SOURCE: http://www.handylex.org/gun/linee_guida_invalidita_INPS.shtml
Law August 3, 2009, No 102 which, in Article 20, set new standards and competence in the processes of assessment of civil disabilities.
From January 1, 2010 the application for assessment of disability, handicap or disability is submitted to INPS and not to the local health units. The competent ASL Commissions are complemented by a doctor INPS.
These legal provisions have been made operational by INPS and regulated by Circular 28 December 2009, n. 131. What does
Circular 131/2009
The new composition of the Boards ASL (integrated with a doctor INPS) was to provide an advantage in terms of time than that - surely - a savings of management.
In fact, the INPS Circular 131/2009 provides that if at the end of the visit of the minutes shall adopted unanimously, the minutes, validated by the Managing Director Forensic INPS, is sent to the addressee by INPS itself. If the report gives the right to financial benefits (pensions, allowances), is also activated the administrative flow for its granting and lending institution, and then also sent grantor and "put in production."
If at the end of the investigation, however, the opinion is not unanimous , INPS will suspend the submission of the report and acquires the acts that are considered by the Managing Director Forensic INPS. These may validate the report within 10 days or proceed with a new direct visit over the next 20 days.
The visit, in this case, is provided by a physician as well as INPS (other than this Commission in ASL), a representative of the medical associations (ANMIC, ENS, UIC, ANFFAS) and in the case of disability evaluation by a social worker (for certifications relative alla Legge 104/1992 e 68/1999).
Quindi: le visite dirette avrebbero dovuto essere limitate ai casi dubbi e ai casi su cui non vi era accordo, consentendo comunque un ampio ricorso alla valutazione sugli atti, senza cioè scomodare il Cittadino.
Evidentemente, a quasi un anno di distanza, INPS verosimilmente rileva che il sistema non funziona : in molte Commissioni ASL il medico INPS non è ancora presente; la documentazione sanitaria completa non viene trasmessa all’INPS, ma, soprattutto, le concessioni di provvidenze economiche stanno riprendendo il loro normale.
Ecco allora che l’Istituto cambia le sue indicazioni con una Comunicazione of September 20, 2010 (internal and not widespread in the official site) Director-General to all the regional leaders INPS.
More direct visits
The General Manager states that "it is essential to reinforce (...) recourse to 'direct medical examination the person with the objective to verify the existence or the permanence of the health requirements (...)."
Even though the note stated that the intent is to make "definitive medical opinion the statutory health INPS, with the objective to avoid future inconvenience to citizens resulting from successive health checks outstanding. " is clear that the purpose is to further tighten the control mechanisms that obviously, despite repeated statements by the President INPS Mastrapasqua enthusiastic, are not working in terms of restriction of the benefits granted. The same
"Guidelines" attached to the note from the Director General (under "Visit Live"), stress "that the 'health check direct is considered priority to to ensure maximum methodological consistency and transparency of the process of evaluation and subsequent medico-legal proceedings. This especially in cases where there is evidence of a severe mental and physical disability from which welfare benefits. "
The consequences for the Citizen
The consequences for the citizen are more severe than it appears. Let's see why.
The Citizen asking for the investigation (the first investigation or audit or investigation at 18 years of age) may receive an assessment is not unanimous but a majority or unanimous by the Commission (including the INPS doctor, then).
In the first case, the Circular already 131/2009 included an assessment of acts or visit directly with the Social Security Commission. Now, the Director-General suggests the use of priority to direct visit.
But the direct use of the visit is a priority - according to Social Security - even if the Commission's view ASL (integrated with the INPS doctor) has been unanimous, especially in cases in which welfare benefits are provided (ie, in particular, pensions, allowances, allowances).
The "Guidelines" propose exceptions discretionary the invitation to visit directly in some specific cases:
- Cases in which it was suggested that application DM 2 August 2007, where they meet the requirements of the individual items;
- Minor Disease validly documented above is within the scope of mental illness or genetic-type malformation;
- Subjects included in long term care or in protected residences;
- forbidden subjects;
- geriatric subjects of interest and loss of personal autonomy adequately documented; (...)
- proven malignant disease severity.
So Citizens will be many that will, henceforth, be subject a double visit: ASL first and then the INPS. The inconvenience and delays will increase a lot.
Considering the political climate and cultural evolution of the current provisions, it is unconvincing justification for Social Security that such procedures are directed at a minor inconvenience for the Citizen.
rises a doubt about the meaning of the continuing Medici INPS within the Local Health Boards. If their involvement was motivated by the opportunity to accelerate and optimize the process, after the new guidelines, this presence appears only as a cost to INPS and not an advantage for the system. But perhaps that is That's the problem. Last
notation concerns "reading" this in the "Guidelines" with respect to medical criteria - legal assessment of the civil disabilities. In multiple passes, there are statements and interpretations that are not no basis in the existing legislation and that are still also questionable in terms of scientific literature.
on these matters, we refer to a subsequent note.
Last Updated: September 25, 2010
Carlo Jacobins
Director responsible for HandyLex.org
© HandyLex.org - All rights reserved - Reproduction prohibited without prior permission.
INPS - General coordination coroner - Pensions Head Office - Head Office Organisation - Head Office Planning and Management Control - Head Office Information Systems and Technology
September 20, 2010
SUBJECT: Investigations of disability support - implementation of the criteria for direct assessment.
After an initial period of implementing the new disability civil process, referred to the circular n.131/2009, it is necessary to provide further instructions operating on the organizational, legal and medical informatics to establish entitlement to welfare benefits.
Therefore, it is necessary to supplement the instructions already provided, with particular reference to methods of completing the assessment phase of the health condition in the ordinary audit, and the resulting paperwork.
The innovations are aimed at improving the quality of the evaluation methodology coroner in the debilitating state recognition and the homogenization of the criteria for medical examination at the territorial structures of the Institute.
To this end it is indispensabile potenziare - per i casi previsti dalle allegate linee guida formulate dal Coordinamento generale Medico Legale – il ricorso all’accertamento sanitario diretto sulla persona con l’obiettivo di verificare la sussistenza ovvero la permanenza dei requisiti sanitari, rendendo così definitivo il giudizio medico legale dei sanitari INPS, con il dichiarato obiettivo di evitare futuri disagi al cittadino conseguenti a successive verifiche sanitarie straordinarie.
Restano esclusi dalle nuove modalità sopradescritte i verbali sanitari validati fino alla data del 31.08.2010 e quelli per i quali è scaduto il termine dei 60 giorni dalla data di ricezione presso i CML, ai sensi dell’art. 1, comma 7 della legge n.295/1990
Therefore, those interested in this way will no longer be subjected to additional controls, unless expressly provided for rivedibilità situations or when required by law.
The completion of the health activities, both acts, whether as a result of direct assessment, must be done exclusively through computer procedures.
To give full effect to the foregoing, the leaders of the UOC / UOST should prepare, on the basis of reports submitted by local health authorities, the lists containing the names of citizens for whom the direct assessment was prepared in order to take measures suspension as soon as possible and to allow the contextual call to visit within 60 days of receipt of those reports and the subsequent definition of the outcome within 10 days from the date of execution of the visit, in case of failure to meet the outcome will be defined in the file by CMS, based on existing documentation.
Pending the release of the data processing system, which we will communicate with a special message from the DCSIT, spatial structures will still have to reply to the steps with written notification.
As already mentioned, the requirements pertaining to health should be guided by the operational guidelines prepared by CGML and attached to this message cui i medici dovranno attenersi.
In attesa del rilascio delle funzionalità della procedura di cui sopra, la formazione dei calendari con la spedizione degli inviti a visita dovrà avvenire con modalità non telematica a cura delle UOC/UOST competenti.
Relativamente alla compilazione del verbale di visita diretta, i medici dovranno utilizzare esclusivamente il formato elettronico che sarà a breve disponibile nella procedura INVCIV2010.
L’attività di verifica ordinaria sarà sottoposta tempestivamente, e comunque non oltre i successivi 15 giorni dalla data di effettuazione della visita, alla validazione agli atti ed al giudizio definitivo da parte della Commissione Medica Superiore, prima of the obligations of the relevant administrative offices and the final minutes before transmission to the public. Once the deadline referred to above, final assessment will be delivered by the competent territorial structure.
The verification of the ordinary, however, CMS will be implemented according to the selection criteria in relation to the evidence set out by the territorial CGML.
To ensure maximum transparency and efficiency of operations, it is essential the cooperation of the associations through the involvement of its doctors, as set out in paragraph 7, letter b, the circular n.131/2009.
Pending the issue of procedures computer, in addition to the requirements for suspension of action, are confirmed in the operating procedures relating to the validation of the minutes for all types not subject to direct assessment. Duties of the Administrative Offices
Offices will be expected to return to the Centre coroner records from 1 .9.2010 validated that have been submitted to CMS - when required by the guidelines CGML in "direct visit" - and on which is not the final decision of the latter.
Regarding the minutes relating to oncological diseases, for the liquidation of its benefits, continue to apply the provisions in the message 12857, 3.5.2006, subject to the need to define the validation process of the same.
are recommended to address local structures in accordance with the procedures and timing expected to allow a proper performance.
THE DIRECTOR GENERAL
Nori
OPERATING GUIDELINES IN DISABILITY CIVIL
BACKGROUND:
The need to ensure maximum uniformity in the national territory of the behaviors and ratings of physicians involved in disability 'civil prompted the General Medical Coordination Law to adopt the following guidelines. Reinforces this need also the finding of the will of the legislator, expressed in the Decree Law of 26 May 2010, converted into Law July 30, 2010, No 122, to invoke the responsibility of doctors who intentionally and falsely certifying a state of disease or disability resulting in payment of the remuneration of civil disability, blindness, civil, civil deafness, handicap or disability within the meaning of Article 5, paragraph 5, of Presidential Decree of 21 September 1994, n. 698 and paragraph 1 of Article 55-d of the Legislative Decree 30 March 2001, No 165, as amended. Article 10 of the said Act states that, subject to the criminal and disciplinary responsibility, ... the doctor is obliged to compensate the financial loss, equal to the amount paid in respect of the remuneration of civil disability, blindness, civil, civil deafness, handicap and disability periods for which it is established on the enjoyment by the beneficiary and the caused by damage to the image.
SOURCES REGULATIONS criteriology-EVALUATION:
subjects aged 'between 18 and 65:
the legislative requirements is Article 2 of Law March 30, 1971, No 23.11.1988 and 118 of Legislative Decree No 509. In the minds of law ... are invalids citizens with disabilities congenital or acquired, including a progressive nature, including the irregular nature of mental oligophrenia for organic or dysmetabolic, mental deficiencies resulting from sensory and functional defects have been reduced working capacity of not less than one third. The estimated time will be aimed at identifying: 1) the anatomical and functional permanent damage (Article 1 of Legislative Decree no. 509/1988: The congenital or acquired disabilities, referred to in Article 2, second paragraph of the Law of 30 March 1971 No. 118, include the outcome of permanent physical disabilities or mental and sensory impairments which involve a permanent functional impairment), 2) the ability to work, with reference to the so-called "aptitude"; 3) the reference to the system tables to compliance with the DM 05/02/1992.
The legislation, to use terms such as "clarity" and "accuracy" regarding the diagnosis and referring to the anatomical and functional damage permanent refers implicitly to the stringent targets typical of Forensic Medicine supported by adequate documentation and clinical instruments. Should be taken into account in this respect, the Guidelines for the evaluation of functional deficits, in the second part of the DM 05/02/1992.
E 'should be remembered that, as envisaged by the first part of the DM 5/2/1992, the report must be completed so that they are expressed with clarity as set out in the clinical diagnosis art. 1, paragraph 3, DL 509/88, the prognosis with particular regard to the permanence of disability and functional impairment, the percentage allocated to each disability based on the table and in case of multiple impairments, the overall assessment in the case of competition d ' or disability, the evaluation obtained by calculating the reductionist case of co-existence of disability, the possibility of application of prostheses and any change in the percentage related to it. It is recalled that in the case of illness expressly provided in the table you are required to strictly apply the relevant percentage, and where an range table must not resort to indiscriminate application the upper limit, which would produce an excess of the will of the legislator, but varying the percentage of second stairs gravity accredited. If, however, it is not tabulated illness is possible, because of the nature and severity, apply a similar criteria than the table. Are to avoid subjectivism and the use of evaluative criteria similar to the method uninformed coroner. Is useful to note in this regard, the legal framework within which it operates, in other words, if you are called to an assessment of the ability to work, it seems unreasonable to attribute, for example, with the scoring of the test analog obsessive psychosis (80% ) to a disorder Obsessive-compulsive personality of a person with normal or even high occupational functioning.
If so, very often, of multiple impairments is necessary to distinguish whether they are competitors , interesting that the same organ or system, or coexisting . In the first case it is recalled that, apart from the competition expressly provided in the table, you must undertake a comprehensive assessment that will be proportional to the percentage value assigned to a total loss of the organ system or anatomical and functional and, usually, will not be the mere arithmetic sum of individual percentages. It is recalled that in its Circular 14/1992, the then Ministry of Treasury urged application of the formula Gabrielli, in analogy with the system accident, where the degree of permanent reduction in earning capacity is compounded by pre-existing disability is not relevant to disability civil (war, work, service). The formula consists of a fraction where the denominator is the existing degree of working capacity evaluation (C) and the numerator the difference between this and the ability to work remaining after the impairment in disability support assessment (C '). D (damage indemnifiable) = CC '/ C . In the case of impairments competitors do not exist, however, an explicit reference to law the use of special formulas, unlike the provisions for co-existing disabilities, for which the calculation refers to DM 02/05/1992 reductionist.
A general method for the impairment level playing field may be the so-called Solomonic calculation, indicative of an intermediate value between the values \u200b\u200bobtained by calculating the sum of the reductionist and disabilities. Please note that impairments
inscribed between 0 and 10% can not be assessed in the overall assessment of disability unless they are competing with each other or with other disabilities related to a higher quality.
In the case of co-existing impairments, interesting distinct functional organs and systems, si procederà al calcolo riduzionistico mediante la seguente formula:
IT= IP1 + IP2 – ( IP1 x IP2 ) dove l’invalidità finale IT è uguale alla somma delle invalidità parziali IP1, IP2, diminuita del loro prodotto. Per tali finalità si rimanda alla funzionalità NEXTMATE presente in procedura.
E’ prevista la possibilità di applicare una variazione percentuale di cinque punti in più o in meno, ove si configuri una incidenza della menomazione sulle occupazioni confacenti alle attitudini del soggetto. L’aumento della variazione percentuale presuppone una accurata valutazione delle occupazioni confacenti alle attitudini del soggetto che può derivare unicamente a careful anamnestic investigation. E 'with the intention of the legislature, where they do not reveal negative effects of disability on the so-called semi-specific skills, apply the percentage change in the reductive sense. The parameters indicative of tabular work generic characteristics are strongly anchored to the world of work outstanding at the time of their enactment, which underlie the attribution of specific percentages of disability to individual disabilities. It 'obvious that the current arrangements for provision of work are qualitatively very dissimilar to those around 20 years ago informed the table still in force, obviously inspired to favor fewer accidents on a hypothetical average type of work done by hand. It can be assumed that the average working type "manual" has given way to a performance mode of opera's most technologically advanced, professionally qualified and the most engaging intellectual sphere, with parallel development of productive sectors previously minority (in particular those of services and service providers). It is therefore appropriate areas where the impairment involves mainly "manual" to consider the application of the percentage change in the reductive sense.
We would point out the need to clearly express the diagnoses and their codes and ICD-9 DM 5.2.1992, any indication revisions to the schedule specified month and year of review required, the occurrence of disease for which there is as provided by MD 2.8.2007, registration for each of the components of assessment "favorable" or "contrary."
must also avoid the abuse of the review of the instrument that may cause undue hardship to the citizen verbalizing, where necessary, the opinion contrary to rivedibilità. At a time when, in fact, we are called to speak about permanent damage to anatomical and functional review is justified only in situations of high dynamics or capable of any appreciable changes. Are covered in such cases the oncological diseases treated with chemo-radiotherapy, organ failure with the possibility of transplantation, developmental disorders.
CHILDREN:
Article. 2 of Law March 30, 1971, No 118 civilians are considered invalid. ... 18 years of age who have persistent difficulties in carrying out the tasks and functions typical of their age ... ... The duties and functions of its age should be construed broadly and should be considered "an integral part of developmental-maturational process of growth, personality structure, the acquisition of a "social role" (incorrect). Are being evaluated, Therefore, activities such as play, the ability to verbalize, for school, sports and recreation, social skills with adults and peers, etc ... .. The wording of legislation does not explicitly quantifies the difficulties but we must assume that they mean something valuable in the way of the person. It will be appropriate to refer, where possible, the second part of the DM 05/02/1992 where are the different levels of severity of functional deficits. The assessment is, according to established doctrine, comparative, it is, in other words, to report the problems to a standard model inspired by the tasks and functions performed by a peer in good health. To underline that the term "persistent" refers to a more flexible assessment of medical examiner than the term "permanent" as it is logical to expect in a context characterized by high dynamics typical age of growth. It should be noted that in the case of children over the age of compulsory schooling, you may want to make an assessment in order to allow the percentualizzata collocabilità assisted. We would point out that in cases with a high burden of care, exceptional compared to healthy peers, it is the carer's allowance for infants (see Judgement the Court of Cassation No 11329, 7.6.1991).
over sixty SUBJECT:
Article. 6 of Legislative Decree No. 509/1988 provides that ... only for social and health assistance and granting an attendance allowance shall be considered disabled or handicapped persons over sixty who have persistent difficulties in carrying out the functions and responsibilities of their age. The next Legislative Decree 124/1998 restored the percentualizzazione for these subjects must be referred to the duties and functions of their age. By directive of the Ministry of Health have defined three classes: 1) slight difficulties with disabilities including between 33.3% and 66.6% 2) difficulties with medium-severe disability between 66.6% and 99% 3), serious difficulties corresponding to 100%. About the duties and functions of both age groups is necessary to refer to all the activities of expectations, typical of the usual and lawful age into account. Given the less chance of functional compensation and adaptation, you should carefully consider the emendabilità of minorities with rehabilitative, restorative or surgery.
BLINDNESS 'MARITAL
legal status and economic benefits associated with blindness are normed by the civil law 382 of 1970, 508 1988, by legislative decree No 509 of 1988 and Law 138 of 2001. The combined legislation identifies the categories of totally blind, with a total lack of vision function and are not able to perceive the shape of objects, being able to experience the most change from shadow to light, and partially blind, those who identified as have a residual vision of not more than one-twentieth in both eyes with possible correction. Please note that any measurable residual vision (1 / 30, 1 / 50, etc.) means that there is a possibility to discriminate shapes and, therefore, a state of partial blindness. The classic definition above identify visual function with acuity central vision is established, since the function visiva contempla numerose altre capacità, come l’estensione del campo visivo, la stereopsi, la capacità di adattamento…ecc.., con la Legge 138 del 2001 il Legislatore ha inteso prendere anche in considerazione il campo visivo, presupponendo che oltre un certo livello di perdita di campo visivo vi sia una perdita della capacità di interagire con l’ambiente in modo autonomo. La legge definisce, quindi, ciechi totali coloro il cui residuo perimetrico binoculare è inferiore al 3 per cento e ciechi parziali coloro il cui residuo perimetrico binoculare è inferiore al 10 per cento. Da notare, ai fini della applicabilità della Legge 138/2001, che si prende in considerazione la perimetria binoculare e che il residuo perimetrico is expressed in percentage terms and not in degrees, depending on specific program perimeter. It should be noted in that forum, that the categories of ipoventi severe, medium severe and mild low vision set out in art.4, 5.6 of Law 138/2001 shall be assessed in terms of economic benefit under the headings in the tabular DM 92. It will be the medical assessor to ensure the reliability of specialized documentation submitted, requesting the necessary in doubtful cases electrophysiological examinations. Visual Evoked Potentials (VEP) el'Elettroretinogramma (PERG) can provide useful information, particularly if they provide answers completely unstructured (see item 11 of Decree 2 August 2007).
DEAFNESS 'MARITAL
The fundamental law in the field of deaf-mutism is the law 381 of 26/5/1970 provides that where article 1 is to be considered deaf " the sensory impairments of hearing deafness congenital or acquired during the time of growth that has affected the normal learning of spoken language, provided that the deafness is not a purely psychological, or dependent upon the cause of war, work or service ". The legal definition
raised problems of interpretation did not specify where the age limit of development, did not specify that deafness does not necessarily mean the absolute loss of hearing function, he quoted the speech impediment of ignoring the difficulties of language. The doubts have been cleared after evaluation by the Legislature with the MD of 02.05.1992, where it is stated that:
- the requirement of the auditory threshold is equal to or greater than 75 dB HTL medium at frequencies of 500, 100, 2000 Hz better ear;
- for the grant of the communication, the diction of "prelingual deaf" under Article 4 of Act 508 of 1988 is equivalent to the condition of "deaf" referred to ' article 1 of Law 381/1970;
- ... ... ... ... .. affected the normal learning of spoken language ... ... "should be understood that" ... ... hearing loss makes or has made difficult the normal learning of spoken language ... ... .... "
must be reported, also, Law No.95 of 20.2.2006 where it is stated that:
- in all the laws in force, the term "deaf" is replaced with the term "deaf"
- the second paragraph of art. 1 of Law 381/1970 is amended as follows: "For purposes of presente legge si considera sordo il minorato sensoriale dell’ udito affetto da sordità congenita o acquisita durante l’età evolutiva che gli abbia compromesso il normale apprendimento del linguaggio parlato, purchè la sordità non sia di natura esclusivamente psichica o dipendente da causa di guerra, di lavoro o di servizio.
Il DM 5.2. 1992 stabilisce che:
- qualora il richiedente non ha compiuto 12 anni, l’ipoacusia deve essere pari o superiore a 60 dB di media tra le frequenze 500, 1000 e 2000 Hz nell’ orecchio migliore;
- qualora il richiedente abbia superato i 12 anni l’ipoacusia deve essere pari o superiore ai 75 dB di media alle frequenze di 500, 1000 and 2000 Hz in the 'better ear;
- Recipients of communication with hearing loss under 75 dB at frequencies above average, fell from the enjoyment of the benefits when he turns 12 years old;
- audiometric examinations be carried out after the first year of age and shall include a statement of trust prepared by the medical examiner;
- must be attached must also examine impedance. In addition, the DM
5.2.1992 clarifying certain conditions listed below:
- in the case of conductive hearing loss or mixed, sensorineural hearing loss with timpanogramma pathological Meniere's disease, ..., we must consider at least three exams oto-functional score that results from their media. It 'also recommends a review every three years;
- evaluation should be done by ear without implants, we apply a theoretical reduction of 9% of disability for hearing loss that prosthesis can be considered are those from 245 db of loss in 'better ear;
there are cases where it is used subjective liminal tonal audiometry in dB HTL (Hearing Threshold Level), but only objective tests such as acoustic evoked potentials with values \u200b\u200bexpressed in dB SPL (Sound Level Pression) in which case you need to convert the dB HTL in dB SPL,, to sum up the loss in dB HTL at frequencies of 500, 1000, 200 Hz stimuli were used where they are characterized in frequency, multiply by 3 the value of the loss found and converted to db HTL where it was used a stimulus characterizable in frequency (in the case of "click evoked potentials). The key issue in evaluation of hearing loss is represented by civilian 'finding that' there is a causal relationship between deafness, onset in childhood, and the impairment of speech and detection of 'integrity for speech signals that would prevent other genesis deficit of language, in other words, the deficit linguaggio parlato deve discendere dal mancato uso del canale sensoriale fisiologico che è stato vicariato da altre modalità. ( vista, tatto…).
INDENNITA’ DI ACCOMPAGNAMENTO:
Giova ricordare l’art.1 della Legge n. 508/1998 : …L’indennità di accompagnamento è concessa: a) ai cittadini riconosciuti ciechi assoluti; b) ai cittadini nei cui confronti sia accertata una inabilità totale per affezioni fisiche o psichiche e che si trovino nella impossibilità di deambulare senza l’aiuto permanente di un accompagnatore o, non essendo in grado di compiere gli atti quotidiani della vita, abbisognano di una assistenza continua….E’ opportuno sottolineare alcune requisiti di legge quali l’impossibilità a deambulare, non la semplice difficoltà, il carattere di permanenza dell’aiuto dell’accompagnatore, non di saltuarietà. Va da sé che presidi ortopedici e protesici che rendano il soggetto autonomo nella deambulazione escludono il diritto all’indennità. Il requisito della permanenza implica la sussistenza di menomazioni anatomo-funzionali irreversibili e immodificabili da qualsiasi presidio. Per quel che concerne gli atti quotidiani della vita, constatando la genericità dell’espressione e in accordo con la prevalente dottrina medico legale, essi vanno intesi come quel complesso di attività che assicurano un livello basale di autonomia personale in un ambito mostly intradomiciliare. The extradomiciliari take into account the activities in complex environments such as modern metropolis, would, in fact, so extensive an evaluation as to overcome the medical office. Please remember that this legislation provides for the need of continued assistance from third parties for the materialisation of the medical legal requirement, it is intended that the term "continuous" refers to a service which is carried throughout the entire day and not only in odd moments. In a manner similar to the inability to walk unaided, the impossibility of completion of the independent daily acts of life refers to conditions Clinical non dynamic, non-upgradeable therapeutic or rehabilitative type and, therefore, irreversible and unalterable by any garrison, in this sense, the prescription of therapies that provide a time limit configured for the most part, a clinical impact in changing the functional can not be called "permanent".
useful reference points are the ADL (especially in describing the basic functions to be taken into consideration: washing, dressing, moving, sphincter continence and independence to the toilet, feeding) and IADL (emphasizing the most basic functions such as recruitment of medications and preparing meals), however, by eschewing schematics. Please remember, in fact, that these tools are created in a physiatrist and derive not only from a careful anamnesis, also from the direct and prolonged observation. It is worrying from the point of view coroner, translation outright scores of non-self-sufficiency, achieved simply by the anamnestic interview and not supported by adequate documentation and clinical instrumental in attendance allowance. In this regard seem to be more reliable instruments such as the Barthel index or index of Katz, used in Physiatric. Similar considerations can be made for the assessment of cognitive impairment, where are mechanically translated in forensic assessments scores obtained by MMSE. In the clinical setting and subsequently in the medical office, a diagnosis of cognitive impairment and its staging fee, in addition to full-blown cases, a careful investigation supported by modern scientific instruments (such as neuroimaging, neuropsychological battery of standardized tests, PET ...) . It seems appropriate in these cases use the appropriate expertise to identify, in our opinion, those in neurological or neuropsychological. A call to the coroner this distinction is essential, given the responsibility of the physician's mentioned in the introduction, for psychiatric illness. The field of psychiatry in fact to many problems, eg not yet reached the uniformity of language about the diagnosis, the use of obsolete terms in the table of DM 05/02/1992, the frequent ambiguity of clinical documentation attached. It is the responsibility of the physician to adhere strictly to objectivity detected, with the possible aid specialist, using the reliable information obtained about current treatment, the overall level of operation as outlined in the scale of the DSM IV, the modern testistica accredited.
VISIT DIRECT :
It reaffirms the provisions of Circular No. 131 of 28.12.2009. The medical examination will be conducted by a committee consisting of INPS doctor, with functions President, stated the Head of the CML and the other component of the Integrated Medical Commission, upon whom the final assessment and a medical representative of the associations (ANMIC, ENS, UIC, ANFASS) and social operator in the cases provided by law . The Medical Board may draw on the advice of a medical specialist in the disease being evaluated which will support functions are not, therefore, the final decision. It is recalled that in the absence of the medical representative of the category, despite regular meeting, the Medical Board should be constituted with another doctor INPS.
The Medical Board is required to comply with the instructions of the DM 02/05/1992 above.
It should be noted that the direct medical examination is to be considered a priority in order to ensure consistency and transparency of the process evaluation methodology and consequent medical-legal proceedings. This especially in cases where there is evidence of a severe mental and physical disability from which welfare benefits.
Under these conditions, ensuring uniformity in the opinions expressed on the medico-legal area is the definitive validation of the CMS.
the provision of direct visits, however, must be avoided automatically.
Possible causes of exclusion are discernible in the following cases:
- Casi in cui si è proposta l’applicazione del DM 2 Agosto 2007, ove siano rispettati i requisiti previsti dalle singole voci;
- Minori con patologie validamente documentate soprattutto concernenti la sfera psichica o con patologie di tipo genetico-malformativo;
- Soggetti inseriti in strutture di lungodegenza o in residenze protette;
- Soggetti interdetti;
- Soggetti di interesse geriatrico con perdita dell’autonomia personale adeguatamente documentata; pur ritenendo ingiustificato assimilare l’anzianità a condizione di patologia, si deve considerare che la prevalenza della demenza raddoppia approssimativamente ogni 5 anni di età tra i 65- 85 anni. Appare opportuno, quindi, evitare accertamenti diretti indiscriminati soprattutto nei casi in cui emerga chiaramente la presenza di un caregiver dedito all’anziano, che del resto dovrebbero essere ricompresi dal DM 2 Agosto 2007;
- Patologie neoplastiche di comprovata gravità.
