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Journal Article

Citation

Schmidt J, Schmidt I. Unfallchirurg 2019; ePub(ePub): ePub.

Vernacular Title

Mitwirkung unfallfremder Krankheiten und Gebrechen in der Begutachtung für die private Unfallversicherung : Eine Problemdiskussion und Hilfestellung.

Affiliation

Ärztlicher Dienst, Reha Assist Deutschland GmbH, Warener Straße 1, 12683, Berlin, Deutschland.

Copyright

(Copyright © 2019, Holtzbrinck Springer Nature Publishing Group)

DOI

10.1007/s00113-019-00719-z

PMID

31492964

Abstract

With the clarification by the Federal Court of Justice, the distinction between the principle of equivalence and the principle of adequacy for assessment has again come to the fore. In contrast to the equivalence principle for assessments in the German statutory accident insurance (DGUV), the principle of adequacy applies in private accident insurance. This means that an accident is always present whenever it does not lie completely outside the probability and the assessor has to carry out a further examination of the liability-based causality. Therefore, not only the accident occurrence has to be assessed but also the observance of the deadlines and, in the case of affirmation of the occurrence of a disability, whether or not unrelated ailments or diseases contributed to the accident. There are so far no points of reference for the estimation of participation. With the help of the theory of equivalence from linguistics, an attempt was made to provide assistance through definitions of the extent of participation.


Language: de

Keywords

Adequacy theory; Definition of involvement; Invalidity assessment; Involvement of nonaccident-related diseases or afflictions

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