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PubMed2006

[Medical expert opinions in oral and maxillofacial medicine regarding incisor tooth trauma].

BACKGROUND: The treatment of traumatized patients plays a significant role in the everyday life of oral and maxillofacial surgeons as well as of dentists. Traumas of incisor teeth account for a considerable part. These traumas are often followed by lawsuits. The aim of this retrospective analysis was to highlight aspects of these lawsuits of special significance and to show the consequences for surgeons and general practitioners. MATERIAL AND METHODS: A total of 398 medical expert opinions were evaluated. Moreover, an online search of databases for relevant court decisions was performed. Analysis was initially based on formal aspects of the cases and reports. It was later supplemented by a differentiated assignment of the questions addressed by the courts to the expert consultants. RESULTS: In 97 (24%) medical expert opinions traumas of the incisor teeth were the main subject. In 35% the trauma was caused by traffic accidents followed by assaults. In one-third the medical expert opinion was commissioned by accident insurance companies. The compensation for pain and suffering was between 1500 and 2000 euros per lost tooth. CONCLUSION: Traumas of incisor teeth are often followed by litigations. Clinicians performing first treatment should ensure that documentation of clinical and radiological findings is detailed and complete. This documentation plays a decisive role in medical expert opinions.

Compensation and Redress↗

PubMedDate not supplied

[Psychosomatic aspects in orthopedic legal assessment].

AIM: Complaints in orthopaedics that are not sufficiently explainable can be caused (partly) by psychosomatic disorders. A manual psychosomatic disorders for legal assessment in orthopaedics will be supplied. METHOD: Diagnoses essential for orthopaedics are classified by DSM-IV and ICD-10 in consideration of the current literature; evaluation was performed under legal assessment criterions. RESULTS: The most important complaints that are often poorly explainable results in musculoskeletal pain. Since a sensorial perception of pain is combined with emotions, emotions and psychic disorders can be perceived as pain. The most important diagnoses for assessing not sufficiently explainable complaints by somatic cause are "somatoform pain disorder", "somatization disorder", "undifferentiated somatoform disorder", "conversion disorder", "hypochondriasis", "body dysmorphic disorder", "maior depression", "dysthymic disorder", "posttraumatic stress disorder", and "adjustment disorder". The relevance of psychosomatic comorbidity in legal assessment is possible in all affairs of civil and social law. Private accident insurances exclude psychic and psychosomatic diseases from all insurance benefits. CONCLUSION: When composing legal assessments in orthopaedics, especially on pain, the knowledge of psychosomatic (co)morbidity is necessary for meeting the different causes of the complaints. Under awareness of possible psychosomatic disorders, additional psychosomatic legal assessments can be recommended and understood as well.

Diagnosis, Differential↗

PubMed1987

[The so-called "compensation neurosis"--psychopathologic syndrome or obsolete concept?].

The problems of the muddy concept of "compensation neurosis" are demonstrated under different aspects. The following fields are discussed: terminological questions, clinical picture including psychodynamic reflections and approaches as to the course, the legal bases in the Federal Republic of Germany, in particular for the legal annuity insurance and accident insurance, and the expert's problems when giving his opinion. It is suggested no longer to use the vague and inexact formulation "compensation neurosis", but a detailed description of the symptom complex and the personality as well as the outer and inner situation should be strived after. Tasks of research are mentioned that still require to be tackled.

Germany, West↗

PubMed1996

Outcome of job change in patients with occupational chromate dermatitis.

Patients with allergic contact dermatitis due to dichromate are reputed to have a bad prognosis. Based on the Swiss Law on Accidents Insurance, the Swiss National Accidents Insurance Organization (SNAIO) may issue a declaration of medical inability (DMI) in cases of severe occupational dichromate dermatitis. With such a DMI, an employee is not allowed to perform any further work in contact with dichromate or cement. In this study, we reviewed medical records from 88 construction workers with DMI due to occupational dichromate dermatitis, between 1986 and 1989. Follow-up was performed by standardized questionnaire. 63 patients (72%) healed in the first few years after DMI. These patients mostly changed industry and strictly avoided all contact with cement or chromium salts. A few retired early. The outcome of our study is favorable in comparison to studies from other countries without the DMI mechanism. We conclude that strict allergen avoidance enforced by authorities, and financial support in the case of job change, are important factors in improving the prognosis in occupational dichromate dermatitis.

Adult↗

PubMed2000

[Traumatic development of rotator cuff lesion. Scientific principles and consequences for expert assessment].

The traumatic etiology of rotator cuff lesions is a matter of controversial discussed in legal assessments. Because of the relatively high prevalence of degenerative changes with increasing age, including partial and complete rotator cuff tears, it may be difficult to demonstrate the cause of an acute traumatic rotator cuff tear. This article presents a review of the literature concerning current knowledge of the anatomy, biomechanics and pathogenesis of rotator cuff pathology. According to this, a catalogue of potentially adequate and inadequate trauma mechanisms is proposed. Another focus of this work is in the post-traumatic diagnostic steps following persistent rotator cuff-deficient shoulder function. X-ray, ultrasound, MRI and operative findings in rotator cuff tears underline the criteria for distinguishing between traumatic and degenerative lesions. From a legal point of view (e.g., private accident insurance, workers compensation claims), various minor and major arguments are defined, which could help the expert in judging the cause of post-traumatic rotator cuff deficiency.

Diagnosis, Differential↗

PubMed2001

Incidence and costs of osteoporosis-associated hip fractures in Austria.

This study is an investigation into the epidemiologic and socioeconomic impact of osteoporosis-associated hip fractures in Austria. We determined age- and gender-specific incidence rates of osteoporosis-associated hip fractures for all patients treated in hospitals in 1995 and calculated mortality rates, hospitalization days and direct costs of hospitalization. The data were obtained from the hospital discharge statistics for all general hospitals and for all hospitals of the General Austrian Accident Insurance. To calculate the portion of hip fractures attributable to osteoporosis in a given age-group, a basic, non-osteoporotic incidence of hip fractures was determined for ages 20-39, using gender-specific regression models. 11,379 patients with osteoporotic hip fractures underwent treatment in Austrian hospitals in 1995, accounting for 79 percent of all hip fracture patients treated. 82 percent of those were female, with the highest incidence among women aged 95 years and older with a rate of 3,000/100,000. For male patients the highest incidence was observed for the age-group of 90-94 years with 1,743/100,000. International comparisons indicate these incidence rates to be similar to those reported for the Swiss population. In 1995, 778 patients or 6.8 percent of all patients with osteoporotic hip fractures died during hospitalization. Hospital care of patients with osteoporotic hip fractures required an overall 250,268 bed-days with an age-group-specific length of stay between 8.5-27 days for female and 16-23 days for male patients. The total cost of hospital treatment of osteoporotic hip fractures in Austria was ATS 1,043,379,000 (US$ 103,509,800), with average costs per patient of ATS 91,700 (US$ 9,097). Due to the aging of the population in the years to come, an increase of osteoporotic hip fractures among individuals aged 50 years and older must be expected. The economic importance of this development and its impact on the health care system must be considered as significant.

Adult↗

PubMed2004

[Wiplash injury and "railway spine"].

Although post-traumatic stress disorder was only recently admitted into the international classification systems, psychological reactions to traumatic incidents have been frequently described for more than 100 years. The article deals with the mental reactions to a trauma in different historical situations. Included are the "railway spine" injuries of the 19th century, victims of accidents where third party liability could be claimed, accident insurance, the psychological consequences of National Socialism and whiplash injury. The analysis suggests that different reactions don't describe an identical disorder. It seems that reactions to injuries are mainly influenced by the historical and social background and the fact of beeing insured.

Diagnosis, Differential↗

PubMed1994

[AIDS-related legal questions in trauma surgery].

Over and above the medical problems, AIDS also presents manifold and likewise still mostly undecided or at least not yet uniformly rated aspects. This article is a roughly sketched attempt at reviewing a few essential complexes at the interface between accident surgery and statutory accident insurance. Special attention is drawn to the update addendum.

AIDS Serodiagnosis↗

PubMed1994

[Criteria for legal assessment of rotator cuff rupture].

The judgement of the correlation between an accident and a rotator cuff tear has an important role in legal and private accident insurance. Owing to the high morbidity of degenerative alterations and ruptures of the rotator cuff tendons, the causality of an acute traumatic rupture can be difficult to demonstrate, which means assessments are often controversial. In a retrospective study we evaluated 25 orthopaedic assessments and tried to find rules for an objective estimation. The judgement of correlation between trauma and rotator cuff tear should be based on four pillars: history, trauma mechanism, initial findings and course of the functional deficit. Possible mechanisms of traumatic rupture are discussed from various angles. Important clinical findings, e.g. a functional supraspinatus deficit, should be fully documented. X-Rays of both shoulders can lead to indirect demonstration of preexistent changes in the rotator cuff. Sonographic evaluation can show up the rotator cuff tear and demonstrate signs of acute injury. After persistent pain and functional deficit, in a few cases operative and microscopic findings will lead to a correct estimate of causality. Because of the diagnostic uncertainty a 20-point score is introduced for retrospective assessment of the history (2 points), trauma mechanism (3 points), initial clinical, radiological and sonographic findings (10 points) and course of functional deficit (5 points) to evaluate the role of trauma in rotator cuff tears. Using this score trauma can be classified as the main or partial cause or as irrelevant to the pathogenesis of rotator cuff tears.

Adult↗

PubMed1993

[Amputation of fingers or a hand. Accident or self-mutilation].

Among the high number of cases of hand injuries investigated each year by accident insurance companies, cases continually occur which give rise to the suspicion of attempted insurance fraud by means of purposely inflicted injuries. Such cases are often difficult to prove. Based on 3 case reports (amputation by means of a chain saw, a blow with an axe and a cutting machine), reconstruction at the place of the crime is shown to be extremely advantageous. The reconstruction of the crime is one of the most important evidential elements. It is recommended for all cases where there is any doubt.

Adult↗

PubMed1996

[Comments on the revision of the Königstein instructional pamphlet].

The "Königsteiner Merkblatt (juris prudence)" is an instructional booklet of the general association of juris prudence involves accident insurance ("Hauptverband der gewerblichen Berufsgenossenschaften") in Germany. Medico-legal examinations of occupational noise-induced hearing loss are detailed. In contrast to prior editions, the 4th edition of this booklet, published in January 1996, has been extended by the definitions of legal regulations important for the physician in making medical decisions. Also the number of tests recommended for audiological investigation has been extended. The rules for estimating hearing disability and the calculation of individual handicaps have been changed, and the handicaps for complete deafness in one or both ears have been increased to 20% or 80%, respectively. The most important changes and extensions of the new edition are cited and discussed.

Eligibility Determination↗

PubMed2006

[Occupational accidents: social insurance costs and work days lost].

OBJECTIVE: To estimate the proportion of occupational accident benefits granted within the total for health-related social security benefits, viewing the costs according to benefit type and the impact on productivity according to work days lost. METHODS: Records of benefit decisions from the National Benefits System of the National Social Security Institute for the State of Bahia in 2000 were utilized. Occupational accidents were defined in accordance with the clinical diagnoses of External Causes, Injuries and Poisoning (SS-00 to T99) of the International Classification of Diseases, 10th Revision, and with the benefit type, which distinguishes between occupational and non-occupational health problems. RESULTS: A total of 31,096 benefits granted due to illnesses or health problems were studied. Of these, 2,857 (7.3%) were caused by work accidents. Greater proportions were found among workers in the manufacturing, construction, electricity and gas industries, accounting for 18% of the total benefits. The costs of occupational accident benefits were estimated to be R$8.5 million, with around half a million work days lost during the year studied. CONCLUSIONS: Despite the fact that these data are under-reported and are restricted to workers who were able to receive health-related benefits, the findings reveal that avoidable health problems have a major impact on productivity and on the budget of the National Social Security Institute, thereby reinforcing the need for their prevention.

Absenteeism↗

PubMedDate not supplied

[The problem of private insurance for patients with epilepsy (author's transl)].

324 epileptics were questioned about their approach to private insurance. Only 9,26% of them were covered by a life or accident insurance policy: 3,70% had life insurance, 3,70% accident insurance and 1,86% both. None of the patients had declared his disability to the insurance company. In 6,17% of the 324 epileptic cases an insurance policy had been taken out by their parents. In comparison about 35% of the Italian population in general are insured. A questionnaire was sent to 20 insurance companies; only 5 of them replied, saying that as far as accidents were concerned, they considered epileptics uninsurable. As for life insurance, policies can be contracted at increased premiums, according to the individual case (including the severity of the illness). Physicians must give epileptics fuller information about their insurance plans because, if their illness is detected after an accident, they will find themselves not covered by insurance. Government intervention is called for with the setting-up of special funds for this purpose.

Cost Control↗

PubMed1956