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Date of reporting----

To be forwarded to the Department of Labor, Trenton,

On the

NEW JERSEY.

(Name of person injured.)

____day of_‒‒‒‒‒‒

Is this first or second REPORT of this case?

Is there another report of this case to FOLLOW?

Was injured subject to SECTION 1 or 2 of the Liability
Law?

Did the injury REQUIRE medical aid?

Was medical aid SUPPLIED in accordance with law?

State approximate COST of medical aid.

Has, or will, this employé, or dependents, receive
COMPENSATION weekly?

If so, how MUCH per week?

And for how MANY weeks?

In case of death, with no dependents, state cost of last sickness and BURIAL.

State TOTAL to which it will amount for all items, paid and to be paid.

19---

(Signature of Insurance Co.)

Sec.

CHAPTER XIV.

THE CALIFORNIA WORKMEN'S COMPENSATION ACT.

262. The nature and scope of

the act.

263. The California act and its

construction by the board. 264. Reports of industrial accidents.

265. Rules of practice of the industrial accident board of California.

266. The formal procedure under the act.

267. Forms to be used by employers.

268. Form of employer's written acceptance of the provisions of the act. (a) 269. Form of employer's withdrawal of acceptance of provisions of the act. (b) 270. Form of notice that employer has accepted the compensation provisions of the act. (c)

271. Form of employer's first report of accident to employé. (d)

272. Form of employer's supplemental report of accident to employé. (e)

273. Forms for employés. 274. Form of notice by employé

of election not to be subject to the provisions of the act. (f)

- Sec.

275. Form of notice to employer of claim for compensation for injury under act. (g) 276. Forms for hearings before board.

277. Form of notice of filing of application for adjustment of claim. (h) 278. Form of notice of hearing of application for adjustment of claim. (i) 279. Form of subpoena for witness to appear before industrial accident board. (j)

280. Forms to be used by physicians.

281. Form of physician's report of accident to employé. (k)

282. Form of request for report of accident. (1)

283. Form of request for fuller report of accident. (m) 284. Form of notice to doctor to file report. (n)

285. Forms to be used by casualty companies.

286. Form of first accident report of casualty company. (0)

287. Form of supplemental ac

cident report of casualty company. (p)

§ 262. The nature and scope of the act.-The California act is an adaptation of the Wisconsin statute with

slight modifications. Briefly stated, it abolishes the defenses of fellow servant and assumption of risk and establishes the doctrine of comparative negligence in actions for injuries to employés. The employer is denied the right to exemption from liability under contracts, rules or regulations. Where the employer elects to be bound by the statutory compensations and his employé does not notify the employer of his unwillingness to be bound thereby, then the compensation for injury or death is that fixed by the statute unless the injury is due to the personal gross negligence or wilful personal misconduct of the employer or his violation of a statutory duty. Where the injuries are due to these causes, the employé may, at his option, claim compensation under the act or, he may sue his employer and the employer may interpose only the single defense of comparative negligence. Compensation will be denied the employé where the injury is the result of his own wilful misconduct.

§ 263. The California act and its construction by the board. The act is entitled, “An act relating to the liability of employers for injuries or death sustained by their employés, providing for compensation for the accidental injury of employés, establishing an industrial accident board, making an appropriation therefor, defining its powers and providing for a review of its awards." The act was approved April 8, 1911, and became effective September 1, 1911. It provides:

Section 1. In any action to recover damages for a personal injury sustained within this state by an employé while engaged in the line of his dutý or the course of his employment as such, or for death resulting from personal injury so sustained, in which recovery is sought upon the ground of want of ordinary or reasonable care of the employer, or of any officer, agent or servant of the employer, the fact that such employé may have been

guilty of contributory negligence shall not bar a recovery therein where his contributory negligence was slight and that of the employer was gross, in comparison, but the damages may be diminished by the jury in proportion to the amount of negligence attributable to such employé, and it shall be conclusively presumed that such employé was not guilty of contributory negligence in any case where the violation of any statute enacted for the safety of employés contributed to such employé's injury; and it shall not be a defense:

(1) That the employé either expressly or impliedly assumed the risk of the hazard complained of.

(2) That the injury or death was caused in whole or in part by the want of ordinary or reasonable care of a fellow servant.

Note by board-The foregoing section abolishes the common-law doctrine of assumption of risk and the fellow-servant rule, and modifies the defense of contributory negligence, thereby increasing the liability of the employer in excess of 300 per cent.

This portion of the act is not elective and applies to every employer. In an action at law, there is no limit placed upon the amount of damages that may be recovered for personal injuries sustained. If, however, an employer elects the compensation schedule fixed by the succeeding sections of the act, the amount that may be recovered by an injured employé is limited to the scale of compensation specified in section 8 of the act. In determining whether or not he will elect compensation, a prudent employer will take into consideration his increased liability, the present tendency of the courts and juries to allow heavy damages for personal injuries, and the fact that the ordinary indemnity insurance is limited to $5,000 for a single injury and to $10,000 where more than one person is hurt through a single accident. The New York Commission investigated two hundred and thirty-four fatal cases, and found that 2.1 per cent. of the recoveries allowed were in excess of $5,000. Statistics show that when an accident causes permanent disability, a larger sum is awarded the injured than is paid where the accident results in death. This is exemplified by the recent decision of the Supreme Court of the State of California, affirming a judgment for $70,000, which, together with accrued interest and costs, amounted to $92,000. These instances plainly show that insurance under the old system of employers' liability is wholly inadequate, and that

only through compensation, with its limited risks, can the employer be fully protected.

Section 2. No contract, rule or regulation, shall exempt the employer from any of the provisions of the preceding section of this act.

Note by board-This section makes it impossible for an employer to avoid liability for damages by obtaining from his employé, as a condition precedent to employment, a waiver of liability which would impair the employé's rights under this act.

Section 3. Liability for the compensation hereinafter provided for, in lieu of any other liability whatsoever, shall, without regard to negligence, exist against an employer for any personal injury accidentally sustained by his employés, and for his death if the injury shall approximately cause death, in those cases where the following conditions of compensation concur:

(1) Where, at the time of the accident, both the employer and employé are subject to the provisions of this act according to the succeeding sections hereof.

(2) Where, at the time of the accident, the employé is performing service growing out of and incidental to his employment and is acting within the line of his duty. or course of his employment as such.

(3) Where the injury is approximately caused by accident, either with or without negligence, and is not so caused by the wilful misconduct of the employé.

And where such conditions of compensation exist for any personal injury or death, the right to the recovery of such compensation pursuant to the provisions of this act, and acts amendatory thereof, shall be the exclusive remedy against the employer for such injury or death, except that when the injury was caused by the personal gross negligence or wilful personal misconduct of the employer, or by reason of his violation of any statute designed for the protection of employés from bodily injury, the employé may, at his option, either claim compensation under this act, or maintain an action

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