Document wgZQr77LxYe3e33wbYmVR7pzd

FILE NAME: Saranac 7th Symposium (SSY) DATE: 1952 DOC#: SSY031 DOCUMENT DESCRIPTION: Transcript of Presentation by Mary Donlon [Intro] 595*. VIEWPOINTS ON COMPENSATION FOR PULMONARY AND OTHER OCCUPA TIONAL DISEASES Chairm an, Hon. Mary Donlon. Tha fu n c tio n s and Valua o f M edical Boards and M edical Exam iners in Controverted Condensation Cases Lemuel C . McGee, M. D. B o ard o f Chest C o n s u lta n ts , Workmen's C o m p en sation B o a r d , New York S t a t e Edgar M ayer, M. D* J . Burns Amberson, M. D . E dvard G . W h ip p le , M. D* A . J . Gentholts D iscussion The P r e s e n ta tio n o f M ed ical Evidence in C o n troverted Compensation Cases D a n ie l C. B raun, M. D . Frank Bamako Ivan Sab ourin D iscusaion BY MB. WATERS: W i l l you gen tlem en p le a s e come in t o the room and be s e a t e d ? W i l l you p le a s e come in t o th e room and be s e a t ed* Appropos o f the sto ry th a t I to ld a t the dinner l a s t e v e n in g , we s h a l l now h e a r the whole s to r y as i t r e i la t e s to the le g a l a sp e cts o f the problem o f the pneumocon i o s e s . We a r e in deed most fo r tu n a te in h a v in g w ith us t h i s m o rn in g , M iss Mary D o n lo n , who is Chairm an o f th e New Y or k .!___________ _ _________________ ____ _____________________________________ ________________ 596*___ | S ta te Workmen' s Com pensation B o ard . I th in k i t i s f a i r to say th a t she has ach ieved n o t only a n a tio n a l b u t an in t e r n a tio n al rep u tatio n in the discharge o f the duties that have been a ssig n e d to h e r in th a t p a r t ic u la r o f f i c e . She does n o t have an easy j o b . No a d m in is t r a t o r o f com pensation laws has an e a sy jo b . 8he I s b e s e t , h ara sse d and p e rp le x e d by members o f my p r o f e s s io n , the l e g a l f r a t e r n i t y , and w it h resp e ct to our b roth ers o f the m ed ical p ro fe e s io n , a g a in , she has her trou b les concerning h e r s e lf w ith the e v a lu a tio n o f m edical testim ony in co n tro ve rted ca se s which she must d e c id e . F o rtu n a tely , sh e is a lawyer and I th ink th a t the tr a in in g th a t she has had in th a t f i e l d , w ith the experience' that she has had as a p r a c tic in g a tto rn e y , has been exceed in g ly h e lp fu l to her in the discharge o f her d u tie s . A fte r a d i s t in g u i s h e d l e g a l c a r e e r w hich I am su re i s s t i l l c o n t i n u i n g , Governor Dewey c a l l e d h e r t o the o f f i c e t h a t she C now o c c u p ie s w ith such d i s t i n c t i o n and i n t h a t j o b , she h as I done an e x c e lle n t s e r v ic e , to the p u b lic , to in d u stry and j when I speak o f in d u s t r y , I in c lu d e b o th management and l a - | bor, ; She w i ll serve as Chairman o f the m eeting t h is ! morning and I tr u s t and hope th a t she r u le s w ith - the ! m eeting w ith an iro n h an d . She not o n ly knows what s h e ' s i t a lk in g about but she knows how to t a l k . I t i s my p le a s u r e ! 597 to In tro d u ce her to you, Honorable Mary Donlon* (A p p lu ase), BY MISS nONLQj?! Ted W a te rs, D o cto r Vorw ald and Members o f the Symposium* A s I r e c a l l i t , i t was f i v e y e a r s ago on Ju s t su ch a b e a u t i f u l Septem ber m orning aa t h i B , th a t ve l a a t met here in Saranac f o r the S ix t h Saranac Symposium, and h e re we a re a t th e S e v e n th , and S a ra n a c l a doing i t s b e e t fo r u s in the m atter o f a very p leaB ant s it u a t io n in which to meet* However, there ie one im portant d iffe r e n c e th at I have b ee n t a l k i n g w ith some o f th e p a r t i c i p a n t s on our p a n e l, a b o u t, th a t t h is i s one o f those even numbered y ea rs t h a t comes once e v e r y fo u r y e a rs and I somehow do n o t f e e l co m p lete freedom to d ev o te my a t t e n t i o n t o th e s u b je c t o f p r e p a r a t io n o f a p a p e r , t h a t I f e l t i n th e y e a r 1914-7# so y o u ' l l have to b e a r w ith me i f , aa C h a irm a n , my p ap er i s n o t q u i t e as w e ll p u t t o g e t h e r as my good f r ie n d Ted Waters^ h f le d you to b e lie v e th a t i t m ight be* F o r one th in g , I don' t th in k the Chalmnan ought to re a d p a p e rs , b u t i t seems the rubs o f th is p a r t ic u la r o c c a sio n are otherw ise* I th in k a Chairman is to see th a t the d iscu ssio n s s tic k to th e ir d ir e c tio n , the d iscu ssan ts s t i c k to t h e ir to p ic s and don' t wander too fa r o f f and wind tip in more than the amount o f tim e th a t was g iv e n to them, and here I am s o t t i n g a bad example p r o b a b ly , by v i o l a t i n g I 598 * t *11 my own r u l e s , i However, I have done what was supposed to be done, and I 'm g o in g to t a lk t o you a b o u t my v ie w p o in t, s in c e t h is morning' s program i s devoted to view points on compensation fo r pulmonary and other occu p atio n al d isea se s* My v ie w p o in t as t o Workmen's Com pensation f o r p u l monary and o th e r o c c u p a tio n a l d ise a se s i s , o f co u rse , the v ie w p o in t o f th e a d m in i s t r a t o r . As s u c h , I am g r a t e f u l fo r the o p p o rtu n ity o f p a r tic ip a tin g in th is d isc u ssio n today* In the p a s t , th e c o n t r ib u t io n o f Workmen' s Com pensation ad m in istrato rs to d iscu ssio n s o f the occupational d ise a se s, o u ts id e o f t h e i r own o r g a n iz a t i o n s , h as b ee n much to o e m a il, I th in k . In p a r t, th is is the S u it o f the a d m in istrato rs, because th ey have u s u a lly been too busy h an d lin g the de t a i l s o f eases to have tim e a lso to record and o rgan ize th e ir exp erien ce* The view p oin ts o f law yers and d o c to rs, as to com pensating o ccu p a tio n a l d ise ase s have, th e re fo re , o fte n r e c e iv e d more c o n s id e r a t io n , and I th in k t h i s i s e s - | p e c ia lly tru e du rin g l e g i s la t i v e committee b e a rin g s, than I have the view points o f ad m in istrato rs* jj I s h a l l , th e n , p re se n t my view point in the l i g h t I o f the h is t o r ic a l development o f occupational disease cover- jj age in the U n ite d S ta t e s * A t the s t a r t o f our n atural developments in th is ____________________________ __ _______________ ____________________ _________________ 5 2 3 * f i e l d , many lo o k e d upon o c c u p a t io n a l d is e a s e co v e ra g e and e s p e cia lly the f u l l or gen eral coverage o f such diseases as a le a p In th e d a r k . The atmosphere in w hich d is c u s s io n to dk p la ce seemed to be th a t o f f e a r , probably born o f ig n o r a n c e . E x p e rts brought fo r t h a p o r t f o lio o f p resed en ts from the exp erience o f fo r e ig n co u n trie s and presented th is aa> t e r ia l w ith an a ir o f overwhelming e r u d itio n . Stunned audiences were convinced th a t the most com plicated and r e s t r i c t i v e sch e m e s, so im p r e s s iv e ly d e s c r ib e d to them , em bodied the l a s t word o f the w o rld 's e x is t in g wisdom upon the su b je ct o f o ccu p a tio n a l d isease com pensation. I t so happened th a t, in th is country, schedules -- ^ ten those double-colum n schedules that you 're fa m ilia r w ith -- were im ported from abro ad . I t seemed ir r e le v a n t to know t h a t th e d is e a s e s l i s t e d in th e sc h e d u le s o f t e n were n o t p r e v a le n t in the p a r t ic u la r s t a t e w hich , how ever, mi; h t be a f f l i c t e d w ith can cers th a t were n o t mentioned a t a l l i n th e s c h e d u le s . I t was s o r t o f l i k e b u y in g a h a t from P a r is J u s t because i t was a h a t from P a r is and re g a rd le s s o f whether or not i t su ite d the w earer's f a c e . I t happened, however, th a t a t t h is tim e , in one o r two s t a t e s , p erh ap s m ore, where the o r i g i n a l in ju r y coverage p ro v isio n s had been l e f t broad and sim p le, om ittint; the r e s t r i c t i v e word 'a c c i d e n t ', the c o u rts h eld th a t th e word i n ju r y * in c lu d e d o c c u p a t io n a l d i s e a s e . Such s t a t e s . 600* th e r e fo r e , s t a r t e d alm ost by a c c id e n t w ith tho a tune oanpena tio n coverage o f occupational d iseases as of a c c id e n ta l in ju r ie s * Other s t a t e s observed the r e s u lt and se n s o f them l ik e d i t * The p r e v a ilin g p a tte rn in th is country now, I think i t is safe to sa y , is f u ll or general coverage o f oc cu p a tio n a l d is e a s e s , and in th is r e s p e c t, c e r ta in ly Am erica lead s the w orld* W ith alm ost every sessio n o f the s ta te l e g i s la t u r e s , the column o f the s ta te s w ith schedule or re -- s tr le te d coverage o f occu pation al d ise ase , shrinks w hile a t th e same tim e , the columns showing a l i s t o f f u l l co v e r age s t a t e s , len gth en s* I n e v e ry stre a m , o f c o u r s e , th ere a re m ain ourren ;a and c o u n te r -c u r r e n ts Alarm as to com pensation coverage fo r s i l i c o e i s f la r e d up d u rin g the dep ression th a t fo llo w ed 1929* and t h i s a larm s t a r t e d a t i d a l wave o f r e s t r i c t i v e b i l l - d r a f t i n g in p a r t , a p p lic a b le to the duat d is e a s e s * In co n se q u e n ce , in co n se q u en ce, many o f the s t a t e com pensation law s a re now c lu t t e r e d w ith r e s t r i c t i v e and d i a crim in a to ry p rovision s a p p lica b le e ith e r to occupational d iseases in general or p e c u lia r to the dust diseases* S i l i c o s i s com pensation sometimes i s more a phe nomenon o f unemployment than a p h y s ic a l d i s a b i l i t y , and I th in k t h a t ' s im portant fo r us to remember. Large s c a le unemployment o f fo u n d ry men and m iners b rou gh t on th e s i l i e b s i a 1 601. co m p en satio n a ca re d u r in g th e 1930` a . Men out o f Jo b s t u r n ed to Workmen** Com pensation as th e l a s t recourse from s t a r v a t i o n . Some o f th e s e men r e c e iv e d perm anent t o t a l d i s a b i l ity awards. A ft e r th e war boom in th e e a r ly 4 0 's , t h is c r e a t e d an a lm o s t i n s a t i a b l e demand f o r w orkers and c a n c e lle d the cu stom ary sw ing to c o m p e n sa tio n . Many men who had r e c e iv e d perm anent home d i s a b i l i t y awards r e tu r n e d to jo b s a t wages h ig h er than they oould earn b e fo re . You can n ot th in k s t r a ig h t as to workmen's com pensation fo r p a r t i a l d i s a b i l i t y from s i l i o o a i s u n le ss you remember th a t h ir in g p r a c t i c e s made t h i s is s u e a h o t - s p o t i n a good many p l a c e s . I t has been noted that as to o ccu patio n al d isease c o v e r a g e , some o f th e s t a t e s s t a r t e d by co p y in g a f o r a p a tte rn o f schedule coverage. O ther s ta te s developed a n a t iv e o r A m erican p a t t e r n o f f u l l c o v e r a g e , w h ich I s now the p r e v a ilin g p atte rn in the s ta te s . The tre n d tow ard sim p le and com prehensive cover age w as, however, com p licated by the economic counter c u r re n ts flo w in g from the s i l i c o s i s alarm during the 1930' Some c o n fu s io n h a s , o f c o u r s e , b ee n c re a te d by t h e s e co u n te r c u r r e n ts . The o rd erly and normal p rocess o f o ccu p a tio n a l disease coverage toward understandable and sim ple lon g ad m i n i s t r a t i o n was d e f i n i t e l y in t e r r u p t e d . To c l a r i f y our th in k in g fu r th e r comment on th e 602 h i s t o r i c a l background seems in d ic a t e d . The h is to r y o f occu p a t i o n a l d is e a s e c o v e ra g e i n th e s t a t e s , even when t h a t h i e - Pear*. w r itte n , m ight alm ost be e n t i t le d *The Conquest o f The f i r s t e p is o d e s have to do w ith fe a r o f th e .moib - ta r y c o s t to in d u s t r y , so t h a t esurly p r e -o c e u p a tio n was w ith the need fo r p ro te ctin g in d u stry from b ein g ruined by sup posedly unbearable c o s ts . The le g is la t u r e s were t o ld th a t looks - th a t lo o ss p r a c tic e on the p art o f a d m in istra to rs in compensating o c c u p a tio n a l d is e a s e s would tu rn workmen' s compensa tio n in to h e a lth in su ran ce. Rare or excep tio n al instance# i^ w hich q u estio n ab le awards have been made, were se ise d upon, p u b lic ly -- they were p u b lic iz e d and m agnified out o f proportion to th e ir r e a l s ig n ific a n c e . Calm and w ell-in fo rm ed d is c u s s io n o f the problem was som etim es im p o s s ib le , bedause th e o p in io n s o f many had been formed by v iv id im pressions o f com pensational cases rath e r than by s t a t i s t i c a l com p ilation s from con sid erab le j I aggregates of experience. The co st e s tim a te s , not anchored to aggregates of mature e x p e rie n c e , were sometimes f a n t a s t i c . The producte - the production o f a s t a t i s t i c a l average is o fte n the b e s t, i f not the o n ly , cure fo r d isto rte d th in k in g , both as to perform ance and c o s t . In 1935, the p r iv a te in su ran ce c a r r ie r s would not 603a _ | p r o v id e c o v e ra g e I n New Y o rk S t a t e f o r s i l i c o s i s * I n s u r j an.ce c o u ld be o b ta in ed o n ly from th e S t a t e In s u r a n c e Fund* i The Fund s e t it s In suran ce ra te s h ig h and h e ld i t s breath | | w a it in g f o r th e c a s e * I t was so on d is c o v e r e d t h a t th e in surance r is k had been ex aggera ted * j Mr* M u lle r , th en E x e cu tiv e D ir e c to r o f the Fund, 1 s a i d and h as been q u oted a s s a y in g * *We were a f r a i d o f a w o lf t h a t was not t h e r e " Of co u rse * i n the absence o f a dependable s t a t i s t i c a l b a s is fo r e a s e s , insurance a ctu a rie s do f e e l com pelled to nake f u l l s iz e c o s t e s tim a te s * That i s t h e i r b u sin e ss r e s p o n s i b ilit y * When the a o tu a r ie s had done t h e ir work, the law yers were then c a lle d upon to d ra ft le g a l r e s t r ic t io n s and lim ita tio n s upon com pensation pro v id e d * The r e s u ltin g p attern s o f o ccu p atio n al disease l e g i s l a t i o n i n some o f t h e s t a t e s c a n b e s t b e d e s c r ib e d as barbed w ire entanglem ents* P a n ta s tlc r e s t r ic t io n s were put on th e way o f c o m p e n s a b ilit y , e s p e c i a l l y as t o s i l i c o s i s * and som etim es b e n e fits fo r o c c u p a tio n a l d ise ase were put on a low er le v e l than fo r a cc id e n ta l in ju r ie s , e ith e r aa to cash payments or m edical care or b o th . ! The laws ltU A s* skat r * t l l l e lu tt*r < l w ith ! these discrim inatory d e ta ils th at are hard to g e t rid of* ; Such harrassing r e s tr ic tio n s are a l i a b i l i t y to insurance c a r r i e r s , and em ployers, because th e y arouse h o s t i l i t y in thJs __________________________ _________ ____ __________ _______ __________ _________ _______________________ i ! -I ---- .----- ----- ---- -------- ------------------------------------------------- 604* _____ ranks o f la b o r , the consequences o f which are a l l out o f prop ortion to the pinch-penny savings e ffe c te d by the re s tr ic tiv e p ovisicns* This is beginning to be apparent in the c o n flic t as to com pensability o f p a r tia l d is a b ilit y from s i l i c o s i s . Such th in g s keep workmen' s com pensation laws in p o li t ic s and th e y sh o u ld be above p o l i t i c a l c o n s id e r a tio n s * In New Y ork and a ls o i n some o f th e s t a t e s where th e law a d m in is t r a t io n s a r e , as we l i k e to t h in k , w e ll ad vanced, the second stage o f th in k in g about occupational die-- j i ease and e s p e c i a l l y s i l i c o s i s , c o v e r a g e , has now been r e a c h - ' ed, j i T h is second sta g e o f th in k in g on the s u b je c t o f j j o ccu p a tio n a l d ise ase coverage is marked by the p re-occu p atio n j w ith an e ffo r t to d e al Ju s tly and w ithout d iscrim in atio n w ith \ a l l the v ictim s of occu p atio n al d ise a se s* The question a r i s e s , can we do t h i s , and i f s o , how* I t becostes n eoes-- a ry , t h e r e f o r e , t o t r y to se e th e problem I n human term s* When o c c u p a t io n a l d is e a s e problems are se en i .i human te rm a , a p p r o p r ia te a c t io n a a y be e x p e c te d . Some e f th e d i f f i c u l t i e s o f co v erage may be o b s c u r e , b ecau se the flo o d lig h t o f re se a rch has not y e t been turned upon them* On th e o th e r h an d , some o f th e re m a in in g ta k k s f o r l e g i s l a tu r e s can be approached through d e m o n stra tio n , and because I ' m t a k in g a l i t t l e more t im e , I ' m g o in g to s k ip a dem o-stra-' 60S, ! t l o n t h a t I was g o in g to g iv e you by way o f i l l u s t r a t i o n , am i | g e t on w ith sty p ap er* One o f the most p e r p le x in g o f the s t i l l u n so lved problem s i n many s t a t e s , t h a t o f co m p en satin g p a r t i a l d ie * . a b i lit y from s i lic o s i s * That i s c e r ta in ly th e case here in j Hew Y o rk * T h ere i s a d ir t h o f In fo r m a tio n b a s e d upon com prehensive ad m in istrative research* Two h y p o th e se s a re e n co u n te re d * One i s th a t th e re is no such th in g as p a r t ia l d is a b ilit y from s lllo o s ls * . Another is th a t the a d m in istra tiv e problem o f han dlin g par* t l a l d is a b ilit y is Insuperable* In the face o f such c o n flic tin g o p in io n s, in fo r* a c tio n i s needed as to what happens to the v lo t ia s o f s l l i - eoels b efore they reach the stage o f t o t a l d is a b ilit y from work* We know t h a t i n th e q u a r r ie s o f V erm on t, and K assae o h u s e t t s , t h e r e a re men who h ave worked i n s to n e a l l t h e i r l i v e s , who a r e g e t t i n g a lo n g w ith th e v i t a l c a p a c it y o f th e ir lungs reduced to a fr a c tio n o f normal cap acity * I f 8 | you do n o t r u s h them , th e y can do a d a y 's w ork. However, | they have no reserves, but th e ir d is a b ility is not reflected ; f in th e ir earning ca p a city , because th e ir s k i l l and exper- Iience o f f s e t s e a t ie f a c t o r ily to the employer, t h e ir lack or p h y s ic a l speed* These men u s u a lly have a stro n g sense o f I, fa m ily r e s p o n s i b i l i t y , and w ith g r e a te r d eterm in ation , they ' go on w ith t h e ir accustomed work, o fte n w ith unaim ini"hed earnings* Those who b a s e t h e i r g e n e r a l i s a t i o n s upon t h ia sa g * ment o f e x p e r le r .e e , may a rg u e t h a t th e r e i a no such th in g a p a r t i a l d i s a b i l i t y from s i l i c o s i s , ao f a r aa workmen*a c o n d e n s a tio n lawa a re c o n c e r n e d , b e ca u se th e r e l a no wage loss a ttrib u ta b le to such d is a b ilit y . T h is c o n t e n t io n , o f c o u r s e , comes more e a s i l y f r o * a p erso n who does n o t h im s e lf h ave s i l i c o s i s , th an from th o so who have t o s t r u g g le f o r b r e a th * I n s h o r t , one segment o f e x p erie n ce aa to s i l i c o s i s is commonly d isp o sed o f i n work* msn*s com pensation a d m in istra tio n by contention that there ia no such th in g aa in d u s tr ia l d is a b ilit y , p a r tia l in d e g r e e , from u n co m p lica te d s i l i c o s i s . On the o th e r h an d , some spokesmen f o r o r g a n is e d la b o r i n s i s t t h a t th e p r e v a il* in g p ra ctie e o f not com pensating p a r t ia l d is a b ilit y fo r e ll* l c o a l s la u n j u s t , and some o f them a r e becom ing somewhat m ilita n t in resp ect to th e ir grievance* W h ile some s t a t e s do n o t p r o v id e com pensation f o r p a r t i a l d i s a b i l i t y f o r s i l i c o s i s , some ju r is d ic t io n s have had considerable experience w ith tak in g care o f such cases i n one way or a n o t h e r . The m ain n eed s seem t o be f o r main* tens n e e , w ith r w ith o u t m e d ic a l a i d , and f o r r e h a b i l i t a t i o n and fo r jo b s* Under varyin g types o f law , the maintenance pay- j: ments may be on th e b a s is o f wage l o s s when th e w orker h as eo7. J to change to work th at la le ss e x a c tin g p h y s ic a lly , or there may be payment baaed upon e a tim a te d d e g rees o f n o d n la t lo n , j f o r r e h a b i l i t a t i o n ,p r o v i s i o n may be w ith o r w ith o u t a sp ec ! i a l award to cover the roughly estim ated co st to th e worker o f c h a n g in g - - pardon me -- from one k in d o f employment to another* These varying provision s can, o f co u rse , eith e r be used w e ll or abuseds The r e h a b ilita tio n type o f p ro visio n fo r the s i l i c o t i c , a t f i r s t g la n ce , looks id e a l, e s p e c ia lly i f . th e attem p ted change o f employment is accom panied by a lump sum payment* How ever, i t s h o u ld be remembered t h a t i n V iso o n a in , the p ro v isio n fo r a h ard ship payment i s used th e a d m in is t r a t io n to d is c o u r a g e em ployers from d is eh.trg--1 in g t h e i r workera when sun X -r a y show* n o d u la tio n * Some ty p e s o f r e h a b i l i t a t i o n p r o v is io n s can be used p rim a rily to clo se out the em ployers' fu tu re l i a b i l i t y ra th e r than improve the h e a lth and s ta tu s o f the w orker, which la the true purpose o f r e h a b ilita tio n * I f there la a I an a l l e r g y , c e r t a i n l y an e f f o r t s h o u ld h made t o a rran ge I s s a tis fa c to r y change o f employment. However, the circum s ta n c e t h a t a worker g e t s a new Jo b does not n e c e s s a r i l y jj mean t h a t he w i l l e i t h e r keep i t o r be a b le t o g e t i n con- l tin u o u s employment a t oth er job s* | When th e shop h ou sek eep in g has been c le a n e d upand th e d u s t removed from the a i r , i t seems p r e f e r a b le not to ***** aqa | in t e r r u p t th e accustom ed employment o r a worker who has t> . s i l i c o s i s , b e c a u s e i n many a re a s when he has been thrown on th e employment m a rk e t, i t is -very h ard fo r him t o g e t another Jo b * i n p a r t , b ecau se o f the way some coznpenration p r o v is io n * a re w r it t e n i n some s t a t e s , em p loyers w i l l n o t h ir e a >!> J who h as an u n fa v o r a b le ch e st X - r a y . F a u lt y com pensation j b i l l d r a ftin g , togeth er w ith the present h irin g p r a c tic e s . i | sh u n t to o many t r u ly em ployable p erso n s toward the perman en t t o t a l d i s a b ilit y c la s s if ic a t io n , or toward the publie w elfare r o lls * I So f a r as Hew York I s co n ce rn e d , com pensation f o r p a r t ia l d i s a b ilit y from s i l i c o s i s i s s t i l l a problem fo r tb s le g is la t u r e * I f com pensation i s provid ed by law fo r th is c a te g o r y o f d i s a b i l i t y , t h e Hew Y o rk Workman's Com pensation Board, o f co u rse , w ill fa c e another d is a b ilit y ra tin g prob lem * At th la p o in t, i t sho u ld be aet fo r th th a t, in com pensating o ccu p a tio n a l d isease c a s e s , adm in istration is hampered by th e la c k o f e a r ly and c o rre c t d ia g n o sis o f d is e a se * In e x p e r t d ia g n o s is and th e la c k o f wide experience w ith I n d u s t r ia l p ro cesses sometimes g iv e s a f a ls e s t a r t in th e in v e s t ig a t io n o f c a s e s . W ithcxit com petent and prompt d i a g n o s i s , maximum b e n e f i t s do n o t flo w f o r trea tm en t* A t p r e s e n t, so fa r as th e Workmen's Compensation a u th o r ity i s con cern ed , the two stages o f h an d lin g o ccu p a tio n a l ~r .609 d ise a se ca se s a re alm o st co m p letely se p a ra te d . The f i r s t sta g e i s d ia g n o s is and tre a tm e n t. The second s ta g e , la d is a b ilit y r a tin g and a d ju d ic a tio n . I n many s t a t e s to d a y , th e re I s a hue and c ry about the h ig h c o s t o f workmen's com p ensation. O f c o u rs e , the pub l i c should be concerned about a l l e x cessiv e c o s ts . However, In d is c u s s io n s o f the c o s t o f workmen's com pensation, the p u b lic i s fre q u e n tly m isled in to supposing th a t the le g a l b e n e fit r a te s a re too h ig h or th a t the workmen's com pensation adm inistration is exceseively lib e r a l In it s in terprstationa and awards* A p ro p e rly worded statem en t m ight th a t - be th a t p ro b a b ly in a l l s t a t e s , th e workmen's com pensation c o s t i are too h ig h in r e la t io n to what is d e liv e re d in payments and se rv ice s* hat th e p u b lic h as n o t been t o l d and does no t now u n d e r s ta n d i s t h a t th e m ajo r so u rce o f u n n e ce ssa ry lo s s Is not the ad m in istrativ e processing o f cla im s, w hich, o f cou rse, is n o t p e r fe c t, but rath er fa u lty d iagn o sis and treatm en t. A t the p resen t stage of a d m in istrativ e develop ment in the s t a t e s , th e workmen's com pensation a u th o rity o fte n has th e sad ta s k when s e t t l i n g o r a d ju d ic a tin g both d is e a s e and a c c id e n t a l in ju r y c a s e s , o f mopping up the re s u i t s o f p r o lo n g e d u n s a t i s f a c t o r y m e d ic a l c a r e . How much lon ger t h is s it u a t io n w i l l be t o le r a t e d , e s p e c ia lly bh th e more advanced a d m in i s t r a t i o n s , rem ains to be s e e n . * j. ilWWr"p 610, I have mentioned too the h is t o r ic a l stages o f de velopm ent o f occu p atio n al disease coverage in the sta te s * I n th e f i r s t , th e main p re -o ccu p a tio n was t h a t o f s h ie ld in g in d u stry from a lle g e d ly unbearable c o s t s . The second, the main p r e - o c c u p a t io n was on com p ensatin g w ith o u t d is c r im in a tio n a l l victim s of occupational d ise ase . We a re now i n a t h ir d s ta g e o f h i s t o r i c a l d e v e l opment o f workmen' s com pensation, w ith em phasis upon prompt and com plete r e s to r a tio n o f in ju re d workers to t h e ir fu lle s t work o a p a c lty . Because o f an o b sessio n w ith the le g a l prob le m s , many o f them e x c e s s i v e ly t e c h n i c a l , we have been l a t e kin g up to the p o s s ib ilitie s fo r reducing both lostefc and m onetary c o s ts in the f i e l d o f workmen's com pensation, both through ob tain in g the r ig h t type o f sp e c ia lis e d m edical care and by supplem entary team work in m ed ical c a r e , what you and I c a ll r e h a b ilita tio n . The a d v e n t o f t h is new s ta g e o f developm ent c a l l s fo r an in te g ra tio n o f the supervision o f m edical care w hich, o f cou rse, eventuates in d is a b ility ratin g and ad ju d icatio n . A t th e p rese n t tim e , a d m in istra tio n d e a ls c h ie f ly w ith what is r e a lly only a fragm ent o f the t o t a l m edical problem , A r e p o r t by th e l a t e D o cto r Howard M. P r in c e o f m ed ical exam in in g f a c i l i t i e s o f th e New Y o rk S t a t e Workmen's Compensatioja Board s e v e r a l y ea rs a g o , c o n ta in s t h is sta te m e n t! The Chiefs M ed ical Examiner should in s t it u t e an in te g ra te d m edical ! JSIXa. program fo r workmen's com pensation. Such a th in g has not ye s been done i n any s t a t e . T h is f a i l u r e i s r e s p o n s i b l e , i n sjy o p in io n , not alon e fo r huge monetary lo s s e s , bu t a ls o for t r a g i c and u n n e c e s s a r y human l o s s . As you know, th e monetary c o s t o f w orkm en's com p en sation a ris e s from and ia augmented or dim inished by the e x t e n t o f human l o s s . We w orry a b o u t m onetary l o s s . P er haps we ought to w orry more a b o u t i t , b u t our p ar amount con c e rn sh o u ld be w ith th e human l o s s . I f we red u ce th e human lo s s , the monetary lo s s w ill dwindle as w e ll* Our e f f o r t i n New Y o r k i s t o p r o t e c t in J u r i e d work* era in -- to the f u l l e s t p o ssib le e x te n t. The program o f p rev en tio n , the programs o f p reven tion and r e s to ra tio n are f u l l y d evelo p ed . The c o s t o f adequate payments and se rv ice s fo r in ju re d workers should not be oppressive to industry* At p re se n t, th e program of prompt and f u l l re s to r a tio n o f i n ju r e d w orkers i n Hew Y ork and e ls e w h e r e , i a th e m ost un developed segment o f workmen's com pensation a d m in istra tio n * The r e s u l t i n g l o s s , b o th i n human and monetary te r m s , may w e ll be a p p a l l i n g . We s h a l l study how b e s t we cak s e rv e th e in ju r e d w orker and th e new l i g h t upon the ta sk w i l l c o n f id e n t ly come upon th e c o o p e r a tio n o f our p eo p le i n p e r f e c t i n g th e New Y o r k C o u r ts perform ance so f a r as may be humanly p o s s ib le * (A p p la u se ). Due t o th e f e s t i v i t i e s o f l a s t e v e n in g , We've g o t