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THE DANGERS OF WORKMEN'S COMPENSATION. The Industrial Accident Board would not feel it had done its full duty to the Legislature if it did not call attention to the conditions which have shown, especially in Europe, a tendency to sap the vital elements of character and check the growth of the qualities of the highest value in national development, because when all is said and done the material well-being of the wage earner depends as largely on his character as it does on the regulations which laws impose, or assistance which Legislatures can give. No innovation begun by a State can be stopped at any one's pleasure or regulated according to the original intention.

One of the logical but most unexpected developments of the Workmen's Compensation Act was shown almost immediately in the throwing of aged and infirm employees out of industry to reduce the cost to certain employers of insurance premiums. One company in Massachusetts, after a physical examination, discharged 22 employees, who were either aged or under par physically, within a few weeks after the act went into effect. For instance, employees found with varicose veins, hardened arteries and advanced in years, if injured, would not be likely to respond to treatment, and a trifling injury might result in payment for total disability under the act. Epileptics and others who, by reason of their infirmity, would be likely to be injured in their occupations, when discovered, find employment more difficult and in some cases impossible.

The State which has thrown these employees out of work will eventually be asked to make provision for them, although the danger of acts providing for non-employment insurance and superannuated insurance is so obvious that they need not be here discussed. However, because such legislation is dangerous, and, if adopted, would necessarily result in a great burden to the State, it should be studied, and if possible, b.y providing against the need of it, make such laws unnecessary.

Workmen's compensation acts have been effective in some of the European States for thirty years or more. It is alleged, with substantial proof, that workmen's compensation acts have been followed by successful attempts at malingering, it being more difficult year by year to get injured workmen cured of their injuries. The growth of new forms of nervous diseases arising out of workmen's compensation acts had begun to attract attention in Germany as long as twenty years ago. European doctors are accused of using irregularly the workmen's compensation act as a form of revenue; some of the workmen are accused of exploiting their accidents, - a process so human and easy to understand that it is a proceeding quite normal and psychical. It does not follow that all these cases of simulation are wholly fraudulent, because there is nearly always ground for making the original claim. German literature on this subject gives the case of a man who hoodwinked the insurance authorities in Berlin for the payment of 50 per cent. of his average weekly wages for a disability arising out of industry, and who was accidentally discovered to be following the occupation of an acrobat in Alsace. Another case has been quoted where a man drawing disability payment for an injured elbow, at the same time, under another name, was earning a living as a pugilist.

These cases are not manifesting themselves in great numbers in Massachusetts, but there are already indications that before long they will be of sufficient importance to constitute a problem. Such cases involve aliens of a certain type, temperamentally nervous; alcoholics, whose vital energy and stamina have become undermined; the subnormal; neurotics and those suffering from various forms of nervous diseases. The lazy and incompetent, the failures in industry, may prefer, after injury, to receive one-half their average weekly wage for an indefinite period rather than try to get work at their old or in any occupation.

The object of the act is to return people to industry; one of the effects of the act is that people refuse to go to work while they are in pain. Before the act went into effect the uninsured workman with a broken leg, whose muscles became contracted and partially atrophied because of the fracture, was forced by

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National Insurance and National Character," Edinburgh Review, July, 1913.

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.

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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:

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