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Objective:To discuss the technical standards of disability assessment in personal injury compensation in China, and to put forward the conception of standard construction. Methods:The disability assessment technical standards in China were systematically reviewed, as well as the contents of the United States Guides to the Evaluation of Permanent Impairment (GEPI) and the United Kingdom Guidelines for the Assessment of General Compensation in Personal Injury Cases (GAGD). Results:There were six standards for disability assessment and three of them were commonly used in China at present, coming from different departments. There were some repeated, intertwined, contradictory contents. The disabilities were graded in ten grades, and the disability rate was difference of 10% between two successive grades. The determination of disability grades came from the consensus of specialists, and was little scientific. In comparison, GEPI was developed according to the ICF standards formulated by the World Health Organization, which contained continuous disability value instead of disability grade, along with the weight of organs to calculate synthetically. GEPI emphasizes objective indicators. GAGD directly gave the financial amount of disability compensation. Conclusion:It is needed to integrate the standard management departments of technical standards for disability assessment in China to link standards up; strengthen macro plan and establish the system table of forensic disability assessment standards; carry out international exchanges of technical standards and refer to the concept and data of foreign standards when revising standards.
ABSTRACT
Objective:To perfect disability assessment in China. Methods:The nature and method of disability compensation inside and outside China were reviewed, as well as the promulgation of disability assessment outside the region. The Classification of the Impairment Related to Injury was analyzed based on the Guides to the Evaluation of Permanent Impairment (GEPI). Results:The Classification of the Impairment Related to Injury was consistent with GEPI in general, but there also were some problems, such as the omission of clauses, and lacking the promoted principle of multiple injury. Conclusion:The Classification of the Impairment Related to Injury is universal. But it needs to take quantification of impairment of GEPI as reference, and refine the principle and supplement of the promoted principle, to meet the practical needs of disability assessment in China.
ABSTRACT
Resumen.La primera barrera con el medio ambiente que protege contra sustancias nocivas y organismos es la piel. Las actividades humanas son sumamente diversas y muchas de los trabajos pueden actuar en detrimento de esta barrera natural provocando enfermedades dermatológicas asociadas con la dinámica laboral. El 90% de todas las dermopatías laborales son dermatitis de contacto, la cual puede ser irritativa o alérgica. En la mayoría de los casos se trata de un eczema en zonas expuestas del cuerpo y con cierta frecuencia en las manos. El diagnóstico se basa en una historia clínica y examen físico detallados, conocimiento de las sustancias que permita diferenciar los irritantes de los alérgenos y una correcta interpretación de las pruebas de alergia. Este es conocimiento básico para peritar en el ámbito médico legal.
Abstract.The skin is the primary interface with external environment and performs quite efficiently as a barrier against noxious chemicals or living organisms. The range of human activities is extremely diversified and many occupations can lead to break down of the epidermal barrier, with subsequent development of work-related dermatoses.Occupational contact dermatitis accounts for 90% of all causes of work-related cutaneous disorders. It can be divided into irritant contact dermatitis, wich occurs in 80% of cases and allergic contact dermatitis. In most cases, both types will present as eczematous lesions on exposed parts of the body, notably the hands. Accurate diagnosis relies on meticulous history taking, thorough physical examination, careful distinguishing between irritants and allergens, and comprehensive patch testing to confirm or ruled out allergic sensitization. This is a basic review to issue a forensic professional judgement.
Subject(s)
Humans , Occupational Risks , Dermatitis, Irritant/pathology , Dermatitis, Allergic Contact/pathology , Occupational Diseases/diagnosis , Occupational Health , Forensic MedicineABSTRACT
ResumenEn este artículo se describirán los elementos básicos necesarios que deben tomarse en cuenta cuando se está valorando médico legalmente a una persona con cardiopatía isquémica, tanto en la historia clínica, examen físico y los estudios complementarios. Además se dará una explicación breve sobre el uso de tabla de enfermedad coronaria para la asignación de porcentaje basado en las Guías de Valoración del Deterioro Permanente de la Academia Americana de Medicina y con ello brindarle al médico forense las herramientas necesarias para asignar de forma objetiva un porcentaje de pérdida de la capacidad funcional por los efectos de la cardiopatía de origen isquémico.
AbstractIn this article will be described the necessary basic elements to be taken into account when using a forensic medical approach to diagnose a person with ischemic heart disease, both in clinical history, physical examination and complementary studies. In addition, is a brief explanation of how to use the table of coronary heart disease for the allocation of a percentage based on the Guidelines for Evaluation of Permanent Impairment of the American Academy of Medicine and thereby provide to the medical examiner the necessary tools to assign subjectively the percentage of loss of functional capacity by the effects of ischemic heart disease.
Subject(s)
Humans , Coronary Artery Disease/diagnosis , Coronary Disease/physiopathology , Forensic Medicine , Task Performance and Analysis , Costa RicaABSTRACT
Evaluation of visual impairment is the fundamental research of visual impairment standards and appropriate application. In the absence of basic study, impairment standard is in the trouble of formulating, understanding and apply, the accuracy and scientific of appraisal opinion is also weakened. The following five key problems should be resolved above all, definition of visual function of disability, the proportion between visual impairment and individual dysfunction, appropriate examinations, quality of life investigation of disability and the integrated measure of vision damages. Assessment research and cross-over study of law, forensic science and clinical medicine should be enhanced. Developing of impairment evaluation theory is needed to the standardization and standardization of permanent impairment assessment guides.
ABSTRACT
El presente trabajo busca responder a la necesidad de contar con un estudio actualizado sobre valoración del perjuicio estético en el rostro en el campo de la medicina legal en Costa Rica. Para este estudio se utilizó una población de 239 casos valorados por secuelas de lesiones en el rostro extraídos de los expedientes de la Sección de Clínica Médico Forense del Departamento de Medicina Legal en el año 2011. Se utilizaron variables sociodemográficas y variables utilizadas en la caracterización y valoración del perjuicio estético en el rostro. dentro de los resultados más relevantes del estudio se evidenció un predominio de casos del sexo masculino y en el grupo de edad de los 20 a 29 años, las lesiones encontradas, en la mayoría de los casos, fueron producidas con un objeto contundente. El tipo de perjuicio estético más encontrado fueron las cicatrices, en más de la mitad de los casos no se indicó si las cicatrices producían alteración de la armonía facial o si eran retráctiles y en una tercera parte tampoco se mencionaba si producían alteración de la mímica facial. La mayoría de las cicatrices se describieron como hipocrómicas y planas. En cuanto a la visibilidad más de la tercera parte de los casos presentaban lesiones descritas como visibles a distancia de conversación y un 20% se describieron como visibles a distancia social. Solamente la quinta parte de los casos valorados, se catalogaron como con marca indeleble. En cerca de un 70% de los casos no se estableció porcentaje de incapacidad permanente. El presente estudio refleja la importancia de la valoración del perjuicio estético en la actualidad así como la necesidad de contar con criterios estandarizados para realizar este tipo de valoraciones así como para determinar la presencia de marca indeleble en el rostro.
The present study aims to answer the need to have an up to date study related to facial aesthetic damage assessment in the field of legal medicine in Costa Rica. For this study it was used a population of 239 cases evaluated for facial injury sequels extracted from the files of the Clinical Forensic Medicine Section of the Legal Medicine Department in Costa Rica during the year 2011. Variables used include socio demographic and others used in characterization and evaluation of facial aesthetic damage. Among the most relevant results of this study it was evidenced a predominance of masculine cases and in the group of 20 to 29 years, the injuries, in the majority of cases, were produced by a blunt object. The most frequent type of aesthetic damage encountered were the scars, in more than half of the cases it was not indicated if the scars produced alteration of the facial harmony or if they were retractable and in a third of cases it was not mention if there was facial mimic alteration. The majority of the scars were described as hipocromic and flat. In regard to visibility, in more than a third of the cases the alterations were described as visible in conversation distance and 20% as visible in social distance. Only a fifth part of the cases were cataloged as indelible mark. In nearly a 70% of the cases no percentage of permanent impairment were established The present study reflects the importance of the evaluation of the aesthetic damage nowadays and also the need to have standardized criteria to perform this kind of assessment and to determine the presence of facial indelible mark.
Subject(s)
Humans , Cicatrix , Costa Rica , Facial Injuries , Forensic MedicineABSTRACT
An impairment is defined as "a loss, loss of use, or derangement of any body part, organ system or organ function". The impairment evaluation should be performed by physicians. To determine permanent impairment associated with medical condition a standard method should be used. It is a general principle that an evaluation of permanent impairment only be performed when the physician considers the person to have reached a state of maximum medical improvement. Maximum medical improvement is considered when the person's condition has been medically stable and is unlikely to change by more than 3% of whole body impairment within the next 12 months. The physician must use the entire clinical skill and judgment to perform the proper impairment evaluation. A report of the evaluation of permanent impairment should be accurate, comprehensive and fair. The physicians are reminded that they have a duty to act in an ethical, professional and considerate manner when examining the person for the purpose of assessing the permanent impairment.
Subject(s)
Humans , Clinical Competence , JudgmentABSTRACT
In this study, literature review was done to examine and compare the current status and problems of different evaluation approaches toward permanent impairment in Korea. Alternatives and improvements in the current approaches in Korea were suggested. Series of cases were also examined to compare different approaches applied to the real cases, using 105 cases from a hospital data and another 207 cases from insurance company data. The main findings of the literature review are as follows; 1. The current evaluation methods of permanent impairment in Korea are grouped into two categories, grading and rating. Grading of impairments are expressly specified in 17 various statutes. 2. In Grading methods, the rigid system of 14 different grades has been adopted uniformally for the convenience of administration, which may not be, appropriate or valid from medical and scientifical aspect. 3. The advantage of McBride method is assessment of occupational disability rate. However the classified compensable occupations are only 280 and limited to manufacturing industries in 1960s' of U.S.A., which is not appropriate to current Korean circumstances. Especially, the job list does not include managerial officers or mental workers. 4. AMA Guides is the scientific and reasonable method for the assessment of physical impairment rate. However compensation and reparation of impairment case is difficult because this method cannot assess the disability rate according to occupation, age, etc. The results of cases comparative study are as follows: 5. The physical impairment could be compared in 167 out of total 312 cases and for the cases of complex impairment, McBride method underestimate physical impairment rate compared with AMA method. 6. When disability rate was assessed, occupation was considered the compensation of only 85 cases, and age was used in only 21 cases. This was because occupation and age compensation in McBride method are unreasonable. 7. The most ideal alternative is to assess physical impairment according to AMA method and then to develop a compensation method appropriate for the circumstances of Korea society.
Subject(s)
Compensation and Redress , Insurance , Korea , OccupationsABSTRACT
In 1992 the Korean Medical Association intended to make revised evaluation and rate of physical impairment based upon rate and evaluation of physical impairment according to National Compensation Law which was composed of 14 subdivisions with various rates of physical impairment. Committee of Evaluation of Physical Impairment in Korean Neurosurgical Society provided revised evaluation of nervous or mental impairment, peripheral never impairment and spinal column impairment. Because McBride Disability Evaluation and Guide to the Evaluation of Permanent Impairment by American Medical Association have been used widely in this field the author describe evaluation and rate of physical impairment in each method briefly and compare to revised evaluation by Korean Medical Association in subject of neurologic and spinal impairment.