[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.

[Medical notification of occupational skin diseases by dermatologists]. / Ärztliche Meldung von Berufskrankheiten der Haut in der dermatologischen Praxis.

In accordance with § 202 SGB VII, physicians in Germany have a legal obligation to report to the statutory accident insurance institution any justified suspicion of an occupational disease. With regard to skin diseases, various occupational disease numbers (Berufskrankheitennummer = BK No.) can be considered, depending on the type of disease and the type of exposure, e.g. BK No. 3101, 3102, 3104, BK No. 5102 and others in addition to the most common BK No. 5101 and BK No. 5103. The prerequisite for a well-founded suspicion is that occupational effects exist or existed which can be brought into a causal relationship with the skin disease. Form F6000 "Medical notification of a suspected occupational disease" is used for reporting. In the case of the numerically most significant BK No. 5101, there is the special feature that even if the skin disease is classified as occupationally caused, but not as severe or repeatedly relapsing, according to § 41 (1) of the contract between physicians and the accident insurance institutions, every physician is obliged to immediately present the insured person to a dermatologist so that the so-called dermatologist procedure can be initiated to enable the rapid initiation of prevention. Since 1 January 2021, it has been stipulated that the dermatologist's report must be submitted in every case-i.e. both when there is merely the possibility and when there is a well-founded suspicion of the existence of a BK No. 5101. This ensures that preventive measures can be quickly and effectively implemented.

[Investigation of the reduction in the disability after fractures in children and adolescents]. / Ermittlung der Minderung der Erwerbsfähigkeit nach Frakturen bei Kindern und Jugendlichen.

The student accident insurance has been part of the German Statutory Accident Insurance (Deutsche Gesetzliche Unfallversicherung, DGUV) for 50 years. In order to assess the reduction in working capacity (Minderung der Erwerbsfähigkeit, MdE) in the event of permanent consequences of accidents and injuries, the recommendation to treat the affected child or adolescent "as an average adult" is currently still valid. The present work deals with the everyday practice of the MdE assessment in children and adolescents and their weaknesses through the transfer of the principles from adulthood. In addition, proposals for the adaptation of the assessment principles for the growth age are drawn up.

[Medical assessment in the field of Social Act VII: pre-existing damage and causality of apophyseal injuries and detachments]. / Begutachtung im Bereich des SGB VII: Vorschaden und Kausalität bei apophysären Verletzungen und Lösungen.

The medical assessment of affections of the apophyses frequently presents the assessor with problems in causality testing and estimation of functional impairment. Apophyses are the insertion of tendons and are therefore at the center of an acting parallelogram of forces. They fuse via an apophyseal plate in the second decade of life. Depending on the age there is a reduced mechanical load-bearing capacity of the apophyseal plates in the last 1-2 years before complete mineralization of the joint. Two types of injury must be distinguished in an expert opinion: apophyseal detachment as a result of repetitive microtrauma in the event of chronic overload and apophyseal avulsion fracture as an acute injury due to sudden maximum muscle tension. While chronic overload leads to exclusion from insurance cover by the statutory accident insurance, apophyseal avulsion fractures fulfil the necessary requirements for acceptance as an insurance case. The apophyseal avulsion fracture is subject to a time-limited force, which directly leads to damage to health and avulsion of the tibial tuberosity including its tension system. The sudden jerky maximum muscle pull leads to an overload of the tension system and avulsion of the apophysis in cases of an age-related vulnerable apophyseal plate. Once the mineralization is complete, this type of fracture no longer occurs. Osgood-Schlatter disease, an insertion tendinosis of the patellar tendon, occurs in around 20% of all sport-active adolescents but it is questionable whether it can be associated with the acute avulsion fracture. Knowledge of the pathogenesis of affections and injuries of the apophysis can provide the assessor with good foundations for the estimation of a causal association.

[Joint arthrodesis in functionally favorable position : Considerations on measurement of disability in private accident insurance]. / Gelenkversteifung in gebrauchsgünstiger Stellung : Überlegungen zur Invaliditätsbemessung in der privaten Unfallversicherung.

If an accident results in a functional disorder that persists and permanently restricts physical and/or mental capacity, this is referred to as a disability. In private accident insurance it is the task of the medical expert to assess this disability by examining the medical findings and produce an assessment taking account of the literature and comparing against generally acknowledged guidance values. The priority dismemberment disability rating schedule initially provides loss values. For the "next lowest" disability levels for arthrodesis of extremity joints, the assessment recommendations are based on a functionally favorable position although this functionally favorable position is not more precisely defined.In this article the authors have defined these functionally favorable positions based on the information available in the literature. In particular, the operatively favorable settings for arthrodesis of the affected joint that are stated in the literature on trauma and orthopedic surgery were consulted. Of course, the functional perspective has been especially emphasized.A difficulty in achieving this was that the literature on arthrodesis is now almost only of historical value due to modern endoprosthetics. The knowledge gained was checked against medical experience and is expounded here.

[Bone marrow edema syndrome from the perspective of appraisers and insurance clerks]. / Knochenmarködemsyndrom aus Sicht von Gutachter und Sachbearbeiter.

Various diseases or groups of diseases can trigger bone marrow edema (BME). The task of the appraiser is to work out the role of a diagnosed BME in the context of the causality based on liability; however, the inconsistent ICD 10 coding of the BME complex also poses a problem, especially for medically untrained insurance clerks. The coding of the BME as a fracture provided by the coding guidelines poses a problem when assessing reserves for damage settlement. Based on the etiology of BME an algorithm is presented that should make it easier for the expert as well as for the insurance clerk in the case of liability and also for the private accident insurance to classify the diagnosis of BME in the case.

[Effects of the new injury type catalogue of the German statutory accident insurance on a center for severe injury type procedures]. / Auswirkungen des neuen Verletzungsartenverzeichnisses der DGUV auf ein SAV-Zentrum.

The development of the numbers of cases involved in accident insurance consultant procedures (DAV), injury type procedures (VAV) and severe injury type procedures (SAV) after the introduction of the new injury type catalogue from 1 July 2018 is presented. Furthermore, possible alterations to organizational aspects, such as operating room times and average duration of hospitalization are presented. A first critical assessment of the modifications in the new catalogue was carried out, particularly with reference to the newly introduced section on complications (section 11). METHODS: A retrospective study of all inpatients treated in the context of the DAV, VAV and SAV procedures at a SAV center from the 2nd and 3rd quarters of 2018 was carried out. The development of the number of cases, the case mix index (CMI), the mean number of operations, the mean time in the operating room and the length of hospitalization were analyzed. Furthermore, an assessment of the SAV cases was carried out with respect to the new developments and with particularly reference to complications. RESULTS: The total number of inpatients in the context of the DAV, VAV, SAV procedures changed only slightly. There was a clear decrease in DAV cases and a relevant increase in SAV cases. The CMI increased by 47%, the number of surgical procedures by 15%, the mean time in the operating room by 36% and the length of hospitalization by 43%. When converted to a daily operating room unit of 7 h (Tagestischeinheit, TTE) the operating room time increased from 89 to 108 TTE and the length of hospitalization increased from 1028 to 1358 days. Of the 111 SAV cases in the 3rd quarter, 52% were assigned to the catalogue number 11 "complications". In comparison to the previous version of the VAV/SAV catalogue, it was now possible to assign all inpatients to a single category. CONCLUSION: The modifications of the VAV in the observational period led to an enormous increase in SAV cases. It remains to be seen whether this development is confirmed in subsequent quarters. The increase in CMI, the number of necessary operations, operating room times and duration of hospitalization showed the necessity of these innovations on structural changes of hospitals involved in the treatment of SAV cases.

[Alpha-Gal-associated delayed red meat anaphylaxis as an occupational disease]. / Alpha-Gal-assoziierte verzögerte Anaphylaxie gegen rotes Fleisch als Berufskrankheit.

In a 30-year-old chef with recurrent delayed angioedema history as well as the experimental detection of IgE antibodies against galactose-alpha-(1,3)-galactose (alpha-Gal) pointed to alpha-Gal as the causative agent. The diagnosis, therefore, was delayed anaphylaxis due to alpha-Gal. Because of the potential relationship to his profession, we submitted a dermatologist's report BK 5101 to the liability and insurance association, whereupon his contract of employment was terminated without notice. As a consequence, we reported an occupational disease. This case demonstrates an underdiagnosed, potentially life-threatening allergy to the disaccharide alpha-Gal in red meat as an occupational disease.

[Osteoporosis in private accident insurance]. / Osteoporose in der privaten Unfallversicherung.

Osteoporosis is a multifactorial disease resulting in reduced bone strength and increased bone fragility. The cause of osteoporosis is underexplored. The manifestation of osteoporosis makes a significant contribution to the development of bone fractures. In the medical assessment, the question arises to what extent osteoporosis is considered to be a previous disability or in particular as a contributory factor. In particular, there are some uncertainties relating to the degree of possible participation, as there are only insufficient scientific evaluation systems. From the authors' point of view no valid assessment of the degree of participation exists on the basis of technical examinations or even the severity of the trauma. At the current time there is no possibility to indicate the level of contribution in 10% or 20% steps. Taking the total picture, including clinical and radiological findings into consideration, it seems possible to assess the contribution only in larger percentage steps (e.g. 0%, 50% or ≥80%). The mere diagnosis of osteoporosis does not justify a participation rate unless its effects can be pathomorphologically proven.

[Current SHI physician legislation: succession rules for surgical seats : Surgical vacancies can be filled with orthopedic/trauma surgery specialists only within narrow limits]. / Aktuelles Vertragsarztrecht: Nachfolge bei Chirurgensitzen : Nachbesetzung einer chirurgischen Zulassung durch Fachärzte für Orthopädie/Unfallchirurgie nur in engen Grenzen.

It is a physician's certified continuing medical education category-rather than their actual medical activity, in this case in the field of trauma surgery-that is decisive in filling statutory health insurance (SHI) practice vacancies. This evaluation arising from §16 of the requirement planning guideline applies accordingly when filling physician vacancies. Thus physician vacancies or statutory health insurance (SHI) practice places can only be filled by a physician in the same physician group in line with requirement planning. Scope for argumentation initially remains in the context of filling surgical SHI physician vacancies where the ceding physician is certified as an accident insurance consultant.

[Aspects of expert opinions of avulsion fractures]. / Gutachtliche Aspekte von Apophysenschäden.

The apophyses as secondary ossification centers are connected with the bone by cartilage. During the growth phase of puberty, the apophyseal plate is a mechanical weak spot. Especially, apophyses in the hip and pelvic area are exposed to considerable tensile and sheer stresses due to the strong muscles which are inserted here. The frequency of injuries to the apophyses correlates with the extent of sporting activities. For athletes participating in "Youth Train for the Olympics", this is the most common injury of all. Most often, the apophysis of the rectus femoris muscle is affected at the anterior inferior iliac spine. In adults, after complete ossification of the apophyseal plate such injuries are rare. However, in a very unusual mechanism of injury with maximum forced hip flexion and simultaneous maximum knee extension, avulsions of the ischial tuberosity are observed in adults. During the causality test-especially in the legal area of statutory accident insurance-the question is always whether the alleged course of events has to be regarded as a legally significant (partial) cause or if a longer period of time has been involved, so that the resulting morbid apophysis detachment was predominately due to fate, in which the alleged event must be interpreted as legally immaterial.

[Reform of occupational insurance medical treatment from the perspective of an accident insurance consultant]. / Neuordnung des BG-lichen Heilverfahrens aus der Sicht eines niedergelassenen D­Arztes.

The reform of occupational insurance medical treatment in 2011 also resulted in many changes for occupational insurance consultants in private practice. The transformation of the physicians participating in treatment status (H-Arzt) to accident insurance consultant status (D-Arzt) has resulted in a significant increase in numbers in outpatient fields, which in some cases leads to increased competition. The tentative flexibilization of the conditions for participation of a D­Arzt is welcomed but must be broadened to safeguard the future. The relaxation of obligatory attendance of a D­Arzt is contemporary and is welcomed. The regularly checked obligation for further education initially led to irritation but has now been extensively coordinated with the mandatory further education for contract physicians. As from 1 January 2016 many smaller alterations and specifications in the implementation regulations have been undertaken. The scale of charges for physicians in invoicing with accident insurance companies as with other scales of charges is urgently in need of reform with respect to the performance rating and in particular to the classification.

[The new medical treatment procedure of the German Statutory Accident Insurance: From the perspective of BG hospitals]. / Die neuen Heilverfahren der DGUV: Aus Sicht der BG Kliniken.

The Hospital Group of the Statutory Accident Insurance (BG hospitals) was affected by the new requirements for severe injury procedures (SAV) in the same manner as all other maximum care hospitals. Simultaneously, the BG clinics were merged to form a centrally organized hospital group. A substantial need for adjustment existed for specialties, such as neurosurgery and visceral surgery at some sites. Needless to say, all trauma victims benefit from the high standards required by the Statutory Accident Insurance regardless of their insurance status. The provision of medical treatment with respect to its implementation into routine practice must be further optimized and additions, e.g. for the occurrence of complications are necessary.

Experiences of pathways, outcomes and choice after severe traumatic brain injury under no-fault versus fault-based motor accident insurance.

PRIMARY OBJECTIVE: To explore experiences of pathways, outcomes and choice after motor vehicle accident (MVA) acquired severe traumatic brain injury (sTBI) under fault-based vs no-fault motor accident insurance (MAI). METHODS: In-depth qualitative interviews with 10 adults with sTBI and 17 family members examined experiences of pathways, outcomes and choice and how these were shaped by both compensable status and interactions with service providers and service funders under a no-fault and a fault-based MAI scheme. Participants were sampled to provide variation in compensable status, injury severity, time post-injury and metropolitan vs regional residency. Interviews were recorded, transcribed and thematically analysed to identify dominant themes under each scheme. RESULTS: Dominant themes emerging under the no-fault scheme included: (a) rehabilitation-focused pathways; (b) a sense of security; and (c) bounded choices. Dominant themes under the fault-based scheme included: (a) resource-rationed pathways; (b) pressured lives; and (c) unknown choices. Participants under the no-fault scheme experienced superior access to specialist rehabilitation services, greater surety of support and more choice over how rehabilitation and life-time care needs were met. CONCLUSIONS: This study provides valuable insights into individual experiences under fault-based vs no-fault MAI. Implications for an injury insurance scheme design to optimize pathways, outcomes and choice after sTBI are discussed.

[Development and current recommendations on the assessment of disability in private accident insurance]. / Entwicklung und aktuelle Bemessungsempfehlungen der Invalidität in der privaten Unfallversicherung.

Private accident insurance complements the offer provided by statutory accident insurance in Germany. Private accident insurance can be taken out on a voluntary basis with private insurance companies. The amount of compensation paid in the event of accidents is subject to the dismemberment schedule (Gliedertaxe) and the permanent impairment of the physical or mental capacity, which is to be determined by a medical practitioner. The essay describes the development of the medical recommendations for assessing disability from the origins of private accident insurance in the 19th century to the present. It also considers individual scientific articles from medial personalities and the importance of accident surgery and orthopaedic specialist societies for the development of relevant assessment criteria and disability tables (Invaliditätstabellen) of private accident insurance.

[Recommendations for assessment of disability in private accident insurance-Interdisciplinary consensus-Status September 2024 : Recommended for use by the Specialist Society of Interdisciplinary Medical Expert Opinion (FGIMB) on 6 October 2023]. / Bemessungsempfehlungen zur Invalidität in der privaten Unfallversicherung ­ fachübergreifender Konsens ­ Stand 09/2024 : Von der Fachgesellschaft Interdisziplinäre Medizinische Begutachtung (FGIMB) e. V. zur Anwendung empfohlen am 06.10.2023.

The centerpiece in private accident insurance is the compensation in cases of disability, which must be determined by a physician within a certain time limit. The insurer contract specifies the compensation rate for loss or inability to function. In cases of insurance the medical expert has to refer to generally accepted revised or updated assessment recommendations in order to be able to apply the given framework to the specific individual disability situation of the insured person. This article deals with the interdisciplinary consensus benchmarks for the assessment of disability, which form the principles of a uniform medical assessment of accident-related functional disorders in the private accident insurance.With the publication of these new assessment recommendations developed under the guidance of the Specialist Society of Interdisciplinary Medical Expert Opinion (FGIMB), the recommendations published by Schröter and Ludolph in 2009 [12] are withdrawn, so that these are now replaced as the authoritative version by the assessment recommendations of the FGIMB.

[Hand eczema and statutory accident insurance-what you should know for your practice]. / Handekzem und Unfallversicherung ­ was man für die Praxis wissen sollte.

Since January 1, 2021, recognition of occupational hand eczema as an occupational disease (OD) No. 5101 has been made significantly easier by eliminating the obligation to cease and desist work in the eczema-eliciting job. As a result of this change in OD law, an occupational disease can now also be recognized if the patient continues the (eczema-eliciting) work. This results in a significantly higher liability for accident insurance companies to enable high-quality care for affected patients by the dermatologist-and this, if necessary, in the long term until retirement. The number of recognized OD No. 5101 cases has already increased tenfold (around 4000 cases per year). Work-related hand eczema must be treated as quickly as possible in order to avoid a protracted course of the disease and job loss. Accordingly, those affected should be reported quickly to the accident insurance (dermatologist's report and/or OD notification). After the notification, in addition to the granting of outpatient treatment, the reporting dermatologist has an extensive range of preventive measures available (including skin protection seminars and inpatient treatment). In addition, there are no prescription fees and even basic skin care can be prescribed ("basic therapy"). The extra-budgetary care of hand eczema as a recognized occupational disease is associated with many advantages for the dermatologist's practice and the patient.

[COVID-19 as an insurance case of the statutory accident insurance: occupational disease or occupational accident : Relevant knowledge for the (general and abdominal) surgeon]. / COVID-19 als Versicherungsfall der gesetzlichen Unfallversicherung: Berufskrankheit oder Arbeitsunfall : Relevantes Wissen für den (Allgemein­/Viszeral­)Chirurgen.

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic resulted in many infections with the virus and sickness due to coronavirus disease 2019 (COVID-19). Therefore, there was a dramatic increase in the number of reported and recognized occupational diseases (Berufskrankheit, BK) and occupational accidents (Arbeitsunfall, AU) at the German Social Accident Insurance Institutions (BG) and accident insurance funds (Unfallkassen).The publication aims to show the differences between BK and AU and to review the current data on occupational diseases. It deals with the definitions of BK and AU, the differences in the conditions for recognition as BK or AU. Furthermore, the claims for benefits are presented. Finally, statistical key figures of the BK according to No. 3101 and the AU are presented.Results (key points)- According to § 7 SGB VII, AU and BK are insured events of the statutory accident insurance.- In surgery, like specifically in the rest of the healthcare system, the relevance of the SARS-CoV­2 infection with post-COVID in personnel for occupational medical prevention and as a case to be recognized by the statutory accident insurance (BK or AU) becomes clear.- Relevant for the recognition are the duration and the intensity of the contact (local proximity) and the SARS-CoV­2 occupational health and safety rule of 20 August 2020 essentially recognizes a contact duration of at least 15 min at a spatial distance of less than 1.5-2 m (further aspects: more intensive shorter contacts, number of verifiably infected persons in the closer activity environment or the usual personal contacts, spatial situation, work route, special constellations).- No case numbers can be elicited for the detailed presentation of the surgery setting.- There are still immense problems and challenges in the assessment of COVID-19 consequences or post-COVID as occupational disease, as numerous uncertainty factors, such as insufficiently secured knowledge about the further long-term course over the years or the widely varied symptom spectrum complicates the medical assessment of the consequences of this disease.Conclusion: the SARS-CoV­2 pandemic is a special challenge for surgery with intensive patient contact and for the entire healthcare system. This caused long-lasting changes and the adequate health care as well as insurance law processing of the (case-specific) consequences might still require considerable efforts and resources.

[The problem of long/post-COVID in expert assessments]. / Problematik von Long­/Post-COVID in der Begutachtung.

Assessing long/post-COVID syndrome (PCS) following an infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a multidisciplinary challenge due to the diverse and complex symptoms. Besides discipline-specific evaluation of infection-related organ damage, the main issue is expert objectivity and causality assessment regarding subjective symptoms. The consequences of long/PCS raise questions of insurance rights in all fields of law. In cases of persistent impairment of performance, determining reduction in earning capacity is crucial for those affected. Recognition as an occupational disease (BK no. 3101) is vital for employees in healthcare and welfare sectors, along with occupational accident recognition and assessing the illness's consequences, including the reduction in earning capacity (MdE) in other sectors or work areas. Therefore, expert assessments of illness consequences and differentiation from previous illnesses or damage disposition are necessary in all areas of law, individually based on corresponding organ manifestations in medical fields and interdisciplinarily for complex late sequelae, for instance, by internists with appropriate qualifications for pulmonary or cardiac manifestations and neurologists, psychiatrists, and neuropsychologists for neurological and psychiatric manifestations, etc.

[What are the principles for measurement and estimation of accident sequelae? : Development and function of the reduction in earning capacity (MdE) tables in the statutory accident insurance]. / Was sind die Grundlagen der Bemessung und Einschätzung von Unfallfolgen? : Entstehung und Funktion der MdE-Tabellen in der gesetzlichen Unfallversicherung.

The evaluation of permanent dysfunction after injuries to the musculoskeletal system is one of the core activities of a trauma surgeon and orthopedists. Based on the knowledge of the injury and an accurate description of the dysfunction, the medical expert then makes a proposal regarding the amount of the reduction in earning capacity (Minderung der Erwerbsfähigkeit, MdE). The amount is based on the MdE tables, which have been derived from a decade-long harmonization and coordination between administrative authorities, courts and the medical profession. They have been published in the fundamental guidelines for evaluation. Individual recommendations are subject to change; however, the benchmark figures for amputations have not changed significantly since the introduction of the statutory accident insurance in 1884, although the treatment with prostheses has continuously improved. The benchmark for the MdE is the labor market which becomes unavailable to the insured person due to the dysfunction. In the Social Code for Employment Accident Insurance (Sozialgesetzbuch für die Unfallversicherung, SGB VII), the reduction in earning capacity is defined and the amount "… is based on the extent to which job opportunities are available as a result of the impairment of the physical and mental capacity across the entire area of the working life". The article traces the history of this central instrument for measuring the sequelae of accidents. In this context it is shown that the MdE values did not in fact arise concurrently with the introduction of statutory accident insurance at the end of the nineteenth century but date back to the millennia-old principle of the law of talion (ius talionis). This is the basic form of material civil liability law, according to which the injuring party must compensate the injured party in the case of a culpable impairment of health for the resulting material loss. Here the loss of earnings, the impairment of the capacity to work or, in other words, the reduction in earning capacity is of paramount importance. In the middle of the nineteenth century, private accident insurers developed dismemberment schedules based on the principle of ius talionis. These dismemberment schedules were adopted by the professional organizations after 1884. The highest competent instance for social security matters, which was the Imperial Insurance Office (Reichsversicherungsamt), redefined the dismemberment schedules: the values for the dismemberment schedules then became the benchmark for the reduction of capacity to work (Erwerbsminderung, EM) and subsequently the reduction in earning capacity (MdE). The fact that the MdE values have remained stable over more than 100 years support the view that they not only grant legal certainty but are also regarded as appropriate and fair by both the persons affected and society.