Evoluzione metodologica dell’invalidità civile in Italia: confronto ragionato tra i sistemi valutativi tabellari, di legge e non, che si sono succeduti negli anni

Abstract

The authors describe the evolution from 1980 to the present of the tables that describe invalidating states, on which the medical-legal judgments of civil disability in Italy are based.The first part of the work briefly describes the main disabilities, grouped by both body system and percentage value range, that can be found in the tables attached to the main documents applied, or applicable, to the sector: those issued alongside the Ministerial Decree n. 282 of 1980, those that accompanied the Ministerial Decree of February 1982 (still in force today) and those proposed by the Italian Institute of Social Security (INPS) in 2012, which have not yet entered into force.The second part of the paper has two aims. On the one hand, it seeks to underline the change in the pre-eminent type of disability featured in the tables: from osteoarticular diseases, which were the most significant type in the 1980 tables, to neoplastic diseases, which are the most prevalent overall in the 2012 tables.On the other hand, the authors highlight that the tables themselves have evolved, moving towards a more precise definition (both clinical and instrumental) of the organ damage causing the reduction in general working capacity. In the 1980 tables, disability was often evaluated empirically rather than based on the use of functional indices or systematic classification. In the 2012 INPS proposed tables, evaluations of the reduction in working capacity are often based on specific functional parameters for the various organs (EF for the heart, FEV1 for the respiratory system, GFR for the urinary system) or on standardized disability evaluation scales (NYHA classes for heart diseases, EDSS or the Hoehn & Yahr classification for neurological disorders, MMSE or CDR for dementia, the Child-Pugh classification for cirrhogenic hepatopathies).