Abstract

Expert assessment of traumatic damage in the head and neck area by the adjuster broadly comprises two main questions: does acausal relationship between the complaint and the specific insured event exist, and what is the extent of the damage? Arelationship is probable if the trauma is quantitively and qualitatively suitable to have caused the existent damage. Aparticularly difficult scenario is represented by cases lacking pre-accident findings or when the claimant claims that pre-existing hearing loss or tinnitus has been worsened by the event or that the accident was the cause of the impairment. It must also be taken into account that claimants frequently relate their complaints to an insured event due to causal thinking. Comprehensive tables are available for evaluation of the extent of the damage in otorhinolaryngology. In statutory accident insurance, the health damage is "considerable" if it leads to areduced earning capacity of at least 10%. In private accident insurance, physical damage is financially regulated at below 10% invalidity, e.g., 2-3%, although this is hardly possible to calculate using conventional tables. These and other difficulties are discussed in the article based on examples.

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