[Unlisted osteoarticular pathologies. The National Insurance Institute for Occupational Diseases approach]

In the case of unlisted microtraumas, the patient must first be evaluated in terms of his or her risk exposure, followed by an exact determination of the relationship of causal dependency, and lastly an accurate diagnosis must be made. Since the disorder is not listed as an automatically compensated disease, the burden of proof lies with the insured. Regarding microtraumas, in particular, the causes must be studied with reference to: chronological criteria, qualitative and quantitative efficiency factors, topographic criteria, modal criteria, continuity of event seriation, evidence of unrelated pathogens. The principle of adequate causality appears to be the only one offering a sufficient guarantee of scientific exactness in determining the relationship of causal dependency. At present, Circ. 35/92 of INAIL regulations states that the work-relatedness of microtraumas may be admitted when the worker's personal history (anamnesis) points to the existence of an occupational risk whose nature, duration and intensity can reasonably be considered as to exert an equal or higher influence than that exerted by non-occupational aetiological factors. The statistical and epidemiological data must demonstrate a significantly higher incidence of the pathology among a given category of workers. Only cases featuring the aforementioned characteristics, are currently legally entitled to the relevant insurance services.