Mr. WOOD. But suppose he still complains that the pain suffered from it prevents him from going to work: How do you determine whether he has that pain or not?

Mr. VERRILL. There is no way known under heaven to do that. The CHAIRMAN. Do you let him decide it?

Mr. VERRILL. No, sir; we have an examination made. We find out what he is doing. We may have the man observed when he does not know it.

The CHAIRMAN. Can you outline the system that you follow in that regard?

Mr. VERRILL. Yes, sir; but it depends upon the nature of the

case.

The CHAIRMAN. Do you have any system, or could you give us in writing an outline of the system you have in that regard?

Mr. VERRILL. Yes, sir; but it would have to be an outline of the routine cases, which would represent the large percentage of the cases, and then we would have to have an outline covering the special cases.

The CHAIRMAN. The routine cases are the ones you have to watch. are they not?

Mr. VERRILL. No, sir; by routine cases I mean the ordinary cases where there is a statement under oath by the person and a statement from his official superior. In most such cases the medical examination would be considered conclusive. A man who is injured is sent to a doctor for medical treatment and the doctor makes an examination of him and reports to us. This report shows how long the man will probably be disabled.

The CHAIRMAN. Is the doctor required to make a final report when the man is able to go back to work?

Mr. VERRILL. Yes, sir.

The CHAIRMAN. Nobody is kept on your compensation roll after the doctor makes that final report?

Mr. VERRILL. Not contrary to the doctor's report: no, sir: unless, of course, there is another doctor's report. The man would have the right to say, "Here is what my doctor says; my doctor does not agree with yours."

The CHAIRMAN. What is the matter with our doctors? Are they not in control of it?

Mr. VERRILL. Not exclusively. When the man's doctor says one thing and our doctor says another, the man is entitled to have a referee physician appointed. The law gives him that right. We would send for a referee and would abide by the referee's decision. The CHAIRMAN. Who selects the referee physician?

Mr. VERRILL. We do.

The CHAIRMAN. Will you put in the record a statement outlining your system?

Mr. VERRILL. Yes, sir.

The CHAIRMAN. Let your statement cover your method of dealing with the various classes of cases, how you reach your final conclusion that a man is no longer entitled to compensation, and, in that connection, I would like to have in the record a statement showing the average length of time that these men are on the compensation roll as a result of injuries.

Mr. VERRILL. Our annual report shows that.

The CHAIRMAN. Let your statement show how many men there are on the roll and the average rate paid; how much per annum is paid to widows and orphans; how much is paid to men temporarily injured; and how much to men permanently injured.

Mr. VERRILL. I will do so.

In the ordinary accident case the employee immediately upon injury notifies his immediate superior, filling out a brief notice stating the circumstances of his accident and injury and giving the names of witnesses, if any. The official superior upon receipt of the oral or written notice sends the injured employee for first-aid medical treatment to the medical officer in the establishment, if the establishment is one having a doctor in attendance, as would be the case in a navy yard, in the Government Printing Office, or Bureau of Engraving and Printing. If medical examination or treatment is needed beyond what can be given in the first-aid room of the establishment by the doctor in attendance, or if there are no first-aid facilities available, as is the case in most Government establishments, including many large ones, the injured employee is given by his official superior an order for examination and treatment addressed to a medical officer of the Public Health Service, if there is one conveniently accessible, or, if not, to one of the surgeons designated by the comm'ssion for rendering service in such cases, or if no doctor of either class is conveniently accessible then the employee is told to go to any good physician conveniently accessible and to submit the bill for services rendered to the Compensation Commission. The official superior, upon the information given to him by the injured employee and inquiry of those having knowledge of the circumstances of the accident in the establishment, submits a formal report to the commission. The injured employee, if any medical expense is required or if obliged to lose any time from his work on account of the injury, submits a claim to the Compensation Commission. The claim consists of the employee's affidavit of the circumstances of injury on account of which claim is made. He secures statements of witnesses, if any are available, a statement of his attending physician and of the establishment medical officer, if any, and the whole is accompanied by a statement of the official superior as to the correctness of the statement of the injured employee or making comment if in his opinion the employee's statement is not entirely correct.

Upon papers as above described most claims on account of disability of Government employees can be settled. A large proportion of the cases are of relatively short-time disabilities, the disability immediately following accidental injuries. The employee returns to work as soon as possible, because his regular pay is in practically all cases largely in excess of what he can receive as compensation. This statement, however, should not be understood to mean that the commission assumes as a matter of course that the employee will return to work as soon as he is able, since medical evidence is required in all cases and the official superior usually is active in assisting the commission to ascertain the facts.

If the statement of the injured employee and his official superior leaves doubt in regard to the occurrence of an accident resulting in disability, one or both of them are asked for further information, and if the case is not satisfactorily cleared up by this means, it is listed for investigation. If the medical evidence submitted leaves doubt as to whether the disability was the result of injury, a thorough medical examination is required including specialists of whatever kind the nature of the case may suggest. In case a medical examination made in behalf of the commission does not agree with the medical opinion of the injured employee's own physician, it is his right to have a medical examination by a referee physician selected by the commission.

Compensation continues payable so long as there is satisfactory evidence of disability for work due to the injury. If the disability lasts for a considerable time full medical reports are required from time to time supplementing the routine medical certificate of disability which is the essential basis of the payments made twice each month. If the case continues so long as to suggest doubt as to bona fide disability, special explanation is asked of the attending physician or special medical examination with the assistance of specialists is required, and the case is the subject of an investigation by a representative of the commission. A special examination in the case of long continuing dis

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ability not infrequently requires the services of a general surgeon, an orthopedic surgeon, a specialst in intenal medicine, and a special'st in nervous diseases. Public Health Service Hospitals as a rule have such specialists attached to the staff of the hospital, but when not so available the necessary assistance is secured and payment made upon a fee basis.

The principal questions arising in compensation cases demanding personal investigation by representatives of the commission may be enumerated: (1) Did an accident occur as alleged.

(2) Was the accident sustained while in the performance of duty.

(3) Is the disability from which the employee is suffering a result of an injury.

(4) Is the employee disabled for work.

(5) Is the employee totally or partially disabled, and if only partially disabled to what extent.

(6) Has the employee who is only partially disabled for work made a reasonable effort to secure work.

(7) Is the person claiming as widow actually the widow of the deceased employee.

(8) Were the persons claiming as dependent parents actually dependent, and if so to what extent.

(9) Were the persons claiming as dependent brothers and sisters actually dependent.

(10) Was the death for which claim was made due to injury while in the performance of duty.

NUMBER AND AVERAGE DURATION OF TEMPORARY DISABILITY CASES.

The average duration of disability in temporary disability cases, as shown by the last annual report, was 25 days in 15,663 cases. Many of these cases did not require the payment of compensation, because the entire disability period was covered by leave. Such cases did, however, require medical attention either from a Government physician or by some one of those designated by the commission under the compensation act. Disability compensation was paid in 9.424 temporary disability cases, the average duration of such disability being 36 days and the average compensation $64.74. Compensation on account of permanent disability is payable during the period of disability for work without limit as to time. Such compensation ceases temporarily when loss of earnings ceases, but is again resumed whenever loss of earnings due to the disability is shown. The experience of the commission to date, therefore, in regard to permanent disabilities is not sufficiently long to be significant, or such that the average amount of compensation paid will be of special value. The medical treatment paid for in 9.504 cases averaged $31.47. In addition to this, however, much medical service was furnished by Government physicians and in Government hospitals, probably exceeding in value that paid for by the commission. As a rule the long continuing cases requiring the most medical and hospital treatment are cared for in Government hospitals and are not a charge against the funds of the commission. Sixty per cent of the cases were cared for by Government physicians and no medical charge was made against the commission's funds.

The last annual report of the commission shows 475 death claims passed upon by the commission during the year. One hundred and fifty-one of these were without dependents, while 324, or 68 per cent, were with dependents. The average monthly award in these cases was $34.39. During the first six months of the present fiscal year the expenditures from the compensation fund amounted to $1,283.746.35. This was 11 per cent in excess of the rate of compensation paid during the preceding fiscal year. This increase in payments was made in spite of the fact that the new accidents occurring in this six months' period was considerably less than the number occurring in the previous half year. The increase in compensation is a natural and necessary effect of the continuance of payments on account of deaths, permanent disabilities, and long continuing disabilities occurring in previous years. Evidence of this is shown in the fact that during this six months' period 22 per cent of the compensaton paid on account of nonfatal injuries was for accidents which had occurred more than three years before and on account of which payments were continuing and must continue in many cases for a long time to come.

From the beginning of the compensation law, September 7, 1916, to the end of the calendar year 1920, there were nearly 1,700 fatal cases, 1,300 dismember

ments causing partial disability, over 700 permanent partial disabilities other than dismemberment, and over 80 cases of permanent total disability. Additions to these numbers of cases of equal seriousness are being made at the rate of over 600 each year. Any of these cases enumerated may come before the commission as perhaps entitled to claim compensation for a long period of time. The only exceptions to this statement are the death cases with no dependents and the permanent partial disability cases, where the disability is of such minor degree as not to cause loss of earning capacity. In addition to these cases, there are also the temporary disabilities involving disability continuing for several years, relatively few in number, but costing fully as much as many of the permanent partial disability cases.

Payments made the first six months of the current fiscal year,

Injury compensation

$824, 295. 74

Death compensation_.

286, 056.68

Burial expense, and embalming and transportation on account of burial.

Medical treatment, and supplies and transportation to secure medical treatment_

10, 835. 11

162, 558.82

The CHAIRMAN. You say there is no chance for you to get along with this $600,000, but $60,000 of which you say you do not need. According to your statement, you do not need $60,000 of it.

Mr. VERRILL. No, sir; that is hardly correct.

The CHAIRMAN. You have stated that you estimated $10,000 per month for prospective increases.

Mr. VERRILL. That was the estimate made on the 20th of January, and our balance will be exhausted early in April. We spent $240,000 in the month just closed. We calculate that we will probably reach June 30 with a balance of less than $1.000.

FRAUDULENT CLAIM CASES,

The CHAIRMAN. Are you sure that you use every precaution in the expenditure of this money to see that nobody gets it that is not entitled to it?

Mr. VERRILL. That is what we are constantly trying to watch.
The CHAIRMAN. How closely do you watch it?

Mr. VERRILL. We watch it as closely as we can. We have not made as many investigations as we ought to have made, because we have not had the facilities. We know that at times we are beaten, or we find such cases occasionally.

The CHAIRMAN. What happens in such cases?

Mr. VERRILL. We try to recover from them.

The CHAIRMAN. How often do you succeed?

Mr. VERRILL. Not very often.

Mr. WooD. Did you ever try to prosecute them?

Mr. VERRILL. We have referred cases to the Department of Justice

for that purpose, but up to date there has been no result.

The CHAIRMAN. To what extent has that happened?

Mr. VERRILL. The cases that I know of have been no more, possibly, than I could number on the fingers of one hand.

The CHAIRMAN. How much has been expended in such cases? Mr. VERRILL. That I can not say. If you are interested in it, I can tell you of the most recent case: The most recent case that I know of was the case of a man over in New Jersey who suffered from lead poisoning. Of the fact of the original disability of this man there

seemed to be no doubt. He was sent to a Public Health Service hospital for treatment, and the compensation was paid upon exceptionally good medical reports for quite a long time, the last payment being at the end of the last calendar year.

Just before the end of the year we got word from the hospital over there that they had learned that that man had brought suit against a railroad company for an injury received by him on the premises of the railroad company last June, and he was alleging disability from and after that date on account of a fall. I got in touch with an official of the railroad company, as it happened, and talked with him the day before the case went to trial. The railroad's representative knew the history of the case under our supervision, but, unfortunately, so he said, he disclosed to the attorney on the other side what he had up his sleeve, and that rather hampered the case. The man stated under oath before the trial that he had been an unusually healthy person up to the time of this alleged injury on the railroad company's premises; had not had a doctor in three years, and that he had been an athlete, able to do anything. He alleged that from and after that date he was able to do nothing. He certified also that he had worked and earned a high rate of pay during the period in which we had been paying him compensation. The case went to the jury, and the jury awarded him $1,500. That $1,500 was paid for supposed injuries during the period in which we had paid him $460. The evidence either in one case or the other was not good. The award or the verdict was based on evidence that was not very good.

The CHAIRMAN. He might have been injured, might he not?
Mr. VERRILL. Yes, sir; he might have been injured.

Mr. WOOD. But he testified that he was in perfect condition? Mr. VERRILL. Yes, sir; yet during all of that time he was being treated in the Public Health Service Hospital and was under examination of some of the best physicians in New York City.

Mr. WOOD. Was it developed upon the trial of the railroad case that he was receiving money from the Government?

Mr. VERRILL. Yes, sir. He was awarded damages for a kind of injury that might be described as purely subjective. He claimed that his back was hurt and that he suffered pains in his back and hips. The doctor admitted that nobody could prove or disprove it. The award would have to be based upon the man's statement of his injury, or upon his statement that he was disabled, and that was something that could not be confirmed or denied by a medical examination.

The CHAIRMAN. What did your board do?

Mr. VERRILL. We suspended the compensation, and we are awaiting a transcript of the testimony at the trial before further action. I might say that the railroad company appealed from the verdict. That illustrates the need for investigations.

PROSPECTIVE CASES.

The CHAIRMAN. Tell us about this $10,000 prospective need in addition to what you say you will certainly require.

Mr. VERRILL. It is not exactly prospective. For example, if we should make an award in two death cases in the month of January