proper subject for amendment to
the Federal bankruptcy act.
Because of that state of mind in which I find myself after my lim
ited investigation, I hope no very definite conclusions in relation to
the matter, but I have prepared a resolution for your consideration,
and, in the language of Abe Lincoln, you can vote it up or vote it
down. I f you vote it down, that will end this matter and there will
be nothing further to do. This resolution simply determines whether
it is the sentiment of this association that the law ought to be amended.
If you vote it down, you will express your conclusion that the matter
is not important enough to bother with, and that will end it. On the
other hand, if you conclude it is important and the law ought to be
amended, I have a resolution providing for the appointment of a
committee. I took the liberty in that resolution to depart from pre
cedent and make the president a member of that committee, because
I think he would be quite competent, with two others to be selected
by him, to take such action as may be necessary to bring about that
result.
My own notion is that the proper thing to do would be to confer
with this special committee on bankruptcy of the American Bar Asso
ciation at its coming meeting and see if it can be induced to amend
its proposed bill in that particular, because if it does, the work is
pretty nearly done; its bill will go by. If you go before Congress
with a separate bill for a matter of this land upon which there are
all these varying views which I have suggested to you, and a lot more,
Congress may consider that it is a case of hunting sparrows with a
cannon and forget all about it, so my own notion is that about the
only possibility of getting the law amended, if you conclude it ought
to be amended, is to cooperate with this committee which is doing a
wonderful work in the amendment of the law.
If you vote the resolution down, I will bow to your wisdom. A
habit which I have observed in legislative bodies, and I think it
applies to all other bodies, is that it is always a little more courteous
and easy to vote “ aye ” than “ no.” There is something about the
fellow who votes “ no ” which we do not like, but it will not offend
irie if you vote “ no ” on this resolution. The resolution is as follows:
Whereas the Federal bankruptcy act does not by the provisions thereof
give priority against the assets of the bankrupt for compensation claims and
awards, for the reason that no such claims existed at the time said law was
passed; and
Whereas this association believes that the peculiar character of that class
of claims warrants that same be given priority over general creditors; now,
therefore, be it
Resolved, That this association earnestly recommend that the Federal bank
ruptcy act be amended to give compensation claims that degree of priority
which the nature of such claims may require.
200
AD M INISTRATIVE PROBLEMS
DISCUSSION
[A motion was made and seconded that the resolution be adopted.]
The C h a ir m a n . It has been moved and seconded that this resolu
tion offered by Senator Duxbury be adopted. Are you ready for the
question ?
Mr. S tew art . While I am inclined to agree that the cases of bank
ruptcy are so few that this is not a life and death matter in any
sense, I do feel that this association ought to bring this compensation
question, as well as all of our other problems, up before every com
mittee of Congress and every legal association where it can be
brought up, for the very purpose of letting people know that we are
on earth. The encyclopedic ignorance shown by people who ought
to know something about this association and its work is perfectly
amazing. I f for no other reason, I think the resolution should pass,
and let the Detroit convention know.that we live, move, and have
our being, and that we want things along their line.
Mr. W il l ia m s . I am in favor of that resolution. I suggest that
George E. Beers, of Connecticut, who is commissioner for the third
district and has been for many years, always goes to those American
Bar Association meetings; he is on some of their important com
mittees, and is one of the three men appointed from Connecticut
on the committee on uniformity of laws. It might be perfectly
proper to call Mr. Beers’s attention to this resolution and perhaps
get some action that way.
Mr. S c a n la n . I think the resolution ought to be adopted, but it
occurred to me that maybe it would not cover all the questions in
volved. For instance, in Illinois we have the right to require em
ployers to satisfy the commissioner that they are either financially
responsible or that they carry insurance in a reliable company.
Some of our mining companies have been in bad shape. One
company down in southern Illinois had some difficulties with its
insurance carriers and in the course of a couple of months it had two
or three changes, and finally wound up without any insurance. The
next move it made was to go into the Federal court and institute
bankruptcy proceedings. Receivers were appointed and we were
enjoined from conducting any hearings or entering any orders for
the payment of any compensation.
It seems to me that under those circumstances, in addition to the
bankruptcy amendment, the order of the court ought to be such
that the receivers, pending the bankruptcy, would take care of these
awards, because in the cases I have reference to there are widows
who have nothing in the world but these weekly payments com
ing to them because of the death of their husbands. We have asked
the attorney general of Illinois to intervene with the Federal court
and set up those facts to try to get the order modified. I was won
dering whether the resolution was broad enough to cover such
cases.
M r. D u x b u ry . I do not think it quite covers that situation. That
is another matter entirely.
Mr. S c a n la n . Except that it might by order of the court protect
these compensation claims.
NEUROSES PROM A COM PENSATION STANDPOINT
201
Mr. D u x b u ry . It might come in the general orders for bank
ruptcy which the United States Supreme Court has lately adopted.
Mr. K ingston . I wish to make one suggestion. It ocears to me
that you would get further with the proposition before this com
mittee in Detroit if you suggested some limitation to the amount of
the preference.
Mr. D u x b u ry . My idea is that that is a detail we have not time
to consider here; it is a matter that the committee which I propose
to authorize the appointment of in the next resolution can be charged
with. We want to give it entire authority to do the best it can. In
this resolution, as I intimated, I made the president of this asso
ciation a member of the committee, and he is to pick out the other
members. I have so much respect for his wisdom and judgment
that I think you will get a committee that can give better consider
ation to the matter of details than we can.
The C h a ir m a n . I suppose if the president of the association
thinks there are other matters that ought to be considered by that
committee, he will take the pains to call its attention to them.
[The resolution was adopted.]
Mr. D u x b u r y . I think if I had not moved the adoption of the
resolution I would have voted 44no ” myself, but it is all right, be
cause 1 have serious doubt about whether or not it should be done.
Mr. Stewart, with his usual persuasive arguments, convinced me
that I was wrong again;.that encyclopedic ignorance of which he
speaks is a new one on me. The other resolution which I desire to
offer is:
Resolved, further, That the president elected at the present meeting be
authorized and directed to appoint a special committee, consisting of himself
and two other members, to take such action as they may determine necessary
to secure an amendment to the Federal bankruptcy act giving priority to
claims and awards of compensation against a bankrupt estate.
Of course that leaves the details of it entirely to them. I move
the adoption of this further resolution.
[The motion was seconded and carried.]
The C h a ir m a n . The next paper is by Mr. Williams on the ques
tion of 44Neuroses from a compensation standpoint.”
NEUROSES FROM A COMPENSATION STANDPOINT
BY F. M. WILLIAMS, CHAIRMAN CONNECTICUT BOARD OF COMPENSATION COMMISSIONERS
The subject assigned is so large that in the limits of such a paper
as can properly be read here only the slightest outline can be at
tempted. Such slight value as this paper may have will be prin
cipally due to the footnotes giving authorities read. So many States
make no provision in their acts for the various occupational neuroses
that this subject will be passed over lightly. The neuroses with
which we have to deal are for the greater part traumatic neuroses.
By this term is intended 44any deviation from the normal state of
the nervous system caused by violence.” We shall not consider
those cases due solely to fright, when there is no immediate personal
injury. It is doubtful whether in most of the States this type is a
202
AD M INISTRATIVE PROBLEM S
compensable injury any more than it was a ground of action at
common law.1
It is not essential for a compensable injury that it should leave
such external signs as are perceptible to inspection. This is a matter
involving questions of evidence only. The most common type is that
where a comparatively slight trauma is followed by a disabling
neurosis. This is especially liable to follow if there is fright at
tending the trauma. A typical case of this kind is Brewster v.
Hemingway Silk Co., 2 Conn. Comp. Dec. 128-135. In this decision
there are cited a very large number of authorities, both medical and
legal. Prior to the general adoption of compensation statutes such
conditions were not usually brought to public attention, certainly
not litigated to a large extent, except in personal injury suits,
brought for the most part by passengers who had been in railroad
accidents, against the railroad.
From this circumstance arose the use of the phrase “ railroad
spine.55 This phrase was apt to be spoken with a sneer, and in
the minds of many persons came to connote something like con
structive fraud. Many fraudulent suits of this kind were no doubt
brought. In many other cases of genuine injury symptoms were
grossly exaggerated. Granting this, the fact remains that this termi
nology is unjust. Traumatic neurosis is just as genuine a condition
as a broken bone.
In the 1910 edition of Keen’s Surgery, written before the exist
ence of any general compensation system in this country, is found
the following: “ Surgeons should be cautioned against too hastily
deciding that a given patient is a malingerer. The time has long
since passed when the reality of genuineness of the symptoms met
with in the traumatic neurosis can be questioned. Everyone knows
that cases constantly occur independently of litigation.” 2
It may be granted that a disabling traumatic neurosis is more
apt to occur, and is more serious in its consequences, in a person
somewhat below normal prior to the trauma. This while true is not
from a legal standpoint important. It has become elementary law
that an employer takes his employee as he finds him.3
When the Brewster case above cited came before me in 1916, I
had very little help from reported decisions. In 1918 when I next
had occasion to go somewhat carefully into the matter,4 authori
ties were more plentiful.
The Supreme Court of Massachusetts had held in substance that
if one who had sustained a trauma accompanied by shock and fright
(the man was in a falling elevator) was physiologically able to work,
but by reason of a neurosis due to the injury was possessed of an
honest belief that he could not work, his condition was compen
sable.5
Still more illuminating is a decision of the British Court of
Appeal rendered in 1916, but owing to war conditions not accessible
in America until much later.6 In this case it was for the first
1 Mitchell v. Rochester Ry. Co., 151 N. Y. 107, opinion, 110; Spade v. R. R„ 168 Mass.
285, opinion, 290.
2Keen’s Surgery, 1910 ed., vol. 2, p. 781; see vol. 6 (1913 ed.), p. 255.
3 Clover, Clayton & Co. v . Hughes, 3 B. W. C. C. 275; Crowley’s case, 223 Mass. 288;
Bongialatte v. Lines. 97 Conn. 548.
4 Smith i\ Smith, 2 Conn. Comp. Dec. 628.
6 William Diaz’s case, 217 Mass. 36.
6 Southampton Gas Light & Coke Co. v. Stride, 9 B. W. C. C. 555.
NEUROSES FROM A COM PENSATION STAN D POIN T
203
time, so far as I know, definitely set forth by a court of high au
thority that the gravamen of a neurosis consisted in a. definite impair
ment of the victim’s will power. It was not so much a question of
what the patient could physically do if he made proper effort
to work as it was whether, by reason of the neurosis, he was dis
abled from making such an effort.
A compensation tribunal must of necessity be constantly watch
ful against making an award in favor of a malingerer. Those
interested in studying this aspect of the problem will be entertained
by reading a monograph entitled “Hysteria and accident compen
sation,” by the famous Doctor Dercum, published in 1916. My own
experience, extending over nearly 12 years of this work, is that the
genuine malingerer is comparatively rare, and the troublesome cases
are those with some genuine neurosis mingled with a considerable
tendency to exaggerate. In this class of cases a proper and reason
able lump-sum settlement is probably the most valuable therapeutic
agent.
Probably all the States recognize insanity due to an injury as
one of the gravest consequences possible, and often the question
of when a neurosis ends and a psychosis begins is difficult, if not
impossible, to decide. No attempt is here made to go into this
question.
In dealing with disputed questions where the issue is as to
whether in a given case the claimant’s alleged neurosis is a ground
for an award it is most important from a legal standpoint to bear
in mind the distinction between “ proximate cause ” and result, in
sisted on as an essential in a common-law action of negligence or a
suit on an accident policy, and “ causal connection,” which is a
sufficient basis for a compensation award.7
Some practical considerations of importance which should be
borne in mind in our trial work are these: So far as possible, keep
the claimant out of the trial room while his symptoms are being
discussed by expert witnesses. In case of bone injuries followed by
neurosis do not encourage him to examine radiographs of his own
body. I f possible, do not let him see them. Study the patient’s
home surroundings, and if his neurosis is being aggravated by
somebody, either accidentally or purposely, get him, if possible,
into a different atmosphere.
A partial list of authorities referred to is here annexed: Oschner’s Surgical Diagnosis and Treatment, vol. 3, p. 982; vol.
4, p. 885; Frazier on Surgery of the Spine and Spinal Cord,
374 et seq.; Mott on War Neurosis and Shell Shock, 188 et seq.;
Barker’s Monographic Medicine, vol. 4, pp. 595-596; Brackett, E. J.,
M. D., on Low Back Strain with Reference to Industrial Accidents,
Boston [1924?] (reprint of paper read by the author before the
orthopedic section of the American Medical Association, at its meet
ing in Chicago in June, 1924. No attempt is made to make the cita
tion of either legal or medical authorities complete).
The C h a ir m a n . We will pass to the next paper, “ Supervision of
compensation payments,” by Dr. Andrew F. McBride.
7 Aquilanov. Lambo, 1 Conn. Comp. Dec. 145; Harle’s case, 217 Mass., opinion, 224:
Fqq oi V' Til?£ley, 5- W. C. C l ; McNichol’s case, 21-5 Mass, 497, opinion, of Rugg, C. J.,
499; Clover, Clayton & Co, v. Hughes, 3 B. W. C. C. 275.
73891°—26----- 14
204
a d m in is tr a tio n
p r o b le m s
SUPERVISION OF COMPENSATION SETTLEMENTS
BY ANDREW F. M ’BRIDE, M . D., COMMISSIONER, NEW JERSEY DEPARTMENT OF LABOR
In 1910 the Legislature of New Jersey created the employer’s
liability commission for the purpose of drafting a workmen’s com
pensation law. The commission was composed of two legislators,
two business men, and two representatives of labor. The bill pre
pared by this commission was enacted in 1911, and the commission
was continued in office and charged with the duty of observing the
workings of the law. The present secretary of our compensation
bureau was appointed its secretary, and has been in a position to ob
serve the operation of the law since 1911, nearly 14 years.
From 1911 to 1916, a period of five years, there was no official
administration of the act, except in rare and important cases, when
suit was actually brought in the common pleas court. An act of the
legislature required employers and insurance carriers to report to
the commissioner of labor all compensative accidents and the comensation settlement. These reports were, by law, accessible to
ic employer’s liability commission, whose clerical force made a study
of all such reports with regard to nature of injury, length of dis
ability, rate or wages, and compensation paid.
Five years’ experience, as disclosed by this means, demonstrated
beyond question that active supervision of the administration of the
law was imperative. Compulsory insurance was not in effect in New
Jersey at that time, and it was found that, owing to inexperience
in interpreting the terms of the law, employers were constantly mak
ing mistakes, and the absence of any checking of the activities of
carriers left them free to make agreements as inadequate as they
could work out.
The employer’s liability commission, therefore, advocated the cre
ation of a bureau to supervise adjustments and to certify to the com
mon pleas court such cases as could not, by informal means, be
brought to a just conclusion. At the instigation of the commission
there was enacted in 1916 a law creating the workmen’s compensa
tion aid bureau. This bureau undertook to administer the law,
without, however, having judicial powers.
Two years’ experience under this act was sufficient to demonstrate
that a system requiring joint action on the part of the bureau and
the common pleas court, in order to compel obedience to findings,
was incapable of giving the best results. Consequently, in 1918 the
compensation bureau was given original jurisdiction of all compen
sation matters, endowed with judicial powers, and its findings were
placed on a par with the decisions of the common pleas court. These
courts were relieved of all jurisdiction except in case of appeal as
provided by law.
It will be seen, therefore, that New Jersey, through having one
official associated with this subject throughout its entire history,
has been in a position to observe and compare the workings of the
act during the three stages of its development, as described hereto
fore.
Our views, therefore, of what constitutes successful supervision of
compensation settlements are based on very complete actual experi
ence, and the methods in use in New Jersey are the result of a grad
ual development along lines dictated by such actual experience.
S
SUPERVISION OF COM PENSATION SETTLE M EN TS
205
The following explanation of supervision of compensation settle
ments as accomplished in New Jersey is presented with the assur
ance that it is not a theory which is being advanced, but a system
which has developed gradually as time and experience dictated.
The supervision of a compensation settlement in New Jersey
ordinarily has its inception upon the receipt of the first report of
the accident by the employer to the compensation bureau of the
department of labor. Our method requires the employer to prepare
a duplicate first report, one to be sent to the bureau, the other to
the carrier. A supplemental report is sent in like manner at the
expiration of the waiting period, or earlier if the employee resumes
work. This enables the bureau to start its checking up on the
case. Next follows a report by the carrier of the cause of the
accident and the preliminary estimate of injury. If this report
is not received within a specified time, an investigator of the bureau
calls on the carrier. When received, the case is card indexed by a
visible system, given a number, and then assigned to one of the
examiners, whose duty it is to enter the number in a follow-up book
and keep the record active until the case is finally closed. The carrier
next files an agreement for compensation, which also contains a
wage statement. At the close of the period of temporary disability
the carrier files a final statement, giving all the facts relative to
temporary disability, nature of permanent injury, and compensation
paid and payable. These are carefully reviewed and calculated and
an approval sent the employee and employer if no error is detected.
This approval states the amount of compensation the injured em
ployee should receive per week ,the number of weeks, and the total,
and accompanying it is a list of the offices maintained by the State
in the different cities, with the suggestion that if there be any ques
tion about his compensation he call at one of the offices listed.
If, upon reviewing the form above mentioned, error is dis
covered, we correct it by correspondence or refer the case to the
office in the territory concerned. At this office the case is listed for
an informal hearing, and notices as to time and place are sent the
injured and the carrier.
In the larger cities of New Jersey offices are maintained which are
open each day of the week. An official visits the smaller cities once
a week or once in two weeks, while some of the rural towns are
visited but once a month. The dates of these visits are published
and sent to each injured man. When a man presents himself with
some complaint his case is docketed and the notices issued for an
informal hearing. At this hearing, or prior thereto, the injured per
son is examined by the bureau’s physician and the carrier’s repre
sentative is present, also such witnesses and records or other medical
testimony as may be obtainable. The case is then fully discussed and
an award or dismissal issued. These awards are informal and do not
have the same standing as an award issued after due process of
law; nevertheless, in about 95 per cent of the cases heard a just set
tlement is reached, and a formal trial becomes unnecessary.
When the above-described informal methods do not avail, legal
procedure must be followed by the filing of a petition, the service
of same, followed by due notice of hearing, and trial. An award so
reached can be filed in the common pleas court as a judgment. In
206
BUSINESS M EETIN G
formal hearings are conducted by referees or assistant referees.
Formal trials are conducted by deputy commissioners.
It has not been our judgment, nor has our experience indicated,
that it is necessary for every injured man to attend a hearing. The
majority of cases are not serious, either as to lost time or permanent
injury, and a wholesale ordering of every man to a hearing must re
sult in a’useless waste of time and loss of wage in about 50 per cent
of the cases. In New Jersey we deem it sufficient if we notify every
injured man of a place and time where he can present his case.
The results of each informal hearing are reported to the main of
fice at the capitol and are used as a check on the final report
filed by the carrier.
It may be mentioned in passing that the surgeons who assist the ref
erees at the hearings are connected with the rehabilitation commission,
and one element of their work is to refer to the rehabilitation clinics
any cases which seem to indicate further treatment.
Recapitulating briefly, our experience leads us to conclude that
supervision of compensation settlements involves the following prin
cipal elements :
Supervision by the State is absolutely essential.
Early knowledge of accidents by the bureau.
Prompt information to injured person as to location of our offices.
Division of the State into territories.
Establishment of a unit of the bureau in each territory, each unit
to consist of a referee, a doctor, an investigator, and such clerical
force as may be necessary to docket cases, issue notices, act as secre
tary at hearings, handle correspondence, etc.
Reports as follows: Immediate report by employer to State and
carrier. Supplemental report at end of waiting period. First re
port by carrier of cause and result of accident. Second report con
sisting of agreement to pay and to receive compensation with state
ment of wage and compensation rate. Third report of full terms of
settlement, covering temporary disability and permanent injury and
nature of same.
Expert examiners for checking all reports with statute.
A strict and efficient follow-up system.
Notice to every injured person of amount payable.
Facilities for conducting informal and formal hearings.
Capable officials, preferably attorneys.
Sufficient appropriation of funds to make all of the foregoing
possible.
BUSINESS MEETING
CHAIRMAN, FREDERIC M. WILLIAMS, NEW PRESIDENT I. A. I. A. B. C.
The C h a ir m a n . The first is the report of the committee on reso
lutions.
REPORT OF COMMITTEE ON RESOLUTIONS
RESOLUTIONS
Resolved, That we do hereby express our grateful appreciation of the many
privileges and courtesies that the association and individual members thereof
have enjoyed at this twelfth annual meeting of the International Association of
REPORT OF COM M ITTEE OK RESOLUTIONS
207
Industrial Accident Boards and Commissions held at Salt Lake City, Utah,
August 17 to 20, 1925.
Resolved, further, That the thanks of this association be extended to his
Excellency, the Hon. George H. Dern, Governor of the State of Utah, to the
Mayor of Salt Lake City, the Hon. C. Clarence Neslen, to the Industrial Com
mission of Utah, and to the many other citizens of said convention city and
State who have had part in providing for our welfare, instruction, and enter
tainment, and especially to the several members of the medical profession
who contributed the unusually able and practical papers to the literature of this
association. [Adopted.]
Whereas, it is reported that certain universities have and now are engaged
in research work relating to the results of compensation laws and the adminis
tration thereof; and
Whereas we believe that such work may be of value to our members and
helpful in the work in which this association is engaged if it be wisely directed
and efficiently done: Therefore, be it
Resolved, That a committee be appointed by the president elected at this
convention, to consist of such number as he may determine, to consider and
adopt suggestive lines, subjects, and methods of such research work, and to
use its good offices in cooperating with those engaged in or about to under
take such research work, to the end that the same may be wisely directed and
correspondingly valuable for practical purposes. [Adopted.]
Resolved, That Bulletin of the United States Bureau of Labor Statistics No.
385 be, and the same is hereby, approved as the record of the proceedings of
the eleventh annual convention of the association held at Halifax, Nova Scotia,
August 26-28, 1924. [Adopted.]
RECOM MEND ATION S
Whereas the matter of the practice heretofore prevailing in this association
of advancing the vice president to the position of president, as well as the prac
tice of holding the annual conventions in the State where the president resides,
has been presented to the committee on resolutions by a resolution for its
consideration, and the committee having given the matter due consideration:
Now, therefore,
The committee has concluded that while it is convinced that the matter is
one that the association at any convention has the right to determine as the
circumstances may seem to require, yet, we recommend that the present con
vention take no express action in relation to the subject matter, either approv
ing or disapproving the practice, and that the association at all future con
ventions be left entirely free to take such action as the circumstances and ex
isting conditions may seem to require. [Adopted.]
The committee on resolutions, to whom was referred the resolution offered
by R, E. Wenzel, commissioner Workmen’s Compensation Bureau of North
Dakota, in connection with his paper on “Preexisting Diseases,” which resolu
tion is as follows, to wit—
Whereas it is one of the aims of the International Association of Indus
trial Accident Boards and Commissions to bring about equity and uniformity
in the adminstration of workmen’s compensation legislation; and
Whereas it is the opinion of the representatives of the International Asso
ciation of Industrial Accident Boards and Commissions from the Provinces of
the Dominion of Canada and States of the United States, assembled at this,
the twelfth annual meeting of said association, held in this year 1925 in the
city of Salt Lake City, Utah, that equitable administration of such workmen’s
compensation legislation will be furthered by and through the uniform adop
208
BUSINESS M EETIN G
tion and adaptation of the following basis for the handling of preexisting
disease cases arising in the course of industrial employment, to w it:
That, in case of aggravation of any disease existing prior to such injury, the
compensation shall be allowed only for such proportion of the disability due
to the aggravation of such prior disease as may reasonably be attributable to
the injury; and
Whereas it is the further opinion of such representatives that it may reason
ably be expected that definite and proper expression and publication of such
opinion will hasten the uniform adoption and adaptation of such basis for
the handling of preexisting disease cases; now, therefore, be it
Resolved, That the various industrial accident boards and commissions of
the Provinces of Canada and the States of the United States be, and they
hereby are, urged to accept, adopt, and adapt the foregoing basis in the han
dling of preexisting disease cases; that the same be done as speedily as pos
sible through the adoption and publication of rules by such bureaus or com
missions, wrherever they possess the power; and that, wherever such power
is not now possessed, such bureaus, boards, or commissions sponsor the neces
sary legislative amendments to make this resolution effective; be it further
Resolved, That due and proper publicity be given the passage of this resolu
tion.
reports that, in the opinion of your committee, the question of whether or not
any action should be taken by this association on the subject matter of said
paper and resolution, as well as what such action should be taken, if any, are
matters of too much importance and depend for wise action upon fuller in
formation and deliberation than is available to your committee, or in the
opinion of your committee, is obtainable at this convention of the association;
now, therefore,
Your committee recommends that the said resolution and paper offered by
Mr. B. E. Wenzel, together with this report, be referred to a special committee
of five members to be appointed by the president elected at this convention,
to consider the subject matter and the provisions of compensation laws re
lating thereto, as well as the state of the law generally on the subject, with
such recommendations for the action of this association on the subject as
the committee may determine, to be submitted to the next convention of the
association. [Adopted.]
With reference to the resolution brought before your committee by
Mr. Ethelbert Stewart of the United States Bureau of Labor Statistics, as
follows—
Resolved, That the committee on statistics and compensation insurance
cost be and is hereby instructed to investigate and report at the next conven
tion on administrative costs.
That the committee shall take into consideration the question of what items
and elements of expense shall enter into such costs as has been brought out in
the discussion of this general subject in the Salt Lake City convention. But the
committee need not be confined or restricted in its study by such discussion.
That the committee’s report indicate just what items have been covered
in its investigation, and it shall report five ways—
1. By total number of accident cases reported.
2. By total number of compensable cases reported, whether compensation
was in fact granted or not.
3. By number of compensated cases.
4. By number of cases really investigated, whether compensated or not,
wherever such information can be made available; and
5. By percentage of money condensation actually paid.
your committee reports that the matter has had consideration and the commit
tee has concluded that the subject matter is one that can best be determined by
the standing committee on statistics and compensation insurance costs, both as
to the question of whether the matter is one that is important enough to justify
the action suggested as wTell as the form and method of such work, and we rec
ommend that the whole matter be referred to the committee on statistics and
ATTENDANCE AND M EM BE RSH IP
209
compensation insurance costs for such action, if any, as that committee may
determine. [Adopted.]
[A rising vote of thanks was given R. G. Lucas, as chairman of
the entertainment committee for the convention.
The customary honorarium of the secretary-treasurer and of the
clerical and stenographic help for the secretary’s office was author
ized.]
The C h a irm a n . I s there any further business?
Mr. Monroe. It appears to me that it might be a good idea that
a committee be formed to look into the question of attendance and
membership at these conventions. There are a lot of States where
there is no special appropriation covering traveling expenses. I
believe their commissioners would like to come, but they have not
been provided with the funds. I would like to see what everybody
thinks about it—say appoint a committee of three members known
as the membership and attendance committee. I may be out of order
in making that suggestion, but I would like to see what you think
about it.
[Mr. Monroe put his suggestion in the form of a motion, which
was seconded, and the following discussion thereon was had:]
Mr. W ilcox . I think Mr. Stewart carries on correspondence from
the beginning of the year until the end, from one convention to an
other, with all these States, trying to prevail upon them to have
representation at these gatherings. What do you think, Mr. Stew
art? Is there any advantage in a committee handling it?
Mr. S tewart . I do not think there is. I do think, however, it
might help if this association, by some motion or resolution, would
express its regret and concern that so many States have cut out the
appropriations that the commissions used to have for such purposes.
For instance, it is not the legislature in the case of Michigan, and
I do not know that it has been the legislature in any case, but some
board or other has cut out the expense fund of the Michigan commis
sion, the Oregon commission, and the Washington commission.
There is no trouble in getting the commissioners to agree to come—
that is not the problem at all—it is this new trick of putting the
power to expend the money in some other commission, and after the
commissioner plans to come and everything else, he finds himself
forbidden to do so. I f this convention could hit that somehow, it
might be helpful. As to having a publicity committee to try to round
up these fellows, why we do that 365 days of the year, and so I do
not think that would be necessary; but I do think we ought to ex
press our opinion on this stinginess which prevents the compensa
tion men from coming here, where they get as much for the money
spent as the State does for any other money that it spends.
Mr. C la r k . Might I suggest, following Mr. Stewart’s remarks,
that the best one to whom this association could go would be the
governor of the State. The board that Mr. Stewart talks about
(I suppose it is the same in all States) is known as the board of
control. It is the board that is left over from the legislative sessions,
in many places called the emergency board, which has the power
to make appropriations out of the general fund of the State for
extraordinary expenses or for unforeseen expenses which were not
210
BUSINESS M EETIN G
put in the State budget. We hare that committee in our State, and
it took it until about 48 hours before the train left to decide whether
Ohio should be represented here.
The governor, the auditor of State, the treasurer of State, the
attorney general, and two other members appointed by the legis
lature constitute that committee. It seems to me that the governor
would be the person to whom to go. I do not think you can reach
it any other way than through your governors.
Mr. G leason . This is one of the times that Massachusetts agrees
with Ohio. I think it is a good idea, and that if Mr. Stewart will
write to the governors of the States a month or two before the con
vention is held, stating what we do at these conventions, it will help
a great deal. We have in our State a committee on administration,
and every request for travel outside of the State has to go to that
committee; at the same time a letter goes to the governor, and if
that committee approves it, the governor O. K ’s it. In my particu
lar case, the committee tried to block the governor, but he finally
approved the expenses of my coming out here. I believe it would
help a great deal if Mr. Stewart would take it up with the governors
of the States.
The C h a ir m a n . In Connecticut we have to go to the governor
and obtain his approval in advance. I wonder if Mr. Monroe would
accept as a substitute for his motion something like this:
Resolved, That it is the sense of this association that the various States in
the Union having workmen’s compensation laws would receive benefit by being
represented at each meeting of this association; and be it further
Resolved, That the secretary of this association is requested prior to the next
meeting to communicate with the governor or other proper authorities in each
State having a compensation law, with a view to urging upon them the feeling
of this association.
Is that acceptable to you, Mr. Monroe?
Mr. M onroe. Yes, sir. Might I also suggest, Mr. Williams, that
we do not confine ourselves to compensation laws, because I believe
there are certain individuals in the noncompensation States who
would be just as much interested.
The C h a ir m a n . Those States would not pay their expenses to
come.
M r. M onroe. In that event it is acceptable.
Mr. W ilco x . It ought to apply to the Provinces.
Mr. K ingston . That would not apply to the Provinces.
The C h a ir m a n . Any member who does not want Mr. Stewart to
write such a letter can tell him so.
Mr. S tew art . A s a matter of fact, I know about which commis
sions can handle that matter. Oklahoma, for instance, has written
into the law a provision for a fund to attend these conventions. Cer
tain States do not want me to butt in, but when they have wanted
me to do so, I have written to the governors. I have a file of let
ters written to the governors which we will have to burn to get space
for the next file. Last year the question came up in Ohio, and I
not only wrote to the governor but also got the Secretary of Labor
to write to the governor; he said, “ We will get those fellows there
if I have to get the President to write to the governor.”
ATTENDANCE AND M E M B E R SH IP
211
Now I can not do any more than I am doing. It is simply a ques
tion as to whether a motion or resolution from this association will
tend to make these boards of control let that expense go through. I
think the first part of the president’s resolution probably will do
just as much good as anything that can be done.
The C h a i r m a n . Y ou write up as much as you approve of.
Mrs. R o b l i n . Before my associate’s and my term was about to
expire, we went before the legislature and had written in the com
pensation law a section that we should meet with this association;
in fact, the legislature made it mandatory that we do meet. We felt
free in doing that because it appeared that it would not serve our
own interests particularly. We went in the interest of those who
would follow us, not knowing at that time that either one of us would
be reappointed, so that was written into the law, and being now a
specific provision of our law, it is not hard to get an appropriation.
The C h a i r m a n . I f Mr. Monroe will accept as much of my sug
gestion as Mr. Stewart approves as a substitute for his motion, that
is the question before the house.
M r . M o n r o e . I a m a g r e e a b le .
[The motion was carried.
A rising vote of thanks was given to the retiring president,
O. F. McShane, and to Nephi L. Morris and William M. Knerr,
members of the Utah Industrial Commission for the personal atten
tion they had given to the comforts and desires of the delegates and
the visitors to this convention.
The auditing committee reported that the financial statement of
the secretary-treasurer is true and correct, and the report was
adopted. The report of the medical committee as to the action
the association should take on Doctor Black’s report was called for
but not given, the time being limited. Meeting adjourned.]
APPENDIXES
APPENDIX A.—.OFFICERS AND MEMBERS OF COMMITTEES FOR
1925-26
President, Frederic M. Williams, chairman Connecticut Board of Compensa
tion Commissioners.
Vice president, H. M. Stanley, chairman Georgia Industrial Commission.
Secretary-treasurer, Ethelbert Stewart, United States Commissioner of Labor
Statistics.
E
x e c u t iv e
C o m m it t e e
Frederic M. Williams, Connecticut Board of Compensation Commissioners.
H. M. Stanley, Georgia Industrial Commission.
Ethelbert Stewart, United States Commissioner of Labor Statistics.
O. F. McShane, Utah Industrial Commission.
Fred W. Armstrong, Nova Scotia Workmen’s Compensation Board.
James A. Hamilton, New York Department of Labor.
Mrs. F. L. Roblin, Oklahoma Industrial Commission.
Ralph Young, Iowa Workmen’s Compensation Service.
W. H. Horner, Pennsylvania Department of Labor and Industry.
C o m m it t e e
on
S t a t is t ic s
and
C o m p e n s a t io n I n s u r a n c e C o st
Chairman, L. W. Hatch, New York Department of Labor.
Secretary, Ethelbert Stewart, United States Commissioner of Labor Statistics.
Charles E. Baldwin, Assistant Commissioner, United States Bureau of Labor
Statistics.
William J. Maguire, Pennsylvania Department of Labor and Industry.
Charles A. Caine, Utah Industrial Commission.
E. I. Evans, Ohio Department of Industrial Relations.
N. Fletcher, Manitoba Workmen’s Compensation Board.
O. A. Fried, Wisconsin Industrial Commission.
E. K. Erwin, Washington Department of Labor and Industries.
Miss R. O. Harrison, Maryland State Industrial Accident Commission.
G. N. Livdahl, North Dakota Workmen’s Compensation Bureau.
H. C. Myers, Oklahoma Industrial Commission.
C. E. Gleason, Massachusetts Department of Industrial Accidents.
Charles H. Verrill, United States Employees’ Compensation Commission.
M
e d ic a l
C o m m it t e e
Chairman, James J. Donohue, M. D., Connecticut Board of Compensation
Commissioners.
Vice chairman, Robert P. Bay, M. D., Maryland State Industrial Accident
Commission.
Nelson M. Black, M. D., Wisconsin.
T. R. Fletcher, M. D., Ohio Department of Industrial Relations.
A. J. Fraser, M. D., Manitoba Workmen’s Compensation Board.
Harley J. Gunderson, M. D., Minnesota Industrial Commission.
Andrew F. McBride, M. D., New Jersey Department of Labor.
M. D. Morrison, M. D., Nova Scotia Workmen’s Conpensation Board.
F. H. Thompson, M. D., Oregon State Industrial Accident Commission.
Maurice Kahn, M. D., California.
Charles J. Rowan, M. D., Iowa.
Ralph T. Richards, Utah.
212
213
OFFICERS AND M EM BERS OF COM M ITTEES
Sa f e t y C o m m it t e e
Chairman, John Roach, New Jersey Department of Labor.
Lucian W. Chaney, United States Bureau of Labor Statistics.
Thomas P. Kearns, Ohio Department of Industrial Relations.
R. MeA. Keown, Wisconsin Industrial Commission.
James L. Gernon, New York Department of Labor.
C o m m it t e e
on
I n v e s t ig a t io n
of
R
e su lts of
C o m p e n s a t io n A
w ards
Chairman, Ethelbert Stewart, United States Commissioner of Labor Statistics.
Secretary, W. H. Horner, Pennsylvania Department of Labor and Industry.
Miss R. O. Harrison, Maryland State Industrial Accident Commission.
T. J. Duffy, Ohio Department of Industrial Relations.
R. E. Grandlield, Massachusetts Department of Industrial Accidents.
APPENDIX B.— CONSTITUTION OF THE INTERNATIONAL ASSOCIA
TION OF INDUSTRIAL ACCIDENT BOARDS AND COMMISSIONS
A
r t ic l e
I
This organization shall be Known as the International Association of Indus
trial Accident Boards and Commissions.
A
r t ic l e
II.—Objects
1. This association shall hold meetings once a year, or oftener, for
the purpose of bringing together the officials charged with the duty of adminis
tering the workmen's compensation laws of the United States and Canada to
consider, and, so far as possible, to agree on standardizing (a) ways of cutting
down accidents; (b) medical, surgical, and hospital treatment for injured
workers; (c) means for the reeducation of injured workmen and their restora
tion to industry; (d) methods of computing industrial accident and sickness
insurance costs; ( e ) practices in administering compensation laws; ( /) exten
sions and improvements in workmen's compensation legislation; and (g) re
ports and tabulations of industrial accidents and illnesses.
S e c . 2. The members of this association shall promptly inform the United
States Bureau of Labor Statistics and the Department of Labor of Canada of
any amendments to their compensation laws, changes in membership of their
administrative bodies, and all matters having to do with industrial safety, in
dustrial disabilities, and compensation, so that these changes and occurrences
may be noted in the Monthly Labor Review of the United States Bureau of
Labor Statistics and in the Canadian Labor Gazette.
S e c t io n
A
I I I .—
r t ic l e
Membership
S e c t i o n 1. Membership shall be of two
S e c . 2. Active membership.—Each State
grades—active and associate.
of the United States and each Prov
ince of Canada having a workmen’s compensation law, the United States
Employees’ Compensation Commission, the United States Bureau of Labor
Statistics, and the Department of Labor of Canada shall be entitled to active
membership in this association. Only active members shall be entitled to vote
through their duly accredited delegates in attendance on meetings. Any per
son who has occupied the office of president or secretary of the association
shall be ex officio an honorary life member of the association with full privi
leges.
Sec. 3. Associate membership.— Any organization or individual actively in
terested in any phase of workmen’s compensation or social insurance may be
admitted to associate membership in this association by vote of the executive
committee. Associate members shall be entitled to attend all meetings and
participate in discussions, but shall have no vote either on resolutions or for
the election of officers in the association.
A r t ic le
IY
.—lie present a(ion
S e c t i o n 1. Each active member of this association shall
Sec. 2. Each active member may send as many delegates
have one vote.
to the annual meet
ing as it may think fit.
Sec. 3. Any person in attendance at conferences of this association shall be
entitled to the privileges of the floor, subject to such rules as may be adopted
by the association.
A
r t ic l e
V .—
Annual dues
S e c t i o n 1. Each active member shall pay annual dues of $50, except the
United States Employees’ Compensation Commission, the United States Bureau
of Labor Statistics, and the Department of Labor of Canada, which shall be
exempt from the payment of annual dues: Provided, That the executive com
214
CO N STITU TION OF T H E ASSOCIATION
215
mittee may, in its discretion, reduce the dues for active membership for those
jurisdictions in which no appropriations are made available for such expendi
tures, making it necessary that the officials administering the law pay the an
nual dues out of their own pockets for the State.
S e c . 2. Associate members shall pay $10 per annum.
S e c . 3. Annual dues are payable any time after July 1, which date shall be
the beginning of the fiscal year of the association. Dues must be paid before
the annual meeting in order to entitle members to representation and the right
to vote in the meeting.
A
r t ic l e
VI.—Meetings of the association
S e c t i o n 1. An annual meeting shall be held at a time to be designated by the
association or by the executive committee. Special meetings may be called by
the executive committee. Notices for special meetings must be sent out at
least one month in advance of the date of said meetings.
S e c . 2. At all meetings of the association the majority vote cast by the
active members present and voting shall govern, except as provided in
Article X.
A r t i c l e VII.—Officers
S e c t i o n 1. Only officials having to do with the administration of a workmen’s
compensation law or bureau of labor may hold an office in this association,
except as hereinafter provided.
S e c . 2. The association shall have a president, vice president, and secretarytreasurer.
S e c . 3. The president, vice president, and secretary-treasurer shall be elected
at the annual meeting of the association and shall assume office at the last ses
sion of the annual meeting.
S e c . 4. If for any reason an officer of this association shall cease to be con
nected with any agency entitled to active membership before the expiration of
his term, he may continue in office notwithstanding until the next annual meet
ing; but if for any reason ai vacancy occurs in the office of president, the
executive coimmittee shall appoint his successor.
A r t ic l e Y I I I . —
Executive committee
S e c t i o n 1. There shall be an executive committee of the association, which
shall consist of the president, vice president, the retiring president, secretarytreasurer, and five other members elected by the association at the annual
meeting.
S e c . 2. The duties of the executive committee shall be to formulate programs
for all annual and other meetings and to make all needed arrangements for such
meetings; to pass upon applications for associate membership; to fill all offices
which may become vacant; and in general to conduct the affairs of the associa
tion during the intervals between meetings. The? executive committee may also
reconsider the decision of the last annual conference as to the next place of
meeting and may change the place of meeting if it is deemed expedient.
A
r t ic l e
IX.—Quorum
S e c t i o n 1. The president or the vice president, the secretary-treasurer or his
representative, and one other member of the executive committee shall consti
tute a quorum of that committee.
A r t ic l e
X.—Amendments
This constitution or any clause thereof may be repealed or amended at any
regularly called meeting of the association. Notice of any such changes must
be read in open meeting on the first day of the conference, and all changes of
which notice shall have thus been given shall be referred to a special committee,
which shall report thereon at the last business meeting of the conference. No
change in the constitution shall be made except by a two-thirds vote of the
members present and voting.
APPENDIX C.— LIST OF PERSONS WHO ATTENDED THE TWELFTH
ANNUAL MEETING OF THE INTERNATIONAL ASSOCIATION OF
INDUSTRIAL ACCIDENT BOARDS AND COMMISSIONS, HELD AT
SALT LAKE CITY, UTAH, AUGUST 17-20, 1925
CANADA
Ontario
George A. Kingston, commissioner Workmen's Compensation Board.
MEXICO
Carlos Y. Ariza, Consul of Mexico.
UNITED STATES
Alabam a
Walter H. Monroe, compensation clerk Bureau of Insurance.
California
John A. McGilvray, chairman Industrial Accident Commission.
C onnecticut
James J. Donohue, M. D., member Board of Compensation Commissioners.
L. E. Evens, M. D.
F. M. Williams, chairman Board of Compensation Commissioners.
Georgia
R. C. Norman, commissioner Industrial Commission.
Idaho
Joel Brown, chairman Industrial Accident Board.
John D. Case, secretary Industrial Accident Board.
W. D. Yager, manager State Insurance Fund.
Illinois
George B. Arnold, director Department of Labor.
William M. Scanlan, chairman Industrial Commission.
Indiana
D. H. Bynum, chairman Industrial Board.
Io w a
Ralph Young, deputy commissioner Workmen's Compensation Service.
K a n sa s
Alice K. McFarland, director women's work, Public Service Commission.
Frank O’Brien, commissioner Public Service Commission.
Mrs. F. O’Brien.
Maryland
Robert P. Bay, M. D., chief medical examiner State Industrial Accident Com
mission.
A. E. Brown, secretary State Industrial Accident Commission..
216
L IS T OF PERSONS IN ATTENDANCE
217
George Louis Eppler, commissioner State Industrial Accident Commission.
Rowena O. Harrison, director of claims State Industrial Accident Commission.
Massachusetts
Chester E. Gleason, member Department of Industrial Accidents.
Mrs. C. E. Gleason.
Ethel M. Johnson, assistant commissioner, Department of Labor.
Michigan
Morton K. Averill, assistant to vice president, Dodge Brothers, Detroit.
Minnesota
F. A. Duxbury, member Industrial Commission.
Henry McColl, chairman Industrial Commission.
Ora E. Reaves, claims manager M. A. Hanna Co., Duluth.
Louise E. Schutz, superintendent Division of Women and Children, Indus
trial Commission.
Nevada
Frank W. Ingram, labor commissioner.
John M. Gray, commissioner Industrial Commission.
E. Ryan, Ely.
New Jersey
Andrew F. McBride, M. D., commissioner Department of Labor.
New York
L. W. Hatch, director Bureau of Statistics and Information, Department of
Labor.
Mrs. L. W. Hatch.
William Leslie, general manager National Council on Compensation Insurance.
North Dakota
R. E. Wenzel, commissioner Workmen’s Compensation Bureau.
Ohio
J. D. Clark, commissioner Industrial Commission.
H. R. Witter, director Department of Industrial Relations.
Mrs. H. R. Witter.
Oklahoma
Mrs. Carl Jones, claim examiner Oklahoma Industrial Commission.
H. C. Myers, commissioner Industrial Commission.
Mrs. Faye L. Roblin, chairman Industrial Commission.
Pennsylvania
W. H. Horner, director Bureau of Workmen’s Compensation.
Richard H. Lansburgh, secretary of labor and industry.
Mrs. Richard H. Lansburgh.
T. Henry Walnut, chairman Workmen’s Compensation Board.
Rhode Island
Christopher M. Dunn, deputy commissioner of labor.
Mrs. Christopher M. Dunn.
Utah
D. K. Allen, M. D., Salt Lake County Medical Service.
Charles A. Caine, manager State Insurance Fund.
A. W. Christensen, safety engineer Columbia Steel Corporation.
Mrs. A. W. Christensen.
J. F. Coombs, director safety and labor American Smelting & Refining Co.
John Crawford, coal mine inspector Industrial Commission.
Elias L. Day.
218
APPEN D IX C
George H. Dern, Governor of Utah.
Irene M. Fowler, labor inspector Industrial Commission.
J. G. Hadley, employment director Utah Copper Co.
E. D. Hammond, M. D., doctors’ committee Industrial Commission,
T. A. Heringer, factory inspector Industrial Commission.
E. A. Hodges, mine inspector Industrial Commission.
N. E. Everson, claim adjuster.
William M. Knerr, commissioner Industrial Commission.
Mrs. William M. Knerr.
J. C. Landenberger, M. D.
F. L. Leech, Industrial Relations Department.
R. G. Lucas, attorney Utah Copper Co.
O. F. McShane, chairman Industrial Commission.
Mrs. O. F. McShane.
Nephi L. Morris, commissioner Industrial Commission.
Mrs. Nephi L. Morris.
Arthur L. Murray, M. D., surgeon United States Bureau of Mines.
Carroll E. Nelson, claims adjuster Ocean Accident & Guarantee Corporation.
C. Clarence Neslen, Mayor of Salt Lake City.
Ralph C. Pendleton, M. D., Utah State Medical Association.
Robert B. Porter, general attorney Oregon Short Line Railroad Co.
Ralph T. Richards, Salt Lake Clinic.
Carolyn I. Smith, secretary Industrial Commission.
George A. Smith, representative Utah Idaho Sugar Co.
John Taylor, coal mine inspector Industrial Commission.
Jos. E. Tyree, M. D., Salt Lake Clinic.
G. R. Yearsley, safety engineer State Insurance Fund, Industrial Commission.
Wisconsin
Maud Swett, director Women’s Department, Industrial Commission.
L. A. Tarrell, member Industrial Commission.
Fred M. Wilcox, chairman Industrial Commission.
Mrs. F. M. Wilcox.
District of Columbia
Charles E. Baldwin, assistant commissioner United States Bureau of Labor
Statistics.
Lucian W. Chaney, economist United States Bureau of Labor Statistics.
Leifur Magnusson, American correspondent International Labor Office.
Agnes L. Peterson, assistant director Woman’s Bureau, United States De
partment of Labor.
Ethelbert Stewart, United States Commissioner of Labor Statistics.
@FedFRASER