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[职业伤残(补充)保险中的工作能力评估。医学专家应了解哪些工业实践知识?]

[Work capacity evaluation in occupational disability (supplementary) insurance. What should the medical expert know about industrial practice?].

作者信息

Hochheim S

机构信息

Bayerischen Rückversicherung AG, München.

出版信息

Versicherungsmedizin. 1995 Feb 1;47(1):32-5.

PMID:7709505
Abstract

Up to now it has often been the responsibility of physicians to assess whether an insured person qualifies for disability benefits, although the insurance conditions in fact state that the problem is not purely a medical one. Indeed, it is advisable to take advantage of the expertise available in the field of Occupational Studies when assessing elibility for benefits. The spectrum of occupations is subject to constant change. The "classification of Occupations" published by the Federal Employment Agency in Nuremberg lists some 25,000 occupational designations. Further, several thousand agreements are concluded each year between employers and employees' representatives at various levels and these may need to be taken into account when assessing claims for disability benefits. Occupational Studies is a specialist area in its own right, requiring specific training and experience. The assessment of disability claims calls for close cooperation and teamwork: doctors, insurers and occupational consultants must each contribute their own particular skills to the decision-making process. In the final analysis, however, it is the insurer alone who must take responsibility for accepting or rejecting the disability claim. The present paper starts by discussing the term "Occupational Studies" and goes on to explain the tasks of the occupational consultant. Finally, reference is made to descriptions of occupations as well as workplace features and requirements which the medical expert should take into account when assessing and insured's ability to work in a given occupation.

摘要

到目前为止,评估被保险人是否符合残疾福利资格往往是医生的职责,尽管保险条款实际上表明这个问题并非纯粹是医学问题。事实上,在评估福利资格时,利用职业研究领域现有的专业知识是明智的。职业范围在不断变化。纽伦堡联邦就业局发布的《职业分类》列出了约25000个职业名称。此外,雇主与各级雇员代表每年会达成数千份协议,在评估残疾福利索赔时可能需要考虑这些协议。职业研究本身就是一个专业领域,需要特定的培训和经验。残疾索赔的评估需要密切合作和团队协作:医生、保险公司和职业顾问必须各自在决策过程中贡献自己的特殊技能。然而,归根结底,只有保险公司必须对接受或拒绝残疾索赔负责。本文首先讨论“职业研究”一词,接着解释职业顾问的任务。最后,提及职业描述以及医疗专家在评估被保险人在特定职业中工作能力时应考虑的工作场所特征和要求。

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