[Reorientation of Medical Procedures Covered by Statutory Accident Insurance]. / Neuausrichtung der Heilverfahren der Gesetzlichen Unfallversicherung.

As of 01/01/2014, the German Statutory Accident Insurance (DGUV) has reorganized inpatient medical procedures. The central element of reorientation is the reorganization of the catalogue of types of accidents and type of medical procedures of hospitalized injured patients in 3 care stages. In addition, the reorientation also concentrates on hospitals with the highest performance and the best qualification and also focuses on severe and most severe injuries.This reorientation is also based on the White Paper of the German Society for Trauma Surgery (DGU), especially on the Trauma Network DGU. The new regulations will be implemented by the state associations of the German Statutory Accident Insurance.The hierarchy of care depends on established admission criteria and the severity of injury. This structuring also refers to special competence in the field of rehabilitation and will lead to the strengthening of multidisciplinary rehabilitation management and workplace-related modules of the healthcare. Overall, the accident insurance institution will place increased demands on their network partners.

[The new treatment procedures of the DGUV from the perspective of an injury type procedure (VAV) clinic]. / Die neuen Heilverfahren der DGUV aus der Sicht einer VAV-Klinik.

The new treatment procedures of the German Statutory Accident Insurance (DGUV) have ramifications for the injury type procedure clinics (VAV) from medical, economic and structural aspects. Whereas the latter can be assessed as positive, the medical and economical aspects are perceived as being negative. Problems arise from the partially unclear formulation of the injury type catalogue, which results in unpleasant negotiations with the occupational insurance associations with respect to financial remuneration for services rendered. Furthermore, the medical competence of the VAV clinics will be reduced by the preset specifications of the VAV catalogue, which opens up an additional field of tension between medical treatment, fulfillment of the obligatory training and acquisition of personnel as well as the continually increasing economic pressure. From the perspective of the author, the relinquence of medical competence imposed by the regulations of the new VAV catalogue is "throwing the baby out with the bathwater" because many VAV clinics nationwide also partially have competence in the severe injury type procedure (SAV). A concrete "competence-based approval" for the individual areas of the VAV procedure would be sensible and would maintain the comprehensive care of insured persons and also increase or strengthen the willingness of participating VAV hospitals for unconditional implementation of the new VAV procedure.

[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.

[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.

[New regulations for inpatient treatment of the statutory accident insurance: From the perspective of a university medical center]. / Neuordnung des stationären Heilverfahrens der Gesetzlichen Unfallversicherung: Aus Sicht einer Universitätsklinik.

BACKGROUND: New regulations of the German statutory accident insurance for inpatient treatment have been introduced. The aims of the new regulations are to improve cost-effectiveness and the quality of medical care. The introduction of the injury type catalogue and the severe injuries type procedure (SAV) has led to a concentration of resources. The purpose of these innovations is an increase in the quality of treatment of patients with complex injuries. CONCLUSION: The introduction of the new regulations resulted in a centralization of medical care in order to optimize the quality of treatment of complex injuries from occupational accidents. Hence, the high demands concerning infrastructure and human resources expected of a level one university medical center are taken into account.

[The new treatment procedure of the German statutory accident insurance: From the perspective of a community hospital]. / Die neuen Heilverfahren der DGUV: Aus der Sicht eines Städtischen Krankenhauses.

The requirements of the German statutory accident insurance (DGUV) for the new treatment procedure were presented on 1 January 2013 in a new catalogue. The implementation of the certification of hospitals for the very severe injury procedure (SAV) by the DGUV should have been completed by 2014. These requirements placed high demands on trauma-oriented hospitals because of the high structural and personnel prerequisites. The background to the new organization was the wish of the DGUV for quality improvement in patient treatment in hospitals for patients with very severe occupational and occupation-related trauma by placement in qualified centers with high case numbers. No increase in income was planned for the hospitals to cope with the necessary improvements in quality. After 2 years of experience with the SAV we can confirm for a community hospital that the structural requirements could be improved (e.g. establishment of departments of neurosurgery, plastic surgery and thoracic surgery) but the high requirements for qualification and attendance of physicians on duty are a continuous problem and are also costly. The numbers of severely injured trauma patients have greatly increased, particularly in 2015. The charges for the complex treatment are not adequately reflected in the German diagnosis-related groups system and no extra flat rate funding per case is explicitly planned in the DRG remuneration catalogue. The invoicing of a center surcharge in addition to the DRG charges has not been introduced.

[When is the Damage to the Eye to be Assessed as Corresponding to a 25 % Reduction in Earning Ability?]. / Wann ist der Schaden eines Auges über 25 % Minderung der Erwerbsfähigkeit anzusetzen?

In General Accident Insurance, loss of sight in one eye is assessed as giving a 25 % reduction in earning capacity. This does not exclude the possibility that a greater reduction in earning capacity can be assessed for this eye. The ophthalmological situation is outlined under which a much greater reduction in earning capacity can be assessed, if there is not misassessment.

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.

[Principles of intervertebral disc assessment in private accident insurance]. / Grundlagen der Bandscheibenbegutachtung in der privaten Unfallversicherung (I).

Due to the spread of intervertebral disc degeneration, insurance companies and experts are regularly confronted with related assessments of insured persons under their private accident insurance. These claims pose a particular challenge for experts, since, in addition to the clinical assessment of the facts, extensive knowledge of general accident insurance conditions, case law and current study findings is required. Each case can only be properly assessed through simultaneous consideration of both the medical and legal facts. These guidelines serve as the basis for experts and claims.managers with respect to the appropriate individual factual assessment of intervertebral disc degeneration in private accident insurance.

The administrative process for recognition and compensation for occupational diseases in Korea.

In the Workers' Compensation Insurance (WCI) system in Korea, occupational diseases (ODs) are approved through deliberation meetings of the Committee on Occupational Disease Judgment (CODJ) after disease investigations when workers or medical institutions requested the Korea Workers' Compensation and Welfare Service (COMWEL) for medical care benefits. Insufficient data presented by employers or workers or lack of objective evidence may increase the possibility of disapproval. The expertise of accident investigation staff members should be reinforced and employers' and related institutions' obligations to cooperate and submit data should be specified under the law. The deliberation meetings of the CODJ are held separately for musculoskeletal, cerebro-cardiovascular, and medical diseases, and the judgments of ODs are made by the chairperson of COMWEL and six committee members by majority vote by issue. To reinforce the expertise of the members of the CODJ, periodic education and a system to accredit the committee members after appropriate education should be introduced. To fairly and quickly compensate for diseases that occur in workers, the criteria for the recognition of occupational diseases should be continuously amended and the systems for disease investigations and judgments should be continuously improved.

Work-related musculoskeletal diseases and the workers' compensation.

The Industrial Accident Compensation Insurance Act (IACIA) regulates the workers' compensation insurance system and the standards for the recognition of occupational diseases (ODs). Since its establishment in 1994, the IACIA has been amended several times. Before 2008, the approval of compensation for work-related musculoskeletal diseases (WMSDs) was decided based on the recommendation of consultants of the Korea Workers' Compensation and Welfare Service (COMWEL). The IACIA was amended in 2008, and since then, the approval of compensation for occupational injuries has been decided based on the recommendation of COMWEL consultants, whereas the approval of compensation for ODs was decided based on the judgment of Committee on Occupational Diseases Judgment (CODJ) which was established in 2008. According to the 2013 amendment to the IACIA, degenerative musculoskeletal diseases among workers engaged in musculoskeletal-burdening work should be considered compensable ODs. Despite some commendable changes to the workers' compensation insurance system, other significant issues persist. To resolve these issues, related organizations including the associations of orthopedic surgery, neurosurgery, and occupational and environmental medicine; Ministry of Employment and Labor; and COMWEL need to work cooperatively.

Compensation for occupational injuries and diseases in special populations: farmers and soldiers.

Some types of workers such as farmers and soldiers are at a higher risk of work-related injury and illness than workers from other occupations. Despite this fact, they are not covered under the Industrial Safety Health (ISH) Act or the Industrial Accident Compensation Insurance (IACI) Act. The Safety Aid System for Farmers (SASF) is a voluntary insurance scheme, and it is the only public compensation plan for self-employed farmers. Fifty percent of SASF premiums are subsidized by the Korean government. Soldiers are compensated by the Veterans' Pension (VP) Act. The approval standard of and procedure for the VP Act are provided in the Decree of VP Act, and the Council for VP Benefits determines work-relatedness in the claimed cases. Meanwhile, SASF applies the insurance clause automatically without any expert advice or additional procedures. Furthermore, compared with IACI, these programs pay fewer benefits to workers. Thus, a stronger institutional strategy is needed to maintain a safe work environment, to protect workers' health in unavoidably hazardous environments, and to compensate for work-related injuries and diseases.

The scope and specific criteria of compensation for occupational diseases in Korea.

The range of diseases covered by workers' compensation is constantly expanding. However, new regulations are required for the recognition of occupational diseases (ODs) because OD types evolve with changes in industrial structures and working conditions. OD criteria are usually based on medical relevance, but they vary depending on the social security system and laws of each country. In addition, the proposed range and extent of work-relatedness vary depending on the socio-economic conditions of each country. The Labor Standards Act (LSA) and the Industrial Accident Compensation Insurance Act (IACIA) of Korea employ lists based on their requirements without listing causes and diseases separately. Despite a considerable reshuffle in 2003, the basic framework has been maintained for 50 yr, and many cases do not fit into the international disease classification system. Since July 1, 2013, Korea has expanded the range of occupational accidents to include occupational cancers and has implemented revised LSA and IACIA enforcement decrees. There have been improvements to OD recognition standards with the inclusion of additional or modified criteria, a revised and improved classification scheme for risk factors and ODs, and so on.

[INAIL recourse in occupational diseases]. / II regresso INAIL nelle malattie professionali.

The following paper examines the issue of the specific action of recourse brought by the National Insurance Accidents at work (INAIL) for occupational diseases by examining the regulatory framework and the diachronic evolution of the Court's legitimacy in the matter. The authors focus on the most frequent cases and highlight the orientation adopted by the administrative office in the matter.

Current situation and issue of Industrial Accident Compensation insurance.

Industrial Accident Compensation Insurance (IACI) has a history of about 50 yr, and is the oldest social insurance system in Korea. After more than 20 times of revision improvements in benefits, its contents and claim systems have been upgraded. It became the protector of injured workers and their families, and at the same time became the system which could cope with both financial burden of employers and their responsibilities. However, there are some issues to be reformed to upgrade the IACI: 1) the problems in the approval system of occupational diseases, 2) quality improvement of workers' compensation medical care, 3) vocational rehabilitation and return to work, 4) workers' compensation premiums and out-of-pocket money of injured workers, 5) issues in application of IACI. Growth of IACI cannot be achieved by an effort of an individual. Efforts by workers, owners, and government, in addition to physicians and welfare professionals toward the same goal are required for the next level improvement of IACI.