Klemm H-T, Naumann A, Hofmann G, Spahn G
Freies Institut für medizinische Begutachtungen, FIMB Bayreuth/Erlangen, Ludwigstraße 25, 95444, Bayreuth, Deutschland.
Kanzlei Naumann, Bornheim, Deutschland.
Unfallchirurg. 2016 Dec;119(12):1057-1060. doi: 10.1007/s00113-016-0272-3.
After examining the cause of an accident the medical expert working in the area of private health care insurance under the general accident insurance (AUB) sample conditions must ascertain incapacity within a period of time that has been contractually agreed upon between the parties involved. In addition, this person must also state their position on the question as to whether there may exist any circumstances up to the latest possible point in time in insurance terms that would comprise an adequate prognosis of a future change in the long-term condition. This requires a high probability.The sole risk of the evolution of the functional deficit arising from a proven or prognosticated post-traumatic osteoarthritis is excluded from this standard of proof which means that flat-rate risk supplements are not suited to this individualized approach and thus do not apply.
在根据一般事故保险（AUB）样本条件对私人医疗保险领域的事故原因进行调查后，在双方合同约定的期限内，从事该领域工作的医学专家必须确定是否丧失工作能力。此外，此人还必须就保险期限内直至最晚可能时间点是否可能存在任何情况发表意见，这些情况将构成对长期病情未来变化的充分预后。这需要很高的可能性。已证实或预测的创伤后骨关节炎引起的功能缺陷演变的唯一风险被排除在这一证明标准之外，这意味着统一费率的风险附加费不适用于这种个性化方法，因此不适用。
