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[The disability concept in private accident insurance].

Last year the German personal accident insurers introduced a new set of General Conditions, the "AUB 88". These define permanent disability as the "permanent impairment of the insured's physical or mental faculties", whereas the former conditions defined it as the "permanent impairment of the ability to work". The new definition of permanent disability is something that the medical expert will also have to come to terms with when assessing a claim. Here he must first of all bear in mind that the consequences of an accident affecting limbs or sensory organs have to be assessed--as hitherto--on the basis of the "Gliedertaxe" or scale of disability benefits, which establishes degrees of disability for the loss of, or loss of the use or function of, limbs or sensory organs. If other parts of the body are affected, then, in accordance with Article 7 I. (2) AUB 88, "the degree to which, from a strictly medical point of view, normal physical or mental faculties are handicapped" shall be decisive. In such cases, therefore, it is no longer merely a question of whether and to what degree the insured is able to work. An assessment of permanent disability may not take non-medical circumstances into account.

Disability Evaluation↗

Changing the chronic care system to meet people's needs.

Persons who are likely to be the heaviest users of medical and supportive care services--those with chronic illnesses, disabilities, and functional limitations--are often forced to navigate a system that requires them to perform most of the coordination functions themselves and is generally not organized around their needs. In 1996 an estimated 128 million Americans had at least one of these three conditions, and 9.5 million had all three. This paper examines the current programs designed to assist these persons and suggests changes in eligibility rules, coverage policies, and educational programs to provide a system more oriented to people's chronic care needs.

Chronic Disease↗

[Differences and change in insurance legal concepts in West Germany].

In the course of the past two decades the social security system has undergone various changes, which escaped the notice of many doctors; some new legal developments and the hereby resulting medical evaluations are presented, whose emphasis embraces the following main fields: statutory social insurance, social claim for compensation, legislation for the seriously disabled, private insurance, rehabilitation and assessment of reduced earning capacity.

Alcoholism↗

Rehabilitation of the disabled in Hong Kong.

This paper examines the early history of the Hong Kong government's approach to rehabilitation services. The fundamental purpose of the programme was prevention founded on the premise that, by reducing the incidence of disability, the need for rehabilitation services would be reduced.

Child↗

Navigating the disability process: persons with mental disorders applying for and receiving disability benefits.

Persons with mental disorders are less likely to be working and more likely to apply for and receive SSDI and/or SSI benefits than are those without such disorders. Data from the National Health Interview Survey on Disability (NHIS-D) were examined to identify the predictors of SSDI/SSI application and receipt among persons with self-reported mental disorders. Compared with nonapplicants, applicants had higher levels of disability, fewer financial and interpersonal resources, and better access to information about the disability programs. Among applicants, similar factors distinguished recipients from those who did not receive benefits. Navigating the disability process is associated with the extent of impairment, economic and social disadvantage, and linkage to the disability determination process.

Disability Evaluation↗

SSI at its 25th year.

Beginning in January 1974, the three previously existing State adult assistance programs were amalgamated into the Supplemental Security Income (SSI) program, to be administered by the Social Security Administration. This change was made to provide a nationwide floor of income for needs-based assistance, and to make such payments more efficiently by working through SSA's existing network of field offices. This article traces the 25-year patterns of growth and changes in the number of persons applying for assistance, the number and proportion of those applicants who were awarded payments, and the overall number of persons who received SSI. Three major age groups are considered separately: those aged 65 or older, disabled adults aged 18-64, and children age 18 and younger. The last group was newly eligible under SSI for payments based on their own blindness or disability and not, as was the case previously, because they were a member of a needy family.

Adolescent↗

Technical revisions to medical criteria for determinations of disability. Final rules.

These final rules make a number of technical revisions to the Listing of Impairments (the listings). We use the listings when you claim benefits based on disability under titles II and XVI of the Social Security Act (the Act). We are making these revisions to reflect advances in medical knowledge, treatment and terminology, to clarify certain criteria in the listings, to remove listings that we rarely use, and to add new listings consistent with current medical practice. We are making these individual technical revisions in order to improve our medical listings and make them easier to understand and use.

Adult↗

[Increasing psychological stress among young adults in Norway, 1990-2000].

BACKGROUND: Between 1990 and 2000, the number of disability benefit recipients in Norway increased by 19.3%. We wanted to examine changes in the way people cope with society's demands, our hypothesis being that changing demands increase psychological stress; this again leads to increasing numbers of disability benefit recipients with a psychiatric diagnosis. MATERIAL AND METHODS: We examined the ability to support oneself financially among the 20 to 39-year-olds, traditionally the period in people's lives when they are at their most adaptive. We used data for the 1990-2000 period on sickness absence of one year or more, medical or occupational rehabilitation, long-term unemployment, welfare payments without entitlement, and disability benefits. We examined the diagnoses used for one-year sickness absence, medical rehabilitation and disability benefit status. Data were obtained from the relevant public-sector registers. RESULTS: The prevalence of social security clients in the 20-39 age group was up from 6.4% in 1994 to 7.7% in 2000, an increase of 20%. The biggest increases (1992 to 2000 data) were related to minor psychiatric disorders, 152%, and milder forms of musculoskeletal disorders, 111%. INTERPRETATION: Changing demands in the workplace have increased the load of psychological stress in society, but changing demands in people's private lives are a contributing factor. The results imply an increasing mismatch between the adaptation required in our society and people's resources for coping with what is expected of them. Our health care and social security systems in their present form cannot properly come to grips with this situation; they may even exacerbate it by demanding too little of patients and thereby socialising them into the patient role.

Adaptation, Psychological↗

[Socioeconomic risk indicators for disability pension within the Danish workforce. A registry-based cohort study of the period 1994-1998].

INTRODUCTION: The aim was to identify socio-economic risk indicators among the Danish work force (aged 18 to 59) for being granted disability pension. MATERIAL AND METHODS: A closed cohort study based on a random 10% sample of the Danish workforce defined in 1994 and followed in registers from 1995 to 98 for disability pension. The study population included 254,905 persons. Citizens in Denmark have a unique personal identification number so socio-economic data at individual levels from Statistics Denmark were linked with the Disability Pension Registry. All persons but 39 could be traced throughout the study or until the event of disability pension, emigration or death. Cox regression was used to calculate the hazard rate ratio of being granted disability pension. RESULTS: 4443 persons were granted disability pension. The risk of being granted disability pension increased significantly with low social class. Comparing unskilled workers to managers showed that workers had 1.6 (95% confidence interval: 1.4-1.9) times greater risk of disability pension. For female unskilled workers the risk was 1.9 (1.6-2.2). Men with seven years' schooling had 3.1 (2.3-4.3) times higher risk of disability pension than men with a university degree, and women with seven years' schooling had 3.8 (2.5-5.8) greater risk. Having been on sick leave more than 13 weeks compared to sick leave less than four weeks increased the risk by 11.5 (10.1-13.1) for men and 11.2 (9.9-12.8) for women. High age, unemployment, living alone and receiving social benefits were also risk indicators for disability pension. DISCUSSION: The study identified reliable estimates of socioeconomic risk indicators, e.g. low level of education, low social class, and unemployment for leaving the workforce with disability pension.

Adolescent↗

Disability income.

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Persons with Disabilities↗