Wagrowska-Koski Ewa, Rybacki Marcin
Przychodnia Chorób Zawodowych, Instytut Medycyny Pracy im. prof. J. Nofera, Łódź.
Med Pr. 2010;61(1):23-33.
The definition of "inability to work" and principles of medical certification of disabilities, determining the entitlement to an ill-health pension provision are regulated by law. However, the term ,,"inability to work" is not precisely defined and the standards of its assessment are not accurately formulated. This refers not only to the term "loosing ability to work to considerable degree", but also to the criteria of occupational qualifications.
The aim of this study was to identify the most common problems and mistakes in the medical certification that entitles to disability pension provision.
The study, based on medical consultations provided for the president of the Social Insurance Company (ZUS) in the years 2005-2007, was carried out in the Out-Patient Clinic of Occupational Diseases, Nofer Institute of Occupational Medicine, Lódź. In total, 293 medical cases were analyzed, of which 61 concerned consequences of occupational diseases, 44--accidents at work and 188--idiopathic diseases.
Men formed the majorityof the study group (66%) and the mean age of the examined individuals was 49. The predominant causes of medical certification of patient's inability to work, both in men and female, were musculoskeletal disorders, cardio-vascular diseases, diabetes and mental health problems. Significant discrepancies in the medical statements on inability to work were observed between ZUS and the Nofer Institute of Occupational Medicine. They concerned the evaluation of people's inability to work in general, as well as the degree (partial or complete) of lost capability for work. A consensus of medical statements was found in 153 cases, and differences in other 140 (47.8%) cases. Most differences were found in the evaluation of inability to work caused by consequences of occupational diseases.
Lack of certification guidelines, excessive preference of medical criteria used for defining body fitness disturbances and insufficient consideration of occupational and economic aspects of certified inability to work in terms of assuming work in future) are the main reasons for difficulties in inability to work certification. The scheme of certification procedure was also suggested.
“无法工作”的定义以及残疾医学认证原则，决定了享受病残抚恤金待遇的资格，这些都由法律规定。然而，“无法工作”这一术语并未得到精确界定，其评估标准也未准确制定。这不仅涉及“在很大程度上丧失工作能力”这一术语，还涉及职业资格标准。
本研究的目的是确定在给予残疾抚恤金待遇的医学认证中最常见的问题和错误。
该研究基于2005 - 2007年为社会保险局（ZUS）局长提供的医学咨询，在罗兹诺费职业医学研究所职业病门诊进行。总共分析了293个医疗案例，其中61个涉及职业病后果，44个涉及工作事故，188个涉及特发性疾病。
男性占研究组的大多数（66%），被检查个体的平均年龄为49岁。导致患者无法工作的医学认证的主要原因，无论男性还是女性，都是肌肉骨骼疾病、心血管疾病、糖尿病和心理健康问题。在社会保险局和诺费职业医学研究所之间，关于无法工作的医学声明存在显著差异。这些差异涉及对人们总体无法工作的评估，以及丧失工作能力的程度（部分或完全丧失）。在153个案例中发现了医学声明的一致性，在其他140个（47.8%）案例中存在差异。大多数差异出现在对职业病后果导致的无法工作的评估中。
缺乏认证指南、在定义身体机能障碍时过度偏向医学标准，以及在假设未来工作的情况下，对经认证的无法工作的职业和经济方面考虑不足，是无法工作认证困难的主要原因。还提出了认证程序方案。
