[Stress related injuries of the spine--problems of medical certification in accidental insurance, suggestions of solutions].

The aim of this study is to answer the question: whether it is possible to elaborate and apply in the certification an objective method of evaluation of permanent stress related injuries to the spine considering the impact of degeneration illness? PZU Group caters for about 5000 stress related spinal injuries yearly. Until the year 2001 there had been no standard of medical assessment in these types of injuries. Extreme differences in evaluation of similar cases by various doctors had been found. In 2001 the Medical Department of PZU Group organized 4 medical workshops for 386 doctors. We analyzed the particular case of stress related spinal injury on a following basis:--severity of degenerative illness,--power of the force causing spine overloading. As a summary of these analyses the table, which enables to assess the impact of illness upon complete and permanent impairment to one's health, was created. In the same year we introduced this table for the estimation of stress related spinal injuries for all our clients. In a follow-up study analysis of 329 cases examined in accordance with the above mentioned table concerning the most severe stress related spinal injuries in the years 2002 and 2003 were presented. The result of the research is that currently there are no extreme differences in evaluation of similar cases and in 2001 about 90% of the cases the degree of permanent impairment to one's health for similar cases is comparable. It seems possible to elaborate and to put effectively into certification practice an objective method of stress related spinal injury evaluation which determines the influence of external and pathological causes. In addition, other problems concerning certification of spine injuries were revealed e.g. necessity of making the decision about taking responsibility for conclusions drawn for objective of medical treatment documentation of the insured and not from certificates issued exclusively for insurance needs.