Citation

Thomann KD. Unfallchirurgie (Heidelb) 2023; ePub(ePub): ePub.

Copyright

(Copyright © 2023, Holtzbrinck Springer Nature Publishing Group)

DOI

10.1007/s00113-023-01308-x

PMID

37072502

Abstract

The evaluation of permanent dysfunction after injuries to the musculoskeletal system is one of the core activities of a trauma surgeon and orthopedists. Based on the knowledge of the injury and an accurate description of the dysfunction, the medical expert then makes a proposal regarding the amount of the reduction in earning capacity (Minderung der Erwerbsfähigkeit, MdE). The amount is based on the MdE tables, which have been derived from a decade-long harmonization and coordination between administrative authorities, courts and the medical profession. They have been published in the fundamental guidelines for evaluation. Individual recommendations are subject to change; however, the benchmark figures for amputations have not changed significantly since the introduction of the statutory accident insurance in 1884, although the treatment with prostheses has continuously improved. The benchmark for the MdE is the labor market which becomes unavailable to the insured person due to the dysfunction. In the Social Code for Employment Accident Insurance (Sozialgesetzbuch für die Unfallversicherung, SGB VII), the reduction in earning capacity is defined and the amount "… is based on the extent to which job opportunities are available as a result of the impairment of the physical and mental capacity across the entire area of the working life". The article traces the history of this central instrument for measuring the sequelae of accidents. In this context it is shown that the MdE values did not in fact arise concurrently with the introduction of statutory accident insurance at the end of the nineteenth century but date back to the millennia-old principle of the law of talion (ius talionis). This is the basic form of material civil liability law, according to which the injuring party must compensate the injured party in the case of a culpable impairment of health for the resulting material loss. Here the loss of earnings, the impairment of the capacity to work or, in other words, the reduction in earning capacity is of paramount importance. In the middle of the nineteenth century, private accident insurers developed dismemberment schedules based on the principle of ius talionis. These dismemberment schedules were adopted by the professional organizations after 1884. The highest competent instance for social security matters, which was the Imperial Insurance Office (Reichsversicherungsamt), redefined the dismemberment schedules: the values for the dismemberment schedules then became the benchmark for the reduction of capacity to work (Erwerbsminderung, EM) and subsequently the reduction in earning capacity (MdE). The fact that the MdE values have remained stable over more than 100 years support the view that they not only grant legal certainty but are also regarded as appropriate and fair by both the persons affected and society.

Language: de

Keywords

Disability; Accident insurance; Dismemberment schedules; Reduction in earning capacity; Talion principle