[Opinions issued by an expert appointed by a court in civil cases from the point of view of the defendant insurance company].
The paper presents and analyses problems which are encountered by an insurance company in connection with the opinions issued by experts appointed by a court in civil cases and concerning the evaluation of the results of accidents or damages in civil liability insurance. Every year, the group of physicians employed by the Office of Medical Services of Insurance at the PZU Zycie SA and PZU SA, issues opinions for about 3000 appeal and complicated cases from all over Poland. In some of the cases, an individual holding an accident insurance policy or an injured person in the case of civil liability insurance disagrees with the findings of the insurance company and brings the case to a civil court. About 7% of the opinions issued by the Office in 2005 were polemics with court experts, concerning their manner of classifying the results of an accident or an event which resulted in damage to an individual. Among the 200 opinions, there are several important and recurring problems, which are presented in the paper. The main doubts concern: 1. insufficient analysis of the circumstances of an event and drawing hasty conclusions about the cause-and-effect relationship, 2. claiming the certain occurrence of a cause-and-effect relationship, despite substantial doubts, 3. absence of analysis of general conditions of insurance, which in voluntary insurance may contain various exemptions and restrictions, 4. insufficient analysis of medical documentation containing information about some deviations before the event, 5. determining by the experts the degree of permanent loss of health despite the absence of functional impairment revealed in an examination, 6. determining permanent results of an accident based solely on unverifiable subjective complaints, 7. deciding about the percentage of permanent detriment to health in most cases on a slightly higher level than was decided by a physician who took such a decision for the insurance agency.
Truszkiewicz
Waldemar
W
Biura Medycznej Obslugi Ubezpieczeń Centrali PZU SA. I PZU Zycie SA. w Warszawie. wtruszkiewicz@pzu.pl
Pałka
Janusz
J
Maciejczak
Paweł
P
D004185:Disability Evaluation; D004608:Eligibility Determination / Q000331:legislation & jurisprudence* / Q000592:standards; D005104:Expert Testimony / Q000331:legislation & jurisprudence* / Q000592:standards; D005554:Forensic Medicine / Q000331:legislation & jurisprudence; D006801:Humans; D007346:Insurance, Accident / Q000331:legislation & jurisprudence* / Q000592:standards; D018868:Insurance, Disability / Q000331:legislation & jurisprudence* / Q000592:standards; D035846:Law Enforcement; D011044:Poland; D014947:Wounds and Injuries