the law as meaning that hospitals and physicians should continue to treat injured workmen at a low charge as before, while the doctors are of the opinion that the insurance companies should pay reasonable charges for services rendered.

In order to avoid such controversies, many of the larger industrial plants have established their own hospitals and employ their own physicians. Whereas a great many very good men have started as company or contract physicians, using the experience as a stepping stone from which to advance, they very often cannot afford to stay in the work long on account of the inadequate scale of remuneration that has prevailed.

Twenty-eight states authorize their Compensation Commissions to fix schedules for medical and hospital services. New York is one of these, but in this state the problem is yet to be adjusted. Directly after the passage of the Workmen's Compensation Act, the Compensation Commission drew up a minimum fee schedule as a basis of charges. The insurance companies, however, insisted upon regarding the rates agreed upon as a maximum, and the controversies arising from this difference of opinion caused so much trouble that the State Medical Society has since repudiated the fee schedule.

Practice of determining the schedules varies in different states. In Massachusetts, for example, and for that matter in New York, the reasonableness of the fee is determined by the charge which would ordinarily be made to the injured man in his locality and by the standing of the physician in his profession. Ohio, on the other hand, regards the whole question as an industrial accident problem and compensates medical services on the basis of treatment given, regardless of locality.

British Columbia has been particularly successful in arranging a fee schedule for medical service. This was done by collecting a mass of data as to the fees commonly charged and then in cooperation with representatives of all the medical men of the Province, arriving at a schedule of charges that seems to give entire satisfaction.

The rates in the fee schedule are uniformly somewhat lower than the rates charged for the same service in private practice, but the greater certainty of payment and the fact that no compensation cases are treated free offset the difference in charges. In several states an inquiry has been made to determine the effect of workmen's compensation on physicians' incomes. In

general the answers have indicated little change, or a slight increase in income, and very little dissatisfaction was found among physicians on this score.

INSURANCE FOR WORKINGMEN 1

Washington's plan for its workman's compensation plan is a form of state insurance. Under this, the employers do not become responsible for paying death and damage claims; the state assumes this responsibility itself. An injured workman in Washington does not rush into the court against his employer; nor does he file a claim against him. He looks for compensation to the commonwealth itself. The law has created a new and permanent administrative body of three, known as the Industrial Insurance Commission. This commission is composed of well known men not of the politician variety; Charles A. Pratt, the chairman, represents the manufacturers, John H. Wallace, a former business agent, represents the laboring man and Hamilton Higday the legal profession. Their business is to investigate all accidents as soon as they occur and pass upon their merits as expeditiously as is consistent with justice to all parties concerned. After making an investigation the commission attaches the victims, or their dependents, to its regular pension list, according to a schedule stipulated in the law. Though the state assumes the responsibility for these pensions and payments, it collects the money from the employers. The commission divides employers in extra-hazardous occupations into forty-seven distinct groups. Thus the proprietors of mines form one group, of powder factories another, of sawmills another, of canneries another, and so on. It annually collects from the employers so enrolled particular sums based upon a percentage of the payrolls. In this way, it collects forty-seven separate funds. Any person injured in a particular industry thus draws his indemnity out of the fund accumulated from the payments of that industry. In other words, each line of business shoulders the expense of its own casualties. The payments are in the nature of a tax levied for the privilege of engaging in an industry that constantly threatens the lives of the employees.

When this radical law-the only one of its kind in the United

1 From article by Burton J. Hendrick. McClures Magazine. 40:169-77. December, 1912.

States-went into effect, nearly two years ago, there was a general expectation that the employers would oppose it. Hardly had the law passed the legislature when the agents of the casualty companies pounced upon them. There is no form of workman's compensation so unpopular with the casualty companies as state insurance, for its general extension means virtually their annihilation. In fighting this pioneer law in Washington, therefore, the casualty companies were fighting for their own existence. The law, they declared, was clearly unconstitutional; hadn't the Court of Appeals set aside a much less radical measure in New York State? They pleaded with the large employers to refuse to “come in"; to withhold their payments and look to the court for protection.

Unfortunately for the casualty companies, the Supreme Court of Washington, in the first case presented, declared that the new law contravened neither the constitution of the State of Washington nor that of the United States. The decision, however, probably had little to do in disposing the employers favorably toward the law. The closer they scrutinized the new compensation law, the more its terrors and injustices disappeared. True, it did require them to make annual payments to the insurance fund. When the employers figured the thing out, however, they found that these payments did not greatly exceed-in some cases were not so large as-those which they were annually making to the casualty companies. On the other hand, while not more than one sixth of the money taken in by the casualty companies ever reached the injured workman, practically all of the assessments paid to the state fund would clearly go to their employees. Again, the employers found consolation in the fact that this annual payment, once made, ended all their troubles. There would be no more law-suits, with consequent large attorneys' fees and expenses; no more constant pesterings from the "contingent fee" lawyer. And so, greatly to the chagrin of the accident companies and the "ambulance-chasing" lawyers, the five thousand employers in Washington at once began to send in their contributions. As a result, not far from one hundred thousand workmen and their families are now fairly adequately protected against the financial consequences of industrial accidents.

Washington never knew how many people the factories were killing and maiming every day until this law went into effect. The commission passes upon nearly five hundred accidents a

month. These represent all varieties of injury and disability. A certain percentage, of course, are fraudulent; others are merely humorous. There is, however no marked tendency to attempt imposition of this kind.

Obviously the state only can properly attend to the interests of such people; in cases of this kind a certain amount of paternalism is justified. And the attitude of the commission is, above all, paternal. Injured workmen and their families are the wards of the state. The law gives the commission a certain discretion in applying its funds, so as to accomplish the best results in particular cases. In many instances a representative of the commission personally visits the dependent family, looks carefully into its need, and makes such recommendations for the handling of its case as the circumstances justify.

The State of Washington has abolished that particular kind of poverty which is the consequence of industrial accidents. And the only people out of pocket are the personal-injury lawyers and the indemnity companies. How much longer these beneficiaries of the antiquated system will fight is not clear. What is certain, however, is that the battle they are waging is a losing one.

LEGISLATIVE

DEVELOPMENTS IN

WORKMEN'S COMPENSATION MATTERS

1

The most important recent legislative development of workmen's compensation legislation is in extending the benefits of compensation acts to include vocational reeducation and rehabilitation of men disabled in industry. Earlier legislation included only a percentage of wages to an employee while temporarily disabled, or a sum of money computed according to various methods for permanent disability. The responsibility of the state ended when the money was paid the workman, and but little supervision followed to determine whether the benefits would be applied in such a way as to improve the earning capacity or economic position of the crippled worker.

One of the great benefits derived from our recent war experience has been the development by the United States

1 From article, Trend of Workmen's Compensation, by Will J. French, President International Association of Industrial Accident Boards and Commissions and Chairman California Industrial Accident Commission, Monthly Labor Review. 11:875-83. November, 1920.

Government of plans for reeducating and rehabilitating soldiers and sailors crippled in service, and the lessons and experience being developed by the Federal Vocational Board are now being applied under workmen's compensation acts to the rehabilitation of men disabled in industry.

In the industrial rehabilitation act, recently passed by Congress, Federal financial aid is now afforded the states if they will participate in relieving crippled workmen. This work properly belongs with industrial accident boards and commissions, as they are more closely in touch with industrial injuries than any other agency of the state to which the expenditure of funds for this purpose may be intrusted.

Without waiting for the industrial rehabilitation act, a number of states, notably California, New York, Massachusetts, Illinois, Pennsylvania, New Jersey, Minnesota, and Oregon, have proceeded independently to provide for reeducation of injured workers. In some states, a state appropriation is made available for this purpose. In others, a state appropriation, to be united with the Federal appropriation under the industrial rehabilitation act, is now being proposed. In others, the imposition upon industry of the burden of rehabilitating injured employees under the provisions of the compensation acts has been adopted upon the theory that the burden of rehabilitation is as much an industrial charge as that of paying the older forms of compensation. In all states the money raised for rehabilitation is put into a special fund to be expended by the proper state authority, under wide discretionary powers, similar to those exercised by the Federal Board for Vocational Education, instead of being awarded to employees by specific statutory direction.

It is to be hoped that with the Federal aid now offered each state will proceed promptly to exert its full powers for relief along this new line. To give a crippled employee money for his physical loss and turn him loose upon the state without restoration of earning capacity is nearly as bad as to do nothing whatever for his injury. To restore him to useful capacity and citizenship by wisely planning his reeducation is a service almost as useful to society as that rendered by earlier workmen's compensation acts in their entirety.

FURTHER PROVISION FOR DEPENDENTS

Is not the next legislative development in compensation matters indicated by the foregoing? If the rehabilitation of crippled