Document OzE7K78D4zyLJLpBdj4jdb9av

FILE NAME Insurance Industry INS DATE 1948 Apr 1 DOC INS055 DOCUMENT DESCRIPTION Article from The NY State Journal of Medicine - Occupational Disease - The Insurance Viewpoint N. Y. State J. M. ut 2 per cent for the entire series r period igh 10 of these deaths occurred in s whereas there was only one ases of the other three years fortality There were 5 deaths Implications 5 from pneumonia he cause was unknown Special Article OCCUPATIONAL DISEASE INSURANCE VIEWPOINT HENRY D. SAYER New York City General Manager Compensation Insurance Rating Board New York good results meticulous atteni to all details both pre- and postthe prostate is far more prevalent "than in younger men the mortality of operation is 6 ortality of untreated prostatism per cent eighty need no longer be told for surgery 75 WILLETT STREET ae New Jersey and Connecticut New York before April 15 that a society society ople that confuse it most and the edup a medical society are something mostly intelligent quaintly con- avidualists usually with a common aliarly unselfish Mix them all up nest and some bogus idealists and a scrupulous and you have a medical vization the like of which is hard to want to say that the profession of just a company making as much of odd little men money as he can than ng in medicine that is bigger d that fine bigness can find its ex- ough our medical societies M"edical Service A.M.A. January THE extent that compensation laws play a Tovital part in our social and economic life insur- ance has served and will continue to serve an essen- tial interest in our industrial system In so doing it performs a public service in a high degree In that view of the matter it is of little consequence to insur- ance as such what the coverage under the law may be It is sufficient that the obligation is insurable that it is sufficiently definite and described to permit the setting of reasonable and adequate rates and that it is expressed in definite and certain language so as to be readily understood by those affected by it and to warrant fair administration and the avoidance of wastefullitigation particular While it may be assumed that the original purpose of compensation statutes was to cover only disability and death due to injury by accident possibly be cause injury to health gave no right of action against the employer under the old common law logically no one can disagree with the principle of compensa- tion for those diseases that are as definitely occupa- tional as are industrial accidents In many jurisdictions diseases to be compensable under the law must be due to causes and conditions characteristic of and peculiar to the occupation Industry and insurance have joined in advocating passage of occupational disease laws Insurance has ability urged in various places and on various occasions that these laws be drawn with such directness and ex- plicit terminology that there be a correct under- standing of the rights and obligations created there leaving by little room for litigation We are not particularly concerned at this gather- iing ng with those diseases and infections that follow naturally and unavoidably from injury caused by accident we are concerned rather with those dis- eases that result from conditions in the employment caused by exposure to or contact with toxic sub- stances radioactive emanations exposure to dangerous dusts gases or fumes or other conditions neces- Barily present and characteristic of a em- particular however More particularly are we here concerned ployment diseases affecting the lungs and respira- acquiring pathologic changes that may eventually result in his total disablement or death he may be employed by a number of different employers or have sporadic employment for the same employer and in these various employments conditions may be very different and the character and concentration of dust may widely differ His employments may not all be within the same state and may be governed by different laws His various employers may have been insured by different insurance carriers The right to compensation having been established the worker or his dependents are concerned only with the receiving of have no the benefits set forth in the law and concern with respect to the carrier that is liable for such payments But the deter- mination of those questions is the responsibility of the administrative authorities Similar complications arise when the law creating the liability for benefits is of more recent existence than the period of exposure from which the condition arose Thus a period of total disability may arise within a very brief period after the enactment of the new law while the period of exposure out of which the disease arises may almost complteely antedate the law creating the liability Here then condi- tion may arise for which liability is newly imposed law while the conditions out of which the dis- ability arose may be wholly or in large part due to conditions of employment at a time when the law created no liability upon the employer or his insurer for such a disability Recognizing these manifest facts the New York State Legislature accepted certain very important principles in enacting the law with regard to the pneumoconioses namely that the liability for compensation shall be imposed wholly upon the employer who last employed the worker in a dusty employment and that the liability for silicosis or asbestosis under the new law shall be in the beginning merely minimal taking little account of the expo- sures in employment which took prior to the law's enactment The benefits however were in- gradually until and unlimited benefits are creasedpayable with thosetract payable employer The greatest difficulties have been encountered in the consideration of silicosis and asbestosis as occupational conditions While diseases of the lungs due to inhalation of dust have been recognized from the earliest times and have been referred to in the ancient literature until recent years little was known scientifically of their pathology etiology and therapeusis Medical science in recent years especially under the inspired leadership of Drs Trudeau and Gardner has made great strides in research and the determination of the facts as to the nature and de- is velopment of these diseases Over the years while a is presented worker is being exposed to dust and is very slowly be * Condensed from a paper read at the Saranac Bymposium on Tuberculosis Baranac New York October 8 1947 By fixing the liability on the last employer a dusty exposure there is avoided endless difficulty in attempting to assess upon each employer by whom the injured person was employed his proportion of liability for the entire condition This would be manifestly impossible task By always assessing the liability on the last em- ployer the principle of distsruicbhutpirooncoefducroestfabirrouagnhdt about by insurance . it averages out fairly A somewhat different and very complex question question in the matter of compensation for par- tial disability from silicosis or asbestosis At a superficial glance it might be assumed that partial trades disability should compensated in the dusty the same as it is in the case of injury due to accident 801 802 HENRY D. SAYER N. Y. State J. M. But upon slight reflection it will be recognized that a very different situation must be faced In the first place just what do we mean by par- tial disability in dust disease of the lungs Having in mind disease progressive the infinitely slow at what point does it become nature of partially the dis- abling And how is that disability to be measured Do we think of partial disability as a mere physical condition or must it be both physical and economic There are a great many workers in dust perhaps more than we realize who have definite lung path- ology demonstrable clinically and by ray that may be deemed a partial permanent physical impair- jobs a ment but who have nonetheless a full earning capacity These men do full day's work are fully productive and earn full wages when they have Should we say these men must be compensated If so for what and how much We cannot compen- sate them for loss of earnings for they have suffered no such loss nor can we compensate them for in- ability to get jobs for they have jobs when work is available Their skill born of years of experience has been found in many instances in practice to off- physical set any supposed unemployability due to impairment and unless they make claim for com- pensation and are physically does not know of examined an employer the existence of any of degree in their lungs whether partially disabling or fibrosis not It is certain that in some trades the workers prefer not to know that they have a mild degree of silicosis and they assuredly do not wish their em- ployers to learn examinations through of their condition They seem to prefer jobs physical and the wages that they earn to any compensation allowance and to the certain branding of them as silicotics that would be entailed in any system of compensating for partial disability They appear to regard that as economically disastrous and there can be little doubt of the bad psychologic effect of such knowledge In cases of partial disability from silicosia or asbestosis partial disability if it arises at all comes on gradually and insidiously Physical findings by x- ray are usually the first evidence of the disease Never is any disability present at the outset in Progress is not toward improvement as is the case recovery from traumatic injuries but if exposure conti thendiu sabe ilis ty increases It may progres to slowly eventual total disability or worker may continue working almost to the time of his eventual death To the medical man these distinctions may not be very significant to the administrator and to the in- surer they are vital If worker is compensated for a partial disability in a dust disease case it is almost certainty that will continue under partial dis ability until total disability or death occurs Total be long following disability will not in the partial dis ability for once the worker is officially certified as silicotic his days will be numbered in his trade Insurance under the law for partial disability would present almost insuperable difficulties Lo the first place we have no reliable facts as to the number of workers at any time who have silicosis or asbestosis in any degree whether partially disabling or not What the exposure is or may be we have no way of knowing Accordingly this would raise serious difficulties in the way of fixing insurance rates that would be both reasonable and adequate The setting of proper rates is at the very basis of effective insurance If one recalls the principles referred to at the out thofiths is paper it would seem that so far as the New York State law is concerned the obligation for occupational diseases has been made insurable language susceptible of rating and is stated in reasonably definite and certain Insurance may be relied upon to do all in its power to make such laws workable and effective to accomplish the objective set before us sustair local contact Directly at the site of troublesome vaginal infections Bristol Penicil In acute vaginitis and related co of the lower female genital tract by or associated with penicillin- organisms exclusive of the gon as an adjunct in treatment of trichomoniasis CORRESPONDENCE Further Note on the Specialty Boards To the Editor I would like to express my agreement with the opinion of Dr. M. B. Lloyd in regard to the tactics of Specialty Boards as stated in his letter published in the JOURNAL February 1 1948. Although within the past twenty years the field of peripheral vascular diseases has assumed the status of a distinct specialty and is recognized as such not only by but also by the New York State the profession Labor Department with a distinct designation of SM 16 the Specialty Boards refuse recognize this subdivision In- stead they allow the peripheral vascular specialist to smother himself under the classification of general surgery or general medicine The inconsistency of competent periph this is evident in the fact that the eral vascular surgeon must be well versed in both medicine and surgery and would therefore unde fields present regulations have to qualify in both It seems to me that the state medical societie can exert sufficient influence to review and perhap revise the present standards of specialization arbi- trarily set up by the instituted boards Signed SAUL S. SAMUELS M.D. 151 East 83rd Street New York City February 13 1948 Brist LABORATORIES SYRACUSE NEW NEW YORK STATE JOURNAL OF | MEDICINE Copyright 1948 by the biodical Society of the Sents of New York GEORGE W. KOSMAE M.D. Managing Editor LAURANCE . D. Redway M.D. Managing Assistant Managing Literary Literary Literary and Editor ARMITAGE WHITMAN M.D. Assistant Literary Editor DWIGHT ANDERSON Business Manager ALVINA RICH Lewis Technical Editor . Publication Committes GEORGE W. KOSMAK M.D. Chairman JOHN J. MASTERSON M.D. WALTER P. ANDERTON M.D. DWIGHT ANDERSON Laurance D. Redway M.D. JAMES R. REULING MD VOLUME 48 APRIL 1 1948 NUMBER 7 Editorials . STRACT on Ivy and Poison Oak Dermatitis The Annual Meeting 1948 It is time now to plan to attend the Annual Meeting of the Medical Society of the State of New York to be held this year at the Hotel Pennsylvania May 17 to 21 in New York City Again let us urge you to reserve hotel ac- commodations early if you have not already done so The winter having done its worst it is highly probable that by the time of the meeting the weather will be such as to make driving attractive again for those who will come by automobile It is yet too early to announce with certainty the principal speakers at the annual banquet which will be held on Wednesday night May 19 but we feel sure that you will want to hear them whoever they are The chairmen of the Scientific Program and of the Scientific Exhibits have worked hard and productively to make this year's meeting of more than usual interest More applications for the scientific exhibit space have this year been received than could be filled even with a better arrangement of floor space than was possible in 1946 The Teaching Day Programs of the Coun- cil Committee on Public Health and Educa- tion will fill the entire day of Tuesday May 18 and promise to be of extraordinary inter- est we are informed In addition the section on Radiology will again conduct its film reading session on the basis of submitted roentgenograms We are informed that the section on Industrial Medicine and Surgery will include a symposium on Hand Surgery with a number of papers to be read by invi- tation that are of more than usual interest We hope that the Annual Meeting of 1948 will be better attended than any previous meeting of the Society The House of Delegates will commence its sessions on Monday morning May 17. The complex structure of our modern civilization is enveloping the practice of medicine our system of medical education the research groups clinics and hospitals in a vast web of changing laws attempts to break down standards of licensure and practice and to impose government control upon the profession Medicine must preserve its fluidity it must be able to adapt itself functionally to the real the demonstrable needs of a changing economy a changing social structure and to make its own constantly improved technology and practice readily available to the sick It must be jealous of its own independence of thought and action but without va APTN tei, 2299, aagmelr