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At least 451 records · Page 25Linked to original sources
PubMed1986

[Reasonableness of surgical interventions and compliance responsibilities in various insurance fields and under the social compensation law].

According to the German Social Legal Code I (I. Sozialgesetzbuch, SGB I) the recipient of social benefits is under obligation to submit to medical treatment if such treatment would result in an improvement of his/her condition or in the prevention of further deterioration (section 63 SGB I). In certain situations, lack of cooperation may result in total or partial refusalor withdrawal of benefits (section 66 SGB I). This social law parallels the civil law which can recognize, in the area of private liability, co-delinquency in cases of refusal of reasonable treatment (section 157. section 242 and 254 GBG). In private liability insurance, the acceptance of reasonable medical treatments is contractually anchored. - In practice, the underwriter is generally unable to enforce surgical interventions. In the administration of social benefits surgical measures are exempt from the obligation of cooperation through administrative rules and guidelines of the regional state departments. The entitlement to pensions for the visually handicapped ("Blindengeld"), based on the Federal Social Benefit Law (BSHG), is regulated at the state level through state organizations. The corresponding state laws do not provide for the termination of support in cases of refusal of reasonable and prognostically promising operations. The recipients of pensions for the blind are not addressed in SGB I. Benefit recipients are therefore not penalized for refusing reasonable medical measures. - In legal accident insurance and legal social security insurance there exist, under certain conditions, obligations to cooperate in line with SGB I.(ABSTRACT TRUNCATED AT 250 WORDS)

Ethics, Medical↗
PubMed1991

Workers Compensation cases with traumatic brain injury: an insurance carrier's analysis of care, costs, and outcomes.

The purpose of this survey was to review the medical care, medical costs, and outcomes of 86 Workers Compensation cases involving traumatic brain injury. An analysis of ICD-9 diagnoses, Rancho Los Amigos Cognitive Levels, age, sex, accident description, management techniques, costs, outcomes, and many other factors was conducted. The total indemnity (wage loss) and medical payments amounted to $27.1 million. For example, one case with temporal lobe hematoma, due to a fall in 1972, has had $1.1 million in medical payments since the injury occurred. The current average age is 40 years with 71% still residing at home. Only 10% are currently employed and 40% are known to be receiving other benefits. The increasing frequency and severity of these cases, as well as the extension of survival due to improved care and technology, highlight the need to address the question, "Who will be the caretakers, and what will be the associated costs?" Actuarial projections into the 21st century are given. It is concluded that, while further long-term studies are needed, Workers Compensation carrier representatives and health care providers must continue to work together on the interdisciplinary rehabilitation team.

Activities of Daily Living↗
PubMed1997

Workplace injuries and the role of insurance: claims costs, outcomes, and incentives.

Workplace disability and workers' compensation systems were designed in the first 3 decades of the twentieth century with 3 major objectives. The first objective was to reduce the inequities and uncertainties in compensating disabled and injured workers inherent in the previously existing tort based system. The second was to create appropriate employer incentives for safety by internalizing the costs of accidents to the firm. The third, and perhaps little appreciated at the time for its impact on the provision of care and the healing process of injured workers, was to introduce a no fault, prefunded insurance mechanism to guarantee certain benefits to workers injured on the job. Throughout its history, there have been periodic attempts to reform the workers' compensation system. During the past 15 years there has been a growing body of theoretic and empiric social science research that suggests that many of the attempted reforms have not necessarily worked as planned. Indeed, it has become clear that the workers' compensation system, through its varying financial incentives on the system participants, and the differing levels of information that are available, may itself play an important and perhaps not benign role in the outcomes and costs for treating injured workers. The existing research is summarized and some new evidence on the workers' compensation insurance effect is provided.

Accidents, Occupational↗
PubMed1995

[Positive experiences in Scandinavian patient insurance].

Voluntary insurance for the compensation of patients for damage sustained in health care was introduced in Sweden 20 years ago and similar systems exist in Finland, Denmark and Norway. This type of insurance is, or is in the process of becoming, statutory. The basic principle is that the apportioning of blame to any individual(s) is not a prerequisite for compensation to be paid out for injury sustained by a patient. Owing to hospital proprietors and care givers having taken out patient insurance policies with approved insurance companies, it has been possible for damages to be compensated in accordance with current insurance norms and the frequency of lawsuits arising from injury sustained in health care has been minimised. This type of insurance is universally accepted, and has often enabled unfortunate confrontations between doctors and patients to be avoided.

Clinical Competence↗
PubMed2001

The Paget-Schroetter syndrome: work accident and occupational disease.

INTRODUCTION: Primary thrombosis of the upper extremity (Paget-Schroetter syndrome, effort thrombosis) is usually not accepted either as a work-related accident or an occupational disease by the industrial injuries insurance authorities. This study aims to look at the circumstances under which this kind of thrombosis may be recognised as an occupational hazard. MATERIALS AND METHODS: After thoroughly studying the clinical records of 82 patients with thrombosis of the upper extremity in the outpatient department for angiology during a 10-year period, we found that in 51 cases the thrombosis was caused by secondary reasons (i.e., central venous catheterisation, malignoma, hypercoagulability, postoperative). In the remaining 31 patients, we painstakingly conducted a general and occupational history and further clinical, laboratory or technical investigations to differentiate the aetiology. RESULTS: Twenty-eight of 31 patients with suspected primary thrombosis of the axillary or subclavian vein (Paget-Schroetter syndrome) showed unusual private or occupational physical exercise as the underlying cause. Sixteen patients reported only short physical exercise up to several hours or acute trauma. Longer physical exercise periods (several days, months or even more) were found in 12 patients. Ten of the 28 patients who acquired the thrombosis doing occupational tasks covered by the industrial insurance, may be eligible for compensation. In 4 of these 10 insured cases, we found strong hints for work accidents, 6 patients of this group apparently revealed criteria of occupational diseases. Four of the 28 patients had a combination of physical effort and additional thrombogenic risk factors (cardiac pacemaker, hypercoagulability). CONCLUSION: Primary thrombosis of the upper extremity (Paget-Schroetter syndrome) should be announced to and compensated by the industrial injuries insurance either as work-related accident or occupational disease if the patient's occupational history shows close relationship between thrombosis manifestation and extraordinary physical efforts or exercises during occupational strains. For this reason, we recommend the recognition of the Paget-Schroetter syndrome in the national list of occupational diseases.

Accidents, Occupational↗
PubMedDate not supplied

[Occupational exposure to asbestos and recognition of pleural mesothelioma as occupational disease in the province of Genoa].

The present study compares the data of pleural mesothelioma (PM) patients resident in the province of Genoa (Italy) who, in the period 1994-1996, applied to the Italian National Insurance Institute for Work Accident (INAIL), for workers' compensation for asbestos-related diseases due to occupational exposure, with the dataset of PM patients collected by the Mesothelioma Registry of Liguria (REM) in the same period and in the same area. As PM is a malignant tumor of a prevalently occupational origin, it is recognized and acknowledged as such by INAIL when clinical and etiological characteristics are matched. Objectives of this study were to describe observed PM cases, to evaluate completeness of collected data and differences between those who requested compensation and those who did not. The REM describes the incidence of PM among Ligurian residents, proposing patients with a specific questionnaire to assess occupational, environmental and indoor asbestos exposures. The REM collected 199 new cases of PM among the residents of both the city of Genoa (1994-96) and the province of Genoa (1995-96). In the same period, INAIL received 48 (24%) applications for compensation. Among these, 43 subjects were included in a subgroup of 98 patients registered in the REM as cases with definite diagnosis and ascertained asbestos exposure; 32 were awarded compensation, while 11 are under evaluation. The data collected by REM do not show proven asbestos exposure and/or PM diagnosis for five other subjects (two compensated and three under judgment). This study reveals that: a) only a 24% of the patients with a diagnosis of PM and asbestos exposure apply for compensation; b) an exchange of information among institutions involved in primary prevention, in the evaluation of occupational exposures to carcinogens and in insurance compensation is useful.

Aged↗