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PubMed1995

[Claim review in occupational disability insurance].

In a deregulated market characterised by increasing competitiveness and improved conditions, care in assessing proposals in additional disability benefits will take on an even more significant role. The assessment has to be based on overall analysis of the moral and objective risk. This entails risk assessment of financial, professional, economic and medical factors, and should also include experience gained from the specific area of benefits involved. In terms of getting closer to our clients, the possibilities of limiting risk should be offered to an increasing extent on an individual, transparent and differentiated basis. Despite every effort to exercise caution, the time factor, i.e. the speed required to issue policies, should not be forgotten.

Accidents, Occupational↗
PubMed1990

[Developmental trends in application and acceptance of benefits from occupational disability insurance].

The number of contracts being based on disability coverage is increasing for several years. In a certain interval the number of cases in which disability benefits become due is increasing, too. The target of this article is to outline some interesting trends, which will affect the development of that cases, in which benefits will be payable. Besides the trends resulting from existing business (ageing of the existing contracts and conditions at the effective date of the contract) the following subjects be treated: --the alteration in respect of the subjective as well as medical view resp. influence of disability --the development with regard to legal conditions, leading to adaptions and modified interpretations of the provisions.

Disability Evaluation↗
PubMed1997

[Reliability of expert assessment in disability evaluation within the scope of disability insurance].

With the introduction of the law on the statutory nursing care insurance in Germany ("Pflegeversicherung") in 1995, new benefits are provided for the most severely disabled people. Provision of benefits is contingent on a standardised examination performed by the medical service of the German statutory health insurance system (MDK). Results of the first study on the inter-rater reliability of this standardised examination are presented in this paper. The study population consisted of 218 elderly people (age range 60-99) living in 4 nursing homes in Munich. They were assessed by 2 senior medical students and 2 nurses using the standardised questionnaire of the MDK. Inter-rater reliability was assessed by means of kappa coefficients. Reliability was assessed with regard to the summary judgement of disability and the rating of single items (with regard to limitations in activities of daily living, mental status or the prognosis). Inter rater reliability was higher for the overall assessment of disability (kappa = 0.71 between medical students, kappa = 0.66 between nurses) than for most of the single items of the questionnaire such as "need of assistance with dressing" (kappa = 0.57 between medical students, kappa = 0.66 between nurses) or "ability to move" (kappa = 0.58 between medical students, kappa = 0.67 between nurses). Kappa-coefficients were particularly low for variables concerning prognosis of participants and for the mental status item "self-disorientation" (kappa = 0.19 between medical students, kappa = 0.23 between nurses). These patterns were consistently observed for the 2 rater groups (student-student, nurse-nurse). Between the 2 rater groups there was no substantial difference in reliability. However, there was a trend for higher agreement within the group of nurses. Although the overall reliability of the assessment of disability is relatively high in comparison to many other diagnostic procedures (such as x-ray readings), efforts should be made towards further improvement of this standardised examination.

Activities of Daily Living↗