[New assessment recommendations for disability in private accident insurance, part 4 : An interdisciplinary consensus approach-Disability outside the compensation scheme]. / Neue Bemessungsempfehlungen zur Invalidität in der PUV, Teil 4 : Ein fachübergreifend konsentierter Ansatz ­ Invalidität außerhalb der Gliedertaxe.

The following article is an element of a 4-part series on the presentation and discussion of new design recommendations for disability compensation in the private accident insurance. The introduction to the topic and the associated basics as well as the concept of the new draft of the design recommendations for the upper and lower extremities have already been published in Die Unfallchirurgie (formerly Der Unfallchirurg) on 17 February, 18 July and 18 November 2022 [2-4]. The topic of the fourth and final part published here is the assessment recommendations for disability outside the compensation scheme.

[New assessment recommendations for disability in private accident insurance part 3 : An interdisciplinary consensus approach-Lower extremities]. / Neue Bemessungsempfehlungen zur Invalidität in der PUV, Teil 3 : Ein fachübergreifend konsentierter Ansatz ­ untere Extremitäten.

The following article is an element of a 4-part series on the presentation and discussion of new assessment recommendations for disability compensation in the private accident insurance. The introduction to the topic and the associated basics as well as the concept of the new draft of the assessment recommendations of the upper extremities have already been published in Die Unfallchirurgie (previously Der Unfallchirurg) on 17 February and 31 August 2022 [2, 3]. The topic of the third part published here is the assessment recommendations for disability in the lower extremities within the compensation scheme.

[New assessment recommendations for disability in private accident insurance, part 2 : An interdisciplinary consented approach-upper extremities]. / Neue Bemessungsempfehlungen zur Invalidität in der PUV, Teil 2 : Ein fachübergreifend konsentierter Ansatz ­ Obere Extremitäten.

The following article is one component of a four-part series on the presentation and discussion of new assessment recommendations for disability compensation in private accident insurance. The introduction to the topic and the associated basics as well as the concept of the new draft of the assessment recommendations have already been published in the Der Unfallchirurg on 17 February 2022. The topic of the second part published here is the assessment recommendations for disability of the upper extremities within the compensation scheme.

[New assessment recommendations for disability in private accident insurance, part 1 : An interdisciplinary consented approach-Basics]. / Neue Bemessungsempfehlungen zur Invalidität in der PUV, Teil 1 : Ein fachübergreifend konsentierter Ansatz ­ Grundlagen.

The centerpiece of a private accident insurer is the benefit promise in cases of disability, which must be determined by a doctor in due time. The insurer specifies the rates of the compensation scheme for loss or inability to function and the medical expert must then fall back on generally recognized, revised or updated assessment recommendations in order to be able to apply the given framework to the specific, individual situation of the insured person. In four steps (basics, upper and lower extremities [disability within the compensation scheme] and disability outside the compensation scheme) interdisciplinary consensus benchmarks for disability assessment are presented, which should form the basis of a uniform medical assessment of accident-related functional disorders in private accident insurance compensation.

[Cardinal errors in expert opinions for the statutory accident insurance]. / "Kardinalfehler" bei der Begutachtung für die gesetzliche Unfallversicherung.

Expert opinions are subject to restrictions and must abide by the rules laid down by the legal system, much more so than therapies. Cardinal errors in expert opinions for the statutory accident insurance (GUV) are sometimes mistakes which can be found in all forms of expert opinions but in some cases where special questions of social law and the statutory accident insurance are concerned. The first group of mistakes are the differences between the requirements of an expert and a therapist with respect to the certainty of expert opinions, the responsibility of the commissioning authority alone for the non-medical components of an expert opinion, the generally valid principle of only giving opinions on areas of proven expertise and the extremely important aspect of personal responsibility. The second group of mistakes involve specific questions for the statutory accident insurance, such as the principles of causality, the rules of evidence, the estimation of the consequences of an accident with respect to reduction in earning capacity (MdE) and the significance of pre-existing damage.

[Expert assessment of accident sequelae in statutory and private accident insurance]. / Begutachtung von Unfallfolgen in der Gesetzlichen und in der Privaten Unfallversicherung.

Public and private accident insurance companies have in common that the insurance risk is the damage to health caused by trauma. Otherwise, they are fundamentally different. Public accident insurance as part of social law has the function of providing compensation for damage. Functional impairment due to trauma is compensated abstractly according to the general labor market. Private accident insurance as part of civil law is an insurance of fixed sums anchored in the agreement. It is completely unrelated to the consequences of trauma-induced limitation of function.

[Psychological reaction in private accident insurance. Differences in legal apprehension]. / Die psychische Reaktion in der Privaten Unfallversicherung. Unterschiede zum Haftungsrecht.

According to the provisions of private accident insurance, mental or psychological reactions are in contrast to basically not covered by insurance. The body is the object of insurance, not like third party insurance, which covers health. Since 1993 private accident insurance companies have been able to offer better coverage for mental or psychological reactions. But these possibilities for modifications of the AUB (terms and conditions of private accident insurance) introduced in 1993 constitute a departure from the traditional terms and conditions of the AUB.

[Intervertebral disk-induced diseases (BK Nr. 2108, 2109, 2110). The so-called exacerbation and assessment of work disability]. / Die bandscheibenbedingten Erkrankungen (BK Nr. 2108, 2109, 2110). Die sog. Verschlimmerung und die Einschätzung der MdE.

Two problems are discussed from a multitude of problems arising with the assessment of the "new" occupational diseases classified under the heading "Vertebral Column" which are of essential importance in determining the amount of compensation payment under German statutory health insurance legislation. One problem concerns differentiation of damage from already existing damage or dividing the total disease into preliminary i.e. already existing damage on the one hand and worsening or exacerbation on the other. Pathogenesis of disk-related disease does not usually allow splitting the disease into an already existing damage that is not job-conditioned and an exacerbation caused by the insured exposure to job-conditioned risk: compensation must be based on the "all-or-nothing" principle. The second problem is to assess the reduction in ability to cope with gainful employment stress. Preventive considerations will decisively influence the number of working places that can be offered as alternatives if a person has been suffering from intravertebral disk disease. Not only those jobs that require heavy physical work are barred, but also those where the worker has to remain in the same position for a prolonged time. Such disease-specific preventive considerations result in a rejection of the usual assessment criteria for intervertebral disk diseases.

["Extent of damage, previous damage, previous condition, previous disability"--definition of concepts for the legal expert]. / "Schadensanlage, Vorschaden, Vorzustand, Vorinvalidität"--Begriffsdefinition für den ärztlichen Gutachter.

Several examples are discussed to explain the most important legal definitions of social and private accident insurance. The importance of disciplined and lucid language in expert opinions is emphasised. Typical cases are described.

[Occupational accident insurance in intervertebral disk damage--new aspects of legal evaluation?]. / Der nach den AUB versicherte Bandscheibenschaden--neue Aspekte zur gutachterlichen Beurteilung?

The AUB 88 (conditions of private insurance) contain in comparison to the AUB 61 a pratical exclusion of damage of an intervertebral disk. The effort as possible cause of damage is no longer insured, the accident only as preponderate cause. The damage is only insured, if there is a connection in cause. The positive evidence of diagnostic methods are discussed and their significance for expert opinions. Damage of intervertebral disk is generally of degenerative genesis. The so called accident marks the moment of manifestation of the damage not the moment of its development.

[Expert assessment of so-called post-thrombotic syndrome in compulsory accident insurance]. / Die Begutachtung des sogenannten postthrombotischen Syndroms in der gesetzlichen Unfallversicherung.

Expertising a late damage after thrombosis requires most careful investigation of the findings, a detailed description of the damage, and a definition of the impairment of functions. This is imperative for arriving at an administrative decision to implement the conclusions arrived at by the expert without committing a legal error by such implementation. Estimation and determination of the damage and of awarding a reasonable compensation requires a detailed consideration of the circumstances of each case and observance of the legal principle of equal rights.

[Patellar dislocation. Diagnostic and forensic problems]. / Die Kniescheibenluxation. Diagnostische und gutachterliche Probleme.

Very often, patellar luxation or subluxation after spontaneous setting is difficult to diagnose. Concomitant injuries can be highly misleading during diagnosis. Traumatic luxation almost always results from forces exerted on the knee indirectly and by way of the muscles, and must be differentiated from habitual luxation. When the constitution favors the occurrence of luxation it is not the clinical and radiological results that are relevant to the assessment. Only an exact analysis of the course of events can clarify whether the trauma can be recognized as a basic cause covered by insurance laws.

[Expert evaluation of children and students in legal accident insurance]. / Die Begutachtung von Kindern und Schülern in der gesetzlichen Unfallversicherung.

Children and students take part in legal accident insurance as if they were adults. The functional impairment of the childish individual has to be measured. Therefore the child is treated as a fictious adult. The problem is explained by two examples.

[Expert assessment of reduced earning capacity in legal accident insurance following traumatic loss of the spleen]. / Uberlegungen zur gutachterlichen Beurteilung der MdE in der gesetzlichen Unfallversicherung nach traumatischem Milzverlust.

For legally binding assessment of reduced earning capacity after loss of spleen in adolescents and adults--in accordance with the Federal German compulsory accident insurance regulations--the article offers a brief review of expertising practice and then proceeds to examine dogmatically which of the cases of subsequent damage after loss of spleen are relevant according to German social security laws. The risk covered by Federal German compulsory accident insurance is critically discussed while bearing in mind that assessment of reduced earning capacity is done exclusively under the viewpoint of objectifiable functional losses.

[Dislocation of the patella--causality in legal accident insurance]. / Patellaluxation--Kausalität in der gesetzlichen Unfallversicherung.

Fifty-two expertises on connections between cause and effect of patellar dislocations were examined with a view to improving the standards of medical expertizing. On principle, the mechanism of injury is the decisive criterion in determining whether the injury can be considered capable of causing the dislocation. It was found that in about one-half of the cases the dislocation was wrongly attributed to the event and that a reasonable connection existed in only one-quarter of the cases. The typical causes of error in reasoning - first dislocation, impressive pattern of injury, no degenerative changes - are listed and discussed. The importance of the pattern of damage for the first occurrence of a dislocation is demonstrated. The suitability of different courses of events for contributing essentially to the dislocation is discussed.

[Expert evaluation of meniscus damage]. / Die Begutachtung des Meniskusschadens.

There are four main reasons for mistakes in giving expert opinions about injuries of the meniscus. The report about the accident isn't sufficiently detailed. The expert questions the injured person himself. The mechanics of the knee are unknown. The juridical and medical problems of degeneration and previous damage are unknown. The points are discussed to get a higher standard of expert opinions.