Ludolph E, Spohr H, Echtermeyer V
Institut für Arztliche Begutachtung, Düsseldorf.
Aktuelle Traumatol. 1994 May;24(3):95-8.
Two problems are discussed from a multitude of problems arising with the assessment of the "new" occupational diseases classified under the heading "Vertebral Column" which are of essential importance in determining the amount of compensation payment under German statutory health insurance legislation. One problem concerns differentiation of damage from already existing damage or dividing the total disease into preliminary i.e. already existing damage on the one hand and worsening or exacerbation on the other. Pathogenesis of disk-related disease does not usually allow splitting the disease into an already existing damage that is not job-conditioned and an exacerbation caused by the insured exposure to job-conditioned risk: compensation must be based on the "all-or-nothing" principle. The second problem is to assess the reduction in ability to cope with gainful employment stress. Preventive considerations will decisively influence the number of working places that can be offered as alternatives if a person has been suffering from intravertebral disk disease. Not only those jobs that require heavy physical work are barred, but also those where the worker has to remain in the same position for a prolonged time. Such disease-specific preventive considerations result in a rejection of the usual assessment criteria for intervertebral disk diseases.
在“脊柱”类别的“新”职业病评估中出现了诸多问题，本文讨论其中两个对根据德国法定医疗保险立法确定赔偿金额至关重要的问题。一个问题涉及区分现有损伤造成的损害，或将整个疾病划分为一方面是初步的即已存在的损伤，另一方面是病情恶化或加重。与椎间盘相关疾病的发病机制通常不允许将疾病分为与工作无关的已存在损伤和由被保险人接触工作相关风险导致的病情加重：赔偿必须基于“全有或全无”原则。第二个问题是评估应对有酬就业压力的能力下降情况。如果一个人患有椎间盘疾病，预防性考虑将决定性地影响可提供的替代工作岗位数量。不仅那些需要繁重体力劳动的工作被排除在外，而且那些工人必须长时间保持同一姿势的工作也被排除。这种针对特定疾病的预防性考虑导致摒弃了通常的椎间盘疾病评估标准。
