rating organization for workmen's compensation, reports that the average medical cost per occupational disability case rose 94.8% from the late 1950s until 1970-from $67.65 to $131.80. The 1957-59 average was used as the base period, since this is the base period used by the U.S. Department of Commerce in its widely followed Consumer Price Index.

During the same time period, the Consumer Price Index indicates that the cost of hospital services rose 173%, physicians' fees rose 64% and all medical care costs combined rose 60%.

Data published by the U.S. Department of Health, Education and Welfare indicates that workmen's compensation medical expenses consist of 50% hospital costs, 43% physicians' fees and 7% other medical care items and services. Thus the three Consumer Price Index items can be combined into a single weighted index figure to put general medical costs and workmen's compensation medical costs on a comparable basis, as follows:

able to deliver medical care services to persons injured in job-related accidents at a cost only 94.8% above the 1957-59 level, despite a rise of 118% in combined hospital charges, physicians' fees and other medical care expenses. That's a difference of more than 23 percentage points.

Moreover, this cost-saving feat was accomplished without skimping on service or coverage. On the contrary, the workmen's compensation system provides the most comprehensive medical coverage of any benefit system in the country. Most state workmen's compensation laws require employers to provide their employees with unlimited medical and rehabilitation services when they're disabled by an occupational injury or illness. Other medical benefit systems have dollar limits-often as low as $10,000 and don't provide complete coverage of all medical and rehabilitation expenses.

Equally important, the workmen's compensation system provides the injured worker with expert help in getting the medical and rehabilitation services he needs to make a speedy recovery and to minimize permanent impairment. It costs money to provide these expert services. But they're a bargain for the worker and for the employer alike, because they simultaneously produce better medical results and hold down the overall costs of the benefit system.

Reprinted from JOURNAL OF AMERICAN INSURANCE

47418-5M

home and, if feasible, to gainful employment. "There Is A Way" depicts the importance of insurance professionals in spinal cord cases, from claims representative to rehabilitation nurse. In partnership with the doctor and rehabilitation hospital specialists, they play a key role in helping to develop the remaining abilities of the patient and to restore his sense of dignity and purpose.

Among highlights of the video tape:

PART I: Early Recognition Vital-The nature of spinal cord injury is explained by the program's narrator and by Craig's director, Dr. Robert Jackson. They stress the need for clear understanding and sound management of rehabilitation cases.

Using X-rays, Dr. Jackson shows how damage to the spinal cord results in varying degrees of paralysis of voluntary body functions. He explains that the majority of cord injuries are caused by accidents that "jackknife" the spine.

He notes: "The patient's entire future literally hangs in the balance those first days following the accident. And since paraplegia and quadriplegia are among the most expensive cases with which you'll be involved, those first few days become doubly important."

As one example of cost, Dr. Jackson explains, "It can take months to heal just one bedsore-at an average cost of about $6,000." A patient must be turned regularly to avoid these decubitus ulcers, a serious and common danger. Therapy scenes also portray the need for prompt treatment to bring bladder and bowel functions under control and prevent other complications.

The video tape shows how early detection works. An insurance representative receives an initial alert on the phone. This could come via the employer, the family, the news media, the police, or an accident report. A warning:

"Be suspicious if the accident involves any back or neck injuries from a jackknifing fall, diving into shallow water, a whiplash, auto crash, or even butting heads in football."

If the insurance representative has any reason to suspect a cord-injury case, he should contact the attending doctor immediately. Both should be alert to the classical signs that spell spinal cord injury.

These are: (1) Does the patient have any loss of sensation or feeling? (2) Is the patient experiencing paralysis in any extremities? (3) Is there any loss of bladder function?

"If the answer comes up yes to any of these signs," the video tape warns, "chances are you have a cord case on your hands. First, review the coverage to understand the scope of your company's responsibility. Then advise your home office so that reserves can be earmarked for the case. You and your company may be dealing with a life-long disability that could involve treatment and rehabilitation costs running into hundreds of thousands of dollars."

PART II: Treatment and Rehabilitation-Upon identification of a case, the insurance representative must tackle the most sensitive and critical step-convincing the attending doctor, the family, the patient, even the lawyer (if one's involved) that the patient should receive specialized rehabilitation

treatment as soon as possible. The insurance representative shouldn't hesitate to get a specialist from a rehabilitation center on the phone to discuss the case with the attending physician as one doctor to another.

The insurance representative visits the home of the family to impress upon the wife that the chief concern is the long range welfare of her husband: "When the patient is the family breadwinner, the spouse will be apprehensive about the future. Help overcome these worries by explaining the benefits available. Emphasize that medical, hospital and transportation costs will be paid by your company."

The narrator adds, "if the case is a workers' compensation claim, the employer-policyholder should be involved as soon as possible. Many employers have a personal interest in their employees. They can be extremely helpful in convincing the family of the need for rehabilitation. Discuss the prospect of reemployment for the injured worker after his rehabilitation."

The insurance representative arranges transportation to the selected rehabilitation center. If it is less than 100 miles away, he probably uses a good ground ambulance service. For longer distances, air ambulance is the safest and most comfortable method. These planes are equipped with oxygen and other equipment to meet contingencies.

The video tape goes inside a major rehabilitation center to show professional treatment. A young man in a wheelchair strums his guitar and sings a folk song he composed. (His story is the music theme for the video tape, his personal contribution to helping others.) A young girl with a head brace, a perch for

a toy bird, is learning to feed herself. A paraplegic pulls weights to strengthen muscles.

"In recent years," Dr. Jackson says, "the medical and insurance professions have made giant strides to restore hope and maximum physical independence to those formerly written off as doomed. We've learned through experience that the treatment and rehabilitation of cord-injury cases is a life-long effort-a team effort that involves a family of medical disciplines, the insurance representative and, equally important, the patient. No one person, agency or organization can completely solve all the problems involved."

He explains that the initial high investment for rehabilitation-which may exceed $25,000 the first year-can be more than offset by the elimination of considerable costs for attendant care or institutional care for the remainder of the patient's life. If rehabilitation center care begins promptly enough, the average stay for a paraplegic is three months. For a quadriplegic, without complications, it is four months.

Each case is unique, however, and demands unique care that might include a neurosurgeon, a neurologist, urologist, psychiatrist, physical therapist, brace maker, vocational counselor and others.

"If patients are seeking sympathy," the narrator relates, "a rehabilitation center is the wrong place for them. Through expert personalized physical and Occupational programs, they're trained to fend for themselves."

PART III: Home and Beyond-A rehabilitated paraplegic bids goodby to staff and friends at center as he wheels himself down the hallway to the exit.