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Fortschr Neurol Psychiatr 2017; 85(01): 17-33
DOI: 10.1055/s-0042-116681
Übersicht
© Georg Thieme Verlag KG Stuttgart · New York

Beschwerdenvalidierung in der versicherungsmedizinischen Begutachtung

Symptom Validation in Independent Medical Evaluations
Carole Keppler
1   Forensisch-Psychiatrische Klinik – Forschung Forensik Neurophysiologie, Universitäre Psychiatrische Kliniken Basel
,
Andrea Maria Plohmann
2   N/A, Praxis für Neuropsychologie und Psychotherapie, Basel
,
Marlon Pflueger
1   Forensisch-Psychiatrische Klinik – Forschung Forensik Neurophysiologie, Universitäre Psychiatrische Kliniken Basel
,
Kristin Rabovsky
3   Forensisch-Psychiatrische Klinik – Versicherungsmedizin, Universitäre Psychiatrische Kliniken Basel
,
Wolf Langewitz
4   Psychosomatik – Innere Medizin, Universitätsspital Basel
,
Ralph Mager
3   Forensisch-Psychiatrische Klinik – Versicherungsmedizin, Universitäre Psychiatrische Kliniken Basel
› Author Affiliations
Further Information

Publication History

Publication Date:
23 January 2017 (online)

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Zusammenfassung

Hohe Prävalenzraten von nicht authentischen Beschwerden in der versicherungsmedizinischen Begutachtung weisen auf das Risiko hin, dass in einer Gesellschaft zur Verfügung gestellte und limitierte geldwerte Leistungen nicht zielkonform eingesetzt werden. Es liegt dabei wesentlich in der Verantwortung der Gutachter, in geeigneter Form eine Beschwerdenvalidierung zu erbringen, um dem Rechtsanwender eine zutreffende Entscheidungsgrundlage zu bieten und medizinischen Qualitätskriterien gerecht zu werden. Traditionell geschieht dies im Wesentlichen in einer nicht standardisierten Konsistenzprüfung auf dem Hintergrund der klinischen Untersuchungsergebnisse in Abgleich mit der Aktenlage. Die nicht gesicherte Validität dieses Vorgehens mit hoher Abhängigkeit von individueller Expertise, Datenlage und Haltung hat internationale Fachgesellschaften in jüngerer Zeit dazu veranlasst, Leitlinien mit ihren Empfehlungen zu öffnen für eine standardisiertere Erfassung der Beschwerdenvalidität. Die am besten evaluierten Methoden und Instrumente dazu werden in der vorliegenden Arbeit vorgestellt. Dabei wird versucht, ihre Validität insbesondere in Bezug auf die Anwendung im Begutachtungskontext nach der aktuellen Datenlage darzustellen. Die Autoren kommen zu dem Schluss, dass eine lege artis durchgeführte strukturierte Beschwerdenvalidierung die Qualität klinischer Urteile erheblich verbessern kann. Die qualifizierte Integration dieser zusätzlich erhobenen Befunde in eine psychologische oder ärztliche Expertise ist jedoch anspruchsvoll und bedarf einer weiteren wissenschaftlichen Begleitung. Einer mechanischen Beurteilung nach Punktwerten gilt es vorzubeugen.

Abstract

High prevalence rates of non-authentic complaints identified by experts in the field of insurance medicine draw attention to the risk of services, which are of limited availability and financially compensated, being used in ways that are not goal-oriented. Therefore, symptom validity testing has become a growing issue to prevent non-targeted monetary compensations. This paper outlines the best-evaluated methods and instruments. Based on the data currently available, their validity, in particular in the context of medico-legal assessment, is assessed. It is concluded that symptom validity assessment allows inferences about the degree of certainty of clinical judgements on the authenticity of reported symptoms. Thus, the application of the suggested instruments enhances significantly the quality of medical and psychological expertise. However, the integration of the additional results into the overall assessment is challenging and needs to be further clarified.

Schlüsselwörter

Beschwerdenvalidierung - Performanzvalidierung - Begutachtung - Versicherungsmedizin

Key words

symptom validity testing - performance validity - independent medical evaluation - insurance medicine
 

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