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Assessment of Disability & Compensation
Assessment of Disability & Compensation
Categories of cases The assessment of compensation in a Motor Vehicle accident may be for the following categories : 1. Injury cases. 2. Fatal Cases.
3. Loss of Property.
Personal Injury Cases For Personal Injury cases compensation can be claimed under the Heads: 1. Pecuniary Damages. 2. Non-Pecuniary Damages.
Pecuniary Damages
Pecuniary damages are known as special damages and are generally designed to make good the pecuniary loss which is capacable of being calculated in terms of money.
Pecuniary Damages
1. Expenses incurred by the claimant in respect of injury which may include medical attendance.
Non-Pecuniary Damages
Non Pecuniary damages are those which are incapable of being answered by arithmetical calculations
Non-Pecuniary Damages Non-Pecuniary damages or general damages include a number of sub-heads such as : 1.Damages for mental and physical shock, pain, suffering already suffered by the claimant or likely to suffer in future.
2.Damages to compensate for the loss of amenities of life which may include a variety of matters such as claimant may not be in position to walk, run, sit or loss of marriage prospects, sexual intercourse and other amenities in life;
3.Damages for loss of expectation of life i.e.,on account of injury the normal life of the person is shortened; and
Contd..
At present only the medical aspect of disability i.e.,Physical impairment is evaluated by the doctor.
Social, Physiological and vocational activities/potentials are never considered while assessing disability. Physical impairment leads to functional limitation and functional limitation in turn leads to disability. Hence impairment,functional limitation and disability have to be examined in light of their definitions by the W.H.O.
Impairment
Is a permanent or transitory physiological, or anatomical loss and/or abnormality. A missing or defective part, tissue organ, or mechanism of the body, such as an amputed limb, paralysis after polio, myocardial infraction, cerebralvascular thrombosis, restricted pulmonary capacity, diabetes, myopia, disfigurement, mental retardation, hypertension and perpetual disturbances all come under this category.
Functional Limitation
Impairment may produce functional limitation(which may be progressive or regressive) and or the total or partial inability to perform those activities necessary for motor, sensory or mental functions within the range and manner of which human being is normally capable such as walking, lifting loads, seeing, speaking, bearing, reading, writing, counting. A functional limitation may last for short time, a long time, may be permanent or reversible. It should be quantifiable whenever possible.
Disability
Is an existing difficulty in performing one or more activities which, in accordance with the subjects age, sex and normative social role, are generally accepted as essential, basic components of daily living such as self-care, social relations & economic activity. Disability may be short, long or permanent depending on functional limitations duration. It should be noted that functional limitation or impairment is causative/contributory factor in disability. In legal parlance disability is a permanent injury to body for which the person should or should not be compensated. In medical sense of the term disability is physical impairement and inability to perform physical functions.
Kinds of disability
Temporary total disability: The period during which the injured person is totally unable to work and received orthopedic or other medical treatment. MAKES THE PATIENT BED RIDDEN. LONG PLASTERED LIMBS. LARGE OPEN WOUNDS. MAJOR FRACTURES OF LOWER LIMBS.
GOVERNMENT BENEFITS: RESERVATIONS IN JOBS, SCHLORSHIPS. CONVEYENCE & RELATED FACILITIES RAIL,ROAD. INCOME TAX EXEMPTIONS. 80U. OTHER : COMPENSATION FOR: MOTOR INDUSTRIAL, ACCIDENTS, NEGLIGENCE.
DEGREES OF DISABILITY
Name, Age, Sex, Address, identification mark. Existing disabilities, deformities -calculation % of disability of the limb or whole body. Issued for -------- purpose only. Mention scale or law used for calculation. Comments if any.
Medical records The hospital medical record is a complete written record of a patients history, condition,
Medical Records
Medico-legal register
Outpatient record
Inpatient record
Medico-legal register Personal particulars Time of arrival Identification mark Consent Conscious Smell of alcohol Physical examination finding Treatment
Patient accompanied
History of accident with time and place
Nature of Injury
Simple or Grievous
Personal particulars History of illness or accident Past history of any disease Clinical examination findings
Inpatient record
Hospital identification sheet History sheet Treatment order sheet Progress sheet Nursing sheet Anesthesia notes Surgery notes Additional sheets Temperature chart Pulse,BPchart Input ,output chart Head injury chart Miscellaneous.
investigations
Investigation required
Doctors initials
Type of anesthesia
Duration Recovery
INPATIENT-OPERATION NOTES
Identification data Preoperative diagnosis Procedure name Surgeons name First and second assistants name Details of surgery , Initials of doctor
INPATIENT-NURSES NOTES
Identification data
Every day progress of patient nursing aspect Any time SOS to doctor
Initials
Discharge summary
Identification data Diagnosis Brief history of illness ,and patents progress during hospital stay
Investigations
Treatment advised Follow-up Condition on dischange
Medical record
Good record
Accurate
Appropriate
Bad record
Tampering
Alteration
Chronological
Relevant complete
No initials
History
Smell of alcohol Initials of treating doctor in all sheets Operating surgeons
Prescriptions initials
Investigations asked
investigations.
MEDICO-LEGAL AUTOPSY
AIMS
Identification Cause of death
MEDICO-LEGAL AUTOPSY
Cause of death
Furnish opinion Reserved pending No opinion
MEDICO-LEGAL AUTOPSY
Orthopedics
Radiological examination
Special investigation
Operative treatment
Non-operative treatment
Rest Support Physiotherapy Local injection Drugs Manipulation
radiotherapy
Orthopedic-operative treatment
Osteotomy-cutting a bone Arthodesis-joint fusion Arthoplasty-construction of a new movable joint Bone grafting Tendon transfer operation Tendon grafting operation
Avulsion
Impacted depressed
Clinical types
Fresh fracture
Malunited fracture
Un-united fracture pathological
Type of fracture
Type of bone
Duration of immbolisation
Complication of fracture
Late complication:
Malunion Nonunion Cross union Stiffness Contracture Post traumatic osteo arthrodesis
Disability Questionnaires
Example of Questionnaires: Whether you has examined victim? Whether you are was treating Doctor? When was the injured for the first and last examined by you? What is his position as on today? Are you authorized to issue a disability certificate? I suggest to you that only a medical board constituted by
Permanent
Physical
1.The estimation of permanent impairment depends upon the measurement of functional impairment and is not expression of personal opinion. 2.The estimation and measurement must be made when the clinical condition is fixed and unchangeable.
3.The upper extremity is divided into two component parts: the arm component and the hand component. 4.Measurement of the loss of arm component consists in measuring the loss of motion, muscle strength and co-ordinated activities.
Contd
5.Measurement of loss of function of hand component consists in determining Prehension, sensation & strength. For estimation of prehension Opposition, lateral pinch, cylindrical grasp, spherical grasp and hook grasp have to be assessed. 6.The impairment of the entire extremity depends on the combination of the functional impairment of both components.
Arm Component Total value of arm component is 90%. A)Principles of evaluation of Range of motion of joints:
(60x0.30) + (40x0.30)=30%
B)Principles for Evaluation of strength of muscles: 1.Strength of muscles can be tested manually like 0-5 grading.
C)Principles of Evaluation of Co-ordinated activities: 1.The total value for co-ordinated activities is 90%
Hand component The total value of Hand component is 90%.The functional impairment of hand is expressed as loss of Prehension, loss of sensation, loss of strength.
Principles of evaluation of sensation:Total value of sensation is 30% it includes: 1.Radial side of thumb-4.8% 2.Ulnar side of thumb-1.2% 3.Radial side of each finger-4.8% 4.Ulnar side of each finger-1.2% Principles of Evaluation of strength; a)Grip strength-20%
b)Pinch strength-10%
Strength will be tested with hand dynamo-meter or by clinical method.
Guidelines for Evaluation of Permanent Physical Impairment in Lower Limbs: The lower extremity is divided into two components:Mobility component and stability component. The total value of mobility component is 90%.It includes range of movement and muscle strength. The value of maximum R.O.M in the mobility component is 90%.
Stability component: The total value of stability component is 90% It is tested by 2 methods: a)Based on scale method. b)Based on clinical method. Three different readings in Kgs are taken measuring the total body weight(W), scale A reading and scale B reading. The final value is obtained by formula: Difference in body weight/Total body weight x 90 In the Clinical method of evaluation nine different activities are to be tested as given in the proforma. Each activity is given a value of 10%
Extra Points
Extra Points are to be given for pain,deformities, contractures, loss of sensation and shortening, Maximum points to be added are 10%(excluding shortening.Details are follows:
3%
6% 9% 6% 3% 9% 6%
d)Shortening:First
Every beyond first e)Complications:Superficial Complication Deep Complication
Nil
4% 3% 6%
Evaluation
of
1.Trunk(Spine)
2.Amputees. 3.Neurological Conditions.
4.Facial Injuries.
5.Burns of Head and Neck. 6.Burns of Trunk and genitalia. 7.Cardio-Pulmonary diseases.
Assessment of compensation in fatal cases In fatal Accident cases (death ) cases compensation may be claimed under the following heads:
1.Loss of Dependency.
2.Loss of estate of the deceased. 3.Loss of Gratuitous services. 4.Loss of consortium. 5.Mental agony and shock.
Meanings : 1.Loss of dependency: Means loss of income to the claimant due to the death of the deceased 2.Loss to estate: Loss of supervision of immovable property,inability to continue the business,expenses for medical treatment,transportation damages to the property due to accident and funeral expenses come under this head 3.Loss of gratuitous Services: Due to the death of the wife the husband may incur expenses to employ servants,cooks to do the house hold jobs.These items may be brought under this head.
Contd
4.Loss of consortium: Means loss of life partner.For the loss of service,society & intercourse compensation may be claimed under this head. 5.Mental agony and shock: Due to the death ,the claimant might have suffered mental agony or shock.The quantum of Compensation may be granted under this head.
6.Loss of happiness, love, affection and care: Due to the death of the deceased the claimant may lose happiness, love and affection. compensation may be granted under this head.
2.Discounting Method.
3.Interest Capitalisation Method.
Multiplier Method Of all the methods the courts in India adopt multiplier method.In computing the amount of compensation the reasonable expectation of pecuniary benefits reducible to money value is taken into account.The circumstances which may pleaded in diminution should also be taken into account.In determining the quantum,the actual pecuniary loss of each claimant shall have to be balanced by any pecuniary advantage which might come to him by reason of the death person viz.against the actual pecuniary loss suffered by him.Sentimental damage,bereavement,pain& suffering have no place in calculation.From the income of the deceased the amount required for his personal living expenses shall be deducted.The balance will be turned into a lumpsum adopting a certain number of years purchase.Even this sum is brought down on the basis of future uncertainties.
Contd
This method is illustrated by following the formula Known as Lord Wrights Formula:
(A-E) x Y=Total compensation for loss of dependency as well as loss to the estate;
A represents the amount of net wages which the deceased was earning; E represents the expenditure incurred by the deceased for his own self and; Y represents the number of years purchase.
Discounting Method
1.The sums,the deceased would have probably applied out of his income to the maintenance of his wife and family if he had not been killed and would have lived his full span of life;
2.The additional savings which the deceased would or might have left but for premature death and would have probably accrued to his wife and family.
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