Financial impact of radiological reports on medical-legal evaluation of compensation for meniscal lesions.
To evaluate any discrepancy between radiological reports for clinical purposes and for medicolegal purposes and to quantify its economic impact on repayments made by private insurance companies for meniscal injuries of the knee. The medical records obtained pertaining to 108 knee injury patients (mean age 43.3 years) assessed over a period of 12 months were analysed. Clinical medical reports, aimed at assessing the lesion, and medicolegal reports, drawn up with a view to quantifying compensation, were compared. Unlike reports for clinical purposes in reports for medicolegal purposes, in the evaluation of meniscal lesions, in addition to morphological features of lesions, chronological, topographical, severity and exclusion criteria were applied. To estimate the economic impact resulting from the biological damage, we consulted an actuarial table based on the 9-point minor incapacity classification system. Meniscal lesions not compatible with a traumatic event and therefore not eligible for an insurance payout were found in 56 patients. Of these, 37 failed exclusion criteria, while 19 failed to meet chronological criteria. This difference resulted in a reduction in compensation made by private insurance companies with savings estimated with a saving between euro 203,715.41 and euro 622,315.39. The use of a clinical report for medicolegal purposes can be a source of valuation error, as chronological and/or dynamic information regarding the trauma mechanism may be lacking. Therefore, the use of a full radiological appraisal allows a better damage's assessment and an adequate compensation for injuries.
Department of Diagnostic Imaging, University of Foggia, Viale Luigi Pinto n.1, 71100, Foggia, Italy.
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Lelario
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Ciuffreda
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Lupo
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Bristogiannis
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Vinci
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Stoppino
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De Filippo
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Macarini
D000328:Adult; D035881:Compensation and Redress / Q000331:legislation & jurisprudence*; D003365:Costs and Cost Analysis; D005104:Expert Testimony; D005260:Female; D006801:Humans; D007345:Insurance Claim Review; D007558:Italy; D007718:Knee Injuries / Q000000981:diagnostic imaging* / Q000191:economics*; D016365:Liability, Legal / Q000191:economics; D008297:Male; D008592:Menisci, Tibial / Q000000981:diagnostic imaging*; D008875:Middle Aged; D011873:Radiology Information Systems / Q000191:economics* / Q000331:legislation & jurisprudence*; D000070600:Tibial Meniscus Injuries; D014057:Tomography, X-Ray Computed; D014938:Work Capacity Evaluation