the treatment of his hernia, and a truss is chosen, but before a required approval of this settlement by the California Commission the employé requests an operation, and it appears that he is entitled. to relief, he will be required to refund the cost of the truss before being tendered an operation at the expense of the insurance carrier.19 If they furnish medical treatment, and the employé becomes dissatisfied and forsakes the treatment for that of his own procuring, unless the furnished treatment is inadequate or inefficient, he must bear the expense he incurs; 20 but, if the services are inefficient or

and incurs necessary hospital expenses, the employer is not liable for such expenses. Koponen v. Union Lumber Co., 2 Cal. I. A. C. Dec. 1055.

Where a clerk was asked to bind a slight laceration of an injured hand of an employé, and subsequently infection occurs, and with knowledge that there was an employer's physician available, the employé's mother calls in a different physician to treat the hand, and a few days thereafter, when the employer received notice of the injury, offer was made of the services of the company physician, which the employé refused, the employer is not liable for the medical expense incurred. McKnight v. American Can Co., 2 Cal. I. A C. Dec. 427.

19 Taylor v. Spreckels, 2 Cal. I. A. C. Dec. 62.

20 The right to medical and surgical treatment is forfeited if the injured man, without warrant, forsakes the medical service supplied by the employer. Casanegri v. Madera Sugar Pine Co., 1 Cal. I. A. C. Dec. 589; Evans v. Pacific Coast Casualty Co., 1 Cal. I. A. C. Dec. 140.

Where the employer, the county of Los Angeles, had placed the applicant in the county hospital after his injury, and he later became dissatisfied and left the hospital without the consent of the employer, the county is not liable for the reasonable value of medical treatment furnished by other than its own hospital or physicians. Van Lanker v. County of Los Angeles, 1 Cal. I. A. C. Dec. 107. Where it is shown that the injured employé, while receiving hospital and medical treatment furnished by the employer, and, contrary to the wishes of his employer and the advice of the attending physician, gives up such treatment and secures elsewhere and of his own selection other medical treatment, he is not entitled to reimbursement for the charges of the services incurred by him. (Commissioner French dissented on the ground that the facts to him showed an implied permission to secure medical treatment elsewhere.) O'Connor v. Yosemite Lumber Co., 2 Cal. I. A. C. Dec. 334. Where it is understood by the workmen of the defendant employer generally, and by the applicant in particular, that the employer maintains a hospital upon its grounds in which all the employés are entitled to treatment free of charge for

inadequate, the employé is justified in changing to his own physician, and will be allowed the reasonable cost of the services.21

accidental injuries received by them, and the applicant after treatment at such hospital becomes dissatisfied and secures other treatment of his own choice, without the consent of the employer, he is not entitled to an award for the cost of the treatment rendered by his physician, in the absence of proof that the employer's hospital service was inefficient or inadequate. McBride v. Union Iron Works, 1 Cal. I. A. C. Dec. 376. Where the cost of maintaining a hospital for the treatment of injured employés upon the grounds of the employer is wholly or partly defrayed by an association of the employés, or by small assessments deducted from the wages of the employés, and an injured employé receives treatment from such hospital for a time, but becomes dissatisfied and procures treatment of his own choice, the employer is not liable for such treatment. The employer having designated such place as a place where his employés can obtain treatment free of cost to them (as far as the actual cost of the treatment is concerned), the only question is as to the duty of the employer to refund the cost of treatment to the hospital association. While this is a fit subject for legislative control, it is one with which the Industrial Accident Commission has nothing to do as the law now stands. Id. The failure of the employer to disclaim liability for treatment elsewhere on being informed of it does not make him liable for such outside treatment, in the absence of express consent to its being furnished at his expense. Id. Where an injured employé becomes dissatisfied with the medical treatment furnished by his employer, and procures other treatment of his own selection, and is thereafter operated upon by his own physician, and it is claimed by the employer that such operation was unjustifiable, and unnecessarily prolonged the workman's disability, such claim is not a defense against liability for compensation for the whole period of disability actually sustained. It is, however, a good defense against liability for the cost of medical treatment procured by the applicant, following his refusal of further treatment supplied by the defendant. Tennant v. Ives, 2 Cal. I. A. C. Dec. 169.

21 The California Commission will exact from the physician and surgeon whom the employer selects the utmost care and attention of persons injured by accident. But testimony of injured persons as to neglect or poor treatment by physicians or at hospitals supplied by the employer, unsupported by evidence of physicians in charge, is to be carefully scrutinized, as persons in pain and bedridden are wont to regard all hospitals as places of torment. Unless such poor treatment be clearly established, an employé abandoning medical attention or hospital accommodations furnished by his employer does so at his own cost. Kelley v. Pacific Electric Ry. Co., 1 Cal. I. A. C. Dec. 150. Where the employé is dissatisfied with the advice given him by the

The employer's assent to a change of physicians does not bind the insurer, where the original services were furnished by it.22

physician or surgeon first selected by the insurance company or employer, and after the communication of such dissatisfaction he is directed to another surgeon, who is found to be out of town, and thereupon he selects his own family physician, he is entitled to reimbursement for the cost of such services. Mass. Bonding & Insur. Co. v. Pillsbury, 2 Cal. I. A. C. Dec. 480, 170 Cal. 767, 151 Pac. 419. Where an employé, who had sustained a fracture of the right clavicle, was on the day following put by the employer in the care of a physician and told that some one else would be called, if desired, but such physician who attended him, because of lack of facilities in the country town, had no means of determining, and did not definitely determine, the nature and extent of the injury, and the employé, after remaining for two days longer, without receiving or asking for further medical treatment, left the town and entered a hospital in San Francisco, where the fracture was discovered and expert treatment given, the employer was liable for such treatment. Miller v. Etna Springs Co., 2 Cal. I. A. C. Dec. 781. Where the medical treatment accorded an injured employé was shameful and utterly inadequate, and likely to result in death, and the refusal of the physician of the employer to permit the employé to go elsewhere for treatment was unjustifiable, the employer must pay the full medical bill incurred by the employé in securing proper treatment. Campbell v. L. E. White Lumber Co., 3 Cal. I. A. C. Dec. 33.

In Patralia v. American Brass Co., 1 Conn. Comp. Dec. 412, where the physician furnished by the employer to treat claimant's hernia supplied a truss, and, that giving no relief, furnished a second, and told claimant to go back to work in a couple of days, and he, trying to work, was unable to do so, and was then denied the privilege of seeing the physician because of the expense, whereupon he submitted to an operation by a surgeon of his own choice, it was held the employer had failed to promptly provide proper treatment, and was liable for the expense of the operation incurred by the employé.

An employé, not being satisfied with the medical services furnished by the insurer's physician, engaged his own physician and claimed compensation on account of his liability to his physician for the services rendered him. It was agreed that the employé was justified in changing physicians, and was held that he was entitled to a reasonable allowance for the services he secured. O'Brien v. Employers' Liab. Assur. Corp. Ltd., 2 Mass. Wk. Comp. Cases, 398 (decision of Com. of Arb.).

22 Where an injured employé, while under treatment by a physician and at a hospital admittedly supplied by the insurance carrier, abandons such treatment without adequate cause or justification, and without the knowledge of the insurance carrier, and procures at his own expense other hospital and

§ 198. Expense for which employer is liable

26

Medical and surgical services have been held to include dental work,28 and first aid treatment,24 and expense necessarily incurred by him in furnishing two physicians,25 and securing a physician from a distance; 20 but not treatment by a Christian Science prac titioner,27 or the expense of an artificial limb.28 The fact that the medical treatment, with his employer's consent, the insurance carrier is not liable for the medical and hospital charges incurred by him, notwithstanding his employer's consent. Spring v. J. G. Miller Co., 3 Cal. I. A. C. Dec. 4.

23 Where the accident causes the loss of several teeth, but no other injuries or loss of working time, the employé is entitled to compensation for the resonable value of dental services rendered to cure and relieve him from the consequences of the accident. Day v. Lincoln Sightseeing Co., 1 Cal. LA C. Dec. 269.

24 An employé must not refuse first aid treatment at the hands of the per son designated by the employer to render first aid services and provided wi

25 In Wessman v. Bloomfield, 1 Conn. Comp. Dec. 336, it was held that while the Act requires the furnishing of only one physician, if the employe sees fit to furnish two different physicians or surgeons, he must pay them both.

26 In Hodge v. Hoffman, 1 Conn. Comp. Dec. 322, where the employer cosulted the employé as to what surgeon should be called to treat the fra ture, and in pursuance of this discussion secured a surgeon from a town miles away, the employer was liable for the reasonable value of the services rendered, though their cost was considerably more than they would have been had a surgeon been secured in the town where claimant resided.

27 Where the ailments of the applicant indicated necessity for surgic treatment, and she had relied for two months largely upon treatment by a Christian Science practitioner, regardless of what may be said in favor of treatment at the hands of Christian Science practitioners for other alerts occasioned by industrial accidents, the California Commission cannot be that such treatment may reasonably be required to cure and relieve as thes words are used in the Compensation Act. Ash v. Barker, 2 Cal. I. A. C. Dec

577.

As to competency of physician furnished or offered, see § 195, note 96, ante. 28 In Pedroni v. C. W. Blakeslee & Sons, 1 Conn. Comp, Dec. 670, it w held that the medical, surgical, and hospital expenses required of the e ployer by section 7 of part B of the Act did not include the expense of an artificial limb, where the injury necessitated the amputation of the natur

claimant was not sent to a hospital, such treatment not being necessary in view of the extent of the injury, does not entitle him to recover the value of his board during incapacity.29 The California Act limits the extent of the medical services for which the employer is liable to 90 days, and after that time the Commission can neither compel the employer to furnish, nor the employé to accept, such services.30 The Michigan limit is 3 weeks, commencing when it is first needed,31 and in Iowa there is a double limit of $100 in cost or two weeks in time.32 In Minnesota the court has no right to

the proper equipment for this purpose, merely because such person is not a physician or person skilled in such treatment. The law of California requires every considerable employer of labor to keep in his camp a first aid kit, in order that any injury may be washed with antiseptic solution and dressed in a way to keep dirt out of it and avoid infection, and it is the duty of every injured employé to submit to that treatment until the services of a physician can be obtained. But where an employé refuses first aid treatment tendered him, for the reason that no physician was present to administer it, the employer is not discharged thereafter from his duty to furnish treatment by a physician. Gregory v. Merrill Metallurgical Co., 1 Cal. I. A. C. Dec. 408. 29 Hurlowski v. American Brass Co., 1 Conn. Comp. Dec. 6.

30 (St. 1913, c. 176, § 15 [a]) Burkard v. San Francisco Breweries, Ltd., 2 Cal. I. A. C. Dec. 365.

Where, owing to mistaken diagnosis and inadequate treatment, the 90-day period during which medical treatment can be required of the employer or insurance carrier has elapsed without effecting a cure, the Commission has no power to require the employer or insurance carrier to furnish further treatment, nor can it require the injured person to devote any part of his disability indemnity to procuring treatment. Johnson v. Pacific Surety Co., 1 Cal. I. A. C. Dec. 560.

There was a similar decision under the Roseberry Act. Marshall v. Ransome Concrete Co., 2 Cal. I. A. C. Dec. 923.

31 Claimant was injured while in the exercise of his ordinary duties, but serious effects did not develop until more than eight weeks after the accident occurred. Payment for medical and hospital services was disputed on the

32 An employer is required to furnish the injured employé with reasonable surgical, medical, and hospital services and supplies, but he need not furnish any in excess of a cost of $100 or for more than two weeks following the necessity for medical attention. Op. Sp. Counsel to Iowa Indus. Com. (1915)