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A Journal on Forensic Medicine
REFINDABLE AND REIMBURSABLE COSTS OF REHABILITATION.
PRELIMINARY GUIDELINES FOR FORENSIC DOCTORS, LAWYERS AND INSURANCE ADJUSTERS
Minerva Medicolegale 2012 June;132(2):61-72
Treatments in civil legal medicine and insurance
Istituto di Medicina Legale, Università di Torino, Torino, Italia
Alongside classical legal medicine, insurance medicine now deals autonomously and competently with the entire spectrum of problems concerning health protection. Among the most compelling issues facing insurance medicine is the question of the coverage of medical expenses by social and commercial insurers. Rehabilitation therapy, administered for a pathological process or for traumatic injury, may be covered under private insurance which, unlike social insurance (mandatory, regulated and managed by the State which disburses certain benefits to individuals meeting certain requirements) offers protection against specific risks. A correct method for formulating a targeted evaluation of health expenses and residual disability derives from the synergy between rehabilitation medicine and legal medicine. Such a method is currently lacking, however. One way to solve this problem would be to take quality of life as a reference parameter for guiding the evaluation. An element from medicine, forensics, ethics, socioeconomic and cultural sources to draw upon in a systematic approach to the evaluation of major traumatic injury or of severe aging-related conditions would be that defined as “clinical legal medicine” by Benciolini and successfully applied to the problem of worsening of damage that was assumed to have stabilized. All quality of life factors, together with the individual’s medical history, are accurately examined and verified case-by-case so as to establish risk and insurance coverage as precisely as possible by means of a stringent but fair evaluation of therapeutic necessity.