Johnson A L
Blue Cross and Blue Shield of Minnesota, St. Paul 55164, USA.
Semin Orthod. 1997 Jun;3(2):128-32. doi: 10.1016/s1073-8746(97)80048-5.
Courts routinely award coverage for TMJ disorders under medical plans, despite exclusionary language and evidence that the insured failed to disclose preexisting treatment as required by the plan and neglected to attempt more conservative treatment first. Such decisions adversely affect both the health carrier and the plan participants. Various states have enacted legislation mandating coverage of TMJ; however, TMJ issues still exist and will remain a frequent topic for litigation until the judiciary recognizes that validating contract language ultimately benefits insureds as consumers and reinforces the integrity of the industry as a whole.
法院通常会根据医疗保险计划判定颞下颌关节紊乱症的保险责任，尽管存在排除性条款，且有证据表明被保险人未按计划要求披露既往治疗情况，也未首先尝试更保守的治疗方法。此类判决对医疗保险公司和计划参与者都会产生不利影响。各个州都已颁布立法，强制规定对颞下颌关节紊乱症的保险责任；然而，颞下颌关节紊乱症问题依然存在，并且在司法机构认识到认可合同条款最终会使作为消费者的被保险人受益，并增强整个行业的诚信之前，仍将是一个频繁的诉讼话题。
