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A Journal on Forensic Medicine
Minerva Medicolegale 2006 September;126(3):255-71
Inflammatory bowel disease: medico-legal problems concerning the policies of medical expenses reimbursement and of permanent invalidity due to illness
Massimelli M. 1, Pastena M. 2, Vitetta G. 1, Ghiardi M. 1
1 Dipartimento di Anatomia, Farmacologia e Medicina Legale Università degli Studi di Torino, Torino
2 INPS, Vercelli
Ulcerative colitis (UC) and Crohn’s disease (CD) are classified as inflammatory bowel diseases (IBD) or intestinal chronic inflammatory illnesses; UC primarily involves the last tract of the big bowel, while CD, whose distribution is typically segmentary, can spread in any tract of the digestive apparatus: from the oral cavity to the anal orifice, but more commonly on the terminal ileum and the proximal colon. Typical of these pathologies is their ictal evolution and the poor objectivity of the clinical symptoms especially in the phases not yet acute or ravaging of the illness: this makes very difficult to propose any correct medico-legal judgment on the permanent or temporary damage of IBD.
Before any medico-legal evaluation it is, therefore, important to appraise the functional damage of these pathologies since it influences the prognostic judgment especially being surgery not curative: CD has the tendency to cause greater disability than UC, so much that only 75% of the patients in working age are in activity one year from the diagnosis and 15% are no longer at work after 5-10 years of illness.
Since in the medico-legal literature it is not easy to retrieve papers dealing with the sevaluation of the damage due to gastrointestinal pathologies considered by policies of medical expenses reimbursement and of permanent invalidity due to illness, after a brief clinical analysis of the illness and of the general principles of the private contractual provisions and in particular the policies of medical expenses reimbursement and of permanent invalidity due to illness, the authors underline the main evaluations used in literature by the various organizations: INPS, INAIL, and private insurance, with a brief mention to the tabular values used in France, and then they suggest a series of proposals in the two contractual provisions.