Several years ago, Commonwealth's Attorney J. Patrick Graybeal of Christiansburg, Va., prosecuted a man for murder and won a conviction. But subsequently the man was released on parole, and he took the opportunity to plant a bomb at Graybeal's house, blowing off both the prosecutor's hands and damaging his hearing and vision.
Graybeal filed for workman's compensation and was turned down.
Since the blast had occurred at his home and not at his office, the board ruled he was not eligible.
At about the same time, a Mack Truck employee in Maryland who suffered a kidney injury playing touch football during a coffee break was awarded compensation.
And a few years earlier, a travelling salesman's family in California was awarded compensation when he burned to deathe in a hotel fire "caused by carless smoking" in a room where he was staying with "a woman, not his wife but registered as such". He was on a business trip, officials ruled, and thus entitled to coverage.
Workmen's compensation is the mechanism-essentially an insurance which the nation attempts to make system paid for by employers-by sure that an employe who suffers injury or illness as a result of his job gets money to pay his medical bills and to help make up for lost income.
But whether the benefits are adequate and whether they go to the people who deserve them-Graybeal eventually won his case, but it took him two years of appeals-is the subject of a major national debate. The centeral government set minimum standards, and how far should the system go in compensating the victims of long-term illnesses, such as asbestosis and brown lung, not covered before.
The system is governed by state law, each setting its own benefit levels and standards for eligibility. The variations are enormous.
In Texas, a man totally disabled in industrial accident could get a maximum weekly income payment in 1978 of only $91, and only for 401 weeks, even if crippled for life. In Ohio, on the other hand, the maximum was $216 a week for life.
In the District of Columbia, the maximum in 1978 was $367.22 a week. And under the special program for U.S. government workers, the federal the maximum couldd be as high as $678.25 per week for life.
Sens. Harrison A. Williams (D.N.J.) and Jacob K. Javits (R.N.Y.), declaring that some state programs are grossly inadequate, stingy and un-fair-a finding based on a study by a presidential commission six years ago-have been introducing legislation in the past several sessions of Congress to set minimum standards.
Although most states require compensation at two-thirds of the worker's previous wage for total disablility, the maximum payment ceilings are often so low that the higher-paid worker ends up with for less than two-thirds.
Thus, in Texas, a worker earning $240 a week would get a benefit of only $91 (the maximum).
One key provision of the 1978 Williams-Javits bill required state eventually to raise their maximum to 200 percent of the state's average wage-so the ceiling,based on current average wage levels, would be close to $400 nationally.
This doesn't mean that every totally disabled worker would get $400 a week-only that the ceiling will be higher than now. A worker who earned $240 would get two-thirds ( $160). He would get $400 only if he earned $600 or more.
This proposal brought screams of protest from industrial and insurance groups (which sell workman's compensation insurance to companies)on groups that very high benefits would incite malingering and break the bank.At present, very few state have a ceiling equal to even 100 percent of state average wage.
Still another provision which could escalate costs specified that long-term illnesses like asbestosis and brown lung form cotton dust be at least potentially compensable under broad criteria to be developed by the federal government. At present, in many cases, proof that beryllium, cotton-dust, asbestos, caused long term illness must be given on a case-by-
Employer and insurance groups oppose the Williams-Javis bill. Bud Collyer, a spokesman for UBA, a lob-bying and research group which represents 350 of the 500 biggest corporations, said the proposed maximum benefit of 200-percent-of-sate-average weekly-wage "is awfully high," and the Williams-Javits bill would increase employer insurance costs "tremendously."
Tom O'Day of the Alliance of Amercian Insurers (AAI), whose members write about a third of all workmen's compensation insurance purchased by employers, said that despite low maximum payments in some states, in four-fifths of the states now replace at least 70 percent of the worker's pre-injury spendabel of income.
AAI testimony to the Senate sub-committee on labor said the bill will "explode costs," which have already gone up one-third over the last five years.
Moreover, AAI spokesmen said workmen's compensation is incresingly being used in effect, to effect, to replace welfare for aging and ill persons who can't get other forms of income. And in many areas, administration is too lenient, permitting big payments for trivial injuries which don't cause any real income loss.
"New concepts such as 'cumulative trauma' may soon extend the workers' compensation system to cover the majority of physical and mental conditions medicallu acknowledged to be primarily associated with aging and personal habits," said AAI.
Although compensation in the past has been applied mainly to easily verifiable work injuries (a crushed had, a broken leg, death in a fall) rather than to long-term illnesses whose causes may be hard to establish, Collyer said employers don't object to paying for illness which can be traced to the job. But in some cases, there really isn't a clear link.
"If a guy is working in a battery plant and he is exposed to lead over many years and you find high levels in his blood, it's clearly our case. But we found one guy in Nebrasks who was running a still, boiling the stuff in a lead [container] and drinking it." In a case like that, Collyer said, the employer or insurer has a right the lead-damage is work related.
Workmen's compensation laws were passed in most states in the years before World War II and now all have them. The laws require employers-with a handful of exceptions, mainly in agriculture, small business and household work-to guarantee that if an employe suffers a job-related injury or illness, the employer will pay the medical bills plus compensation for lost income and functions.
About 90 percent of all wage and salary workers are covered. The state laws set standards, conditions and benefit levels. Most require payment of all medical costs plus two-thirds of the employe's salary if totally disabled, up to specified maximums. Benefits are paid on a no-fault basis, that is, regardless of whether the accident was the fault of the worker-so long as the accident or injury took place on the job or resulted from it. To get these relatively fast no-fault benefits, the employe gives up the right to sue the employer for damages.
Every year there are millions of employment accidents, many trivial, many serious, and about 13,000 to 14,000 deaths, according to estimates by the National Safety Council. Over 2 million persons receive benefits annually. Benefit outlays in 1978 were estimated at $9 billion, including federal employe programs and the special federal "black lung" benefits program for miners.
In most states, employers simply buy insurance from firms like Liberty Mutual, INA, Aetna or Travellers to cover their obligations. However some states have their own state-run insurance fund. Some companies self-insure-that is, they pay benefits out of their own revenues. General Motors is an example.
Since the presidential commission's report six years ago, many states have changed their laws and costs have jumped.
Income-replacement and medical benefits totaled only $4 billion in 1972. Now they are more than twice that. In 1972, program costs equaled 1.12 cents out of every dollar of covered payroll; in 1976, 1948 cents-a one-third jump. This is the average cost of insurance or self-insurance-1.48 percent of payroll. In dangerous industries like iron-erection it can be 15 or 20 percent.
Despite improvements since 1972, Williams, Javits and Labor Department, spokesmen say many states still have inadequate benefits, agonizingly long waits, and disqualifications for trivial reasons.
A particular problem, according to the Labor Department, is long-term illness such as brown lung disease, black lung, cancer and other conditions resulting from beryllium exposure, vinyl chloride exposure, degeneration of tissues, back problems from standing and carrying over a long period.
In many cases, the fact that certain types of work cause long-term illness is only now being discovered. Insurance premiums weren't paid to cover didn't know about them.
The National Institue of Safety and Health has estimated that as many as 100,000 persons a year may be dying and 400,000 becoming disabled because of work-related long-term illnesses-but most aren't receiving compensation and must prove their claims on a case-by-case basis. Many industry sources question these figures as too high.
But if these figures are correct and all these people start getting compensation, it could add $20 billion or more to employer costs a year.
In a recent statement, Labor Department official Thomas Brown said that as more claims are being filed for long-term illnesses, employers and insurers are challenging each claim in court to force employes to prove illness is work-related. Thus, claims of lung cancer from asbestos exposure are often challenged on grounds the employe was a smoker and studies show abestos workers who smoke are much more likely to contract the disease.
The department found in a national survey that only about 10 percent of injury claims are challenged, but over three-fifths of disease claims are. This leads to lump-sum settlememts at a discounted amount. In illness-claims settled by by compromise, the average settlement for total disability is $10,000 compared to $23,400 in similar injury settlements.
Both Collyer and O'Day angrily denied any deliberate strategy of knocking down legitimate illness claims by contesting every one. "There are many cases where it's just not clear what the cause of the disease is," said Collyer.
"A guy gets heart disease.It is job-related? What if a heart attack occurs when he's at home and they say it's the culmination of years of work?"
There are plenty of examples of excessive awards, particulary in the generous federal emploue program, to stoke employer fears. In one case, a government employe got benefits of $25,326 his first year injured (these are all tax-free, by the way), based on putative annual salary of $32,531 a year, even though he had been working only part-time at $15,640 a year prior to slipping while getting out of a chair.
One solution to the newly-discoverd-illness problem has been for the United States to pick up the costs in the case of one major disease-black lung, which costs the Treasury nearly $1 billion a year. Whether this could be a pattern for other diseases isn't at all clear in these days of tight budgets.
Williams and Javits, meanwhile, intend to introduce their standards bill again early in the 1979 session but will again face all-out business opposition.
"Chances arewe'll hace a fight next Congress," said Collyer.