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their children among the working classes unless the parents need the support. They are wholly dependent upon their children because they can't help being so, and the children support them because they must be supported. Parents of the well-to-do may enjoy the luxury of being supported by their children when such support is not actually necessary, but this is not true among the working classes. The second fact is that parents and grandparents are always old, and frequently die before the 300 weeks' compensation period elapses. The first of these facts brings home the inadequacy and injustice of the provision; the second reveals that the employer not only gains by the low percentage in these cases but also frequently by the death of the dependent. Dependent husbands, parents and grandparents are more apt to actually suffer because of the pitiful compensations provided by our act than many widows are.
Brothers and sisters are wholly dependent on a brother or sister under one of three sets of circumstances. They are either young and in school; or a sister is home keeping house while her brother or sister earns an income for both; or they are incapacitated from earning. ' In either case it is perfectly clear that it is neither just nor expedient to limit their compensations to 25 per cent of the deceased's wage. They are wholly dependent and should receive an adequate compensation.
RECOMMENDATION FOR DECREASE OF WAITING PERIOD.
We recommend that the words “two weeks” be stricken out of section 17, and the word "week” inserted, which will make the first clause of the section read as follows:
"In cases of temporary total or temporary partial disability no compensation shall be allowed for the first week after injury received.”
A two weeks' waiting period is too long, especially when coupled with our 50 per cent rate of compensation. In the case of lesser injuries which heal up within the two weeks we believe that it is unfair to compel the workman to lose his entire wage for two weeks. A number of employers in the state pay full wages from the day of injury because they feel it is both unfair to workman and unwise for the employer to force the workman into debt.
The burden of the waiting period is even more severe when the disability lasts a month, two months, three months. We have already shown (table “A”) that at the present time the workman receiving between $13 and $22 per week, who constitutes 45 per cent of all workmen compensated under our act (see statistical report), receives 25 per cent of his wage loss during the first four weeks of his disability, 33 per cent at the end of the first six weeks and 37 per cent during the first eight weeks.
Every study which has been made in this country of workingmen's family expenses has agreed that approximately 20 per cent of the workingman's wages goes for rent; that from 30 per cent to 60 per cent goes for food, depending upon the size of the family and the amount of the weekly income; and that approximately 6 per cent goes for fuel and light. Persons disposed to question the accuracy of these figures can abundantly satisfy themselves on the point by reference to the footnotes. (1)
We will cite in detail only the figures obtained in the Minnesota in vestigation of 1909, which was under the management of the British Board of Trade with the co-operation of this department. Typical workingmen's families were studied in St. Paul, Minneapolis, Duluth and twenty-six of the smaller cities of the state. It was found (2) that the families studied in St. Paul spent on an average 19.9 per cent of their income for rent; those in Minneapolis 17.2 per cent; those in Duluth 18.21 per cent; those in the
(1) Chapin "The Standard of Living Among Wage Earner's Families in New York City"; Byington “Homestead, the Households of a Mill Town"; Minnesota Department of Labor Twelfth Biennial Report, pp. 559-68; U. S. Report on "Women and Child Wage Earners in the United States”; Vol. XVI "Family Budgets of Typical Cotton Mill Workers.”
(2) Twelfth Biennial Report, Minnesota Bureau of Labor, p. 550.
two groups of smaller cities, 12.62 per cent and 16.52 per cent. The average percentage of income spent for rent in the state was 16.51 per cent. For families earning from $10 to $14.99 per week this percentage rose to 20.3 per cent, and for those earning from $15 to $19.99 was 19.7 per cent. The amounts spent for food by families earning from $10 to $14.99 was 56.2 per cent of the income, and for incomes of $15 to $19.99 it was 45 per cent.
If a workman's rent constitute about 18 per cent of his income, and he receives compensation during the first month of disability equal to 25 per cent of his wages, it is apparent that the first month's compensation pays his rent, fuel and light, and leaves him in debt for his food and all other necessities of his family.
During the second month he receives 50 per cent of his wage loss. This pays his rent, fuel and light, and probably about one-half of his food and other necessities. At the end of the second month his compensation has paid for his rent, fuel and light, and about one-third of his food costs. Each successive month is a repetition of the second. The longer the disability lasts the deeper the family must go in debt, or else the wife or children must go out to work.
The reduction of the waiting period to one week would give the workman an extra week's compensation at the time when it will do him the most good-at the beginning when it may enable him to avoid serious debt.
Twenty-two of the states have a two weeks' waiting period and Colorado has a three week. But Alaska, Michigan, and Nebraska provide that compensation shall be paid from the day of injury if the disability lasts more than eight weeks, and Arizona and Nevada that it shall be paid from the day of injury if his disability lasts more than two weeks. When closely examined the Arizona and Nevada' provisions are found to be more liberal to the workman than a one-week waiting period. These retroactive features - reduce the number of real two week waiting periods to seventeen.
Connecticut and Wyoming have à ten day waiting period, and Illinois, Nevada, Ohio, Texas, West Virgina, and Wisconsin a one week. Wisconsin also has a retroactive clause which provides that if disability lasts more than four weeks compensation shall be paid from the day of injury. Oregon has no waiting period at all.
We cite these figures simply for the legislature's 'information. We recommend a one week waiting period because it is right, and not because some other state has one. There are enough laws in operation with one week waiting periods to prove the recommendation practical, and we believe that the considerations we have already advanced are sufficient to prove that it is right. The total additional cost to the industries of the state would not exceed $60,000 a year. The figures given in the statistical portion of this report show that it would probably be considerably less.
RECOMMENDATIONS ON MEDICAL BENEFITS. Those portions of a compensation act which determine the amount and quality of the medical care received by the injured employe are of the first importance. Some states have been extremely short sighted in this particular and have either provided no medical care or extremely inadequate
The Minnesota act has always been among the more liberal acts in this respect, but is not as liberal as the laws of Connecticut, Oregon, California, Nevada and Wisconsin. Conneticut is, in our opinion, the only state which has really dealt with the matter properly. All of the others have proyided an arbitrary limitation of one kind or, another in a matter which should have no limitations except the needs of the employe.
This department has watched the operation of the medical provisions of our act very closely during the three years that the law has been in oper-ation and we now desire to recommend as forcefully as we possibly can that the legislature of 1917 strike out the first paragraph of section 18 of the Minnesota act and substitute for it a new paragraph similar to the portion of section 7 of the Connecticut law quoted below:
(Chapter 138, Acts of 1913, State of Connecticut as amended by Chapter 288, Acts of 1915.)
“The employer, as soon as he has knowledge of any such injury, shall provide a competent physician or surgeon to attend the injured employe, and in addition shall furnish such medical and surgical aid or hospital service as such physician or surgeon shall deem reasonable or necessary. In the event of the failure of the employer promptly to provide such physician or surgeon or medical, surgical and hospital service, the injured employe may provide such physician or surgeon or medical, surgical or hospital service at the expense of the employer; or at his option the injured employe may refuse the medical, surgical and hospital service provided by his employer and provide the same at his own expense.”
In other words, this department recommends that the employer be required to provide the medical care necessary to cure the workman from the effects of the injury, as far as such cure is possible.
Reasons for This Recommendation. Our 1913 legislature wisely took the position that the first and most important need of an injured workman is adequate medical attention, and we have no doubt that it would have enacted a medical clause such as we are recommending if at that time it had been possessed of the facts we will now present in this report. The legislature of 1913 enacted section 18 with a money limit ($200.00) and a time limit (90 days) for medical care because no one knew at that time how many cases out of a thousand would create large medical costs or what the average cost of medical care for accidents would be under a compensation act, and because there was a fear that the doctors might try to impose exorbitant charges upon employers in accident
The facts we will give in a moment show that large medical costs occur in but very few of the cases and that the average cost of medical care, both in Minnesota and in the other states, is small. The experience of this department and the testimony of the other states indicate that the fear that the doctors will attempt to rob the employer is likewise without foundation. We have had many more complaints that employers were attempting to evade their liability for the medical care of the employe than we have had doctors trying to collect fees to which they were not entitled. There have been cases in which doctors have unquestionably tried to collect unduly large fees, but in every one of those cases a frank discussion of the matter between the doctor, this department and the employer or 'insurer has adjusted the matter to the mutual satisfaction of the interested parties and without recourse to legal methods.
The medical division of the Ohio Industrial Commission states (1) that actual fraud in the rendering of a physician's bill for services is almost unknown in their experience, and that there had been but a few out of 60,000 handled by the commission in which the physician attempted to collect more than was due him.
The second paragraph of section 18 of the Minnesota act, which limits the employer's liability for medical charges “to such charges as prevail in the same community for similar treatment of injured persons of a like standard of living when such treatment is paid for by the injured persons," and which gives the district court power to cut down an excessive bill rendered by a physician or hospital is an effective bar against any effort of physicians to charge exorbitant rates in workmen's compensation cases.
An even more effective check on any such tendency, if it existed, is the fact that it is the employers or their insurers who select the doctors who care for injured workmen, and these employers and insurers will not permit injured workmen to be cared for by physicians whom those who pay the bills consider unfair. This economic check has proved more effective in dealing with this bug-a-boo that has made some people fear a medical clause such as we have recommended than any legal check which can be devised.
(1) Bulletin of Industrial Commission of Ohio, Vol. 1, No. 6, p. 30.
The plain facts are that physicians are practicing a profession by which they earn a living, that they cannot earn a living unless they can get work to do, and that they can not afford to antagonize those who can send them work. If a physician attempts to charge an excessive fee in an industrial accident case it simply eliminates him from the group of physicians who will be hired for such work. We have seen these forces operate to practically eliminate several physicians from this field of work during the past three years, and we consider the fear that physicians will charge excessive rates if the $200 limit is removed as unfounded in fact. Employers and insurers meeting at their clubs, places of business, etc., are bound to discuss their experiences under the act and to pass the knowledge on from one to another that a certain physician tends to charge more than others do for the same work.
There have been some cases where bills which would have run a little above $200 have been reduced to $200 by the physicians and hospitals out of sympathy for the injured workman. The medical men did part of their work for nothing rather than collect a part of their bill from a man terribly injured and trying to support a family on $6 or $8 dollars a week. But we question whether it is sound public policy to maintain the $200 limit simply because it enables insurance companies, and in occasional cases employers, to get the services of physicians without paying for them.
Need for Complete Medical Care for Injured Men. The greatest need of an injured man is unquestionably adequate medical care.
And care is not adequate which throws a man who has been seriously injured upon his own resources as soon as $200 has been used up or ninety days has expired. Take the case of a man who had both legs fractured. He was earning $15 a week. He is sent to a hospital. The doctor charges $50 for setting the bones in his legs and $2 a daily visit. The hospital charges $15 a week and for a week he has a special nurse at $25. Allow $10 for the use of operating room and for dressings during the first week. At the end of the first week his medical bills are $114. At the end of the second week they are $143, exclusive of any charge for medicines, dressings, etc. At the end of the third week they are $172. He is moved to the ward at $9 a week. The physician now comes but three times a week. At the end of the fourth week $187 is gone and at the end of the fifth week the whole $200 is gone.
The man must now provide his own medical care. Let us then examine his situation. He has a wife and three children. He rents a house for $15 a month. At the end of the fourth week his wife has received in compensation one-half his wages, beginning the first day of the third week. She has received at the end of the fourth week, $15. This pays her house rent for the month that her husband has been laid up. For food, clothes and miscellaneous expenses she has either had to run in debt or resort to some income other than her husband's compensation. At the end of the fifth week, when her husband's medical care at the employer's expense terminates, she has received $22.50 as compensation. She and her husband must now face the task of completing his medical care and supporting the family. on $15 a month, which is what is left after the rent is paid. And he faces a disability of at least sixth months—perhaps eighteen months or two years.
Someone who reads this illustration will say that it is an extreme
On the contrary it is a conservative illustration. We can cite cases far more distressing: The crux of the matter is that a medical section which limits the employer's liability to a certain sum or a certain period of time operates in exact opposition to the fundamental theory of a workmen's compensation law. Compensation is based on the theory that the industry ought to repair the damage it does; the theory that the repair of an injured workman is as legitimate a charge upon the industry as the repair of an injured machine or tool. Limited medical care furnishes adequate care for the man slightly injured, who needs it least, but leaves the man who is very seriously injured and who needs it most with inadequate care. With adequate care these men can frequently be brought back to a good measure of working efficiency. Without it, they cannot. And it is perfectly certain that adequate care cannot be purchased by a workman who is trying to support a family out of the income provided by the compensation act.
We have already stated that it is our belief that the legislature of 1913 would have enacted the clause we recommend if it had been possessed of the information now at our disposal. We herewith present the information referred to. We will first show that the number of cases in which medical costs run above $200 is so small that the adoption of the recommendation would not add an appreciable burden to the employers' costs under a compensation act.
There were 11,619 accidents under the compensation act reported in Minnesota in the year 1914-15 and 12,968 in the year 1915-16. Between 40 and 50 per cent of these were handled by firms who hire their doctors and hospitals on an annual contract plan and provide complete medical care, and who entirely disregard the $200 and 90-day limits fixed by section 18 of our act. The rest were the accidents of employers (and their insurers) who hire and pay a doctor for each specific case. Only 72 of nearly 7,000 cases handled on the case plan in 1915-16 caused medical bills amounting to $200, and only 41 caused medical bills in excess of $200. (1) In 31 of these 41 cases the excess over $200 was paid by the insurer; in four cases the excess was paid by the employer and in the other six excess was paid by the injured. Another case should have cost in excess of $200, but the city hospital furnished the balance of the treatment free. In one of the cases where the injured paid for the excess the medical costs amounted to $423.70, in another to $357.38, and in a third to $1,100. In all three of these the insurer escaped with the payment of only $100 by availing himself of the technicalities of language in section 18. In the other three cases where the injured paid only the excess above $200 the bills were $459, $366.90 and $252.40. In two other cases where the medical costs amounted to $200, and in a number of cases where it was between $100 and $200, the insurers paid only $100 by resorting to the same subterfuge, namely, that the injured had not secured an order of court within 90 days requiring the excess payment.
Someone who reads the foregoing discussion may point out that the injured were required to meet the excess medical charges in only six of the 72 cases where medicals were $200 and over, and that the figures do not, therefore, constitute proof that the amendment suggested should be adopted. On the contrary, this fact constitutes the most conclusive link in our claim of proof. The fact that the employers and insurers are now voluntarily paying the entire cost of medical care in far more than 90 per cent of the cases (if we include the cases of those who furnish complete medical care on an annual contract plan) that require medical expense in excess of $200 is absolute proof that the amendment suggested is reasonable and would not be financially burdensome to them. The fact that they do not always assume the entire cost of the medical care and that seriously injured workmen are in some cases thrown on their own resources to pay their pittance of compensation to the doctor or else do without adequate care is sufficient reason for compelling the employer to assume this cost in the balance of the cases.
We have already shown that the number of cases where medical care costs more than $200 is so small that no increase in insurance rates can legitimately follow an amendment requiring the employer to furnish all the medical care necessary for injured workmen. We will now show that the average cost per accident of medical care is much lower than is commonly believed.
(1) There were four or five cases in which the injured may possibly have paid something in addition to the $200 paid by the insurers, but the injured disappeared and we could not get the exact facts. None of them were cases where the excess would be enough to alter the conclusions to be drawn from the figures given.