Massachusetts FORM Receipt on account of compensation Received of. (Name of insurance association or company.) the sum of.... ...dollars, and. . . . . . . . cents, being the proportion of my weekly wages for the period from the. . . . . . . . day of. . . . . . . ., 191., to the....... day of..... 191., under the Massachusetts Workmen's Compensation Act, subject to review by the Industrial Accident Board. $. ........ in equity and not that in law. Pigeon v. Employers' Lia. Assur. Corp., 215 Mass. 000; 102 N. E. Rep. 932. The word "court" is broad enough to include the Committee of Arbitration and the Industrial Accident Board as instituted by the Workmen's Compensation Act and should be given such construction in relation to R. L. Chap. 175, § 66, providing that "a declaration of a deceased person shall not be inadmissible in evidence as hearsay if the court finds that it was made in good faith before the commencement of the action and upon the personal knowledge of the declarant." Pigeon v. Employers' Lia. Assur. Corp., 215 Mass. 000; 102 N. E. Rep. 932. In the last-mentioned case the deceased employé was a driver and stated shortly before the accident that he was going to take the horses to water. On the way to the watering trough the horses ran away and the employé was killed. It was held that this declaration by the employé was admissible in evidence in a proceeding on behalf of dependents before an Arbitration Commission and the Industrial Accident Board for compensation. The Massachusetts Industrial Accident Board has no authority to arbitrate injury cases not under the Workmen's Compensation Act. Bulletin No. 2, Mass. Indus. Acc. Bd., Jan., 1913, p. 12. Massachusetts FORM Application for review of claim before full board To the Industrial Accident Board, Boston, Mass. GENTLEMEN:-The undersigned, as provided in Part III, section 7, chapter 751 of the Acts of 1911, and amendments thereto, makes application for a review of the findings of the Committee on Arbitration in the claim of.. .vs... This claim for a review is based on the following ground: 191.. Note. "No party shall as a matter of right be entitled to a second hearing on any matter of fact." FORM Appointment of next friend of minor Under Part II, § 14 of the Act, which permits a minor to nominate a next friend to receive compensation the Board has adopted a simple form which may be used in such cases as follows: I, .. (Name and address of employé.) being a minor, hereby request my mother (or as the case may be), whose name is.... to exercise all my rights and privileges under the Workmen's Compensation Act, and I hereby nominate and declare my said mother to be my next friend for said purposes. Dated at the.........on the..... ..day of... 191.. (Signature of employé.) The Act is administered by the Industrial Accident Board consisting of three members appointed by the Governor. Part III, § 1. The Board prints and furnishes free of charge to employers or employés all blanks necessary in the administration of the act. Part III, § 4. Questions relating 1 RULES OF PROCEDURE, MICHIGAN INDUSTRIAL ACCIDENT BOARD WHAT ACCIDENTS TO BE REPORTED Rule 1. All accidents which result in disability continuing for more than one full working day shall be reported to the Board; all accidents involving the loss of a member shall be so reported irrespective of the question of disability resulting; all accidents causing death shall be reported to the Board. WHEN TO BE REPORTED Rule 2. All employers subject to the Compensation Law shall make reports to the Board weekly of all accidents to their employés which come within the classes of accidents designated in Rule 1. Such reports shall be on and in accordance with the requirements of the weekly report blank, "Form No. 5-a," of said Board. FIFTEENTH-DAY REPORT Rule 3. In all cases where the disability resulting to the injured employé continues for more than fourteen days, a further report, on and in accordance with the requirements of report blank, "Form No. 6," shall be made to the Board on the fifteenth day of such disability: Provided, That in all cases where the accident causes the loss of a member or death, such report on Form No. 6 shall be made to the Board within ten days after such accident or such death, as the case may be. IMMEDIATE REPORT REQUIRED Rule 4. In all cases where a claim for compensation is filed with the Board by an injured employé, if it appears that the report required by Rule 3 has not been made and filed by the employer on account of disagreement as to the continuance of the disability or for any other reason, the Board shall thereupon require such employé to forthwith file a report Michigan to compensation may be settled by agreement, but they are subject to the approval of the Board. Part III, § 5. If the parties fail to agree as to the compensation the Board of the accident on and in accordance with the requirements of blank Form No. 6 of said Board. MEMORANDUM AGREEMENT Rule 5. When an agreement in regard to compensation is made between the employer and the injured employé, the same shall be in writing on and in accordance with Form No. 10 of the Board, and such agreement, together with the supplemental report in accordance with the requirements of form No. 7, shall be immediately filed with the Board. SUPPLEMENTAL REPORT Rule 6. In cases where the employer and employé fail to reach an agreement in regard to compensation and either of such parties files application with the Board for arbitration of the matter, such employer shall, within fifteen days after the filing of such application for arbitration, make and file with the Board a supplemental report of the accident on and in accordance with the requirements of Form No. 7 of said Board. RECEIPTS FOR COMPENSATION Rule 7. After an agreement relating to compensation is made between the employer and the injured employé, and approved by the Board; and also in cases where an application for arbitration has been filed and an award of compensation made by the Board, receipts for weekly payments of compensation made upon Form No. 11, signed by such employé or his dependents, shall be filed in the office of the Board monthly. FINAL REPORT Rule 8. When the disability of the injured employé terminates; and also when the payment of compensation for the loss of a member, or in case of death, has been fully made, final report thereof shall be filed with the Board, on and in accordance with Form No. 7-a, together with settlement receipt on and in accordance with Form No. 12, signed by the employé or his dependents, as the case may be. Rule 9. Wherever the word "employer" is used in the foregoing rules, numbered from 1 to 8 inclusive, it shall be construed to cover either the employer, or the insurance company carrying the risk, or the Commissioner of Insurance, as the case may be. Michigan forms an arbitration committee which hears the matter and reports to the Board. If a claim for review is filed the matter. is heard by the Board, which has power to hear the parties, LUMP SUM PAYMENTS Rule 10. It is manifest that the clear purpose of the legislature was to provide that the compensation receivable under this law should go to the persons or families entitled to the same in weekly payments, it being the opinion of the legislature that when so paid it would more effectually meet and relieve the wants of the injured employés and their families, than if paid in a lump sum. This view has the full endorsement and concurrence of the Board. Therefore, lump sum payments will only be authorized in exceptional cases where circumstances create a necessity for such action. Application for lump sum payments can only be made after an "Agreement in Regard to Compensation" has been filed with and approved by the Board, or an award of compensation made; and such application is required to be in the form of a sworn petition setting forth in detail the facts and circumstances on which application is based. Desire of the applicant to go to another state or country or to buy property, or to invest in business, etc., do not constitute reasons for lump sum payment. In general conditions created by the acts of the injured employé or his dependents after the accident, do not constitute ground for such payment. As a general rule, the circumstances and conditions that will justify such payment are those existing prior to the accident or created by it, such as mortgage indebtedness on the home of the employé. In such case, both the indebtedness and attendant conditions must be set forth in detail, and if secured by mortgage, the location and description of the property must be given, the name and address of the mortgagee, and the office or place where the mortgage is filed or recorded. APPEALS TO SUPREME COURT Rule 11. In case an appeal is taken to the Supreme Court by certiorari, it is incumbent upon the appellant to prepare the return to such writ in much the same way that a bill of exceptions is prepared in cases appealed by writ of error. Such proposed return should be submitted to and served upon the opposite party, or his attorney, so as to give opportunity to prepare and submit amendments in substantially the same way as in settling bills of exceptions. The appellant at the time of serving the proposed return on the opposite party should serve such opposite party with notice of the time when the proposed return will be presented to the Board for settlement. This practice will give both parties an opportunity to be heard and to have all matters which they |