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[Assessing disability--a piece of cake or a profound challenge?]
1Aus den Client Services Gen Re LifeHealth.
Abstract:
When evaluating disability for BUZ (German income protection benefit) a medical expert's task is to assess the consequences any physical or mental impairment may have on the insured's ability to perform his/her occupation. In the absence of specific details regarding the core and secondary duties which the insured has last performed, the expert is unable to accomplish his task. In fact, in a legal dispute the expert's opinion would be rendered worthless if it was not based on precisely established non-medical aspects of the insured's individual occupation. Details about the insured's occupation and duties must be provided to the expert by the insurer who in turn has to ensure that full details have been obtained from the insured. Only then will the expert be in a position to establish the insured's remaining abilities and assess any occupational impairment and its likely duration. The medical expert must relate specific legal aspects and income protection insurance terms to the medical facts and occupational merits of the case. Only then can his opinion be considered decision-relevant and court-proof. To accomplish this complex task the medical expert must be familiar with these specific conditions. A high standard of quality for BUZ expert opinions is best assured with continuing training and education in this field.
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