To What Extent Are Main Accident-Insurer Cases Representative of All Significantly Injured? A Swiss Monocenter Perspective.

Background and Objectives.-Even though Switzerland has a compulsory insurance system, there is a lack of detailed information on the treatment and outcome following trauma. The objective of this evaluation was to examine to what extent cases insured by the largest accident-insurer (Suva) are representative of all significantly injured. Methods.-Trauma center analysis of all ≥16 year old trauma patients with a New Injury Severity Score (NISS) ≥8, comparing the characteristics of Suva- vs non-Suva cases (chi-square; univariate explained variance R2; multivariate logistic regression analysis, Nagelkerke R2). Results.-Over 7 years, 2233 trauma patients were treated at the hospital, of whom 29.4% were Suva-insured. Compared to non-Suva-insured, Suva cases were younger (41.6 vs 64.2, R2 = 0.23) and more often male (88.0% vs 59.4%; R2 = 0.08). In multivariate analysis, these two factors together explained 37.5% of the differences between groups. No other investigated factor explained more than 2%. If only those patients of obligatory working age were analyzed (n = 1264), Suva cases (50.6%) were more often male than non-Suva-insured (n = 562 [87.8%] vs n = 393 [63.0%], resp.; p<0.001, R2 = 0.08). In multivariate analysis, other factors taken together were only 2.6% of the variance. Conclusions.-Significantly injured patients in Switzerland may be considered comparable from a statistical point of view whether insured by the main accident-insurer or not, provided groups are adequately controlled for age and gender. Other differences appear to be only marginal. Respecting these limitations such data can justifiably be given as Swiss reference statistics and the relevant insurer outcome information used for international comparison.

[Hands well - all's well : Prevention campaign of the Austrian General Accident Insurance Institution (AUVA) to reduce hand injuries]. / Hände gut ­ Alles gut : Die Präventionskampagne der österreichischen Allgemeinen Unfallversicherungsanstalt (AUVA) zur Reduzierung von Handverletzungen.

Overall, 41% of all work-related accidents lead to a hand injury. In the younger generation, the incidence rate even rises to 50%. In Austria, these accidents result in approximately half a million sick leave days per annum, an average of 12.5 days per accident. In comparison, leisure-time hand injuries show a significantly higher accident rate: 60% of hand injuries occur during leisure time. Far fewer safety measures are taken and a lack of adequate training and a disregard for safety recommendations are observed.This large number of hand injuries led to the launch of a campaign in Austria in 2014-2015 called "Hände gut - Alles Gut", (Hands well - all's well). This campaign was aimed at reducing the costs, a sum of 309 million Euros, incurred solely from work-related hand accidents, by at least 5-10%.These exorbitantly high costs are not only due to severe hand trauma, most result from a multitude of slight and superficial wounds.

Per-capita claims rates for decompression sickness among insured Divers Alert Network members.

Decompression sickness (DCS) in recreational diving is a rare and usually self-limiting injury, but permanent disability can occur. Incidence rate estimates are difficult to establish because the number of divers at risk is usually unknown in population samples with well-documented DCS. We estimated the annual per-capita DCS incidence rates for 2000-2007 based on insurance claims submitted by members of the Divers Alert Network (DAN), Durham, N.C., with dive accident insurance. The overall per-capita DCS claims rate (DCR) was 20.5 per 10,000 member-years. Based on the age-adjusted DCR, males submitted 28% more claims than females. Male-to-female difference was greatest between 35 and 40 years of age and disappeared by the mid-50s. Highest rates were observed in the 30- to 39-year age category, after which DCR declined with increasing age. Highest yearly DCR was estimated in 2002. Insurance dropout rate was greater among those who had DCS in the first year of their insurance compared to those who did not have DCS in their first year.

[Special characteristics in the private and compulsory accident insurance]. / Eigenheiten der Begutachtung in der Privaten und der Gesetzlichen Unfallversicherung.

In this manuscript the basic ophthalmological survey criteria for the private and compulsory accident insurance have been collected in order to illustrate their diversity.

[Analysis of sports injuries covered by German occupational accident insurance associations at a former district hospital over a period of six years]. / Analyse der berufsgenossenschaftlichen Sportunfälle eines ehemaligen Kreis- krankenhauses uber den Zeitraum von sechs Jahren.

An epidemiological analysis was carried out of 1,126 sports injuries covered by German occupational accident insurance at a small regional hospital over a period of six years, of which 86.6% were allotted to the sport at schools. The types of sport most frequently involved were general fitness sports (n = 486), soccer (n = 137), volleyball (n = 126), gymnastics (n = 125) and basketball (n = 121). In the general fitness sports (n = 228 women/girls, n = 258 men/boys), bruising injuries dominated (47%), followed by sprains (29%), mostly involving the upper extremities (53%). In soccer injuries (proportion of woman = 15%), bruising and injuries to the lower extremities ranked first. Falls (33%) and sprains (31%) were the most common gymnastics injuries. Injuries to the upper extremities were most common in volleyball and basketball with 72% and 68% respectively. The distribution of these sports injuries more or less mirrors the distribution of sports disciplines at schools and institutions like the Federal Border Police. Sporting activity here should include preventive elements such a proprioceptive training.

Workers' compensation insurer risk control systems: Opportunities for public health collaborations.

INTRODUCTION: Workers' compensation (WC) insurers offer services and programs for prospective client selection and insured client risk control (RC) purposes. Toward these aims, insurers collect employer data that may include information on types of hazards present in the workplace, safety and health programs and controls in place to prevent injury/illness, and return-to-work programs to reduce injury/illness severity. Despite the potential impact of RC systems on workplace safety and health and the use of RC data in guiding prevention efforts, few research studies on the types of RC services provided to employers or the RC data collected have been published in the peer-reviewed literature. METHODS: Researchers conducted voluntary interviews with nine private and state-fund WC insurers to collect qualitative information on RC data and systems. RESULTS: Insurers provided information describing their RC data, tools, and practices. Unique practices as well as similarities including those related to RC services, policyholder goals, and databases were identified. CONCLUSIONS: Insurers collect and store extensive RC data, which have utility for public health research for improving workplace safety and health. PRACTICAL APPLICATIONS: Increased public health understanding of RC data and systems and an identification of key collaboration opportunities between insurers and researchers will facilitate increased use of RC data for public health purposes.

Economic growth and the incidence of occupational injuries in Austria.

OBJECTIVES: The aim of this paper was to analyze the impact of economic growth measured by real gross domestic product (GDP) on the incidence of occupational injuries in Austria. METHODS: The relationship between GDP and the occupational injury rate of the wage-earning population between 1955 and 2004 was analyzed using an error correction model. The sample size increased from 1.568,371 persons in 1955 to 2.656,952 in 2004. Occupational injuries were divided into fatal and non-fatal injuries. RESULTS: Occupational injuries (fatal and non-fatal) decreased from 8.59% to 4.08%: non-fatal injuries decreased from 8.56% to 4.07%; fatal injuries decreased from 0.03% to 0.01%. Austrian GDP increased from EUR 37.7 billion to EUR 202.8 billion (base year 1995). Statistical analysis clearly shows that a growing economy is associated with declining injury rates (fatal and non-fatal). Two mechanisms are discussed. Firstly, rising GDP is accompanied by greater investment in safer technologies and occupational safety measures. Secondly, booming economies are associated with a reduced risk of unemployment, which is already known to be a risk factor for occupational injuries. CONCLUSIONS: Economic development appears to have an impact on the incidence of occupational injuries in Austria. Health policy should emphasize the necessity for safety at work particularly in phases of economic slowdown.

[Hannover-Polytrauma-Longterm-Study HPLS]. / Hannover-Polytrauma-Langzeit-Studie HPLS (I).

UNLABELLED: From the period of September 2000 to March 2006 Hannover Reinsurance and the Department of Traumatology of the Hanover Medical School conducted a retrospective observational study of the long-term outcome of patients after polytrauma. The follow-up period was on average 17 +/- 5 years. The goal of the study was to determine the social, financial, medical and psychological long-term outcome after a severe accident. Of the 1560 enrolled patients 519 patients died in the observed period, 397 patients were followed up but could not be examined, 637 patients (female n = 158, male n = 479) were examined and answered detailed questionnaires concerning their social, financial medical and psychological situation. 6 patients did not fullfil the input criteria and one patient had two polytraumata. The average age at the time of accident was 26.5 years (+/- 12.3). RESULTS: Financial losses were observed in 41.1% of all males and 44.4% of females. 21.7% of all male (female 18.4%) had no financial protection at all. Due to the accident 30.1% of all men were unemployed and 19.8% permanently disabled (women 27.4% and 27.6% respectively). Psychological treatment almost doubled after discharge from rehabilitation centres. Even 20 years after the accident extra-mortality was substantially increased by 79%. CONCLUSION: Ten to twenty years after polytrauma significant financial, social and medical impairments are still present.

Diabetes and accident insurance. A 3-year follow-up of 7,599 insured diabetic individuals.

OBJECTIVE: Individuals with diabetes pay increased premiums and experience limited coverage when taking out accident insurance, despite the lack of scientific support for this practice. The aim of the present study was to analyze whether diabetic individuals have an increased risk of accident or an increased risk of permanent disability after an accident, compared with two nondiabetic groups. RESEARCH DESIGN AND METHODS: All diabetic members of the Danish Diabetes Association were given free accident insurance for a 3-year period. Based on informed consent, they were also asked to participate in a follow-up study, comparing accident rates in diabetic individuals with a nondiabetic group. A total of 7,599 diabetic members accepted. The control groups were 1) individuals with a leisure-time insurance in the same company (individual issue) and 2) members of full-time group-based insurance (bank employees) in the same company. RESULTS: The risk of accidents was 0.7 per 1,000 person-years in the diabetic group, compared with 4.5 per 1,000 person-years in the first and 5.5 per 1,000 person-years in the second nondiabetic control group (P < 0.001). The degree of permanent injury did not differ between the diabetic and the nondiabetic group. CONCLUSIONS: The risk of accidents and permanent disability is not increased in diabetic individuals. Thus, diabetic individuals should be offered accident insurance at a standard premium without limited coverage.

[Characteristics of the most important accidental health impairments in the population of the insured in PZU group]. / Charakterystyka najczesciej wystepujacych nastepstw nieszczesliwych wypadków, w populacji ubezpieczonych w Grupie PZU, na podstawie analizy orzeczen lekarskich niezbednych do realizacji roszczen.

The aim of the study is to present and analyze the types of bodily injuries which are the causes of the most often issued medical certificates in the population of insured against accident. The following study encompasses the years 2001-2003 where certificates issued by about 1500 doctors cooperating with partnerships of PZU Group were analyzed. In this period 1 300 000 permanent impairments which were stated on the basis of PZU's Group Norm Table of Percentage Evaluation of Health's Permanent Impairments were registered in the computer data base. On the basis of available data the following issues were characterized: 1) what are the most often evaluated injuries?, 2) what average values of permanent health impairment were issued by doctors in particular cases?, 3) in what percentage doctors classified health impairment to particular groups of after-effect severity and, 4) in what percentage health impairment was not stated? For the needs of the following study the human body was divided into particular parts: 1) head with neck and central nervous system, 2) sight, 3) ear, 4) chest, 5) abdomen and urinary system, 6) spine and spinal cord, 7) limb with hip joint, 8) leg, 9) knee joint, 10) region of ankle joint, 11) foot, 12) arm with shoulder, 13) arm, 14) hand, 15) injuries of peripheral nervous system Hands are the most often evaluated part of the body by doctors. Injuries of hands constitute 20% of all evaluated parts of the body. The average value of permanent impairment to health is 3.1%. In 6.7% cases of hand injury evaluation, doctors did not state a permanent impairment to health. The most severe injuries--amputations constituted 9.6% of cases.

[The Assessment of REC after Thermal Trauma as Part of the Appraisal Process for Statutory Accident Insurance in Germany (Part 1): Low Validity of the REC Form Developed by Donnersmarck and Hörbrand]. / Die Einstufung der MdE nach thermischen Trauma im Rahmen der Begutachtung der gesetzlichen Unfallversicherung (Teil I): Geringe Validität des MdE Bogens nach Donnersmarck und Hörbrand.

The total REC (reduction in earning capacity) after a thermal trauma is usually assessed using an appraisal form for burns victims, initially developed by Hoerbrandt and von Donnersmarck (1995). The criteria for functional impairment, local findings and vegetative-somatic complaints are somewhat imprecise given the broad scope of interpretation which the evaluator can employ in making an appraisal. This means that the overall appraisal of REC is subjective on the part of the evaluator. In addition, one can only calculate an overall REC of at most 40% from local findings and vegetative-somatic symptoms, even in patients with extensive large area burns. Considering these points we investigated the dependency of the results on the evaluator as well as the limited validity of the appraisal form originally developed by Hörbrand and Donnersmark.

Prognosis for people with back pain under a No-fault 24-hour-cover compensation scheme.

STUDY DESIGN: A retrospective descriptive casenote review of consecutive back pain claimants assessing claim outcome at 12 months from onset. OBJECTIVE: To assess prognosis for back pain claimants in a no-fault 24-hour-cover accident compensation system. BACKGROUND: New Zealand has a unique accident compensation system that may provide incentives for health professionals to classify people with backache as having a back injury and incentives for back pain claimants to continue claims longer than would be the case in other compensation systems. METHODS: One hundred consecutive back pain claimants were identified from a single office of New Zealand's sole accident compensation insurer (Accident Rehabilitation and Compensation Insurance Corporation; ACC), who were still receiving compensation payments 4 weeks after the initial date of the claim. The study end point was case closure in the subsequent 12 months. Case closure rate was analyzed in relation to several potential prognostic variables. RESULTS: Of the 100 cases identified in which the claimant was receiving compensation 4 weeks from the initial date of the claim, 43 cases were not closed by 6 months, and 30 cases were not closed at 12 months. The variable most strongly associated with case nonclosure was whether the claimant was receiving earnings-related compensation (equal to 80% of previous income), with 41% of this group still receiving compensation at 12 months versus 16% of the group not receiving earnings-related compensation (chi2 = 8.55, P = 0.003). These results compare unfavorably with those from previous published studies from The Netherlands and Jersey in the United Kingdom. CONCLUSION: New Zealand's unique accident compensation environment may discourage return to work for people with back pain. New Zealand legislators should assess the impact of the ACC scheme on people with back pain, particularly in light of the recent recommendations of the International Association for the Study of Pain Task Force on Back Pain in the Workplace, that compensation cover for workers with back pain be limited to 6 weeks.

Parallel risks of automobile collisions and thefts: a potential means of separating driver and vehicle factors.

This paper examines the value of data published by the Highway Loss Data Institute (HLDI) on the collision frequency of different automobile models as a potential guide to vehicle safety. It is argued that these data fail to control for factors other than design, including vehicle usage and driving quality. An alternative measure of collision risk, controlled for some of these factors, is constructed employing the fact that theft risk is determined by many of the same usage characteristics as collision risk. This alternative measure is validated by demonstrating that it is a more effective predictor of injury risk than collision frequency. In conclusion it is argued that if HLDI collision data are to provide a more useful guide to the relative design safety of different automobile models, the data need to be controlled for a wider range of potentially confounding factors.

[15 years insurance statistics of incidents and accident types of combat sports injuries of the Rhineland-Pfalz Federal Sports Club]. / 15jährige Versicherungsstatistik zu Inzidenzen und Unfallhergangstypen von Kampfsportverletzungen im Landessportbund Rheinland-Pfalz.

The primary intention of this study is the grouping of sports accidents, being described by the athletes in their own words in a classification system of specific accident classes with regard to specific motions and topography. The investigation is based on the data of the sports insurance Gerling-Konzern during a 15-year period in Rhineland Palatinate (1981-1995). The study is based on the insurance documents and clinical protocols if available. 137 accident protocols were related to this 15-year period including weight lifting (n = 1) and martial arts (n = 136). Listed in hierarchical order we received the following results: judo (n = 47), karate (n = 44), wrestling (n = 22), taekwondo (n = 9), boxing (n = 7), ju-jutsu (n = 5), fencing (n = 1) and aikido (n = 1). In accordance to accident types there were no sex related differences. As special preventive measures we suggest the use of protective mouthguards and solid glasses, proprioceptive training and physiological taping for knee, ankle and elbow joints.

Modelling crash propensity of carshare members.

Carshare systems are considered a promising solution for sustainable development of cities. To promote carsharing it is imperative to make them cost effective, which includes reduction in costs associated to crashes and insurance. To achieve this goal, it is important to characterize carshare users involved in crashes and understand factors that can explain at-fault and not-at fault drivers. This study utilizes data from GoGet carshare users in Sydney, Australia. Based on this study it was found that carshare users who utilize cars less frequently, own one or more cars, have less number of accidents in the past ten years, have chosen a higher insurance excess and have had a license for a longer period of time are less likely to be involved in a crash. However, if a crash occurs, carshare users not needing a car on the weekend, driving less than 1000km in the last year, rarely using a car and having an Australian license increases the likelihood to be at-fault. Since the dataset contained information about all members as well as not-at-fault drivers, it provided a unique opportunity to explore some aspects of quasi-induced exposure. The results indicate systematic differences in the distribution between the not-at-fault drivers and the carshare members based on the kilometres driven last year, main mode of travel, car ownership status and how often the car is needed. Finally, based on this study it is recommended that creating an incentive structure based on training and experience (based on kilometres driven), possibly tagged to the insurance excess could improve safety, and reduce costs associated to crashes for carshare systems.

Analysis of precipitation-related motor vehicle collision and injury risk using insurance and police record information for Winnipeg, Canada.

INTRODUCTION: Police records are the most common source of data used to estimate motor-vehicle collision risks, understand causal or contributing factors, and evaluate the efficacy of interventions. The literature notes concerns about this information citing discrepancies between police reports and other sources of injury occurrence and severity data. The primary objective of the analysis was to assess the adequacy of police reports for an examination of weather-related injury collision risk. METHOD: Analyses of relative risk were carried out using both police records and comprehensive insurance claim data for Winnipeg, Canada over the period 1999-2001. RESULTS AND CONCLUSIONS: Both data sets yielded very similar results-precipitation substantially increases the risk of injury collision (police records: RR 1.76, CI 1.55-2.00; insurance: RR 1.80, CI 1.62-1.99) and risk of injury (police records, RR 1.74, CI 1.55-1.96; insurance, RR 1.69, CI 1.55-1.85) relative to corresponding dry weather control periods. Both rainfall and snowfall were associated with large increases in collisions and injuries. IMPACT ON INDUSTRY: While relative risks are almost identical, over 64% more injury collisions and 74% more injuries were identified using the insurance data, which is an important difference for evaluating absolute risk and exposure.

Accidental circular saw hand injuries: trauma mechanisms, injury patterns, and accident insurance.

INTRODUCTION: Hand injuries due to circular saws are a common reason for patients seeking medical care in emergency departments. With respect to cases of insurance fraud, these injuries are of medico-legal interest. It is the aim of this study to investigate the critical circumstances of the incidents, the accident mechanism, and the specific injury patterns of circular saw related hand injuries with regard to accident insurance coverage. PATIENTS AND METHODS: Circular saw related hand injuries for the years 1999 through 2007 were followed-up and assessed in detail. Type, severity and pattern of the injury were assessed. An accident analysis investigated characteristic of the activities, of the saws, of the stock/cutting material, operational activities of the operators prior to/at the time of the incident, and detailed information on the insurance status. RESULTS: The follow-up study encompassed 114 patients. A majority of these were covered by private or statutory accident insurances. Compensation payments were made in all cases. All lesions involved one hand, mainly the left non-dominant hand. Thumb and index were at highest risk for injury. One-finger injuries occurred mainly at the middle or distal phalanx. With increasing number of affected fingers, the level of the injury moved closer to the proximal phalanx. A majority of injuries occurred during do-it-yourself activities. Among blade contact injuries, the so-called kickback-mechanism was at highest risk. CONCLUSION: Positive circumstantial indications of a self-inflicted injury, which are often cited in the literature are less conclusive for the medico-legal decision finding. The detailed anatomic description of any lesions and the alleged accident mechanism as initially described by the patients in the emergency setting is the basis for any later accident reconstruction.