Accident Insurance Research Articles

Psychotherapy prescribed by accident insurance consultants : Important component in treatment procedures of the statutory accident insurance

In Germany around 1 Million working and commuting accidents per year are officially registered. Since several years this number is constantlyat this high level, only just since the appearance of the actual Covid pandemia significantly lower because of lockdowns and increase of homeoffice workplaces. To ensure the professional care of psychotraumatic sequelae of work-related injuries, in 2012 new regulations were introduced by the DGUV, the national umbrella organization of the German statutory health insurances. This healthcare reform (named "Psychotherapeutenverfahren", verbally translated: psychotherapists' procedure) is looked at 10 years later. Is the new regulation accepted by the surgeons' community? What case constellations can be observed? The use of this new instrument among trauma surgeons was evaluated by national data for the complete years 2013-2021. Additionally, we include regional data and case reports from amultidisciplinary medical facility including trauma surgery and psychiatry, located in Güstrow (Northeast Germany). Nationwide the percentage of psychotherapy amongst the regular treatment has doubled between 2013 and 2021 from 0.47 to 0.96%. Looking at the first 10 years of its clinical implementation, the new German psychotherapy regulation is apparently well accepted by the accident insurance consultants. As data from population based studies are not available, the actual percentage of psychological sequelae of accidents in this cases is notknown yet. So there is further need of research and training in this interdisciplinary field to ensure appropriate treatment of victims of work-related accidents. The integration of psychotraumatological facts in the educational agendas of accident insurance consultants has already started.

A correction procedure for the working hours variable in the IAB employee history

Administrative labour market data for Germany do not contain detailed information on working hours. This poses a serious challenge for many empirical research questions. Between 2010 and 2014, however, it is possible to merge a supplementary data source containing information on working hours reported by employers for each job to the German Social Accident Insurances. One complicating factor is that employers were allowed to report actual working hours, contractual working hours or a full-time worker reference value, and it is not obvious from the data which re-porting scheme was actually used. In this report, we describe this supplementary data source and propose a correction procedure that maps all data entries so that they uniformly reflect contractual working time. After this correction, the distribution of contractual weekly working hours in the combined administrative labour market data closely resembles the distribution from the German Structural Earnings Survey.

Skills from General Practice Applied to Polydisciplinary Medical Assessments

Skills from General Practice Applied to Polydisciplinary Medical Assessments Abstract. In Switzerland, the case leader plays a central role in the polydisciplinary medical assessment performed by disability and accident insurances. Until now, a specialist in general internal medicine has been involved in every polydisciplinary assessment. Medical generalists are well suited to take on the role of case leaders due to their clinical activities in day-to-day care. A separate "case leadership" module in medical assessment training could standardize the heterogeneous facets of case leadership, convey specific responsibilities in the polydisciplinary process, and thus sharpen the task profile. This will enable the case leader to uniformly implement the legal expectations for quality assurance.

The neuro-urological expert opinion in statutory accident insurance : Consensual recommendations for diagnostics and for the assessment of reduction of earning capacity

Previous assessment guidelines from standard sources for urologic expert opinions show considerable differences in the recommended percentages for the assessment of reduction of earning capacity (MdE) for accident sequelae in the neuro-urological specialty. To develop a"revised and standardized version of the MdE assessments of neuro-urological accident sequelae (in tabular form) as aguideline/manual" for expert opinions in the legal area of the German and Austrian Statutory Accident Insurance ( www.dguv.de , www.auva.at ). Aworking group of neuro-urologists from spinal cord injury centers of different BG ("Berufsgenossenschaft") clinics was formed within the working group Neuro-Urology of DMGP (German-speaking Medical Society for Paraplegiology; www.dmgp.de ). Between January2017 and September2022, atotal of 7working meetings and 2video conferences were held. The consensus of the developed documents was reached by formal consensus finding in anominal group process and in afinal consensus conference. The necessary bases for atargeted, legally sound diagnosis of accident consequences in the neuro-urological field were elaborated and, based on the experience of many years of expert opinion activity, a"matrix" for auniform, graduated assessment of the level of reduction of earning capacity in the (neuro-)urological field in the case of confirmed neuro-urological accident consequences was created. In the interest of equal treatment of all insured persons, it is of great importance to make auniform and comprehensible assessment of the amount of the MdE on the basis of "table values" that reflect the available empirical values.

상해보험에서 자살사고에 대한 증명책임의 귀속과 실무상 증명내용에 대한 고찰

Accident insurance, which is defined as an insurance accident in the accident insurance clause, requires contingency in the sense of an accident that is not intentional. At the same time, “in case the insured intentionally harms himself” is stipulated as the reason for indemnification of the insurer, and in the proviso that the insured is “in a state where he or she is unable to make free decisions such as mental or physical loss,” the exemption is allowed and the insurance money is paid. stipulated as a reason As such, the structure of the provisions of the accident insurance clause is complicatedly intertwined, and the connotation and extension of the requirements set forth in each reason for payment and reason for exemption are not clearly established, causing various problems regarding the burden of proof.
 In this paper, we reviewed how to distribute the burden of proof in order to recognize the liability of the insurer when the insured person dies by suicide. In this way, we looked at what was missed by the judgment in question, which only focused on medical findings.
 Accident insurance clauses stipulate that an accident that occurred intentionally is a reason for exemption from liability of the insurer, so the insurer must prove that the accident occurred intentionally.
 On the other hand, the state of being unable to make free decisions is a normative level of judgment that is distinguished from intention. Even if the insured was conscious of ending his own life and committed suicide intentionally, the fact that he was in a state of exclusion from free decision-making dilutes the possibility of blame for the insured's intentional death and mitigates the degree of destruction of good faith in the insurance contract. In other words, even though suicide is an intentional accident, it is exceptionally included in the scope of insurance coverage. According to precedent, the state of being unable to make free decisions is determined by comprehensively examining various facts.
 In the judgment at issue, when the motive for suicide, the method and mode of suicide, the progress of depression, and the greetings sent by the suicide just before suicide were comprehensively reviewed, it can be judged that the insured committed suicide in a state of free decision-making. The target judgment focused only on the fact that the deceased had been diagnosed with a “severe depressive episode” by a specialist during his lifetime, acknowledging the inability to make free decisions without properly examining other factors.
 The state of inability to make free decisions means what factual factors have influenced the formation process of the inner psychological state and to what extent they are influencing. Therefore, the tendency to rely exclusively on medical findings and to regard them as absolutes is unreasonable. It is necessary to make a comprehensive judgment on the various facts surrounding the suicide.

Spinal Cord Injury Fact Sheet in Korea.

Spinal cord injury (SCI) has been recognized as a medically complex and life-disrupting condition. As the aging of the population accelerates, the trend of SCI has changed. This review aimed to provide comprehensive statistics and recent epidemiological changes in SCI and rehabilitation in Korea. All three insurance databases (National Health Insurance Service [NHIS], automobile insurance [AUI], and industrial accident compensation insurance [IACI]) were considered. These nationwide databases provide data on the current trends in term of incidence, etiology, and rehabilitation of SCI. Traumatic spinal cord injury (TSCI) was more frequent among the elderly in the NHIS compared to working age individuals in the AUI and IACI. In all three trauma-related insurance databases, male with TSCI outnumbered female. TSCI incidence per year was approximately 17 times higher among males than females, on average, in IACI. In all three insurances, the cervical level of TSCI was the most frequent. Although the ratio of SCI patients receiving rehabilitation treatment at primary and secondary hospitals increased for nine years, the increase in training on activities of daily living (ADL training) was found to be relatively small. This review provides a broader and comprehensive understanding of the incidence, etiology, and rehabilitation treatment of SCI in Korea.

Severe injury type procedures-Influence of the cipher11 "complications" and the COVID-19 pandemic on acenter for maximum care of severe injuries

Ensuring the best treatment options for injured patients (healing process, Heilverfahren, HV) is the main goal and responsibility of the German statutory accident insurance (DGUV). The injury type catalogue is the tool to guide the HV. The development of the number of cases treated in acenter for severe injury type procedures, the effects of the cipher11 "complications" of the catalogue and the effects of the COVID-19 pandemic are presented. Aretrospective study of all patients treated in the context of the DGUV from January 2019 to December 2021 was carried out. The number of cases before and during the legal lockdown actions were compared. The case mix index, the mean number of operations, the mean time in the operating room and the hospital stay were analyzed. Additionally, the cases under the cipher11 were classified according to the specific anatomical regions. Out of 2007cases 67% were classified as severe injury type procedures (SAV). Of these cases 51% were categorized to the cipher11 of the injury type catalogue. Complications were observed particularly in the anatomical regions of the shoulder girdle, elbow, hand, knee, ankle joint and foot. These complex cases are economically not sufficiently represented. During the governmental COVID-19 lockdown actions, the number of patients treated in the context of the DGUV significantly decreased. The injury type catalogue is used effectively in the catchment area of the present trauma center. Most of the cases treated in the present trauma center are severe injury type procedures; however, more than half of these cases are classified as complications. This development might show the need for astructural change or an adjustment of the HV. The current comments on the injury type catalogue offer important definitions and specifications; however, the conciseness of the entire catalogue should be maintained.

Stationäre und ambulante Heilverfahren der Deutschen Gesetzlichen Unfallversicherung

It is one objective of German Social Accident Insurance (DGUV) to restore the health and performance of insured persons after an accident "using all appropriate methods". Because of the legal requirements, possible rehabilitation may greatly differ from that provided by sickness or pension insurance. This article provides an overview of the available treatments after accidents at work and the rehabilitation phase in which they may be used.

Assessment of workplace bullying in Italy by INAIL: forensic and occupational medicine considerations.

The Authors, after a broad examination of the operating methods of inail (National Institute for Accident Insurance at Work) for the correct assessment and indentification of workplace bullying, carried out a comparative evaluation on the various diagnostic tests in the forensic psychiatric field for this occupational problem.

Differences in Work and Commuting Accidents between Employees and Students at Higher Education Institutions in Rhineland-Palatinate, Germany, from December 2014 to December 2019.

Accidents are one of the most important public health concerns because of their high prevalence and considerable health outcomes. Although higher education institutions (HEIs) play an important role in health promotion and disease prevention, accidents are rarely investigated in this setting. Therefore, the aim of the present study was to address this gap by analyzing the frequency and characteristics of employee and student accidents at HEIs in Rhineland-Palatinate, Germany. A dataset of all accidents that happened to employees and students at HEIs in Rhineland-Palatinate from December 2014 to December 2019 and the characteristics of these accidents was provided by the responsible statutory accident insurance (Accident Insurance Fund of Rhineland-Palatinate). Modified thousand-men quotas (the rate of injuries per 1000 people) were calculated to investigate the differences in frequencies and characteristics of accidents between employees and students, as well as between institutions. A total of 3810 accidents (n = 1326; 34.8% work and n = 2484; 65.2% commuting) were reported, of which 426 involved employees and 3384 involved students. The frequency and characteristics of the accidents varied between employees and students, as well as between institutions. Sports programs at HEIs for example imply high risks for unintentional injuries especially for students (as they make up the majority of participants). Other main findings are that medical students, as well as students of subjects including laboratory work, are at a higher risk to experience study-related accidents whereas employees seem to be at a higher risk when working in a technical field. The results call for the development of accident prevention concepts at HEIs and the implementation of interventions in respective institutions and target groups.

Deep quantile and deep composite triplet regression

A main difficulty in actuarial claim size modeling is that covariates may have different effects on the body of the conditional distribution and on its tail. To cope with this problem, we introduce a deep composite regression model whose splicing point is given in terms of a quantile of the conditional claim size distribution (rather than a constant). This allows us to simultaneously fit different regression models in the two different parts of the conditional distribution function. To facilitate M-estimation for such models, we introduce and characterize the class of strictly consistent scoring functions for the triplet consisting of a quantile, as well as the lower and upper expected shortfall beyond that quantile. In a second step, this elicitability result is applied to fit deep neural network regression models. We demonstrate the applicability of our approach and its superiority over classical approaches on a real data set from accident insurance.

COVID-19 as an Occupational Disease-Temporal Trends in the Number and Severity of Claims in Germany.

COVID-19 is considered an occupational disease (OD), when infection occurs at the workplace for health workers (HW). Because of the increased infection risk of these workers, they were deemed to be a priority group when the vaccination campaign started in Germany in December 2020. By December 2021, more than 90% of HW had been vaccinated twice. We studied the number and the time trend concerning the severity of OD claims related to COVID-19. Workers' compensation claims for OD are recorded in a standardized database of the Statutory Accident Insurance and Prevention in the Health and Welfare Services (BGW). We analyzed all notifiable COVID-19 related claims filed between 1 March 2020 and 30 September 2022. The proportion of severe cases was estimated by inpatient stays, injury benefit payments, rehabilitation measures, and deaths. The data analysis was descriptive. Due to COVID-19, 317,403 notifiable cases were reported to the BGW. Of these, 200,505 (63.2%) had thus far been recognized as OD. The number of notifiable cases was highest in 2022 and lowest in 2020. In total, 3289 insured individuals were admitted to rehabilitation management. This represented 1.6% of all recognized ODs due to COVID-19 at the BGW. The proportion of cases admitted to rehabilitation management decreased from 4.5% of all recognized ODs in 2020 to 3.2% in 2021 and to 0.1% of all recognized cases in 2022. For inpatient stays, injury benefit payment, and death, a similar trend was observed. Therefore, it might be concluded that the successful vaccination campaign mitigated the negative health effects of COVID-19 on HW. Even with vaccination, severe cases can occur. Therefore, infection prevention at the workplace remains paramount.

НАПРЯМИ РОЗВИТКУ СТРАХОВОГО РИНКУ В УМОВАХ СЬОГОДЕННЯ

The insurance market in Ukraine is one of the most important components of the country's financial system. In today's conditions, it is under the influence of a number of factors that are leading to a change in its development trends. The article examines the main trends in the development of the insurance market in Ukraine under martial law and post-war recovery. The authors analyze the dynamics of the insurance market, its structure, insurance products and services, insurance companies, and insurance culture in Ukraine. The main trends in the development of the insurance market in Ukraine in today's conditions include: decrease in the size of the insurance market. In 2022, the volume of insurance premiums in Ukraine fell by 30% compared to 2021. This is due to military operations, as well as the economic crisis that arose as a result of the war; change in the structure of the insurance market. In 2022, the share of compulsory insurance in the total volume of the insurance market in Ukraine increased to 60%. This is due to the fact that in the conditions of martial law, the demand for compulsory insurance products, such as life insurance, property insurance, and accident insurance, increased; the growth of the role of digital technologies in the insurance industry. In 2022, insurance companies in Ukraine actively implemented digital technologies. This allowed them to improve the efficiency of their activities and ensure the availability of insurance services to the population. The growth of the role of insurance companies in ensuring financial stability. In 2022, insurance companies in Ukraine played an important role in ensuring the financial stability of the country. They paid insurance claims to those affected by the war, and also provided financial assistance to businesses. Conclusions: the insurance market in Ukraine has significant potential for further development. To do this, it is necessary to create favorable conditions for the activities of insurance companies, increase the level of insurance culture of the population, and ensure the stability of macroeconomic indicators.

Functioning of the insurance market of Ukraine: new challenges and threats

The domestic insurance market can be described as a complex system of interconnections between insurance entities. Modern events give rise to new challenges and threats to the functioning and development of the insurance market of Ukraine. Therefore, despite the existence of a number of publications in the sphere of functioning of the insurance market, the study of this issue should be systematic, since the balanced operation of the insurance market has a significant impact on the entire economic system of the state as a whole. In the research process, the authors considered the interpretation of scientists and practitioners to determine the essence of the concept of «insurance market». The authors systematized the definition of scientists and formed scientific approaches. The insurance market category was also proposed. In order to understand the current state of the insurance market of Ukraine, statistics were analyzed, which best characterize the functioning of the market. The analysis showed that against the background of reducing the number of insurance companies, and fluctuations in the dynamics of gross insurance premiums and payments for the analyzed period, the insurers were able to increase assets and increase the volumes of the formed insurance reserves. Despite the crisis caused by the coronavirus pandemic, as well as the extreme conditions of martial law, the insurers were able to resist the challenges and continue to continue their activities. The level of insurance payments in the Ukrainian market is lower than the generally accepted world practice by more than 17%. This indicator indicates a low level of insurance culture in Ukraine. The structure of the insurance portfolio of the Ukrainian market is represented in general CICL, life insurance, continuous health insurance, accident insurance and property insurance. In recent years, the proportion of continuous health insurance has been constantly reduced due to low solvency as well as the emigration of the population abroad due to hostilities. One of the main indicators that illustrates the level of insurance market development, the level of insurance penetration is extremely low compared to countries such as the United States, Italy, France, the United Kingdom, and the Netherlands. Modern insurance products designed to protect against military risks are considered. The authors propose a few measures, the implementation of which will improve the functioning of the insurance market of Ukraine and increase its level of development.

Accident Year Development, Bonus Banks and Insurance Incentive Compensation

Accident Year Development, Bonus Banks and Insurance Incentive Compensation

Implementation of the Group Accident Insurance Scheme (GAIS) under Pradhan Mantri Matsya Sampada Yojana (PMMSY) – Impact on fisheries sector across INDIA Dr Suvarna Chandrappagari, Ajith Stalin J.L, and Rachel Joyce Olive

Implementation of the Group Accident Insurance Scheme (GAIS) under Pradhan Mantri Matsya Sampada Yojana (PMMSY) – Impact on fisheries sector across INDIA Dr Suvarna Chandrappagari, Ajith Stalin J.L, and Rachel Joyce Olive

WFID: Driver Identity Recognition Based on Wi-Fi Signals

Driver identification is a key factor in attributing liability for car accident insurance claims and assessing driver competency. Existing driver recognition systems use mechanisms based on identity keys (e.g., car keys and identity cards) or biometric characteristics (e.g., fingerprints, voiceprints, and face recognition). However, identity keys are prone to loss or misappropriation; biometric methods are prone to driver substitution and raise issues pertaining to privacy; and neither approach is applicable to the majority of commercial applications (e.g., hiring delivery drivers and renting out vehicles). This paper presents a novel driver identity recognition system based on the channel state information (CSI) of Wi-Fi signals, which tend to vary with the user, even when performing identical tasks. CSI values corresponding to driver maneuvers (e.g., turning or going straight) are used as inputs for a deep neural network tasked with establishing a driver recognition model. The feasibility of this approach was verified through simulations in the laboratory and with a vehicle, both of which achieved average recognition accuracy of roughly 95%.

Asbestos related cancers: burden and recognition as occupational diseases

Although asbestos has been banned in Switzerland since 1989, diseases caused by asbestos are still present and increasing today. In Switzerland, per year, occupational exposure to asbestos is responsible for approximately 135 deaths from mesothelioma and 930 deaths from lung cancer, though the latter is rarely recognized as an occupational disease. Taking an occupational history is essential for all such diagnosis, especially in smokers, whose risk of lung cancer increases due to the synergistic effect of asbestos and tobacco exposure. The medical practitioner can play an important role in occupational diseases being recognized as such, which is essential for the reimbursement of medical expenses by the accident insurance companies and the allocation of indemnities and pensions for the patient or their family.

Legal analysis of the implementation of insurance programs in the Republic of Kazakhstan to prevent accidents at work and assess the need for investments in safe work at the expense of the insurance fund formed in the compulsory accident insurance system

Accident insurance systems that adhere to international standards and approaches form an essential element of occupational safety management systems, serving to enhance working conditions while mitigating occupational risks while safeguarding our country's workforce. Insurance is one of the most cost-effective regulatory mechanisms available today for improving working conditions while safeguarding workers. As part of the Order of the Prime Minister's of the Republic of Kazakhstan dated December 29, 2020 to develop and implement the National Labor Protection Program outlined there, which mandated developing an effective National Labor Protection System by uniting government with social partners, on January 20, 2022 the Concept for Labor Safety until 2030 was approved. As part of the implementation of the Action Plan to Increase Occupational Safety in Kazakhstan until 2025 approved by Decree of the Government of the Republic of Kazakhstan on June 17, 2021, No 419, several measures designed to strengthen occupational safety management systems within enterprises have been introduced.

The Utilization and Limitation of Genetic Information in Insurance: Improvement Plan of China’s“Genetic Non-discrimination Act”

According to current Chinese law, insurance companies cannot use genetic information for medical, disease, disability, care and medical accident insurance. Nevertheless, this approach has not effectively solved the problem of “genetic discrimination” in China. Genetic information plays a vital role in insurance. The theory that genetic information can be used in insurance is based on risk classification and price equilibrium principle. Adverse selection can be avoided by dividing genetic information into different risk classes. This is an inevitable requirement of the insurer's right to know. For the consideration of social and public interests, commercial insurance should undertake a reasonable social relief function, but it is necessary to clarify the limitations of the social relief function of commercial insurance, and commercial insurance and social insurance cannot be equated. In terms of the characteristics of genetic information itself, there is no substantial difference between it and general medical information. Insurance covers uncertain risks, and with the progress of technology, the accuracy of genetic testing has also been improved. Therefore, theoretically speaking, it is not necessary to completely prohibit insurers from using genetic information in the insurance field. Therefore, in the future, China's legislation on genetic discrimination should be changed from completely prohibiting the use of genetic information by insurers to conditionally restricting the use of genetic information by insurers. First of all, the way to obtain genetic information by the insurer should be clarified, and the insurer should be prohibited from forcing the insured to carry out predictive genetic testing. The insurance applicant only must inform the specific genetic testing results. Secondly, it is necessary to set conditions for the insurer to use genetic information. The insurer can only use genetic information in personal insurance that meets a certain amount of money, and the use of genetic information must meet legal procedures and obtain the consent of the insured. In addition, it is also necessary to strengthen the regulation of the gene testing industry, formulate strict market access rules, and establish a gene consultant system to make up for the inferior position of the insured in the profession. Finally, improve the rescue of the insured, let professionals participate in the settlement of disputes, and increase the severity of punishment for the illegal use of genetic information by insurance companies.