accident, the compensation agency must be prepared to detect possible cases in second reports or in later compensation papers. Not a few accidents which are at first reported as trivial develop later into permanent impairments.

In most States there will be no legal obstacles to the transmittal to the rehabilitation service of information about accidents, since the statutory language making them confidential usually permits their use for public purposes, and places the penalty not upon disclosure by one State agency to another, but upon disclosure to outside persons by any State employees having access to the records. If legal obstacles exist in any State, it is desirable that they be discovered when the enabling legislation for the rehabilitation work is being considered, and that they be removed at this time.

(b) Supplementary reports on cases.-Clearly it will be desirable for the rehabilitation service to have in its files as complete information regarding cases as possible. The Accident Commission will be in a position to give information respecting such points as the physician's determination of the injury, amount of compensation, whether payment is periodical or in lump sum, and any other pertinent facts bearing on the case.

Frequently in the development of cases being heard by the compensation agency, conditions arise that would materially affect the rehabilitation work being done. Arrangements should be made for prompt transmittal to the rehabilitation service of such develop

ments.

(c) Payment of compensation. The compensation agency can render inestimable assistance to the rehabilitation service if careful consideration is given to the effect of the amount and manner of payment of compensation. The amount of compensation which the disabled person is to receive should not limit his opportunities for training. Selection of an occupation should be made on the basis of the best interests of the disabled person rather than on his available income. Every possible source of help should be exhausted before a decision is reached which in any way sacrifices the permanent welfare of the disabled person. Payment in lump sum in a given case may effect rehabilitation favorably, unfavorably, or not at all. The disabled person may be unable to take training unless he has adequate compensation. If investigation shows him to be a prudent person, the rehabilitation service may in his case actively urge upon the compensation agency the granting of a lump sum.

Attention may here be called to the possibility of reopening a compensation case where an award has already been made. Developments in a rehabilitation case may indicate that a change should be made in the manner of payment of compensation.

SERVICES THAT MAY BE RENDERED BY STATE BOARDS.

(a) Medical information.-Every compensation agency will be interested in the medical care given to injured workmen under provisions of the compensation act. The scope of the administrative work is so large, however, that it will not as a rule permit close supervision of individual cases. Even in States which have an exclusive State insurance fund, and are, therefore, directly responsible for the medical service, a checking of inadvertencies and omissions will probably be appreciated. In those jurisdictions where the State itself is not directly responsible for medical care and where supervision is now limited to redressing complaints, cordial welcome will no doubt be given to incidental information about medical care which the rehabilitation service will secure through its early visits to seriously injured persons. Care must be exercised in investigating complaints; all persons concerned should be consulted and authentic information obtained from reputable sources relative to the professional standing of the medical facilities offered, but in all cases reports should be made of conditions if unfavorable to the maximum improvement of the patient.

(b) Statistical information.-All compensation jurisdictions which are enrolled in or cooperating with the International Association of Industrial Accident Boards and Commissions are endeavoring to secure certain standardized items of information about the persons who have received and are receiving compensation for permanent impairment and the effect of their impairments upon their future. Desirable revisions of compensation acts will depend upon the securing of accurate information. The rehabilitation service will be in much closer and more prolonged contact with permanently impaired persons, especially those in training, and can with very little extra effort on its part secure the data which would cost the compensation agency a considerable outlay.

MUTUAL ASSISTANCE.

Both the rehabilitation service and the compensation agency will be sending agents to different parts of the State at different times. Often there will be occasions when one service can be of assistance to the other without material inconvenience, and thereby save time and money for both agencies. To illustrate: The compensation agency may request that a rehabilitation agent already assigned to visit a disabled man be instructed to secure the latest statement by the physician as to his condition. On the other hand, the rehabilitation service may request the compensation service to have one of their agents visit a disabled person, acquaint him with the benefits of the rehabilitation law, and secure preliminary

information, provided their agent happens to be at the time in the vicinity of the man.

Many ways in which the compensation agency and the rehabilitation service may cooperate will undoubtedly develop in practice, and it is, therefore, desirable that the plan of cooperation should include a general agreement for each to be of assistance to the other when the service asked is germane to the work or not too great an administrative burden.

MACHINERY OF COOPERATION.

As has already been pointed out, the maintenance of close cooperative relations between the State board for vocational education and the compensation agency is extremely important. This may be facilitated by provision for an advisory board or committee, consisting of representatives from each board. The function of such a committee would be to insure harmonious working of the plan of cooperation, and in general to advise in connection with policies pursued by the State board. Such a committee in one of the States consists of the State vocational director, or one officer of the department of education designated by him, and the chairman of the industrial board, or one officer designated by him.

LIAISON OFFICER.

Employment of a liaison officer by the State board and the compensation agency may offer an excellent method of binding together the two activities. As an illustration, a liaison officer working in the offices of the compensation agency would discover all possible rehabilitation cases, and would materially assist the reporting system mentioned above; similarly working in the offices of the State Board he could see that information was gathered which the compensation agency desired, and in this way could be of material assistance to both activities by giving rehabilitation applicants advice as to compensation phases of their cases.

3. COOPERATION OF SOCIAL SERVICE AGENCIES.

SERVICES THAT MAY BE RENDERED.

Extensive cooperation between the State board and public and private social service agencies working within the State will be essential for effective administration of rehabilitation work. Individuals, also, as well as social service agencies can render essential aid. Such cooperation will be found to be helpful in the following ways:

(a) Reporting cases.-Almost every social service agency will in the normal course of its work come in contact with cases in which the State board will be interested. When these agencies understand the types of cases eligible for rehabilitation they can be of great assistance to the board in bringing the rehabilitation service to disabled persons.

(b) Influencing disabled persons to accept rehabilitation service.— Disabled persons in individual cases may be disposed to refuse or to postpone acceptance of rehabilitation service, and in cases of this kind employers and other persons as well as organized agencies may be of great assistance to the board. A word from some one in whom the disabled person has confidence may be all that is necessary to persuade him or her to accept the benefits of rehabilitation. Such personal counselors will frequently be in position to persuade the disabled person to accept rehabilitation when representatives of the State board might fail to do so.

(c) Providing maintenance.-Social agencies may assist the State board by supplying or arranging for maintenance for the disabled person and his family during the period of training. Even though compensation or other money is available, there will be many cases where additional financial resources will be needed to meet emergencies during the training period.

(d) Securing medical service.—The agencies already referred to may assist the State board in securing medical service for the disabled person or his family during training. Interruptions in training due to sickness in the family of the disabled person may be materially reduced by the help which social agencies can render.

(e) Maintenance of morale.-While State boards will deal with a considerable number of fairly self-reliant persons who will not require anything outside of the regular services of the board, there will undoubtedly be a number of individuals who will require the help of every available influence in the solution of their personal problems throughout the period of training and the period of adjustment which follows it. For such cases it will be extremely important that the cooperation of the proper agencies be secured.

ORGANIZATION OF COOPERATIVE EFFORT AND ADVISEMENT.

Cooperation between State boards and the agencies referred to will be materially facilitated by the forming of advisory committees. The manner in which this is handled will be more or less determined by the State board. However, the value of such advisory help should not be lost sight of. In some instances an advisory State committee may be formed to consist of representatives from the public health department, the association of manufacturers, the federation of labor, and organized social workers. Such a committee to be effective should serve from the time the work is started, giving counsel in matters of general policy. Subsequently such a committee may assist in reviewing the development of the work and in effecting such changes in State legislation as will advance the industrial rehabilitation work.

Advisory committees in the larger industrial centers made up of representatives of social agencies with which the State board will

have more frequent and direct dealing can be used to advantage in reviewing the more serious individual cases that arise from time to time. It is clear that in many cases such committees will make it possible for the board to save time and annoyance for its representatives. The type of advisory help which the State board selected will be determined largely by their practice along other lines and the usual procedure in the State in such matters.

It will be evident from what has been said that the organization of cooperation with social service agencies is something which will merit particular attention on the part of the State board. In some of the more populous States it will be considered desirable to accomplish this through an employee of the board having it as his principal duty. In other States it will be made one of the most important duties of the executive in general charge of the work.

4. COOPERATION OF INSURANCE CARRIERS.

State boards may be assured of the cooperation of the insurance companies. Some employers may have the idea that if they employ handicapped persons their insurance rates will be increased. Such may have been the practice in the earlier years of compensation laws under a theory that handicapped persons were more likely to have a second injury. Statistics do not bear out this inference of actuaries, however, and many of the compensation insurance companies have not been taking cognizance of such a factor for some time.

At the time when the rehabilitation of disabled soldiers, sailors, and marines was begun, a conference was held with the insurance companies by representatives of the Federal Board and assurances were received that there would be no discrimination.

It is important that State boards have definite assurance along this line in connection with industrial rehabilitation work because in attempting to place the handicapped men they may find employers of the opinion that there is discrimination.

Most of the compensation States are in a position to stop any attempt to discriminate by administrative action, if necessary. As a rule the compensation insurance rates must be approved by the commissioner of insurance. It should be feasible, therefore, in such States for the commission to disapprove any schedule of insurance rates which takes into consideration the employment of persons who have permanent disabilities.

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