necessity to go to work, and did go to work. Every day he found that the pain was less and less, and it soon disappeared. The injured employee receiving half or more of his average weekly wage under a compensation act, and who for any reason is not ambitious, may, and sometimes does, refuse to go to work while there is any pain in the injured part. The longer such injured employees stay away from work the harder it is for them ever to go to work; and unless prompt and stringent means are taken to force them back into employment, it is not long until the atrophy becomes permanent, and the injured employee becomes a charge on the law up to full period of total disability, and subsequently on private or public charity. This is not to be wondered at. The ordinary person after a fortnight's vacation in the summer time finds it difficult on his return to start to work, and if the incentive to remain away at vacation on half pay could be supplied, it is probable that summer vacations would be extended longer than they are to-day.

Some workmen who are victims of bad advice, or afraid of pain, refuse to accept the medical or surgical services offered by the insurance companies which is necessary to put them back on a working basis. To remedy this defect in the Massachusetts law it is suggested that section 19, paragraph D, of the Illinois law be added as an amendment to the act. This is as follows:

If any employee shall persist in unsanitary or injurious practices which tend to either imperil or retard his recovery, or shall refuse to submit to such medical or surgical treatment as is reasonably essential to promote his recovery, the board may, in its discretion, reduce or suspend the compensation of any such injured employee.

The principal danger of malingering, which up to now has not been very great in Massachusetts, is not in the cost of insurance to employers, or its effect on the profits of the insurance companies, but the great danger of the spread of these practices is to the workingman himself, because nothing more quickly undermines energy and self-respect than this practice, the consequences of which are permanent and hit him when he is down.

In the opinion of the Board the way to prevent the growth of practices which have made similar acts odious in Europe is:

First. The establishment of a definite medical policy regarding injuries, so that, as far as possible and human, all injuries shall be judged on a uniform basis. Every time the Board is outwitted by a malingerer the precedent is important. The Board needs a medical advisor whose duty it will be to pass on the medical problems which rise out of industrial injuries. A competent medical adviser will assist the Board in fairly and uniformly administering the law, and, while benefiting the employee whose injury is genuine and disability honest, will prevent the malingerer from getting benefits which are not deserved.

Second. To give the Industrial Accident Board authority to hire or establish one or more wards in hospitals, located to serve the industrial centers of the Commonwealth, where doubtful cases of disability may be sent, at the discretion of the Board, for observation and study, the cost to be assessed pro rata on the insurance companies.

LUMP SUM PAYMENTS.

Under the present act the Industrial Accident Board has the right to approve the payment of the compensation due in the future, by lump sum, six months after the date of injury. The experience of the Board in lump sum payments is that awarding a lump sum payment is often of dubious benefit. The tendency of some persons who have never had so much money at one time is towards excess of various kinds when they receive a lump sum, which offers a premium to get-rich-quick swindlers and others desirous of wheedling this money away from the beneficiary, and in many ways it proves a source of danger rather than a benefit to the person involved.

The Industrial Accident Board finds many cases in which it would not be proper to give the total amount of benefit due in a lump sum, where, however, a partial amount would relieve a widow, for example, of debts pressing, and enable her to get a clean start in life. In these cases the proper course seems to be, if a widow or other dependent is entitled to $10 a week for three hundred weeks, to find out what the debts are; what sum is necessary to make the beneficiary independent, and to take this sum from the end of the term of payment, commuting the amount paid at an interest set by the Industrial Accident Board; then to have payments continue to the end of the three hundred weeks, minus the number of weeks awarded in lump sum for this purpose.

The Board respectfully recommends that the Legislature amend the section relating to lump sums so that the Industrial Accident Board may have, in addition to the power to award a lump sum after six months, the power to decree that any part of the total amount due shall be paid, not to be contingent on the approval of the insurance companies. Under the present law any lump sum payment first requires the approval of the insurance company, which gives opportunity for dickering, not in conformity with the spirit of the law.

Lump sum settlements are figured in accordance with the following table:

-

Present Value at 4 Per Cent. Interest, compounded annually, of the Remainder of an Original Benefit of $1 per Week for 300 Weeks.

Explanation.

If the weekly compensation has been paid for a period of 28 weeks, the table shows that the value of $1 for the balance of the period is $242.87. If the weekly payment is $6 the lump sum value of the balance due under the Workmen's Compensation Act is 6 X $242.87 or $1,457.22.

THE MEDICAL AND WAITING PERIOD.

As has already been shown, the average compensation under the act for injuries that last more than two weeks is less than $5.50 a week. During the first two weeks after the injury the injured workman is entitled to his reasonable hospital and medical services, to be paid by the insurance company. The waiting period for compensation was put in the law to prevent malingering, and because of the fear that if compensation began immediately after the injury it would give rise to unwarranted claims, on the basis of trifling injuries, under the act. While the chapter on malingering in this report will indicate that the Board has given full consideration to this important subject, there is no doubt that if the injury continues more than two weeks the medical attention provided is not sufficient to keep the employee from being a subject of charity, and is very much less than most of the other States have provided.

Michigan (section 4, Part II.) gives three weeks' medical

attention.

Illinois (section Sa) provides necessary first-aid surgical and hospital services for a period not longer than eight weeks, not to exceed in amount $200.

Minnesota provides medical and surgical treatment, medicine, medical and surgical supplies, crutches and apparatus as may be reasonably required at the time of the injury and thereafter during the disability, but not exceeding ninety days, to cure and relieve from the effects of the injury, the same to be provided by the employer, and in case of his inability or refusal seasonably to do so, the employer to be liable for the reasonable expense incurred by or on behalf of the employee in providing the same, provided that the total liability shall not exceed the sum of $100; except that the court may, during said period of ninety days, upon necessity being shown therefor, require the employer to furnish such additional medical, surgical and hospital treatment and supplies as may be reasonable, which together with any such sums or relief theretofor furnished, shall not exceed in all $200 in value.