Dáil Éireann debate -
Thursday, 24 Feb 1949

Vol. 114 No. 4

Private Deputies' Business. - Workmen's Compensation (Amendment) Bill, 1949—Second Stage.

Dr. Maguire

There is, I hope, no necessity for my dwelling at any great length on our reasons for introducing this Bill. Justification for our having done so will be evident to any Deputy with a knowledge of Section 73 of the Workmen's Compensation Act, 1934, and who will carefully consider it and compare it with the amendments we have introduced. May I say at the outset that Section 73 of the 1934 Act has been the bugbear of, and a source of continued dissatisfaction and irritation to, not alone the medical profession but members of the legal profession as well, who are frequently nonplussed by the manner of its loose interpretation, to say nothing of its irregular administration. I think it well, at this stage, to point out to the House the portions of Section 73 which we have incorporated in our new amendments. It states that where compensation is payable under the Act and

"such workman has received, whether in hospital or elsewhere, medical or surgical treatment in respect of such injury, and any fees are due by such workman to a medical practitioner in respect of such treatment, and such compensation is fixed by an order of the court or under a weekly payment agreement, commutation agreement or an agreement by way of compromise registered by order of the court under Part VI of this Act, the court may, if it so thinks fit".

I may point out that in our opinion it is this wording

"the court may if it so thinks fit" that is giving rise to such confusion and misinterpretation of the section. We have suggested that it be changed to "the court shall." The original section says:

"Upon the application of such medical practitioner made immediately upon the making of such order..."

I would like to point out that in all those cases of workmen's compensation one of the first witnesses called is the medical practitioner and as those cases proceed for quite a long time, perhaps a couple of hours, it is quite impossible for the medical officer to remain in court until the case has been decided in order to comply with the regulations and make a personal application for his fee. In justice, however, shall I say, to the learned judge in the areas where this grant is made he has not adhered strictly to the letter of the law in this matter and he has on a number of occasions, I know, permitted the counsel or solicitor for the workman to make this application. However, the fact of the matter is that strictly in accordance with the law the medical officer in order to receive £5 or less is compelled by the section to make a personal application. It says in the original section :—

"upon the application of such medical practitioner made immediately upon the making of such order, direct the employer to pay, in addition to the compensation, to such medical practitioner in respect of such fees such sum, not exceeding £5, as the court may fix."

We have suggested instead of that :—

"The court shall, upon the application of such medical practitioner or upon the application of the workman's counsel or solicitor made immediately upon the making of such order direct the employer to pay, in addition to the compensation, to such medical practitioner in respect of such fees such sum as the court may fix having regard to the period of reasonable medical attendance upon such workman."

We have suggested that instead of: "a sum not exceeding £5".

Mr. T.F. O'Higgins

That applies to all doctors attending a patient.

Dr. Maguire

I am coming to that later. To my knowledge the cases are legion in which the fee paid to the doctor has been a maximum of £5, irrespective of the length of time that he has been in attendance. With regard to Deputy O'Higgins' remark, it may interest him to know what my own experience has been in some cases in which I was concerned as medical attendant. This is one. I was attending an injured workman for well over a year; his compensation was fixed and at the end the sum of £5 was divided between the county surgeon and myself. Cases of that sort have happened on numerous occasions.

Mr. T.F. O'Higgins

The proposed section, as it stands, would cover attendance whether fees were chargeable or not.

Dr. Maguire

I maintain that fees are always chargeable. It may be that other portions of the Act, as well as the part of it to which I am referring, are interpreted in a different manner. I have dealt with cases in which some proportion of the £5, if not all of it has been made. I want to tell the House that, in certain Circuit Court areas, the Act is so misinterpreted that the medical attendant to the workman is very often refused not only the £5 but even a portion of it. I should like to instance a case in which I was appearing for the insurance company. The workman was found to be incapacitated up to the day of the trial. Full compensation was paid. His medical attendant, an eminent and conscientious man, made application through a solicitor for payment of the £5, and the learned judge refused it. This medical gentleman assured me that, even had he been granted the £5, the fee would fall far short of covering his expenses in connection with that case. He had been attending the workman for well over a year. That is not by any means an isolated case. The amazing thing about these cases is that the one person on whom the onus falls of restoring the workman to a condition which will enable him to return to work, is refused even this paltry remuneration.

I have said that there are certain areas in the country in which this section of the Act is either ignored completely or, if observed at all, would appear to depend entirely on the humour or whim of the learned judge hearing the case. We must remember that any workman whose claim for compensation eventually reaches the Circuit Court, has been receiving medical attention for at least six months. That has been my experience extending over 15 years. Indeed such people, generally speaking, have been receiving treatment for a year. I have known of cases that have gone on for two years. My submission is that it is disappointing, to say the least of it, that the medical attendant's chance of getting the miserable pittance provided is just a matter of pot luck. Deputies should also bear in mind the multitude of cases of minor injuries that occur in which the persons concerned recover and return to work. For their treatment of these cases, the medical attendants receive absolutely no remuneration whatever. We have absolutely no redress in the matter, though I maintain, and justifiably I think, that the responsibility in these cases should be that of the employer.

Now, it may be alleged by some Deputies that, if this Bill goes through, the insurance companies will increase the premiums on employers. In view of the fact that following the passing of the 1934 Act, insurance companies increased their premiums by 20 per cent. I feel that ample provision and sufficient safeguards were made by them to cover this £5 which was tentatively suggested as remuneration for the medical attendant, but which, I assert, has never been paid in almost 50 per cent. of the cases. Therefore, I do not think anybody should allow this question of a possible increase in insurance premiums to affect him when considering this matter.

With regard to sub-section (2), we are all aware that a number of workmen's compensation cases are settled out of court, the registration of the agreements eventually going before the county registrar. We thought it was necessary to make provision for a settlement of such cases out of court. I know of instances where these cases have been disposed of without any provision whatever being made for the medical services given. When one considers the scant consideration and unspecific provision made for those services we can understand the omission, however regrettable, on the part of the workman's solicitor. I admit that does not happen very often, but the fact is that it can happen.

Speaking on behalf of the medical profession, I want to say that we are merely seeking what I believe reasonable people will concede we are entitled to, namely, adequate recompense proportionate to the services rendered as is the custom in every walk of life as between doctor and patient. Regarding the wording of the section itself, all we desire is that it be couched in such unmistakable terms as will ensure uniformity in its administration and an end to confusion and misinterpretation. I move that the Bill be now read a Second Time.

Dr. Brennan

I formally second this motion and I reserve my right to speak later.

Minister for Social Welfare (Mr. Norton)

I think the House ought to know something of the background of workmen's compensation and of the slow and early beginnings of our code of social legislation so far as workmen's compensation is concerned. The original and principal purpose of the workmen's compensation code was to provide compensation for injured workmen. Every other aspect of our workmen's compensation code was subsidiary to that main consideration, namely, to make provision for the man who was injured. I should, therefore, like the Deputies who are supporting this Bill to keep that point of view in the forefront of their perspective and to remember that the whole approach to this problem must be to consider the main purpose of the original and every subsequent Act. Our workmen's compensation code is probably the oldest of any piece of social legislation now in existence. The original Workmen's Compensation Act was passed in 1897. Prior to that workers had no right under any workmen's compensation code. Admittedly they had rights of common law against negligent employers or under the Employers' Liability Act of 1880 which was in operation for the 17 years between the enactment of that Act and the Workmen's Compensation Act of 1897. However, the workers' rights of common law then were both difficult and costly to establish.

The enactment of the 1897 Act represented a very substantial revolution in workmen's compensation inasmuch as it enthroned the first Workmen's Compensation Act and established the worker's right to compensation in respect of industrial injuries in a manner which had not previously existed. The Act at that time covered specially hazardous occupations such as employment on railways, in mines, quarries and engineering works and was then limited to persons in those classes of employment. In 1900 the Act was extended generally to take in agriculture and in 1906 it was extended to cover all classes of employment where the relationship of master and man existed, except for non-manual workers in receipt of salaries in excess of £250. That £250 was increased to £350 for non-manual workers in the 1934 Workmen's Compensation Act.

The Act of 1934 did one thing in respect of medical fees which was not done under any previous code of workmen's compensation legislation. It established for the first time the rights of a medical practitioner to go to the courts, either in person or through a solicitor, at the time the settlement was being made there and to ask the court to award him a sum of money in respect of his treatment of the injured workman. The court could, if it thought fit, grant the medical practitioner a sum not exceeding £5 in respect of his attendance on the injured worker. However, bear in mind that the outstanding feature under which a doctor could get £5 medical fees as set out in the 1934 Act was this. He could go to a court or a solicitor. The court had a right to say yes or no to his application and the sum could never exceed £5 in respect of any one doctor. Two doctors could make an application and both could get £5 or, presumably, 32 could make an application if they could show they had attended the injured worker, and they could all get it. But the amount could not exceed £5 for one doctor, and the court had the right to say whether or not he should get £5, £1 or anything between £1 and £5. That was the setup. Bear in mind that up to 1934 no previous workmen's compensation code had ever provided for the payment of medical fees to persons who attended injured workers and since 1934 no workmen's compensation code, either in the Six Counties or in Great Britain, provides for payment to a doctor who attends an injured workman as such. The 1934 Act, therefore, was responsible for the introduction of what might be called a medical novelty in the sense that it provided the right under certain circumstances to a doctor to secure a maximum fee of £5 in respect of attendance on an injured workman. That has been the position from 1934 until the present date. We alone in this area of jurisdiction provide that entitlement to fees. No such entitlement is provided in Britain or in the Six Counties.

I said at the outset that the Workmen's Compensation Act was passed in the main to provide compensation for injured workmen. It was not intended that it should provide sources of income for insurance companies. It was not intended as a source of income for doctors, dentists or surgeons. The main purpose of the Act—and it is still the main purpose—was to provide compensation for the injured workmen because the legislators said that a workman injured in the course of his employment had a legitimate claim against his employer for compensation in such circumstances.

A feature of all our workmen's compensation legislation has been that it was always restrictive in character. If a workman met with a very serious accident, was mauled in the wheels of an engineering plant and, as a result, suffered not only serious physical damage and impairment but suffered also a very considerable loss in earning, the maximum amount of compensation to which he was entitled under the 1934 Act was 30/- per week. Thus, under that Act, a workman earning £6 or £7 a week, with a wife and four, five or six children, when he met with an accident in the course of his employment which resulted in his being unable to follow his occupation for three, six, nine or 12 months, got as a maximum 30/- per week. That is all he got between 1934 and 1943 when, under an Emergency Powers Order, the maximum compensation was stepped up from 30/- to 37/6 a week.

In the Workmen's Compensation (Amending) Bill, which I introduced in this House recently and which is now law, the maximum compensation has been raised from the 1934 level of 30/-to the current level of 50/- per week. It is worthy of note that here again that is still the maximum compensation which can be secured by an injured workman incapable of following employment as a result of injuries sustained in the course of his work. Even though that workman may to-day, if he had not met with the accident, be capable of earning £7 or £7 10s. 0d. a week, he can get only one-third of his normal wage as a maximum—that is, 50/- per week. Not only in the 1934 Act, but in all previous pieces of workmen's compensation legislation there has been that restriction by the Legislature.

The workman is entitled to some compensation, but the compensation has fallen short, in some instances very substantially short, of his normal rate of income. Even if the workman should lose his life, under the 1934 Act his widow and children going to court cannot get from the court the actuarial value of his income, ascertained by actuarial standards. There is a limit set there to the amount of compensation which the widow can get if she loses her husband. The actuarial value with regard to a man of 30 years earning £8 a week might be reckoned at £8,000 or £10,000. The widow cannot get that. There is a ceiling of £600 for the widow if her husband is lost at the age of 30 years. That is another instance of the restrictive character of our workmen's compensation legislation.

In short, therefore, the 1934 Act said to the injured workman: "The maximum compensation you will get under this Act, mainly introduced to provide compensation for you, is 30/- per week," now adjusted to 50/- per week. That was a variation of a rate of benefit which existed from 1897 to 1934. The medical attendant of the injured workman previously could not recover from the employer. It was in the 1934 Act for the first time he got the right to recover from the employer. The employer did not employ the doctor. The employer may not be in the country at all, but he may be liable for the workman who meets with an accident in the course of his employment. Under the 1934 Act the medical practitioner got the right to recover compensation from the employer, even though the employer had nothing to do with engaging the doctor.

The 1934 Act said to the injured workman: "Your ceiling is 30/- per week," and to the doctor it said: "Your maximum fees will be £5." Since 1934 we have amended the 30/-maximum compensation for the workman so as to enable him to get to-day a ceiling of 50/- compensation. That is the maximum amount to which he is at present entitled. Nobody will deny that that legislation was overdue, inasmuch as it gave to an injured workman some additional measure of compensation for the shrunken purchasing power of money and to compensate for the fact that wages generally had risen.

This Bill is seeking to break new ground, not on behalf of the injured workman, but on behalf of doctors and dentists and surgeons who may attend injured workmen. In the past the court was empowered to give a doctor who attended an injured workman a sum of not more than £5 as fees for his attendance on the injured man. But it was not an automatic right to pay. The doctor or his solicitor had to go to the court and say to the district justice or the Circuit Court judge trying the case: "I claim payment of fees for attending the injured workman" and the court could grant a maximum of £5 or it could refuse it. That was the relationship of the doctor and the injured workman under our 1934 code of workmen's compensation legislation, and that is the relationship which exists to-day, with the 1948 amending Act grafted on to the 1934 Workmen's Compensation Act.

This Bill wants to reverse that relationship entirely. From a position in which the doctor or his solicitor had to go to the court and ask for payment of fees, subject to a maximum of £5, this Bill seeks to put the medical attendant on the injured workman in a position immensely superior to anything he has occupied in the past and in an immensely better position than the injured workman, for whom all our compensation legislation was introduced. The amending Bill says that whereas in the past the court might, if it thought fit, award compensation, it will take completely out of the hands of the court the right to refuse compensation. The doctor has merely got to go into the court and say: "I am proceeding under Section 73 (1) of the measure introduced in the Dáil by Deputy Maguire and Deputy Brennan," and the judge thereupon looks at the section and says: "Well, I have got to do what these two Deputies desire; I must award compensation." He cannot refuse. He has to start off from that angle.

Every time a doctor demands payment under Section 73 of this measure, if it is passed, the judge has to find out how much he has got to award. He need not bother asking himself will he make any award at all. This measure renders it unnecessary for the judge to trouble himself with such an academic question as whether or not he will make an award. Deputy Maguire and Deputy Brennan say to the judge: "Forget about it; it is none of your business in the future. You have got to make an award and you have no discretion whatever to refuse." The judge says: "How much have I got to award?" and he looks at Section 73 of the Act of 1934 and he says: "Under the Act of 1934 I am limited to awarding a maximum sum of £5." But under this new Bill the sky is the limit so far as medical fees are concerned. He is not obliged to award a maximum of £10 or £20 or £30. Any Circuit Court judge can award £1,000 medical fees between surgeons and specialists and psychiatrists and dentists or anybody else under Section 73 of this new Bill; and each of those could get the full amount awarded.

Dr. Brennan

Could he not allow £1?

Mr. Norton

There would be no trouble at all if he did that. Section 73 of the 1934 Act allows him to award £1 or £2 or £3 or £4; but it also stipulates that you cannot charge the employer more than £5. The section proposed provides that there shall not be any limit to the sum of money which may be awarded as fees to any medical attendant who goes into court and claims compensation under this new Bill. In the first place he must get it; the Circuit Court judge cannot say "No." He has got to make the award and there is no limit to that award.

When I saw this Bill I took the trouble to ask the insurance companies with whom employers lay off their liabilities under the Workmen's Compensation Act if they could tell me what additional premium would be required to cover this risk: firstly, the judge must award a sum of money for medical fees and, secondly, there is no restriction on what he can award any doctor, specialist, surgeon, dentist or anybody else. The insurance companies told me they did not know what it would cost. I myself have no idea what it would cost because this is uncharted territory. There has never been any experience to show what the annual payments under this would amount to in a Bill which makes the sky the limit so far as the payment of medical fees is concerned.

The House is asked to pass a Bill, therefore, under which it is not possible to measure the liability to which the House is committing itself. If this Bill is passed any person who employs a workman will have to find out from the insurance companies what increase in premiums he will have to pay if this new Section 73 is inserted. I have not been able to find out how much the employer will have to pay. Of one thing I am certain and that is that he will have to pay a very substantial increase in his present premiums. A man might be a small industrialist, merchant, shop-keeper or farmer who elects not to insure his workmen but decides to carry the risk himself. If this Bill were to become law he would undertake a liability for the payment of disablement benefits at a maximum of 50/- per week. To some extent that can be measured because there are statistics available from which it is possible to discover what the normal liability is. He may decide to carry the risk in respect of fatal injuries as well. Again, it is possible to find out what that risk is from statistics. But he is now being asked to shoulder another risk. He is being asked to shoulder the risk which would accompany the enactment of this amending Bill and which would take the form of committing the employer to accept a risk—he may be a relatively small farmer or man of modest income— whereby he would be held liable for the payment of medical fees awarded by a court which was not empowered by the Act to fix any ceiling in respect of the sum which it could award for medical expenses.

Not all of us live up in the clouds. We know that it is easy enough to go to an eminent surgeon and run up a very hefty bill running into three figures for a not very major or prolonged operation. The figure represents the measure of value which the surgeon attaches to his own skill. The surgeon may decide that the operation he performed on a particular person is worth 200 guineas. He is entitled to fix that fee. As many Deputies are aware, many surgeons get fees running into such figures. If an injured workman were to receive medical attention from an eminent surgeon or physician who thought highly of his medical knowledge and practice the Circuit Court judge would be obliged to award such medical fees as might be demanded without any legislative restriction as to the maximum amount which could be awarded.

If an eminent surgeon who is used to getting fees of 200 and 300 guineas for operations goes into court the Circuit Court judge would not find it very easy to award him £10 if the surgeon elects for £200 or £300. It cannot be pleaded, on the other hand, that the employer cannot pay because by then it will be pretty well known that an insurance company is standing behind the employer. In the long run the insurance company will not lose because it will adjust its premiums to cover that risk and it will collect the additional premiums necessary from the person who thinks it desirable to cover his risks with an insurance company.

Deputy Dr. Maguire and Deputy Dr. Brennan would not attempt to prophesy what additional cost premiums of this kind would involve. A somewhat similiar proposal was put forward when the 1934 Act was being enacted. The then Minister for Industry and Commerce, Deputy Lemass, hazarded the view that it would result in an increase of 50 per cent. in the premiums for workmen's compensation purposes.

Dr. Maguire

If?

Mr. Norton

If there were no ceiling on the fees which could be awarded to doctors. I think he arrived at that figure of 50 per cent. because of a similar proposal which was made in Australia some time previously in respect of which somewhat comparable legislation would cost up to 50 per cent. more. I have not been able to ascertain on what figures precisely he based his calculation. The matter is not sufficiently clear to me. At all events the Minister in charge of the 1934 Act made the case that it would cost 50 per cent. more. Assuming that 50 per cent. is exaggerated and that it would only cost 25 per cent. more in premiums, does Deputy Dr. Maguire realise what even that involves? Present premiums paid in respect of workmen's compensation amount to approximately £1,000,000 per year. A 50 per cent. increase would mean pushing that up by £500,000 if that basis of calculation were correct. I do not say that it is either right or wrong. It was put forward by Deputy Lemass, then Minister for Industry and Commerce. Assuming it was 50 per cent. exaggerated it still represents an increase of £125,000 on the present premiums payable for workmen's compensation purposes. That must come out of the pockets of those who pay premiums for workmen's compensation purposes.

I put it to Deputy Maguire and Deputy Brennan, both of whom are reasonable men: do they think it equitable in all the circumstances that, in a code of legislation designed to benefit the injured workman, the main purpose of which is to befriend and assist the injured workman and by which the injured workman himself is compelled to accept a fragment of his wages in lieu of his normal earnings, there should be no ceiling so far as the expenses which could be claimed by the medical attendant on an injured workman from an employer who did not employ the medical attendant?

If there is to be a ceiling for the unfortunate mangled workman—that is what the 1934 Act and every other previous Act imposed—and if there is to be, as the 1934 Act provided, a ceiling of £5 maximum fees for the medical attendant, is it reasonable to say to-day in all the circumstances that, while you will keep the injured workman's compensation down to a maximum of 50/- per week, irrespective of his injuries, their duration or his domestic circumstances, you will allow the medical attendant to get from the Court any fees that the Court awards, without the Court being restrained in any way in the matter of fixing a limit to the fees claimed? I suggest to both Deputies that that is not a reasonable approach to a problem of this kind and that it is not reasonable to keep the workman tied down to a specified figure, while the medical people can make claims for fees and get, without any legislative restriction, the full value of their claim.

Let me concede this, however, and I do it at once. When the 1934 Act was introduced, it contemplated a relationship between the injured workman, the doctor and the legislation. It said to the injured workman: "Your maximum compensation will be 30/-"; and to the doctor: "Your fees will be £5 as a maximum. That is what both of you now can get out of the benefits provided under the 1934 Act." Whatever we do, I think that relationship has to be preserved in some way or other. I will concede at once that if 30/- a week was regarded as adequate compensation for an injured workman in 1934, it cannot be regarded as adequate in 1949, because of the change in the value of money in the meantime. It is because I did not believe that that I recently introduced the Workmen's Compensation (Amendment) Bill, which increased the 30/- to 50/- and thus gave the injured workman an increase of 66? per cent. on the 1934 figure. In all the circumstances, the medical attendant would scarcely think that he ought to get more than the injured workman.

The relationship of 1934 was 30/- to £5 and the injured workman has got a 66 per cent. increase on his 30/-. I put it to Deputy Maguire that there is no argument he can adduce to show that the doctor should get more than the man for whom the Act was primarily intended. It would, therefore, be reasonable to say to the doctor who attends an injured workman: "If £5 was a reasonable figure for you in 1934, it cannot be regarded as reasonable in 1949 in view of the changed value of money" and I should be prepared to meet an argument based on such a contention; in other words, to maintain, in relation to 1949 rates of benefit and fees, the money relationship which existed between these in 1934 and which is now ascertainable on the basis of the increase between 1934 and 1949 in the amount of compensation paid to the injured workman. I am sure, however, that it will not be contended by any reasonable Deputy that the medical attendant ought to get a higher percentage increase on the 1934 rates than the injured workman.

If this Bill were a Bill asking for an adjustment of the medical fees in relation to 1934 levels and in accordance with the adjustments already made in respect of the injured workman, one could approach it in a reasonable way and find a yardstick by which to measure what the shrunken value of £5 in 1949 is in relation to its 1934 buying power; but that is not the position. This Bill wants to deprive the court of any right to refuse a claim and wants to prevent the fixing of any maximum by law. I should be prepared to look at this Bill from an entirely different standpoint, if the claim were: "Since you gave the injured workman an increase in his 1934 rates, you ought to give the doctor an increase as well." That is a reasonable and understandable approach, but Deputy Maguire perhaps unconsciously—and Deputy Brennan is in the same position—wants to open a door which would give rise to grave doubts as to whether this Bill is properly called a Workman's Compensation Bill at all, because it seems to me that the workman's portion of the cake would be pretty small, with the restrictions imposed on the kind of knife he can use when operating on the cake, compared with the substantial portion of the cake that would be distributed to medical attendants by Circuit Court judges in the future.

I am prepared to believe that Deputy Maguire and Deputy Brennan have the feeling that the medical profession are not getting a fair deal in being tied down to £5, but, as I said at the outset, that was an innovation. It is an innovation which is not known in the Six Counties or Britain. I do not want to take that fact as even a guide to an approach to this matter, but it is a fact which ought to be kept in mind. It will not be very long until the House will have to deal with a comprehensive social insurance scheme which will embrace not only all our present unco-ordinated schemes of social legislation but, I hope, workmen's compensation as well. How we are going to deal with it in the future I cannot say at the moment. Whether by State operation of the service or by integrating workmen's compensation in a common social insurance scheme or by following the present pattern of workmen's compensation, I cannot at the moment indicate.

No matter what course we adopt, we will still have to face up to dealing with workmen's compensation legislation, and, knowing that the problem will come under comprehensive review in the near future and that they will have an opportunity of dealing with the matter on a broader canvas than is available on this narrow amending Bill, might I suggest that, having given their point of view an airing, the proposer and seconder might reasonably be content to withdraw this Bill, so that they might see the whole problem in a different and broader light in the future. In any case, if they are not satisfied with the position in the future, or not satisfied that they are seeing the Bill with the expedition they desire, there is nothing to prevent them coming in here in a few months' time with a similar Bill and taking any course they wish in connection with it. I am sure it is not just for fees that both Deputies are arguing this matter. I prefer to believe that they are advocating a line of policy which they feel, looking at it from their angle, represents a grievance to a class of the community which they represent. However, seeing that the £5 maximum has been in the Act for the past 15 years and that it does represent a relationship to the compensation payable to the injured workman, then they might agree, having heard my views on the matter and of the legislation which is coming, together with having ventilated their own point of view, to withdraw the Bill on the understanding that they will have an opportunity of dealing with the problem in a bigger and more comprehensive way at a date which will not be too far distant.

Dr. Brennan

After the closing statement of the Minister, it would be a waste of time to continue this discussion very much longer, unless the opportunity were to be used as a time when certain views on this question could be aired. As far as I am concerned—and I am perfectly sure that Deputy Dr. Maguire would agree with me—the course which the Minister has suggested is one which we shall gladly take. The Minister will not, I hope, take the remarks which I am about to make in a very few sentences in any other way than as being intended to assist, to be constructive on this subject of workmen's compensation, in so far as it relates to doctors, in regard to an outlook which I think he has developed through smoked glasses so far as the medical profession is concerned.

We agree that the primary object of the 1934 Act was to provide compensation for injured workmen, but surely the basis of providing compensation is in some way related to the restoration to health of the injured workman and it is not unreasonable to expect that, whatever incident may be responsible for the injuries to the workman, it is the duty of the State to see that that workman receives adequate medical attention. When my colleague, Deputy Dr. Maguire, and I introduced this Bill, we were not really personally concerned. We regard the provisions of the 1934 Act, under which the amount payable to a doctor was £5, as entirely inequitable and unjust. We have been reliably informed that, when that Act was introduced in 1934—if I am wrong, the Minister will correct me—the insurance companies said that such a provision would mean the raising of the premiums 20 per cent. At any rate, the fact was that the doctors were very rarely paid £5. It is no justification to this House that the Minister, or any Minister of State in this country, could come to this Dáil and state that because such a set of circumstances prevail in Northern Ireland or Great Britain they should prevail here also.

Mr. Norton

I did not say that, of course.

Dr. Brennan

Not in fact, but that was the inference.

Mr. Norton

I wanted to show how well off doctors were here.

Dr. Brennan

At any rate, the Minister said that no medical fees were payable for workmen's compensation in Northern Ireland and Great Britain——

Mr. Norton

My main point being to show how well off doctors were here.

Dr. Brennan

We will see that, when it comes to an analysis of the £5. It is no ground for even attempting to show how well off doctors were here to compare the conditions which prevail in Northern Ireland and Great Britain with those which prevail here. It is well known that in Great Britain and Northern Ireland there is a large industrial community and that the circumstances which exist are not at all comparable with those which exist in our divided portion of the country. The Minister said that he wanted to show how well off the doctors were because they got £5. Suppose they got the maximum, suppose that after two years a doctor went to court, probably to give evidence. Before going to court, he had to write a report for a solicitor and before doing so he had to attend the patient for any time from two months up to two years. For all that, he gets the princely sum of £5. If he does go to court and employs a solicitor, the solicitor will charge him at least £2 or £3.

The medical profession do not desire that the humanitarian motives which inspire most of them to do their bit for the sick and the injured should in any way be curtailed or restricted. They do think, however, that in present conditions it is not right for the State or for any authority to presume on the existence of these motives in order to satisfy the needs of something which the State itself should provide.

I do not wish to detain the House any longer, nor do I wish to make any further comment on what the Minister has said. Our Bill was not intended to be accepted in the manner which the Minister indicated. If he said there was a ceiling, there was also a floor. There is nothing in the Bill which we introduced which would prevent a judge giving the smallest possible fee to a doctor but it did give to the judge the power of exercising equitably his judicial functions to state what in his view would be an equitable fee for attendance over a long period of time. The Bill, if it were passed, could be amended in such a way as to suit the desires of any Deputy desiring to put down an amendment but in view of what the Minister has said, that it is his intention to introduce a comprehensive social insurance scheme and that then an opportunity will be afforded to discuss this question of medical fees, I am quite prepared, so far as I am concerned, to withdraw the Bill.

Sir John Esmonde

This Bill seeks to substitute a new section for Section 73 of the Workmen's Compensation Act of 1934. It has been my experience, since the passing of the Act of 1934, that there is a rather serious defect in Section 73 which this particular Bill would remedy. The position at present is that under Section 73, the £5 to which the workman's doctor is properly entitled in certain circumstances, has to be claimed by the doctor himself. It has certainly been my experience and the experience of many legal practitioners who have been appearing in workmen's compensation cases since 1934, that that is a rather unworkable provision. This section does strike a new note, in this respect—that it differs from Section 73 by giving to the workman's counsel or solicitor the right to apply for the £5 in question. I think that is a matter which the Minister should consider when introducing his new Bill. If he consults anybody who has experience of these matters in the Circuit Courts where workmen's compensation cases are tried, he will find that what I am stating is absolutely correct. Since the passing of the Act, in practically every one case out of three the £5 that is justly due to the workman's doctor as provided by the Act, is not received by the doctor by reason of his reluctance to get up in court and claim what is justly due to him. The practice grew up of permitting the workman's solicitor to apply on behalf of the doctor, as if he were instructed to do so, for the £5 in question.

This Bill provides for that by giving the right to the medical practitioner or the workman's counsel or solicitor to make the application. I think that it is not only in the interests of the doctor concerned but also very much in the interests of the workman that he should get the best medical attendance that is provided for and contemplated by the Act of 1934. As the section stands at present, that intention is not properly carried out. If the Minister in the Bill which he contemplates introducing, would keep that aspect of the matter in view, I feel certain that it would meet the wishes and desires of those who have considerable experience in those matters.

Mr. T.F. O'Higgins

I should not like to allow this opportunity to pass without giving my views as a member of the Bar who, like Deputy Sir John Esmonde, has appeared in these workmen's compensation cases from time to time. I agree with both Deputy Dr. Maguire and Deputy Dr. Brennan that this is a matter that should be ventilated. As matters stand at present, medical practitioners who attend workmen have a considerable grievance and in that respect I agree that it is proper to have the matter ventilated in the House. Nevertheless, I endorse the views of the Minister as to the effect which the Bill as proposed would have on the entire administration of the workmen's compensation code. It is necessary, in a code such as the workmen's compensation code is, that some limit or ceiling should be placed on the fees to be charged. It is also necessary and proper that a discretion should be given to the court as to the allowing of any particular sum. I feel that those two safeguards are reasonable and proper and, as the Bill proposes to do away with any limits and to make the allowances compulsory on the court, I feel it goes too far. As a professional man myself, I certainly welcome the hope the Minister has held out that he would be prepared to consider favourably, either in another Bill or when the comprehensive scheme is introduced, the question of increasing the fee at present allowed to the workman's doctor. I think that such an increase would not merely redress the doctors' grievance but that it is also a very necessary step in the interests of applicants for compensation because I do know that, particularly in country cases where the question often is as to whether there had been an accident or incapacity flowing from an accident and where the issue is very finely knit, the insurance company from time to time has the benefit, and certainly uses it, of the best medical advice and help, while the applicant endeavouring to establish his case may be restricted to services not so eminent. I know that, of course, the question of witnesses' expenses or fees allowed for attendance in court is outside Section 73 and that such fees may be allowed by the court as part of the ordinary expenses of the case but the practice has now grown up amongst judges who feel the hardship on doctors of the £5 limit, of making some redress in the fee which they allow for attendance in court. That is straining both the rules of court and the practice but it is a straining which has been found necessary by reason of the statutory limit.

I think that, in the interests of workmen, in the interests of the code generally, some increase should be allowed in the fee. I would suggest that an increase of 100 per cent. in the fee should be sanctioned in the coming legislation. I think it is necessary to ensure that the workman will have the best of medical attention—not only attention to his injury or the treating of his incapacity but also attention in establishing his rights in court if they are challenged or disputed. Deputy Dr. P.J. Maguire and Deputy Dr. J. P. Brennan have rendered a considerable service in raising this matter and, in having obtained from the Minister, I shall not say the assurance, but the hope he held out to-night, they might well leave the matter as it is.

I feel that I should refer to a statement made by Deputy Sir John Esmonde during the course of this debate. I understand that under that portion of the new Circuit Court rules dealing with workmen's compensation, which rules were made under the last Courts of Justice Act, provision is made for the application by the applicant's solicitor or counsel for payment under Section 73.

Mr. Norton

I should like, before the Deputy concludes, to mention one point which might be helpful. Deputy Sir John Esmonde raised a point in regard to the provisions of Section 73 of the Act of 1934. I think he gave the impression that a doctor had to employ a solicitor——

Sir John Esmonde

Not employ.

Mr. Norton

The doctor had to ask himself. I am advised that the provisions in the section specifying that the application is to be made by the medical practitioner must be read with Rule 49 of the Circuit Court, Workmen's Compensation Rules of 1942, which provides that alternatively the application may be made by a solicitor on behalf of the medical practitioner or, with the practitioner's consent in writing, by the workman or by the workman's solicitor. That seems to bring about a considerable simplification of the position which I think Deputy Sir John Esmonde thought was more difficult.

Dr. P.J. Maguire

Let me say at the outset that I appreciate the viewpoints expressed by Deputy Sir John Esmonde and Deputy T.F. O'Higgins. The Minister seems to have expressed no sympathy with our primary reason— I am sincere in that, our primary reason—which prompted us to bring in this Bill, namely, the manner in which Section 73 had been, shall I say, abused, misinterpreted, and irregularly administered in many Circuit Courts throughout the country. On numerous occasions medical practitioners, having attended a case for six months and perhaps for almost a year, were refused anything in the nature of remuneration for their services. There is no denying that at all. I assure the Minister and the House, on behalf of Deputy Dr. J.P. Brennan and myself, that we and all other members of the medical profession would resent any suggestion that we should avail of any improvement in a workman's compensation Act in order to better ourselves. I hardly think there is any necessity for me to have mentioned that.

The Minister alleged that the sky was the limit in this. We had a limit on it, in making out this section. However, it was decided—I think I was really responsible for this part of it— that instead of fixing a limit we would leave it, in view of our past experience, very safely in the hands of the judge to decide what remuneration we were entitled to, having regard to the period of reasonable medical attendance on the worker.

As Deputy Dr. Brennan has said, it is the duty of the State to provide adequate medical attention for the worker and to ensure his recovery and return to work as quickly as possible, and therefore the State should be responsible for medical fees. I myself have had very few cases where three-figure expenses were incurred in connection with specialists. The only specialists I have ever had on cases of that type were employed by the insurance company to contest the workman's claim in the court.

We have dealt with the question of the doctor not being in a position to have a representative apply for his fee. I was not aware that that has been amended, but I am glad to hear that it is. In view of what the Minister has stated to the effect that he will give ample consideration to the views which we have expressed in this Bill—and I am sure that he will, in any future legislation he contemplates in connection with social services—I now withdraw it.

Motion, by leave, withdrawn.