For what it's worth, railroad employment is still extremely dangerous. Railroads in the US still maintain medical departments, (Usually under the auspices of the Risk Management Department), to screen prospective employees, provide regulatory compliance, and to make determination of qualification for retention and re-entry. Much of this is contracted to specialty medical practices, and local surgeons / hospitals in cities along the right of way.
Railroads also pioneered employee health care, in the form of "Hospital Associations" which provided care instead of health insurance. These organizations were more common on western railroads. There are / were also employee relief organizations which provided assistance to sick and injured employees. These were organized on local, regional and system levels, and by craft, separate and apart from the carrier provided benefit.
Railroad work was so dangerous, that Railroad workers were unable to obtain (life) insurance protection due to the high risk, (real and perceived), involved with railroad employment. This is how the various railroad labor organizations became insurance carriers, with their own risk assessment and under writing departments and sales forces. At least one major union still operates their own insurance department, while others maintain close affiliations with well known life insurers.
Boris