treatment. However, employers did recognize the considerations in favor of permitting the employee to select his physician whenever he cared to exercise a choice, and it is generally the practice even in the States that permit the employer or the insurance company to select the physician to recognize and adopt the wishes of the employee whenever he gives expression to them. The arguments offered by employers against being compelled to pay the bills of the physician selected by the injured person are that the physician, having no relation with the person who must pay the bill, would be more likely to be indifferent as to whether his charges were fair, and that the employee who selected him, not being called upon to pay the bill himself, would be at least indifferent, if not willing that the physician should either overcharge or make unnecessary visits.

In an effort to meet the situation, a group of manufacturers of Detroit have organized what is known as the Manufacturers' Mutual Hospital Association, the purpose and plan of which was described to this commission by one of its officers as follows:

With the passage by the State of Michigan of an employers' liability and workmen's compensation law, which became effective September 1, 1912, there immediately arose the necessity for more adequate hospital facilities for the care of injured workmen. Not that industrial accidents would increase through the passage of this act, but because the responsibility of medical and surgical care for the injured was placed directly upon the shoulders of the employer for the first three weeks following the accident.

Through the passage of this law, insurance rates immediately became much higher than heretofore, and a large number of empolyers decided it to be to their best interests to carry their own insurance.

Realizing the shortsightedness of providing medical aid for an injured workman for but three weeks, and then turning him loose to shift for himself, thereby inviting additional treatment for the man of sundry and various sorts, all tending toward the lengthening out of a compensation period, thereby entailing additional cost, a number of Detroit manufacturers got together, and the Manufacturers' Mutual Hospital Association was formed.

A building at 484 Jefferson Avenue was secured, being fairly centrally located to the manufacturers along the river front, who were the originators of the project, and it has been completely equipped as a hospital. The building contains 27 rooms, 6 baths, is steam heated, electrically lighted, has large grounds, and with front and rear entrances. The wards are large, light, and well ventilated, and the private rooms are exceptionally fine, due to the fact that the building was at one time the home of one of Detroit's most representative men.

The staff consists of men of recognized ability, graduates of Yale, Cornell, and Johns Hopkins Universities, to which has been added considerable hospital experiThis immediately insures service of the highest quality.

ence.

The hospital association is organized on a mutual plan, the members being assessed on the number of their employees. Assessments are based on actual expenses, and rebates will be made should more funds be collected than absolutely necessary. The method of handling the injured is as follows:

An accident occurs in the establishment of a member, the injured party is immediately taken to the hospital, where proper aid is rendered. If the injury be of a serious nature, he is immediately assigned to a ward or room, and is then taken care of until he has entirely recovered and is able to report back to work.

Should the injury be of a minor nature, not necessitating a stay at the hospital, he is sent to his home, provided that conditions at his home in the way of sanitation, etc., are favorable to his condition. If not, he is kept at the hospital.

These cases sent to their homes are instructed to return daily to the hospital for treatment, but if they are unable to do this a physician will call as often as necessary, and treat them at their homes until they are either able to report at the hospitals for further treatment or to return to work.

In addition to the staff of physicians, both in and outside, an inspector is employed, whose duty it is to keep track of all cases that are being treated at home or that come to the hospital, follow them up in change of address, bring them to the hospital if they do not report as instructed, make reports through the hospital to the employer, and in every way safeguard the employer's interests, so that the men receive the

very best medical and surgical care and are returned to work within the least possible time.

A complete record of cases is kept at the hospital, such as history sheets, treatment and call records, full data regarding the nature of the accidents, and in fact everything pertaining to each and every case. Should a difference arise between the employee and employer, making arbitration necessary, this detail information is immediately available.

This hospital plan is only a part of the general campaign of education by which we are endeavoring to teach the workmen that their interests are identical with those of the employer; that the employer is making every effort to work for their betterment in various ways, such as proper safeguarding of all machinery and dangerous places, giving them light, well ventilated, sanitary places to work, paying the highest possible wages, and taking care of them when injured, realizing fully that such a course tends toward increased loyalty on the part of the workman, bringing about a closer cooperation and gradually decreasing the width of the chasm which has long existed between capital and labor.

XIX. WAITING PERIOD.

All of the States except Washington and Oregon prescribe a waiting period beyond which disability must extend before compensation begins. The waiting period is one week in Texas, West Viriginia, Wisconsin, and Ohio, and two weeks in Rhode Island, Nevada, New Hampshire, New Jersey, New York, Kansas, Massachusetts, Michigan, Minnesota, Nebraska, Arizona, California, Connecticut, and Iowa. In Nevada, where the period was originally 10 days, it was made two weeks by amending the statute, and in the new California act in effect January 1, 1914, it has been made two weeks, where it had been one week before.

The commission found differences of opinion as to what constitutes a proper waiting period. Employees engaged in a line of work in which most of the accidents are slight look upon the wating period as unfair, while employees engaged in hazardous work, where accidents, if any, are of a serious nature, take but little interest in the length of the waiting period, except to ask that in case the disability extends beyond a certain term the right to compensation shall begin at the time of the accident, as has been done in several of the States. The statute of Wisconsin provides that where the disability lasts for more than four weeks the compensation relates back to the date of the accident. In Michigan and Nebraska the same rule prevails except that the disability must last for eight week; before the right to compensation from the date of injury exists. The Illinois statute provides that in case the incapacity is permanent the right to compensation begins on the day after the injury. Many employers stated to this commission that the waiting period should be no longer than one week, but these were usually engaged in lines of work not involving serious accidents; in fact, in these employments, as one employer put it, "If we did not pay for small accidents, there would be no accidents for us to pay for." It quite frequently happens that this class of employers, without being required by law to do so, pay employees injured from the time of the accident and ignore the waiting period.

As a rule, workmen, even in the less hazardous industries, stated that they would rather have the compensation increased for the serious accidents than to have the waiting period reduced below two weeks; and that a man could better stand an occasional loss from inability to work during a short period if he were assured that he would receive adequate compensation for all serious injuries.

Some idea of the proportion of accidents which would be brought under the compensation act by reducing the waiting period from two weeks to one is shown by the statistics of the board of awards in Ohio, where the waiting period is one week. Out of 5,115 cases entitled to compensation, 1,128 were disabled more than one week and less than two. From the statistics of the Industrial Insurance Commission of Washington it appears that out of 12,380 accidents occurring in that State during the year ending October 1, 1913, 1,681 involved a disability of less than one week, and 3,157 covered a disability of more than one week and less than two weeks, so that more than a third of the accidents in the State, for which employees were paid, involved a disability of less than two weeks. In Massachusetts out of approximately 71,000 accidents occurring in the first year about 67,718 involved a disability of less than two weeks. These figures can not be compared, of course, with the figures given above in the other States for the reason that the number here given as incurring a disability of less than two weeks includes those workmen who were injured but not prevented from working as a result of their injuries, while in the States given above there was an actual loss of time. In California, out of 6,150 accidents coming within the jurisdiction of the industrial accident board, 2,409 involved a disability of more than one week and less than two weeks.

Some workmen are more or less influenced in their attitude toward the length of the waiting period by the nature of the injuries common in their respective occupations. Others have formed a judgment on experience with the act in their State. In Washington, where there is no waiting period, one of the commissioners stated to this commission that it would be better if there were a waiting period of two weeks, provided medical expenses were paid for by the employers and increased compensation given the workmen in the serious cases. The compensation in Washington averages about 40 per cent of the Aside from the question of fraud, which may occur with no waiting period, is the expense connected with handling the small accidents, which is as large as the amount of money involved, if not larger.

A trade union representative in Massachusetts was of this opinion: The waiting time should be reduced to 10 or 7 days. Compensation should begin with date of accident when the injured person is entitled to any compensation; that is to say, when the injury extends beyond the waiting period compensation should be paid from the date of the accident.

From a representative of a Michigan trade union:

Speaking for the beer bottlers, I will say that they are not very much benefited by the compensation act. For instance, one of our workers is injured by the explosion of a bottle. He is unable to handle the bottles by reason of a cut on his hand and he is not so severely injured that he requires the services of a physician. He is laid off for about two weeks and receives no compensation. I believe some steps should be taken whereby the waiting period be reduced to one week instead of two. In some cases the waiting period should date from the time the man received the injury.1 A representative of the Employers' Association of Ohio said:

The employers are of the unanimous opinion that there should be a waiting period and that a reasonable time should be fixed to determine whether or not an injured employee is feigning injury.

f Simple safeguards, at small expense to the employer, would practically eliminate such accidents.

From a representative of a Michigan insurance company:

I think the 14-day waiting period is all right, especially if you take into consideration the fact that the injured person will receive compensation for the first 14 days, provided the period of disability extends beyond eight weeks.

A Massachusetts employer said:

I think the time for compensation should begin after the first week and not the second, as this is a hardship on many employees.

XX. AMOUNT OF COMPENSATION.

The amount of compensation varies in the different States from 50 to 663 per cent of the wages of the injured employee, with besides stated allowances for amputations and certain other specified injuries. While the employers in States paying but 50 per cent of the workman's wages regard their assessment as fair and are fearful of the consequences of increasing it, this commission has not heard much criticism from employers in States in which a higher rate of compensation is paid. In fact, in the latter States there does not seem to be any more complaint about the cost than in States paying but 50 per cent. A representative of the Employers' Association of Cleveland, in response to an inquiry as to how the employers regarded the payment of 663 per cent of wages for compensation, said:

In the first place, there was considerable opposition to that feature; but at the present time I think our members are satisfied with that provision of the law. They have become educated more and more since the law has been in force. The more enlightened our members have become on that subject the better pleased they are with it.

The principal points raised by employers with regard to cost were to have the amount of compensation definite and certain, to have uniformity in the different States, and to have the statutes so drawn as to avoid uncertainties and litigation with its consequent waste. This was well expressed to the commission by a representative of the Illinois Steel Co. when he said:

I will say that I have so much faith in compensation acts that I do not think it makes much difference how long the payments run, or what the amount of the payments may be, because the payments are distributed over the whole industrial community, and I might say over the whole Nation, in the long run. should be a uniformity as to the amounts paid in the different States.

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The commission found no demand on the part of employers in the States paying a rate of compensation higher than 50 per cent for reduction or other change of the amount under their specific law. The States paying more than 50 per cent for compensation are: California, 65; Nevada, 60; Ohio, 66; Texas, 60; Wisconsin, 65; and New York, 663; while in all the other States, except Washington, the compensation is on a 50 per cent basis. In Washington, where the compensation is a specific monthly sum, the statistics of its industrial insurance commission show that the payments under the law average about 40 per cent of the employees' wages, which is the lowest rate of compensation.

The commission found a growing demand in the different States in favor of so extending the compensation period in cases of total permanent disability as to cover the lifetime of the unfortunate victim. This demand has been recognized in the statutes of several of the States. That employers and workmen are commencing to realize

that injuries of this kind, and in fact all serious injuries (rather than the minor ones), are those most requiring compensation manifested itself in the recent change in the policy of California. In its new compulsory act that State changed its waiting period from one week, under the old statute, to two weeks, and the compensation in cases of total permanent disability was extended through life. It is estimated by the California officials that this change will not add to the burden of the employer, the amount saved by changing the waiting period from one week to two covering the increased cost of the life provision in total permanent disability cases. This was agreed to by the workmen in that State, who felt that they could better stand the temporary injuries of two weeks' duration than those incapacitating them for life.

In considering the amount of compensation payable under a statute, the percentage of wages is but one element. Most statutes prescribe a maximum weekly amount, which varies in different States. Of course, under high wages, increasing the maximum will increase the total amount of compensation more than it will under low-wage rates. In Massachusetts an increase in the maximum, which is now $10 a week, would have affected only about 7 per cent of the employees injured during the year ending June 30, 1913, as only that percentage of those injured during that period were receiving more than $20 per week. In some States payment is limited to a certain definite number of years even in case of widowhood or for permanent total disability, while in others compensation is paid during the entire period of incapacitation.

Efforts are being made in some of the States to work out a schedule of compensation along scientific lines, so as to take into consideration the age of the employee, the effect of the injury upon his particular trade or occupation, and other varying conditions. The latest Wisconsin statute provides that in the case of permanent injury to an employee who is over 55 years of age, compensation shall be reduced by 5 per cent; in case he is over 60 years of age, the compensation shall be reduced by 10 per cent; and in case he is over 65 years of age, by 15 per cent. The recent New York statute provides that

If it be established that the injured employee was a minor when injured, and that under normal conditions his wages would be expected to increase, the fact may be considered in arriving at his average weekly wages.

Under this provision, compensation could be increased accordingly. The California statute arranges a schedule depending upon the percentage of disability and provides that, in determining such percentages, account shall be taken of the nature of the physical injury or disfigurement, the occupation of the injured employee, and his age at the time of such injury. Under such a statute, a disability which interferes with the injured person carrying on his particular trade or occupation will be considered as involving a greater percentage of disability than a similar injury inflicted upon a person engaged in an occupation either not affected by the injury or affected to a less

extent.

The Massachusetts Industrial Accident Board, in its report for the year 1913, states that it considers that the California law provides the most scientific method of computing partial disability, and that it hopes to present a similar schedule for the consideration of the Massachusetts Legislature.