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Seanad Éireann debate -
Wednesday, 7 Feb 1934

Vol. 18 No. 5

Workmen's Compensation Bill, 1933—Report Stage (Resumed) and Final Stage.

On behalf of Senator Foran, I formally move amendment No. 1:

New section. Before Section 24 to insert a new section as follows:—

24.—Where under this Act compensation is payable in respect of injury by accident to a workman, whether such injury does or does not result in his death, the court may where it is satisfied that medical or surgical treatment has been rendered to such workman direct the payment to the medical practitioner or practitioners by whom such treatment was rendered of such sum as the court, having regard to the circumstances of the case, may consider reasonable and may direct the manner in which such sum shall be paid and any sum so ordered to be paid shall be in addition to the compensation payable to the workman under this Act.

I second the amendment.

New section. Before Section 24 to insert a new section as follows:—

24.—When compensation is payable under this Act in respect of any injury to a workman, whether such injury does or does not result in his death, and the court is satisfied that medical or surgical treatment has been received by the workman, whether in hospital or elsewhere, the court may, out of the compensation payable under this Act, direct the payment to the medical practitioner or practitioners from whom such treatment has been received of such sum as the court, having regard to the position in life of the workman and to all the other circumstances of the case, may consider reasonable for such treatment and may direct the manner in which such sum shall be paid: provided that this section shall not apply to an agricultural labourer entitled to free medical treatment in his own dispensary district by the dispensary medical officer of that district.

—(Senator Counihan).

—(Senator Wilson).

Government amendment.

New section. Before Section 73 to insert a new section as follows:—

73.—Where—

(a) compensation is payable under this Act in respect of an injury to a workman, and

(b) such workman has received, whether in hospital or elsewhere, medical or surgical treatment in respect of such injury, and

(c) any fees are due by such workman to a medical practitioner in respect of such treatment, and

(d) 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, 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 five pounds, as the court may fix, and if such direction is given the payment by the employer to such medical practitioner of the sum so fixed shall be deemed to be a payment, by such workman to such medical practitioner in respect of such fees.

I suggest that amendments Nos. 1, 2 and 4 might be perhaps more conveniently discussed together since they all deal with the same matter. Senator Foran's amendment, proposes the securing of the doctor's fees at the expense of the employer. There was another suggestion that the doctor's fees should be secured at the expense of the worker, and I brought in an amendment which was an alternative to both of these, namely, that his fees should be secured to a limited extent. The one principle is involved in the amendments.

Cathaoirleach

I think the House might agree to that course.

Agreed: That amendments Nos. 1, 2 and 4 should be taken together.

As Senators are aware, I have not been at any time enthusiastic for the insertion in this Bill of any section with respect to the payment of fees due to doctors for attendance on a workman injured in the course of his employment. I have felt that any statutory provision governing the payment of these fees would be bound to result in a general increase in the cost of medical attention to such workman and that, therefore, the cost of workmen's compensation and the cost of insuring against employers' liability in respect of it would be increased. As, however, there appears to be a substantial body of opinion in the House in favour of the insertion in the Bill of some section securing the payment of fees to doctors attending such workmen, I felt that it was desirable that a proposal, embodied in the form of an amendment to the Bill, should be submitted which would be to some extent half-way between that suggested by Senator Foran on the one hand and that suggested by Senator Sir Edward Coey Bigger on the other hand. Both Senator Foran's amendment and the suggestion of Sir E. Coey Bigger are designed to secure to the doctor his fees without limit and that whatever the doctor claimed he was entitled to for his attendance on the workman was to be secured to him. The only difference between the two amendments was in regard to the source of payment. Senator Foran suggested that the whole of the fees claimed by the doctor and assessed by the court should be paid at the expense of the employer, whereas Senator Sir E. Coey Bigger's suggestion was that it should come out of the compensation awarded. Either suggestion, in my opinion, would be very undesirable. On the one hand, the payment of the fees at the expense of the employer, without any limitation on the employer's liability, would, in my opinion, almost inevitably lead to substantial charges under that head. I mentioned last week that in one particular State the cost of workmen's compensation was increased by such a provision by over fifty per cent. and it would almost inevitably have the same result here. If we are to increase the cost of workmen's compensation to employers I would much prefer that we would do it for the purpose of increasing the cash payments to the workmen. On the other hand, if we are to make the doctor's fees chargeable against the amount of compensation awarded to the workman there would be very little left for the workman in many cases.

We have been taking on this Bill with relation to the maximum payments provided. There are many cases, however, in which these maximum payments are never made. Senators may not be aware that the average payment in respect of workmen's compensation for six industrial groups, excluding agriculture, in 1930 was £22 10s. 0d. The average payment in respect of agricultural workers injured was only £13 11s. 0d. In the six industrial groups payments average from £30 5s. 0d. in the case of constructional workers down to £18 16s. 0d. in the case of railway and tramway workers. If we contemplate a reduction of even £5 on the average payment in these cases the reduction in the compensation will be a very considerable part of the whole. On that account I felt that we should not, under any circumstances, enact a section which would secure the doctor his fees without limit, whether paid by the employer or out of the employee's compensation. Therefore, I suggested an amendment in the form which now appears on the Order Paper providing for the payment by the employer, at the discretion of the court, and on application to the court, in addition to the compensation, such fees, not exceeding £5, as the court may fix. If such direction is given, payment by the employer to the doctor of the sum so fixed shall be deemed to be a payment by the workman to the doctor in respect of such fees. It is understood that, in the event of the doctor's reasonable fees being in excess of that amount, the doctor is still at liberty to recover from the worker the balance of the fees due after the amount to be paid by the employer has been fixed by the court. These fees will be payable only in cases where compensation is fixed by order of the court or under an agreement registered by order of the court. I do not think it is possible to make provision for other cases.

Following the discussion here last Wednesday, I have received representations from various parties interested in this matter and, particularly, from persons associated with insurance companies, who have represented that even this very limited provision is bound to affect the cost of compensation considerably. Having regard to the average payments made in the rases to which I have referred, an all-round increase of £5 per case would mean, of course, a very considerable burden on employers and would necessitate a very substantial rise in compensation insurance premiums. I do not think it will mean, necessarily, an all-round increase of £5 per case. The doctor, in many cases, will try to argue that fees for his services do amount to the £5 mentioned in the section, but the court in many cases will hold that a smaller fee would compensate the doctor for his services. However, even if the average cost of workmen's compensation is increased, in consequence of the enactment of this section, by a much smaller amount than £5 per case, there will be, nevertheless, an increase which is bound to have its reflection in the cost of insurance against this liability. If the Seanad is strongly of opinion that some section safeguarding the doctor should be inserted in the Bill, it is not a matter that should be made one of serious contention, but I would strongly urge them to reconsider their attitude on the matter. I should prefer that the Bill would be left in the form in which it was introduced, but if the Seanad wants to insert such a section I would urge the adoption of the Government amendment which fixes a definite limitation on the amount rather than the acceptance of either of the other amendments.

Am I in order in discussing the amendments now?

Cathaoirleach

Certainly, any of the three amendments.

I trust anything I say in reference to the amendments will not be taken as disrespectful to or causing any reflection whatever on the medical profession. We have many eminent doctors amongst us, some of them enjoying world-wide fame. The Irish doctors, men and women, are renowned the world over, and no profession is more venerated by our people, particularly by the poor. Our doctors are renowned not only in this country but in other countries, and particularly in the industrial centres in England, for being painstaking, for their charity, for their affability and, above all, for not being greedy, a complaint which may be made of other professions and businesses. That being the case, it has occurred to me that the bartering that has gone on in reference to the payment of doctors' fees has been a little indecent. I cannot see why the same law should not apply to doctors as to other creditors. It is a great mistake to bring in special legislation dealing with doctors. It is a very bad precedent to establish in Acts of Parliament and to single out any profession for exceptional treatment. On that score I am opposed to the amendments. At the last meeting of the Seanad I had the temerity to suggest that other creditors should be considered as well as doctors. I took my cue there more or less from a statement previously made by the Minister. The Minister has now let me down, so that I might quote the old saying: "Do not put your trust in princes too much," and I might apply it even to Ministers.

During my association with the Seanad I have seen Ministers sitting still, and not budging an inch when they had a big majority behind them. I take more than a passing interest in the present Minister, because his father and myself have been lifelong friends. Although I do not agree with him in this matter, I am glad to say that he is human and that he has given way a little. I can fully understand his position when faced by men of the sincerity of Senator Sir Edward Bigger. However, I think it would be a mistake for this House to pass the amendments. It is a bad principle to show preferential treatment towards any creditors in any Bill. If this is passed another Bill will come along, perhaps, in a month's time from the lawyers saying: "Oh, we should be paid for our advice." The bankers may then come along saying: "Oh, surely we should be paid first, as we supply the money." Then shopkeepers, tea merchants, dairy proprietors, provision merchants or others, if they can get sufficient friends in this House, may come along. The same thing is going to happen, so that I do not know where it might end. I am not saying that those submitting the amendments are wrong, but I believe I am right in my contention.

As this matter was thoroughly debated before there is nothing left for the members of this House to do but to make up their minds on what proposal they will accept. I think Senator Wilson will agree with me in accepting the Minister's suggestion, that it would be the wisest course to have the three amendments withdrawn and the clause left in the Bill as introduced. We have a very good case in my amendment for excluding agricultural labourers.

On a point of order. It appears to me that Senator Counihan's amendment is not in order, because it deals with the Medical Charities Act, which is not in any way touched on in this Bill. The Medical Charities Act was not framed for the purpose of meeting accident cases, and it does not require dispensary medical officers to attend in accident cases. These medical officers must first of all be provided with tickets. The tickets are in two forms, either to attend a person at the dispensary or in his own home. The doctor need not attend at all until he is furnished with a ticket, which can be given only to a poor person. The proposal here is not to relieve the poor person but the employer. The employer is the person who is going to pay. Therefore, to bring in a provision that he is to be relieved from doing so, because there is a dispensary medical officer available, is, to my mind, quite wrong.

Cathaoirleach

As regards the point of order, whether the agricultural labourers are or are not entitled to free medical treatment, I find it very hard to rule. My personal knowledge is that numbers of people who meet with accidents are treated in hospitals. They are, as a matter of fact, treated there, and if that were against the law, as is suggested, I do not think they could be treated.

The Act does not apply to hospitals at all.

Cathaoirleach

These cases are treated there.

Yes, in the first instance people would get medical treatment, but this is to relieve employers.

It is not. Senator Sir Edward Bigger's contention refers to first aid, but my amendment deals with subsequent illness.

Cathaoirleach

I think I must allow the amendment to stand in its present form.

My contention is that we are already paying dispensary doctors for work which it is proposed to pay them for under this Bill. Whether their fees are sufficient or not is another question. The dispensary doctors get remuneration for attending to people who are not able to pay for medical treatment.

On red tickets.

The majority of the agricultural labourers are entitled to red tickets, and they get them. That is the only class my amendment deals with. It would be rather hard on farmers, for the sake of compensating dispensary doctors, whom they are already paying through the rates, that they should be asked to pay up to 35 per cent. in the way of insurance. That is what it would amount to. The average amount of insurance paid in accidents for agricultural labourers is £14. I am informed that that was the figure in 1931. The premiums on farmers will now be increased by 35 per cent. It is with the farmers I am particularly concerned. They will have to pay the whole amount of the increased premiums, and not the insurance companies.

Because they will have to recoup themselves in the form of increased premiums. The contention of juries is: "Oh, the insurance companies will pay." Juries are in that way inclined to go to the full limit when awarding damages, and in a small way I think that may influence more than juries when considering the compensation to be given to doctors. I am satisfied if the Minister will agree to leave the clause as it originally appeared in the Bill.

I would like to be clear as to the meaning of some words in one amendment. "The court may, upon the application of such medical practitioner made immediately on the making of such order direct the employer to pay in addition to the compensation to such medical practitioner... a sum not exceeding five pounds." Does that cover all medical practitioner's fees and hospital charges? I know of a case near home recently where a servant girl slipped and fell when carrying a sack of meal. She went home after a month, and her mother kept her at home because her leg was painful. An action was taken and the judge awarded £30 to the girl. There were six medical men and three lawyers engaged. Finally the girl got £5 for herself which she did not desire. The lawyers and the members of the medical profession divided the remainder. I think the premium to be paid might be considerable. We should know that £5 will cover the whole of the medical expenses.

There is a certain sum due by the injured worker for medical and hospital treatment. That sum may, in the opinion of the doctors or the hospital authorities concerned, exceed £5. This amendment, as drafted, provides that the court may order that up to £5 whatever sum is due by the workman for medical fees and hospital treatment shall be paid by the employer. The balance, if there is a balance, is still a charge against the workman——

For whichever doctor gets in first, if there are three.

If there are three, each doctor will be entitled under this amendment to £5 if the court is prepared to award it.

I think that in our admiration, as so beautifully worded by Senator O'Neill, for the medical profession, we are inclined including the Minister too readily to agree to the general principle of an amendment without considering exactly what its full effects would be. I have read these three amendments very carefully and have given the matter considerable thought during the week, and I have come to the conclusion that the Minister's earlier speeches were much better than the speech he made last week. The one he made to-day was rather better than the one last week, but in the earlier speeches he showed that he knew more about it than we did, and if we had accepted his point of view then, we would have been wiser than we were last week. That is a further compliment, if he likes to take it as such, following on the compliments Senator O'Neill has showered upon him. I think, however, that we are going gaily into an amendment which although prepared by the Minister or by his Department has not been fully considered. We are not quite clear as to what it will mean. The Minister has stated and I, on my information, know, that it is not at all infrequent that there are two doctors in a case of an accident, one called in at the beginning, and the other—the medical attendant—afterwards, and I am told that there are a number of cases in which there are three and even four doctors. The Minister stated—and I presume he is right, though I rather think the opposite, but we will assume that he is right because it makes my case stronger—that you might even have £20 awarded if the court agreed. It has already been shown that the £5, even assuming that there is only one doctor, represents somewhere about 25 per cent. of the average claim. I have made careful inquiries and I am informed that the considered opinion of the principal insurance companies dealing with this business is that the Bill as it stands, that is, without this amendment, will mean an increase of approximately 15 per cent. on the insurance premiums paid at present. That will apply to farmers, to manufacturers, to traders and pretty well all round. There might be some slight variation, but I am told that that will be the figure.

May I ask if Senator Douglas in coming to that percentage figure, is working on the basis of the £5 being awarded in every case?

I will deal with that in a moment.

In view of your statement, it is a very simple question.

If £5 is awarded in every case, it will, mean 35 per cent. for agricultural employees.

If you will allow me to go on and develop my argument, I will meet, or try to meet, the point raised by Senator Dowdall. My information, which is given to me by representatives of leading insurance companies, is that without this amendment the increased premium will be approximately 15 per cent. That is due to increased benefits provided under the Bill. I am informed on the same information, which I regard as reliable, that the estimate made by representatives of the insurance companies, a number of whom have, I believe, met together, is that this amendment will involve a further 25 per cent. Whether that is a reasonable view or not, I am quite satisfied as to my authority, and that is their view. I am therefore, very reluctantly of the opinion that it is a reasonable view and one which we will not be able to combat.

Senator Dowdall dealt with a point with which I intended to deal. He said that that was on the assumption that there would be £5 in every case. I have come to the conclusion that while I do not say that there will be £5 in each case, and I do not think the 25 per cent. is based on the full £5 in each case, it will be the maximum in a very large number of cases. Under the provisions of the Bill, any workman, no matter how small the settlement—two weeks, three weeks or four weeks—can go to the court and have that agreed, and approved. If his medical man says: "You get £5 for me or £3 or £4 out of the insurance company or the employer, as the case may be," all he has got to do is to insist on this settlement which, being small, would not have gone to the court, and all he need do is ask his solicitor to take it to court to have it approved. The medical man can then claim his fee, and I do not say that he is wrong in doing so; I am merely trying to deal with the effect of the amendment if passed. I do not know who will pay the solicitor's fee in that case, but perhaps the Minister has considered that point and could answer it, but I imagine that the employer would probably have to pay because it would be increased costs. I know, as an employer in a small way, that in preference to doing that I would prefer to pay £4 or £5, because when a workman goes to court, as he is entitled to do, or his representatives, to get a settlement approved, and you have a claim made which you previously resisted, and the court awards £3, £4 or £5, I think the expenses will come on the employer. The net result of that will be that in most cases this claim will be made and, in saying that, I am not merely giving my opinion, but the considered opinion of some of the experts.

The attitude taken by Senator Sir Edward Coey Bigger, for which I have the greatest respect, even though I am unable to agree with it, is that as the employer is paying why should not the employer pay the additional fee. This was put very well, I think, by Senator Comyn in one of the earlier stages of the Bill. If we were dealing with a case of negligence on the part of an employer, he should pay and should pay the medical costs as well, We are not dealing with a case of negligence, but bona fide accidents for which the employer has no responsibility. The whole of this Bill is putting on a certain class of the community—and I am not objecting to the principle of the Bill and I never have—who are the employers, the responsibility for helping out people who are their work-people in case of an accident.

Arising out of and in the course of their employment.

Arising out of and in the course of their employment. That is simply an additional charge to a business or to a manufacturer or farmer and he has to include that in his costs. I am of the opinion that at present the increases provided by this Bill of about 15 per cent. of his costs are as much as are reasonable and it would be very unwise on the part of the House to add another 25 per cent. or 20 per cent. as the case may be to that amount. My information is that it will be 25 per cent. and for that reason and not because I am out of sympathy with the suggestion originally made, I would oppose the amendment as it stands. Senator Johnson has pointed out that the accident was arising in or out of the employment. If some person meets with an accident which does not arise out of the employment, who pays the medical fees? If a man is poor he is entitled to certain public services. I contend that there is no specific reason why the employer as an individual person should meet the fees. It is not a question of justice or right or charity or good-will towards doctors. It is a matter of what percentage you can reasonably and properly add to industry, to the farming community, to the railways and to the others who will be definitely hit by it. This Bill means a definite increase of 15 per cent. and I do not think any of us will dispute that figure having regard to the increased benefits. I think that is as much as is reasonable at present. Most of us know quite well that the tendency of the last two or three years has been to increase costs by various services. Many of these were desirable but there is a limit beyond which, having regard to competition and to the prices which the public will have to pay, it cannot be increased. You may say that you can charge industries which have high protection anything because they can get it out of the public again. That can only be done under tariffs so high that the industry can get it back out of the public and I hold that that is not desirable. Otherwise, if they cannot get it back out of the public you will only be crippling them by increased costs. You may say that 25 per cent. on workman's compensation insurance is not an enormous amount. To some businesses, it would not be an enormous amount but to others, where rates are high, it will be a very considerable amount.

You have this steady tendency to increase rates without, in my opinion, full consideration of what is being done. I do not think that the Minister, from his speech, really believes in his heart that it is wise to insert this amendment. I take it that the amendment is simply suggested to the House and while technically a Government amendment is not one by which the Government stand or fall. It is a matter for the House to vote. I think I am correct in reading that into the Minister's speech, and I suggest that we ought not to pass any of these three amendments and that if the House desires to make any provision at present for dealing with medical fees, none of these three amendments provides the way to do it. Senator Counihan will forgive me if I say that his amendment is rather typical of those who represent the farmers—as long as the farmers do not pay it does not matter who pays and so long as there is no 25 per cent. increase on farmers, it does not matter about other employers. It may be said that I am being selfish in my attitude but I should be false to my position here if I took the attitude of ignoring the interests of those whom, to some extent, I represent here. To my mind, if this is to be done it can be done in one or two ways. It could be limited to fees in cases of larger claims. I do not think the employer class as a whole would object to a certain addition to the larger claims of over £200 or £300 in order to provide a specific fee for the doctor. I certainly would not though I cannot speak for others. If it were on the basis of a reasonable percentage of the claim, we should know where we were and we should know what the increased cost was going to be. As it stands now, it is £5 whether the claim is a £500 claim—and conceivably the doctor's fees might be very high—or whether it is a claim which is the average claim—and £22, I think, was mentioned—or even smaller because if the average is £22 there must be many of £10 and below it. My information is that the increase will be 25 per cent., making 40 per cent. in all, and I put it to the Minister, to the Government and to this House that it is not wise to add 40 per cent. to the premiums as an increased cost on employers generally, particularly in the case of industry at the present time. It will be serious in the case of railways; it will be serious in the case of the building trade and pretty serious in the case of farmers, all of whom pay fairly high rates of premium. In the case of some trades in respect of which the rates are very low, I admit it will not be as serious a matter but again, it is not of much value because where the rates are low, the number of cases is small. On the whole, I believe that none of these amendments are worthy of the support of this House and I hope they will all be rejected.

We were perfectly satisfied with the Minister's proposal, but the speeches of Senator Douglas and Senator O'Neill make us wonder if they are more interested in insurance companies than the relief of injured workmen. What are these sacrosanct insurance companies any more than "laying off" bookmakers of the odds against injury? There is a disparity between the statements of the amounts to be charged against "industry." Senator Douglas in one part of his speech mentioned 15 per cent. and then 26 per cent. Senator Counihan assures us that there will be 35 per cent. charged by these sacrosanct insurance companies which presumably cannot be brought to heel by the Government. Of course they can. What is the premium that the employers are required to pay? About half a crown a year.

Senator Douglas says: "Let us look at what will happen if we accept what the Minister proposes." I say: "Let us look at what will happen if it be not accepted." You shall have thrown upon an overworked medical profession which hitherto has had no rights in regard to the collection of fees, a set of imposed and unwelcome patients. I do not say for a moment that these patients are going to get any worse treatment than they have had hitherto, but in view of the fact that every one else connected with insurance is paid and protected a compulsory and unpaid patient probably will not be a persona grata in a hospital ward. His recovery may be hurried and his convalescence curtailed. There is a story told in connection with the legal profession about a man on whom a brick fell. When he had paid “all fees due” to his solicitor, and found that above and beyond the compensation award he was still a debtor he asked the solicitor “on which of us did the brick fall?” We do not want the brick to fall solely on the medical man because his patient might be in as bad a position if he were to be left to the mercy of an aggrieved and unpaid doctor who has got no chance at all of collecting or even expecting fees. The position is different while the man is in the hands of a solicitor.

There is one point which has been overlooked in this discussion, and it is this: the high percentage of cases settled out of court, 80 per cent., that is one in four, never go before a judge. We are told that these sacrosanct insurance companies, with whom nobody is to interfere, will increase their charges by 15 per cent. At another moment we are told by Senator Douglas it will be 25 per cent., while we have the categorical statement from Senator Counihan that it will be an increase of 35 per cent.

That is my definite statement.

The Senator differentiates between "categorical" and "definite." He must have been in touch with some of the insurance satraps. I think that Senator O'Neill must have had direct information from some insurance society. These societies soon must cater for the people they insure. We are told that there is very little insurance business here. Why, in exception to all other trades, does increased insurance business, instead of resulting in a lessening of costs, lead to an increase of premiums? Take the recent example of compulsory insurance for motor-car owners. Do you find the insurance companies, because they have a monopoly of a trade, lessening their premiums to meet a greater income from universal business? Not at all. There is instead an increase of 25 per cent.—and this, why? Because everyone has to go to them to be insured. We were told by a banker in this House some years ago that the reason why Ireland had to pay 1 per cent more for money than people had to pay in England was because there was not enough business here. In other words, because we were too solvent and, therefore, less to be trusted! But now when we have an increased volume of business there is yet to be an increase in the charges. This is contradictory. There is direct and sinister connection between insurance companies and banks, and it is this, that when the banks invest in insurance companies they can count on about 13 per cent. of a return for their money. Therefore, they are not inclined to lend capital to struggling industrialists at 5, 6 or 7 per cent. The insurance company, we are told, may throw the charge back on industry. They are one of the greatest brakes and preventatives of industries. When it is only a charge of 2/6 a head it should be an easy thing for the Government to tell the insurance companies that they cannot go beyond that. They should even reduce it in view of their increased business. They have insured those employees up to the present for 2/6 a head even though medical fees might reach an unlimited award. In the early days there was a sort of a ramp in regard to compensation claims. Some doctors who had not a high sense of ethics made a point of exploiting an accident. Certain solicitors did it too. An accident, say, at Ranelagh, might have meant a stampede of doctors from Merrion Square—first aid! But now it is a matter for legislation to prevent a ramp of insurance charges beyond the ordinary rates that have hitherto obtained.

As I said before, so many of these cases are settled out of court, that as regards the doctors' fees there is about a four to one chance of recovery. It is only the odd case that comes into court, or where the man is so injured that he has had to go to the nearest hospital. The doctor may be up with him all night and his condition may be a matter of concern to the hospital staff. That presumably is to pass without any remuneration, not from the goodwill of the public and not from the Government, but from these insurance companies. I think it is a monstrous thing that we should be at the mercy of statistics which are, so far as we know, proprietary and not open to the public. When you have a dispute, the insurance company will send down a person who will divulge certain information privately to a county councillor or public body or harbour commissioner, but not to the public. They will only divulge certain facts and figures in the absence of the Press. Why should there be anything hidden about a public compulsory or national thing like insurance? Why all the hugger-mugger?

We all know that the Hospital Sweep was not very difficult to institute, because after all it was only an extension of an insurance system, the only difference being that when you win a prize in the sweep you get your money, whereas if you win in the case of insurance you do not always get your money if you are exempt from criminal negligence. Here is a case in point which I would ask the Minister to take note of, because it has not yet been legislated for. I had the misfortune when motoring from Dublin to Bray, 20 or 21 years ago, to run over a child. My man happened to kill the child. The circumstances were such that it was an absolutely unavoidable accident. Had my car been stationary the accident would have occurred. The accident happened at Donnybrook. The father of the child came to me and said that I had killed his son. I said that I was not going to be a party to any conspiracy of any insurance company and I told him that I was well insured. The case was thrown out of court because it was shown that the accident was nobody's fault. In other words, my driver was a sober and careful man. Had he been drunk and it was found by the court that he was criminally negligent the insurance company might have had to pay up to £3,000 or £4,000. As it was, I paid all that I could afford. When I went to the insurance company and pointed out the hardship of the case— that I held an "accident" insurance and that this was a pure accident—I was told that if I wished to pay "alms" to the father, I could do so out of my own pocket! Nothing, of course, could compensate the father in terms of money for the loss of his child. I was told by the insurance company "if you like to give alms you can do so, but we do not cover that kind of thing." It is high time, I think, that the workers of this country should not be put at the mercy of people who can look on the payment of compensation when there is loss of life as "alms giving!"

Senator Counihan talked about farm labourers who get a red ticket. He knows a lot about the kind of treatment they are liable to on a red ticket. I know the case of a mountainy man who came from Senator Counihan's district and suffered from a peculiar sickness. For three days neither the doctor nor anybody else could diagnose his disease. In fact, the red ticket was turning blue—like litmus paper. The priest came to him and said to him: "If you do not tell me what is wrong with you, I will not give you absolution." After a long, reluctant, amorous delay, he said: "Father, I am in love." I think the House ought to bear in mind that we have been fairly met by the Minister. Particularly when we know that it is only in one case in four that the doctor has a chance of recovering or claiming fees.

Senator Gogarty's complaint seems to be all against the insurance companies. Our complaint is that if the amendment brought in by the Minister were accepted, it would be a serious matter for the farming community so far as making provision for accidents to their men is concerned. I do not know where Senators got this figure of 2/6 as the fee that would be charged for insuring workmen. That passes my comprehension. I know that on a wage bill of about £500 a year you have to pay £7 or £8 to the insurance company, and that certainly is more than 2/6 a head. Senator Douglas referred to the 15 per cent. that will be collected in future from employers in connection with the passing of this Bill. As a matter of fact, it was collected two months ago from me. That charge of 15 per cent. has been made in consequence of the passing of this Bill and now we are asked to add this £5 for the doctors. In the case of agricultural labourers, I have been told that the increase will amount to 35 or 40 per cent. The insurance companies will force employers to insure to that extent. That is a serious matter, because as a rule accidents among that class are not of a very serious character, and even when compensation has to be paid it only varies from about £12 to £14, taking the average case. Senator Gogarty referred to the man who was in love. Would the Senator consider that it would be fair to ask a farmer to pay £5 in connection with a case like that to a doctor?

Suppose this love malady resulted in the man being in a hospital for twelve months, and that the employee got £1,500, is the doctor not to get a "fiver"?

Would Senator Gogarty say what would be the case if the employer was a lady, and the employee fell in love with her?

Cathaoirleach

I cannot allow Senator Gogarty to say anything more on that matter.

Well, as regards the love case, why should the doctor get the £5 or why should the farmer have to pay him £5? My objection extends to the three amendments. We thought last week that the Ministerial amendment would be carried. Our amendment is a kind of compromise. So far as I am concerned, I would be glad to see the Minister's amendment and Senator Foran's amendment eliminated, and leave the Bill as it stands. The agricultural industry has quite enough to bear at the present time without anything more being added to it. In the case of my own employees, as I said before, the insurance companies two months ago raised the rate by 15 per cent. I can assure the House that that is no fairy tale.

My amendment was put down to protect the injured workman. If Senator Sir E. Coey Bigger will withdraw his amendment, and if the Minister is prepared to leave the Bill as it was when originally introduced to the House, I think it would be much better for the whole of us. I certainly think that the Minister was right in his original attitude on this Bill. A clause of this nature is unique in workmen's compensation law and it would be very difficult to operate it in this country. The number of cases in which compensation is paid and which go into court is very much less than the number of settlements made out of court. In the case of arrangements made outside court, the doctor would not be entitled to the beggarly £5 mentioned in the Minister's amendment. I think that we would be all much more satisfied if amendments of this nature were entirely withdrawn and the Bill allowed to remain as it was when brought into the House. Senator Gogarty's reference to the Hospitals Trust reminded me of a story I heard about an injured workman who wrote to his wife and family in the country telling them that he had got £100 compensation. His solicitor said: "Of course, you will not get £100, because you will have to pay my fees out of that." The doctor said: "My fees have to be paid out of that sum." The patient turned to a neighbour and said: "Write to my wife and family and tell them to go into the poorhouse until I go home. I have got £100 compensation, but when the solicitor and doctor are paid, there will be nothing, left—not even the amount of my train fare home." That is the position for which we are heading in this arrangement.

I suggest to Senator Sir Edward Coey Bigger that he withdraw his amendment and that the Minister withdraw his amendment. I shall certainly be prepared to withdraw mine and to leave the Bill as it originally stood. The doctor has as good a claim for his services in court as any other creditor. People who make an arrangement outside have the means of enforcing it. It is up to the doctor to make some similar arrangement, but not in this way.

On the last day we met, I withdrew, in perfect faith, my amendment in favour of the Minister's amendment, believing that the Minister's amendment would be accepted. Everybody here seemed to be very sympathetic in making allusions to the medical profession. They pointed out how much the doctors should be paid, but when it comes to payment, because it will raise the insurance rates—nobody knows how much and everybody is still talking of the maxima—they try to influence members. I think that that is most unfair and unjust. I withdrew my amendment on the understanding that the Minister's amendment would be accepted.

I think that the Minister should consider the question very carefully before he agrees to withdraw his amendment. Doctors are in an entirely different position from anybody else. When a workman meets with an accident, his solicitor is paid. He takes good care to stop his payment. There is no use in bringing the grocer, baker or anybody else into the question because they are paid. If they are not paid, they bring the debtor to court. The doctor is entitled to adopt the same course but, in practice, he does not do that. If an accident happens in Dublin, the injured person is brought to hospital. A doctor cannot claim for his services in a general hospital in Dublin. Many people seem to be under the impression that because these are charitable hospitals, a workman who meets with an accident should be treated free, same as people who really need free treatment. I do not see why a man in business or a farmer should expect either the hospital or the doctor to give free treatment to his employee—in other words, to give charity to him. He can insure his workmen and the premium is very low.

What is it?

About 37/- per cent. An ordinary workman, paid £2 per week, would cost his employer in insurance about 37/-. If that premium is increased by 15 per cent., it is not a great deal. If a man is loading heavy goods for his employer an accident to those goods might cost the employer £100. I know of a case where a workman saved his employer damage to the extent of £100 at the expense of having his knee-cap smashed. The very least that that employer should do would be to see that the man was properly insured. He had him insured, as a matter of fact. Senators are aware of the system in Dublin. Outside doctors—most of them specialists—attend the general hospitals. When a man meets with an accident, the ambulance comes along. The ratepayers have to pay for that ambulance service. The injured man is brought into hospital. The staff in the hospital know that the outside doctor is not paid. Therefore, they want to make sure that the man is seriously injured before they ring up for him. The man is examined by the senior medical student, in the first place. If he considers the case serious, he brings along the house surgeon. If the house surgeon thinks the case is sufficiently serious, he calls in the outside doctor—the specialist. Often-times, treatment in that way delays the cure. If the staff in the hospital knew that the outside doctor would be paid, they would ring him up at once. The first thing an injured man should get is proper medical attention. There is no use in talking about the grocer or the solicitor or the baker in this respect. What the man needs is first-class medical treatment. There is no reason why the doctor should not be mentioned specially in the Bill. Other parties will bring a debtor to court but the doctor will not. You have to take things as you find them in practice and the doctor should be protected and paid as well as anybody else.

The discussion, which has taken place has raised points of very great importance. I refer particularly to the speech made by Senator Douglas and to one or two speeches made since. It must be remembered that the accidents covered by this Bill are accidents arising out of and in the course of employment which is normally for the benefit of the employer, financially or otherwise. Surely the cost of an occurrence due to that employment is part of the responsibilities which the employer is prepared to undertake in the course of his business or personal activities. I have here the report of the Departmental Committee which inquired into this question. In Appendix VI are printed the International Labour Draft Conventions and Recommendations Relating to Workmen's Compensation. Article 9 of these Draft Conventions states:

"Injured workmen shall be entitled to medical aid and to such surgical and pharmaceutical aid as is recognised to be necessary in consequence of accidents. The cost of such aid shall be defrayed either by the employer by accident insurance institutions or by sickness or invalidity insurance institutions."

Internationally, there was a very sharp distinction made between a debt for medical attendance which was a consequence of the injury and a debt for ordinary maintenance — food and clothing—mentioned by one or two speakers here. It is quite customary for large industrial concerns to have medical and nursing assistance attached to their establishments. From the arguments used here, one would imagine that that kind of assistance should be paid for by the community, that it is unjust and unfair that the employers in these large establishments should have to bear the cost of this special medical attendance. I could understand that view if the speakers were prepared to argue in favour of a State medical scheme in which all medical attendance for general purposes would be provided by the State. But the people who argue that specialised individual treatment ought not to be paid for by the employer, or the insurance company which covers the risk of the employer, would be aghast at the thought that the medical service should be nationalised. The case for insuring payment of the medical attendant is, I think, a sound one. The case against charging the cost of that insurance to the workman is very much stronger. However, we have Senator Sir Edward Coey Bigger and those who supported him on previous occasions, as well as Senator Counihan and Senator Wilson, urging that whatever is to be paid for medical service shall be taken from the injured workman. That is a proposition which I am surprised that anybody, after the discussion that took place, here, should have included in an amendment such as that put forward by Senator Counihan. It indicates that, whatever else may happen under this Bill, the workman, in Senator Counihan's mind and Senator Wilson's mind, will have to bear the cost of medical attendance. That is to be the case notwithstanding that in 37 per cent. of compensation cases in 1930 agricultural labourers received benefits for a period of less than four weeks and that the maximum rate of compensation was 17/- or 18/- a week. Notwithstanding that, Senator Wilson and Senator Counihan want the medical charges to be borne by the workman. Senator Foran's amendment had as its object the saving of the workman from that imposition. Senator Sir Edward Coey Bigger's amendment was in line with that of Senator Counihan. If that case is not to be pressed, then Senator Foran is right in withdrawing his motion and having the whole thing left as it was. Nevertheless, I still think that payment should be secured to the medical attendant. But that payment should be borne by the employer.

I do not want to discuss this matter, but I want to make a suggestion. So far as I can see, no intelligent decision is going to be arrived at to-day, and the suggestion by Senator Foran to withdraw his amendment seems to be a suggestion of despair of finding a way out.

I was going to suggest that this particular section of the Bill be recommitted, under Standing Order No. 86, for re-consideration of a Committee in order that we may have the benefit in Committee of the discussions which have taken place already. I think that by that method we would arrive at a much more satisfactory conclusion.

I want to say that Senator Milroy is not correct in saying that Senator Foran has agreed to withdraw his amendment in desperation. There is no desperation at all about it. Senator Foran's amendment was put down to meet what had been put down by Senator Sir E. Coey Bigger. Senator Sir E. Coey Bigger's amendment meant that the doctor would be entitled to go to the courts and that, out of the compensation to be awarded to the injured workman, the court was entitled to pay the doctor's fees. That was the purport of Senator Sir E. Coey Bigger's amendment. In order to prevent that taking place Senator Foran's amendment was put down deliberately to say this, that if this House insists on the doctor being paid for his services to a workman who meets with an accident the person who should be saddled with the responsibility of paying such fees was the employer in carrying out whose business the workman met with the accident. In order to meet the situation, the Minister agreed to put down an amendment which he thought would meet the views of a section of the House and which he thought would safeguard the position as far as possible.

A good deal of ground has been covered to-day with regard to this particular matter. Senator Douglas held up the picture that the insurance premiums were going to be increased out of all recognition. By the time he was finished adding the premiums on there was going to be about 100 per cent. added on. For what? Are the insurance companies not to take into consideration that under the terms of this Bill they will secure a tremendous amount of relief? Are they to be allowed to get away with the fact that under the terms of this Bill the maximum weekly allowance paid to the workman injured in an accident is reduced from 35/- to 30/- a week? Is that not to be taken into consideration, when the amount of the premiums is being made up? Is it only what they have to pay that is to be taken into consideration and that it does not matter by what amount they are to be relieved? I can say from experience that the workman as a whole is generally prepared, according to his means, to pay for whatever services he gets from the medical profession. In the trade union of which I am a member I have been paying for the last 16 or 17 years an extra contribution every year for the purpose of handing over that contribution to the hospitals in Dublin in case any of the members of that trade union require treatment in these hospitals, and my particular trade union is not alone in that respect. Some years ago the organised workers of this city went to the organised employers of this city and put up a proposition that we were prepared to meet them halfway if the employers would put up their share of the contributions.

To get back to the particular amendments: I have every sympathy with the medical profession. Nobody has more respect for what they do for the poor than I have, but personally I think it is a mistake that we should enact in legislation to be passed here, any provision that would mean that certain people are entitled to go to the courts to be paid under these conditions. Personally, if I were a medical man I should be opposed to it. I think it is degrading to the profession. I think anybody liable to pay should be compelled to pay, but from what I know of the medical profession and what they have done for the poor I think this would be a mistake. There is no muddle about this, nor is there any necessity to recommit this Bill. We have discussed this particular item for three days and everybody has his mind made up about the matter. We put down this amendment, not for the purpose of having it inserted in the Bill but as a safeguard, so that if Senator Sir E. Coey Bigger's amendment was going to be carried, at least you were not going to make the unfortunate workman, who is bad enough through having been injured and having his earnings reduced, in delicate health and with a family dependent on him, pay the medical fees for an accident for which he is not responsible. With regard to the amendment in the name of Senators Counihan and Wilson, upon my word I am ashamed of them. They are out to safeguard their own position as farmers but they have no consideration for the unfortunate workman. I will tell you why. An amendment is put down here that anybody who is not an agricultural labourer and who meets with an accident is liable for medical fees without limit. That is what their amendments amount to. It means that in the case of an unfortunate working man, earning £5 per week— say, an engine driver—whose maximum compensation would be 30/- a week, fees without limit should be given. All I have to say is, God save the unfortunate worker from the farmers. The unfortunate working man would have to pay fees out of any compensation awarded to him, whether it is a lump sum or a weekly payment, and no limit would be put to these fees. We are going to resist that and I think that, under all the circumstances, the best thing we can do is to leave the Bill without any amendment as has been suggested. Senator Counihan is agreeable to withdraw his amendment and Senator Foran is agreeable to withdraw his amendment also. Therefore, I think, that under all the circumstances, the best thing to do would be to withdraw the three amendments and to allow the Bill to remain as it is.

Cathaoirleach

That is simple, but I think the best way would be to allow the Government amendment to be taken first.

I do not think it would be quite fair to Senator Sir E. Coey Bigger to withdraw the Government amendment because he originally had an amendment down.

Cathaoirleach

I think the Government amendment should go to the House first and the House can decide on that. The others can then be withdrawn. I will put the Government amendment, and it is for the House to decide whether they will agree with it or not.

But if this amendment is carried, then the other amendments would go by the board.

Cathaoirleach

They ought to, I think.

If the Minister is going to insist on putting his amendment, I will have to insist on putting mine.

I explained that my amendment was produced following the introduction of amendments by Senators Foran and Sir E. Coey Bigger and certain discussions that took place between myself and members of the Medical Association, who were introduced by Senator Sir E. Coey Bigger. Senator Sir E. Coey Bigger's amendment is not now on the Paper because I gave an indication of my intention to put down this amendment. I stated on that occasion—I quote the words from Column 293, Volume 18, No. 2 of the Official Debates—that:

"When this matter was under discussion in Committee I argued against the insertion of any special provision to secure the payment of fees to doctors concerned in accident cases of this kind on the grounds that the doctor had precisely the same right in law to recover the debts due to him as any other creditor of the injured workman, and that there was no special reason why a debt due by the workman to the doctor should have priority over a debt due by the workman to the butcher, the baker, the grocer, or to the landlord for rent."

I opened my remarks with that sentence, and then I stated that as it appeared there was some possibility of one or other of the amendments being inserted it would be preferable to provide a section which would provide for the payment of fees up to a certain maximum. In view of that, Senator Sir E. Coey Bigger has withdrawn his amendment in favour of the Government amendment now on the Order Paper, and I think, therefore, that it is essential, in justice to Senator Sir E. Coey Bigger, that this amendment should go to the House. The procedure would be that if the amendment is carried it indicates the wish of the House that it should be so carried, and, if it is defeated, it would then be open to withdraw the other two amendments.

Cathaoirleach

If the amendment from the Government goes to the House and is carried, I shall not allow the others to be moved, since they are all of the same substance. If this amendment is carried it defeats the other two.

Our amendment was only placed on the Order Paper after the Minister announced his intention of bringing his forward last week, and, therefore, our point of view will not be served by not putting our amendment to the House.

Cathaoirleach

I hold that the three amendments are of the same substance and the decision of this amendment will rule the other two. That is my decision.

Amendment No. 4 put.
The Seanad divided: Tá, 20; Níl, 13.

  • Barniville, Dr. Henry L.
  • Bigger, Sir Edward Coey.
  • Connolly, Joseph.
  • Costello, Mrs.
  • Cummins, William.
  • Dowdall, J.C.
  • Duffy, Michael.
  • Duggan, E.J.
  • Farren, Thomas.
  • Foran, Thomas.
  • Gogarty, Dr. O. St. J.
  • Johnson, Thomas.
  • McGillycuddy of the Reeks, The.
  • Milroy, Seán.
  • Moore, Colonel.
  • O'Farrell, John T.
  • Phaoraigh, Siobhán Bean an.
  • Robinson, David L.
  • Robinson, Séumas.
  • Staines, Michael.

Níl

  • Blythe, Ernest.
  • Counihan, John C.
  • Douglas, James G.
  • Fanning, Michael.
  • Griffith, Sir John Purser.
  • Keane, Sir John.
  • Keyes, Raphael P.
  • O'Connor, Joseph.
  • O'Hanlon, M.F.
  • O'Neill, L.
  • O'Rourke, Brian.
  • Parkinson, James J.
  • Wilson, Richard.
Tellers:—Tá: Senators S. Robinson and D. Robinson; Níl: Senators Counihan and Wilson.
Amendment declared carried.
No. 3 Government amendment:—
Section 72. To delete the following words inserted in Committee in line 12:—"Subject to the provisions of the next following section."

This is only a verbal change in consequence of the amendment already carried.

Amendment agreed to.
Question—"That the Workmen's Compensation Bill, 1933, as amended, be received for final consideration"— put and agreed to.
Question—"That the Bill do now pass"—put and agreed to.
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