cases in that county. Fraternal organizations may be appealed to for maintenance funds for members of their organizations. Church organizations and women's clubs are particularly interested in maintenance for girls. Perhaps the most important groups for solicitation are the civic clubs, Rotary, Kiwanis, Lions, etc. These are appealed to for two types of funds-first, a direct maintenance fund to take care of specific cases in their community; second, a rotating fund, the purpose of which is to make loans to people who need maintenance and help during the training period. The problem of maintenance can not continue on the basis of appealing to organizations or individuals and be successful. States are coming to realize this and some of the States in the last few years have made amendments to their original rehabilitation acts. In the beginning no maintenance appropriation or clause was made, but their experience has shown that maintenance for indigent trainees has to be provided. It is all right to go to an organization for one case, two cases, or even three cases, but continued solicitation soon gets to be an old story. As I see it, the only ultimate solution of the maintenance problem is through legislation, either direct appropriation for that purpose or an amendment to the rehabilitation act which will enable rehabilitation agents to use from their general appropriations part of the funds for maintenance. Chairman FOSTER. Mr. Percy Angove, of Michigan, on "Second injuries." Mr. Angove. SECOND INJURIES PERCY ANGOVE, Supervisor of Rehabilitation, Lansing, Mich.` The question of second injuries arises with every individual case who is a subject for rehabilitation services, and as rehabilitation workers we are naturally looking toward some possible solution to the problem of returning the physically disabled person to employment. The subject may well be considered from the standpoint of particular provisions of State compensation laws affecting the injured employee, since the attitude of the employer is to a very great degree governed by these laws. As rehabilitation workers we have come to recognize that workmen's compensation does have an adverse effect upon the employment of workers who have some physical defect. Therefore it becomes exceedingly evident that we must interest ourselves in all sides of this important question. At all times, when seeking cooperation from employers, it has become necessary to present some constructive arguments in favor of the handicapped person. We can quote State laws, such as the one in Michigan which seemingly does not discriminate against either employer or employee; we can speak of the apparent infre quency of second injury occurrences; we can discuss how the morale of the plant is affected for good by reemploying partially disabled people; and sometimes, when it is convenient to do so, we refer to the moral obligation involved and its effect upon society; but I am wondering if very tangible results will ever be accomplished until the employer, at least partially, feels that he is not discriminated against. In this connection it would seem most appropriate to have a discussion of how the problem is or is not being met in the various States with the hope of arriving at some probable solution to the problem. Legislative enactments on behalf of the injured employees apparently tend to make employers of labor adopt stringent policies regarding the hiring of physically impaired persons. Medical examinations are fast becoming more rigid. About two years ago the governor of the State of Michigan appointed a representative committee to make a study of labor legislation. The study was made with the result that suggested amendments were made to the present law. The bill was considered in committee and hearings held. Briefly the recommendations which provided the fireworks are as follows: 1. Compensation to apply to occupational diseases—those contracted as a result of usual employment, as well as those which are accidental, and the only ones now coming under the law. 2. That the employer comes under the act unless he files notice with the compensation commission to the contrary. The law is now just the reverse. 3. Extension of the medical period for that service to employees beyond the 90 days now fixed, in the discretion of the commission, and that the employer furnish or cause to be furnished such suitable and proper artificial appliances as may be necessary to replace the lost member or tend to relieve or rehabilitate the injured employee. 4. Increasing the minimum and maximum weekly compensation from $7 and $14 to $8 and $16, respectively. What has this accomplished and how has it affected rehabilitation services, and how much more might it have affected rehabilitation services had the proposed amendments been enacted? To answer these questions one should have attended the hearings where the probable reaction of employees was already very much in evidence. Even now the effects are felt, for some of our most socially minded employers are beginning to assume a much more conservative attitude. Employers were very much in evidence at the hearings and were not reluctant to voice their sentiments in protest against the measures. They presented some very sound, practical, and convincing arguments. They were not opposed to the measure pertaining to proper medical treatment and the providing of suitable appliances (many of them are already adequately taking care of this matter), but they did oppose the raising of compensation rates and the measure pertaining to occupational diseases, stressing the point that the rate of compensation in Michigan compared very favorably with that of other States, and that they were already carrying financial burden enough. Through the discussion of occupational diseases, it was plainly seen that if such a measure were put into effect employers of labor would conduct within their organizations very stringent medical examinations that would shut out a large number from employment and would not only apply to prospective employees, but also to those already employed. Industrial discrimination against disabled workers is very much in evidence. The main fear on the part of the employer is that by employing crippled workers the cost of accident compensation will be increased. Much of the following is taken from Mr. Carl Hookstadt's treatise on the subject which appeared in the American Labor Legislation Review for March, 1919. Several States grant compensation only for the disability caused by that particular injury with no reference to previous injury. Consequently increased compensation costs are eliminated, but, as stated by Mr. Hookstadt, "The employee receives grossly inadequate compensation." Some State boards hold that an employer should not be penalized for his generosity in employing physically impaired workmen. An employer in the State of Montana asked for a ruling as to the extent of liability. He had over 100 cripples on his pay roll and stated that if he was made liable for total disability he would immediately discharge them. The board promptly ruled that the employer would only be liable for subsequent injury without any reference to the resulting disability. This had considerable effect upon other employers who retained several hundred cripples in their employ rather than discharging them. Naturally such a ruling will help rehabilitation services, since remunerative employment is the main objective, but is such a ruling fair to the handicapped person? This might be answered in the affirmative, especially since employment would be impossible and, consequently, the disabled person would become a charge upon society. The handicapped in general would prefer employment in place of immediate financial assistance which usually ends in dependency. California at one time provided for full compensation or life pension. The act, however, was amended at the request of the disabled men, who stated that they found great difficulty in securing employment. Some State's compensation for second injuries is determined by subtracting the disability caused by a previous injury from the whole disability caused by the subsequent injury. Some States make no provision whatsoever regarding second injuries, and in these States it is natural to assume that each individual case is considered on its own merits. There are two or three States which even grant a greater award for the second injury. This plan, however, naturally increases the probability of discrimination against crippled men. In other States provision is made whereby an employee may waive claim to compensation awards in case of a second injury by entering into an employment contract with the employers. This plan, however, leaves the employees unprotected in case of subsequent accident, and as before stated, in case of a second injury the handicapped person will become a public charge. The State of New York appears to be meeting the problem perhaps better than any other State by relieving the employer of extra liability. The New York law provides that in case of a second major disability the employer shall be liable only for the second injury, but the injured employee shall be compensated for the disability resulting from the combined injuries. The additional compensation is paid out of a special fund created by requiring the employer to contribute $1,000 for each fatal accident in which there are no persons entitled to compensation. One or two other States have followed New York's example and have made similar provisions. It is believed that this plan insures justice to both employer and employee. We are always looking for constructive arguments to present to employers, such as the total number of second injuries as compared with the total number of first injuries being comparatively small. Quoting Mr. Hookstadt, a computation made by the United States Bureau of Labor Statistics would seem to show that of all the employees under the compensation act in the State of Wisconsin who had lost a hand, arm, leg, or eye, only one would sustain a second major disability in any given year. Applying this rate to the several States having compensation laws would give a grand total of 39 second major permanent disabilities for all industries covered by the compensation acts of these States. The increased cost of second injuries would therefore be negligible, assuming that all second major permanent disabilities would result in permanent total disability. The increased compensation cost of such accidents would in all probability not exceed three-tenths of 1 per cent of the total compensable costs for all accidents under the compensation acts. These and other arguments are seemingly important, but the employer of to-day is looking for something more tangible. He must be convinced that his present financial load is not increased, and the employee consequently given a square deal. Even though conditions in some States are seemingly in favor of both employer and employee, there is always the personal equation involved. The employer is reluctant to further the possibility of totally disabling a person for life, especially since the person can not be adequately compensated. It is natural to assume that if an employer is required by law to pay compensation for permanent total disability caused by a previous or subsequent injury, in such cases he feels reluctant to employ physically disabled men. My opinion is that in all fairness to both employer and employee a plan similar to the one in operation in New York, creating a special fund, presents the nearest possible solution to the problem. Chairman FOSTER. Now, Mr. Herbert Zinn, of Ohio, is going to lead the discussion on "Reporting cases." Mr. Zinn. DISCUSSION REPORTING CASES HERBERT ZINN, Assistant Supervisor of Rehabilitation, Ohio The reporting of cases has been very ably covered by Mr. Thompson and outside of a few added suggestions, I feel that there is but very little room left for discussion. His summary covers all of the agencies that report cases with probably one exception, and this exception is one that, to my mind, should be more fully developed. I am referring to the manufacturers themselves. It is true that in some of our larger cities one or two plants have been reporting a case now and then, but as a general rule, cases never reach us until reported by the industrial commission several months after the accident has occurred. To me it seems important that a contact with a disabled man be established as soon after the accident as possible, and this in most cases can only be done when we are notified by his employer. Hospital authorities report occasional cases, but most of these seem to be in the charity class and not industrial accident cases. Orthopedic clinics produce in Ohio mostly crippled children and while these make good rehabilitations, they, if left alone, will as a general rule work out their own vocational future. The broadcasting of blanks and posters, while it serves to give publicity to the work, also is very apt to flood your offices with thousands of cases that are not eligible for the service, and therefore merely make an unnecessary amount of work. |