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Minerva Medicolegale 2018 June;138(1-2):6-11

DOI: 10.23736/S0026-4849.18.01776-5

Copyright © 2018 EDIZIONI MINERVA MEDICA

language: Italian

Comparing the medical legal concepts of “illness” and “permanent outcome”: doctrinal clarifications and operational implications in the social insurance and civil invalidity

Michele SAMMICHELI , Marcella SCAGLIONE

Centro Medico Legale INPS, Siena, Italy



The authors compare the medical legal concepts of “illness” and “permanent impairment outcome,” the cornerstones of legal medicine in general, and of social insurance medicine in particular. Illness is understood as an anatomical-clinical process featuring dynamism, a rapid evolution and the ability to be amended in the short-medium term. On the other hand, a permanent outcome is understood as an impairment owing to a functional repercussion which, although alterable in the long term, exerts its deteriorating effects on the psycho-physical validity of the subject over a prolonged timeframe. Despite the two concepts appearing to be easily doctrinally distinguishable, the often incorrect use of the same from a practical point of view emerged during the authors’ daily working experience carried out at various Medical Legal Departments of the Italian National Institute of Social Security (INPS). This became clear both in the daily scrutiny of medical certification, and paper and data transmission versions, where chronological clinical pictures or functional outcomes were correlated to an illness. On the other hand, in carrying out medical examinations to evaluate civil and social security invalidity, pathological processes in fieri are often related to “stabilized clinical-functional pictures,” possessing characteristics that are more ascribable to an illness rather than an impairment. Some practical examples are provided for the reader, both in the area of medical certification, as well as in civil invalidity and social security evaluations, in order to understand the distinction between the two conceptual cornerstones of social insurance medicine


KEY WORDS: Social security - Disability evaluation - Cost of illness - Health insurance

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