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PubMed1998

[Risk assessment expanded accident insurance for children].

Disability is a well known and tragic event for children. While adults are an established group for specific disability insurance cover, children were often neglected in the past. Although parents, organizations and paediatricans are aware of the risk, children specific incidence rates for disability are hardly available. The only sufficient source for some statistical data are the accident statistics because they represent a substantial group of specific cause related disability for children. Incidence rates for disease related chronic severe impairment or disability in children are either derived by single disease research or actuarial calculation of the German Social Disability Registration. Based on this statistical background, an extended accident insurance for children was introduced in Germany covering both accidents and disabling diseases. The key limitation for all variations of this insurance are exclusion clauses for congential diseases and mental disorders. This insurance requires a new approach in underwriting of the health risks. Because of the substantial number of impaired children, a simple decline of substandard cases are unacceptable. The early experience or medical underwriting shows predominantly health impairments of the following types: allergies, bronchial asthma, ectopic eczema (neurodermitis), disorders of speech and articulation, vision disorders and mental impairments. The suggested solution for underwriting of substandard risks is the predetermination of the possible future maximum degree of disability. The need for underwriting guidelines is supported by the market impact of the new disability cover with thousands of insurance policies issued in the first month after introduction.

Adult↗
PubMed1983

[Injuries of tendons and menisci in the expert testimony of statutory accident insurance].

Differentiation between damage due to internal deterioration (degeneration) and damage by external causes (trauma) is the cardinal problem of expertizing for the national accident insurance in cases of injuries of the tendons and meniscus. In contrast to recognition of a disease as an occupational disease, recognition of the sequels of an on-the-job accident does not provide any relief from the burden of proof. The onus lies with the insured person in all respects, because German law does not recognize "formulae" representing a set sequence of events occurring during an accident. The article points to the essential medical and legal questions involved in writing an expertize.

Accidents, Occupational↗
PubMed2006

[Assessment of tinnitus in private accident insurance].

In two recently published judgments of the Federal Supreme Court in Germany dating June 23rd, 2004 (IV ZR 130/03) and September 29, 2004 (IV ZR 233/03) the assessment of tinnitus in private accident insurance and particularly the exclusion clause section sign 2 Abs. 4 AUB 88 has been newly defined. This exclusion clause is still valid according to the actual jurisdiction in the case a tinnitus is asserted following an accident without any organic (physical) damage. In this case tinnitus has to be regarded as mental (psychic) reaction in the meaning of paragraph 2 AUB. According to the actual jurisdiction the compensation of tinnitus could be possible, when as physical underlying reason a proved harm in the field of the inner ear or the auditory pathway is found, which can be traced back to the accident according to the rules of causality.

Blast Injuries↗
PubMed1976

Self-mutilations in private-accident-insurance cases.

Self-inflicted injuries can be classified in groups. One group deals with the simulation of illness, another with the occurrence itself and the application of chemical, thermic or mechanical methods. One sector concerns self-mutilation, which, from a psychiatrist's point of view, is interesting. At this time we are more concerned with the problems of proving it. In wartime and even during military service in peace-time soldiers inflict mutilating injuries on themselves. They are motivated by the notion that they will gain benefit from their action. Economic gain plays a role in the case of people who have taken out private accident insurance: self mutilation to simulate the result of an accident. Our investigation into self-mutilation started with an analysis under the following aspects of 123 cases: age, sex, occupation, place of residence, place and time of deed, method employed (weapon used), localisation, single or multiple wound, direction of injury, position of fingers, nature of edges of wound. Whether or not an injury was suffered voluntarily or involuntarily can only be determined with the help of auxiliary facts. It must be clarified whether or not the information given by the injured person ties in with facts concerning the place where the injury was sustained, its position and its direction. The medico-legal expert should not interpret medical findings without relating them to the facts of the case. Indeed, he should start by examining the claimant's account of the accident. To some extent it almost requires the work of a general staff to compare the findings of a careful medical investigation with the injuries themselves. If the injury was inflicted by a certain tool information must be available regarding, for example, the "accident with the saw" together with an assessment of the wounds sustained (utilization of clinical material). Sometimes tests on corpses need to be carried out because these can provide information on mechanical and physical problems. When the direction of the wound is being clarified together with an appraisal of any traces found electron scanning and microscopic tests should also be incorporated into the examination in addition to medical and X-ray tests. At the slightest suspicion that a wound might have been self-inflicted appropriate tests should be carried out immediately. Conclusions should only be drawn by someone who has made an intensive study of this special field which is of such great forensic interest.

Adult↗
PubMed1978

[Gas gangrene. The files of the Swiss Accident Insurance Company 1963-1975].

The clinical histories of 28 cases registered as gas gangrene by the Swiss National Accident Insurance (Schweizerische Unfallversicherungsanstalt) from 1963 to 1975 are reviewed. According to the classification of Altemeier (1. gas gangrene, 2. clostridial cellulitis, 3. simple contamination of a wound by Clostridium, and 4. gaseous infection without Clostridium) only 5 cases were assignable to group one (1 survivor), 2 cases to group two, 9 to group three and 9 to group four. Typical cases from each group are discussed to illustrate the advantages of this classification, the dangers of treatment based on wrong diagnosis, and the necessary prophylaxis. The more serious prognosis in gas gangrene in comparison to the other groups is emphasized.

Accidents, Occupational↗