Document KRN04xg244V623NnkvObz5Kbo

FILE NAME: Saranac 7th Symposium (SSY) DATE: 1952 DOC#: SSY049 DOCUMENT DESCRIPTION: Text of Presentation by Ms. Donlon Vorfinen'S wompense-uion coei-u State Office Building Albany) Hew lork Albany 3-55H, Bxt. 333 *w* . ~5 _ j Z ' ` Address of Hon. Mary Donlon, Chairmen of the Hev York State Vortoen's Condensation Board, at the Seventh Saranac Symposium at Saranac Lake, Hev lork, Friday, September 26, 1952 RECEIVED f.h .h ss DATE: J U L 3 1 IS?' VIEWPOINTS OK COMPENSATION FOP. PULMOHAEI AND OTHER OCCUPATIONAL DISEASES My viewpoint, as to workmen*s compensation for pulmonary end other occupational diseases, is of course the viewpoint of the administrator. As such, I am grateful for the opportunity of participating in this discussion today. In the past, the contribution of workmen's compensation administrators to discussions of the occupational diseases -- outside of their ovn organizations -- has been much too snail. In part, this is the fault of the administrators because they hare usually'been too busy handling the details of cases to have time also to record and orgerize their experience. The viewpoints of lawyers and doctors, es to compensating occupational diseases, have therefore often received more considerstion especially during legislative committee hearings -- than have the view points of administrators. I shall present my viewpoint in the light of the historical develop ment of occupational disease coverage in the States. At the start of cor me; or developments in this field, many lockec upon occupational disease coverage, end especially the full or general coverage of such diseases, as e lea? in the dark. The atmosphere in which discussion took place was that of fear b o m of ignorance. Speakers brought forth a portfolio of precedents from the experience of foreign countries, and presented this material with an air of overwhelming erudition. Stunned audiences were convinced that the most complicated and restrictive schemer, RECEIVED F.H.H1S DATE:J i l l T , Kn, M.E.M " o - Jct . i bo impressively described to the, embodied the last vord of the vorlo'e existing wisdom upon the subject of occupations! disease compensation. So it happened that schedules, often double-column schedules, vere imported from abroad and sold to the state legislatures. It seemed irrelevant to note that the diseases listed in the schedules often vere not prevalent in the particular State vhich, hovever, might be afflicted vith hazards not mentioned at all. It vas like buying a bat from Parts, just because it vas a hat from Parte and regardless cf whether it suited the vesrer's face. It happened, hovever, that in one or two States vhere the original injury coverage provisions had been left broad and simnle, omitting the restrictive vord "accident", the courts held that the vord "injury" in cluded occupational diseases. Such States therefore started, almost by -accident", vith the same compensation coverage of occupational diseases eg of accidental injuries. Other States observed the result and lik^it. The prevailing pattern in this country now is full or general coverage of occupational diseases. In this respect America leads the world. Vitn 3cs, almost every session of the legislatures, the column showing the list cf States with schedule or restricted coverage cf occupational disease shrink, while simultaneously the column shoving the list of full coverage States rm on lengthens. In every stream there are main currents and counter-currents. Alarm as to compensation coverage for silicosis Hared up during the depression that followed 1929, and this alamo started a tidal wgve of restrictive bill-drafting, in part appliceble to the dust diseases. In consequence =eS many of the State compensation lavs are now cluttered vith restrictive and discriminatory provisions applicable either to occupational diseases received F.H.H&S * MM.E.MK J ! ! U j -J-9-7- s* told that loose practice on the- part of administrators in compensating 5 :o alleged occupational diseases vould turn workmen's coapensetion into health insurance." Rare or exceptional instances in vhich questionable avarus had been made were seized upon, publicized and magnified out of proportion to their real significance. Calm and vell-infoimed discussion of the problem vas- sometimes impossible because the opinions of many had been formed by vivid impressions of exceptional cases, rather than by statistical compilations from considerable aggregates of experience. The cost' estimates, not anchored to aggregates of mature experience, vere sometimes fantastic. The production of a statistical average is often the best, if not the only, cure for distorted thinking both as to performance and cost. . In 1935 the private insurance carriers vculd net provide coverage, in Nev York State, for silicosis. Insurance could be obtained only from the State Insurance Fund. The Fund set its insurance rates high and held its breath, waiting for disaster. It vas soon discovered that the insurance risk had been exaggerated. Mr. Muller, s former executive director of the Fund, said: "V'e vere efraid of a vclf that vas not there.r Of course in the absence of a dependable statistical basis for forecasts, insurance actuaries do feel compelled to make full-sized cost estimates. That is their business responsibility. Vhen the actuaries had done their vork, the lawyers vere then callen upon to draft legal restrictions end limitations upon compensability. The resulting patterns of occupational disease legislation in some of the States can best be described-as barbed wire entanglements. Fantastic restrictions vere put in the vay of compensability, especially as to silicosis; and sometimes the benefits for occupational diseases vere put RECEIVED F.H.H&S or - DATE:--H ilL 3 i 1979 M.E.M on a lover level than for accidental injuries, either as to cash payments or medical care, or both. The lavs in some States are still cluttered vith discriminatory details that are hard to get rid of. Such petty snc harassing restrictions are a liability to insurance carriers end employers because they arouse hostility in the ranks of labor, the consequences of vhich are out of all proportion to the pinch-penny savings effected by the restrictive provisions. This is beginning to be apparent in the con flict as to compensability of partial disability from silieosis. Such things keep vorknen's compensation lavs in politics end they should be above political considerations. In Nev lork, and also in some of the S+etes vhere the lev enc ao- ministration are veil advanced, the second stege of thinking about occupational disease, and especially silicosis coverage, has nov been reached. This second stage of thinking on the subject of occupational disetse coverage, is marked by preoccupation vith an effort to deal justly and. vithout discrimination vith all the victims of occupational diseases. The question arises,, can ve do this, and if so, bov' It becomes necessary to try to see the problem in human terms. Vhen occupational disease problems ere seen in human terms, appropriate action may be expected. Some of the difficulties of coverage ay be obscure because the flood-light of research has not yet been irped upon them. On the other hand, some of the remaining nasas for gislatures can be approached through demonstration. In a certain rlcultural Stele, there had been persistent and formidable opposition occupational disease coverage. Committees had reported adversely on lproposal. There had been the usual negative arguments. It ves isted in the first place that there vas no occupational disease problem RECEIVED F.H.H&S DATE: JU L ? i 1P70 iD that *ate, end in tb. eecond place t U t the " c ^ of c c p a u . : ai.eas. coverage vould he ^ o . sue, a or ,,* -- . s c e n t s U . - t uncommon phe=enon * * " ta- ^ lelElattv. -- l t * ~ . Vhen et last the p p o ..1 for coverage r = ^ the floor of the legislature. th. P p o n t . of o o . * - to furnish . demonstration. . *-. * P - " A group of vomen smplcye.s vho had contracted derm*title vhll. voting ta fruit snd berry processing establishments marched don the aiele, holding out their tortured hand, for oheervetion. Full oorag. of occupational nitease vae Mediately end unanimously adopted by toe legislature. one of the most perplexing of the unsolved problems in many States is that of compensating partial disability from silicosis. This is the ease her. in Nev Tosk. There is a dearth of information base-, upon comnrehensir. administratis, research. Tuo hypotheses are enecunterec. One is that there is no such thing as partial'disability from siHcost, another is that th. administratis, problems of handling nartia! cisa ^ J from silicosis are insuperable. In the face of such conflicting opinions. information is needed es to uhat happens to the victims of siiioosis . *. -ettre of totel dieebility for vork. before they reach the 'Sts.ge ox V. taov that ih the enemies of Vermont Massachusetts there are men uho have varied in stone all their Uvea, uho are getting along vith the vital capacity of their lungs redmnec to e frsetion of n o - ? If you do not rush them, they cen do a day's vork. Bovever, they have ,,c reserves. But their disability is not reflected in their earning capacity, because their skill and experience offset satisfactorily to the employer their leek of physical speed. RECEIVED F.H.H&S DATE:_ J U L 3 1 1979 M.LM These men usually have a strong sense of family responsibility, end vith greet determination they go on vitk their eeoastomed vork, often vith undiminished eernings. Those vho be.se their generalisations upon this segment of experience mey ergue that there is no such thing as partial disability from silicosis, so far as the workmen's compensation lavs are concerned, because there is no vage loss attributable to such disability. Thtr contention comes more easily from a person vho does not himself have silicosis, than from those vho hEve to struggle for breath. In short, one segment of experience, as to silicosis, is commonly disposed of, in workmen's compensation administration, by the contention that there is no such thing as industrial disability, partial in degree, from uncomplicated silicosiE. On the other, hand, some spokesmen for organised labor ineist that the prevailing practice of not compen sating partial disability from silicosis is unjust, and some of them are becoming militant in respect to this grievance. While some States do not provide compensation for partial disability for silicosis, some jurisdictions have had considerable experience vith taking care of such cases in one way or another. The mair. neeos Ere for maintenance, vith or without medical aid, and for rehabilitation and for jobs. Under varying types of lav, the maintenance payments may be on the basis of vage loss vhen the worker has to change to vork that is less exacting physically. Or there may be payment based upon estimated degrees" of modulation. The rehabilitation provision may be vith, or without, a special award to cover the roughly estimates cost tc the worker of changing from one kind of employment to another. These varying pro visions can, of course, either be used well or abused. M.E.M Tbe rehabilitation type of provision, for the eilieotic, at first glance looks ideal, especially if the attempt at change of employment is accompanied by a lump sum payment. However, it should be remembered that in Wisconsin the provision for a hardship payment is used by the administration to discourage employers from discharging their vorkers vhen an X-ray shovs nodulation. Some types of rehabilitation provisions can be used primarily to close out the employer's future liability, rather than to improve the health and status of the vorker vhich is the true purpose of rehabilitation. If there is an allergy, an effort should be made to arrange a satisfactory change of employment. However, the circumstance that a vorker gets a nev job, does not necessarily mean that he vill either keep it or be able to get continuous employment at other jobs. Where the shop housekeeping has been cleaned up and the dust removes from tbe air, it seems preferable not to interrupt the accustomed employ ment of a vorker who has silicosis because, in many areas, vhen he has been throvn on tbe employment market it is very hard to him to get another job. In part because of the vay some compensation provisions are written, in some States employers vill not hire a man vho has an.unfavorable chest X-ray. Faulty compensation bill drafting, together with oppressive hiring practices, shunt too many truly employable persons toward the permanent total disability classification, or toward the public welfare rolls. So far as New Fork is concerned, compensation for partis! disability from silicosis is still a problem for tbe legislature. If compensation is provided by lav for this category of disability, tbe Hew Fork Workmen's Compensation Board vill of course face another disability rating problem. At this point, it should be said that in compensating occupational disease RECEIVED F.H.H&S Da te :J U L l l E l M.E.M cases administration is hampered by the lack of early end correct diegnosie of disease. Inexpert diagnosis end the lack of vide experience vith industrial processes, sometimes give a false start in the investigation of eases. Without competent and prompt diagnosis, maximum benefits do not flov from treatment. At present, so far as the workmen1s compen sation authority is concerned, the two 6tages of handling occupational disease cases are almost completely separated. The first stage is diagnosis and treatment; the second stage, disability rating and adjudicatio In many States today there is a hue and cry about the high cost of workmen's compensation. Of course, the public should be concerned about all excessive costs. However, in discussions of the cost of workmen's compensation the public is frequently misled into supposing th-.t the legal benefit rates are too high or that the workmen's compensation administration is excessively liberal in its interpretations and everas. A properly worded statement would be that probably in all States the workmen's compensation costs are too high in relation to what is delivered in payments ana services. Vhat the public has not been told and does not nov understand is that the major source of unnecessary loss is not the administrative processing of claims -- which, of course, is not perfect but faulty diagnosis ana treatment. At the present stage of.administrative development in the States, the workmen's compensation authority often has the sad task, when settling or adjudicating both disease ana accidental injury cases, of mopping up the results of prolonged unsatisfactory medical cere. How much longer this situation will be tolerated, especially by the more, advanced administration remains to be seen. RECEIVED F.H.H&S D A T E :J!U L LL !? L 9 r> M.E.M I btve mentioned tvo historical stages of development in the pro vision of occupational disease coverage in the States. In the first, the main preoccupation vas that of shielding industry from allegedly unbearable cost. In the second the main preoccupation vas on compensating, vitbout discrimination, all victims of occupational disease. V* are now in a third stage of historical development in workmen's compensation, vitn emphasis upon prompt and complete restoration of injured workers to their fullest work capacity. Because of an obsession vith legal oroblems many of them excessively technical, ve have been late in waking up to the possibilities for reducing both human losses and monetary costs in tne field of workmen's compensation, both through obtaining the right type of specialized medical care and by supplementary teamwork in medical care, which means what ve have called "rehabilitation." The advent of this new stage of development calls for an integration of the supervision of medical care which, of course, eventuates in disability rating and adjudication. At the present time administration deals chiefly with what is really only a fragment of the total medical nrcblen. A report by the late Dr. Howard N. Prince on Medical Examining Facilities of the New lork State Vorieaea's Compensation Board, several years ago, contains this statement: "Tne Chief Medical Examiner should institute an integrated medical program for workmen's compensation." Such a thing has not yet been done in any State. This failure is responsible, not alone for huge monetary losses, but also for tragic and unnecessary human loss. As you know, the monetary cost of workmen's compensation arises from, and is augmented or diminished by, the extent of the human loss. Ve worry about monetary loss - perhaps ve ought to vorrv more about it - but our paramount concern should be with the hmnpn loss. DATE:_m-2-i-l^: M.E.M If we reduce the human loss, the monetary loss will dvina^e also. ' Our effort In New York is to protect injured workers to the fullest possible extent. If the programs of prevention and restoration are folly developed, the cost of adequate payments and services for injured workers a should not be oppressive to industry. At present the program of prompt and full restoration of injured workers, in New York and elsewhere, is the most undeveloped segment of workmen's compensation administration. The resulting loss, both in human and monetary terms, ty well be appalling. Ve shall study how best we can serve the injured worker and, as new light is thrown upon the task, will confidently count upon the cooperation of our people in perfecting the New York performance, so far as may be humanly possible.