正确理解和应用评残等级标准

<正> 正确理解和应用评残等级标准直接关系到有关部门确定经济赔偿和定罪量刑。本文作者认为,在实际检案工作中,评残等级标准的有些条款值得商榷,并应制定出实施细则。1 评残等级标准的现状和分级原则 目前国内较为系统的评残等级标准有《道路交通事故受伤人员伤残评定》(GA35—1992),《职工工伤与职业病致残程度鉴定》(GB/T16180—1996),《革命伤残军人评定伤残等级的条例》(民[1989]优字18号)等,其中常用的是《道路交通事故受伤人员伤残评定》和《职工工伤与职业病致残程度鉴     

浅析视力减弱补偿率在伤残等级评定中的应用

法医在评定外伤性视力障碍残级时,通常参照《职工工伤与职业病致残程度鉴定》标准ＧＢ/Ｔ16180-1996(下称《工伤鉴定》标准),该标准的适用对象是职业工伤或职业病致残者,职业病致残多数为双眼视力障碍。法医鉴定人在使用该标准时,经常出现鉴定人掌握标准不统一、使用鉴定标准时自由裁量权扩大和同一情况使用不同条款、得出不同结论等混乱现象。如例1:某人伤前双眼视力均为12,外伤导致左眼视神经萎缩,视力下降至02,数家法医分别参照《工伤鉴定》标准八级8条和九级11条的规定,作出了八级伤残和九级伤残的不同结论,形成鉴定争议。笔者在鉴定实…     

浅析视力减弱补偿率在伤残等级评定中的应用

法医在评定外伤性视力障碍残级时,通常参照<职工工伤与职业病致残程度鉴定>标准GB/T 16180-1996(下称<工伤鉴定>标准),该标准的适用对象是职业工伤或职业病致残者,职业病致残多数为双眼视力障碍.法医鉴定人在使用该标准时,经常出现鉴定人掌握标准不统一、使用鉴定标准时自由裁量权扩大和同一情况使用不同条款、得出不同结论等混乱现象.如例 1:某人伤前双眼视力均为1.2,外伤导致左眼视神经萎缩,视力下降至0.2,数家法医分别参照<工伤鉴定>标准八级8条和九级11条的规定,作出了八级伤残和九级伤残的不同结论 ,形成鉴定争议.     

伤残评定标准及赔偿方式的比较研究

目的比较目前司法实践中常用的伤残评定标准及赔偿方式,以揭示目前我国人身伤害民事赔偿中存在的现实问题。方法时目前司法实践中常用的工伤标准、交通标准、普通伤害标准三大标准的内容进行比较;对与上述三大标准相对应的赔偿方式进行比较。结果（1）就标准的内容来看：三大标准中伤残条款的设立、级剐有显著的区别,同种损伤依据不同的标准评定,其伤残评定结果差异明显,“同伤不同残”现象较为普遍。（2）就标准的宽严尺度来看：工伤标准宽泛,门槛低,级别评定较高;而交通、普通伤害两个标准严格．门槛高,较轻的损伤不易评定为残疾。（3）就标准的架构来看：工伤标准、普通伤害标准在架构上严谨;而交通标准不够严谨,分级过于简单且涵盖内容不全。（4）就标准的强制力来看,交通标准为国家强制标准,级别最高．工伤标准其次,为国家推荐标准。普通人身伤害标准级别最低,目前尚无全国统一的标准;有的省适用自制标准（如江苏、北京）,有的省适用工伤标准,有的省适用交通标准,其效力常常遭到质疑。（5）就三种损伤类型的赔偿体系来看：赔偿方式各不相同,赔偿额差距显著,“同伤不同价”现象突出。因为目前全国没有统一的普通人身伤害标准．地方对伤残标准及赔偿方式的应用极为混乱,有的地方以宽松的残疾标准（如工伤标准）评定伤残,再配以目前普通伤害案件宽松的赔偿方式,其结果是赔偿额大幅增加,造成明显的司法不公。结论上述问题的解决应从伤残评定的医学标准着手,目前急需制定一部适用于普通伤害的残疾评定标准,这样可以确保在每一赔偿体系中,均存在与其相配套的医学评定标准,以避免因鉴定标准的不同引发的司法不公。     

伤残程度临床法医学评定的有关问题

在刑事附带民事和民事人身损害赔偿案件中，经常遇到伤残程度的法医学评定。现将伤残程度存在的问题讨论如下。1．适用标准。伤残程度的评定，现已有《职工工伤与职业病致残程度鉴定》、《道路交通事故受伤人员伤残评定》、《革命伤残军人评定伤残的条件》、《人身保险意外伤害残废给付标准》、《全国残疾人抽样调查五类（残疾标准）》等标准，其中只有《职工工伤与职业病致残程度鉴定》为国家标准，其余均为行业部门标准。上述标准分别适用于工伤、职业病、道路交通事故受伤人员、现役军人因战、因公负伤致残、人身保险意外伤害残废以及残…     

试论伤残鉴定标准的不均衡性

我国现行的伤残鉴定标准，诸如《道路交通事故受伤人员伤残评定标准》(以下简称《道标》)、《职工工伤与职业病致残程度鉴定标准》及各省制定的《人体损伤致残程度鉴定标准》等，在依据标准进行伤残评定中往往存在伤残等级不能完全反映伤者实际状况，或同样的伤残等级的个体状况存在明显差异，给实际处理带来很大的困惑，往往产生矛盾，增加了实际检案的难度。究其原因是伤残标准存在不均衡性。     

浅谈法医临床鉴定中的精神障碍问题

正近年来,随着法医鉴定行业的日趋规范,各省市纷纷出台有关法医临床司法鉴定的执业指引文件,其中多个省市如广东省的指引中关于涉及精神损伤(伤残)的鉴定,明确规定"关于道路交通事故、工伤与职业病、其他人身损害所致的伤残评定,如涉及精神损伤(伤残),法医临床鉴定机构只对躯体伤残等级进行鉴定;法医临床鉴定机构不能就精神损伤(伤残)进行鉴定"。由此可见,法医临床鉴定和法医精神鉴定在鉴定业务范围有鲜明的"分水岭"。     

骨折内固定的后遗效应及对人体四肢功能的影响

近些年来,随着城乡道路基础设施及机动车辆的迅猛发展,道路交通事故以及由此导致的人身伤害案比例也逐年递增,具有鉴定资格的法医依照《道路交通事故受伤人员伤残评定》标准对有关受伤人员作出伤残等级评定的结论无疑是赔偿及各种诉讼活动的法律依据并直接影响到其结果,完备的国家标准是法医正确进行伤残评定的前提条件。肢体骨与关节损伤在道路交通事故中最为多见,在伤残评定中所占比例也大,新的交通事故伤残评定国家标准在诸多方面进行了修改和完善,尤其对肢体功能丧失程度的计算给出了各关节在肢体功能中的权重指数,有较强的可操作性。但…     

视力减弱补偿率研究

正视功能损伤是伤残评定常见内容之一,我国有关标准多采用损伤述明规定,而在法医伤残评定中,由于损伤复杂多样性,往往因有多个标准可适用,而出现鉴定意见不确定。国标GB/T 16180—2006《劳动能力鉴定职工工伤与职业病致残等级》(下称《工伤》标准)规范性附录A.8规定:视力减弱补偿率是眼科致残评     

无晶体眼视觉功能评价及伤残鉴定方法分析

由于我国刑法和民法有关条款涉及“残疾”、“严重残疾”、“残疾赔偿金”等问题,要求法医对被鉴定人进行残疾等级鉴定,目前大多数法医参照《职工工伤与职业病致残程度鉴定》(以下简称工伤标准)执行。参照工伤标准对眼损伤进行残疾等级鉴定过程中,我们发现在工伤标准有关无晶体眼评残条款中存在误区,执行时对有关条款理解意见不一,给鉴定带来一定的困难,我们在制订我省《人体损伤致残程度鉴定标准》时对这些误区进行了分析研究,现将我们的分析意见、建议方案提供出来,与大家共同探讨。无晶体眼视觉损害程度评价方法之观点在工伤标准附录Ｃ36…     

道路交通事故颅脑损伤的法医学鉴定

目的　研究道路交通事故中颅脑损伤的类型、特点、主要并发症及其受伤人员的伤残评定。方法　 862例道路交通事故颅脑损伤的案例资料 ,按伤者受伤的不同部位、有无并发症、并发症的类型及伤残程度进行统计分析。结果　复合性颅脑损伤 2 76例 ,脑挫伤 192例 ,颅骨骨折 79例 ,颅内出血 91例 ,头皮外伤 2 2 4例 ;主要并发症为脑积水 ( 19例 ,2 2 0 % )、癫痫 ( 16例 ,1 86% )、偏瘫 ( 14例 ,1 62 % )、植物人状态 ( 12例 ,1 3 9% )。结论　道路交通事故中颅脑损伤 ,以头部复合性损伤最多见 ,严重的脑挫伤为最常见的损伤类型 ,并发症的诊断应掌握诊断标准 ,并注意与相关疾病鉴别。     

道路交通事故死者MSCT扫描与尸体解剖结果的比较

目的使用多层螺旋CT(MSCT)对道路交通事故中死者的损伤进行观察分析,探索MSCT在道路交通事故鉴定中的应用价值。方法对10例道路交通事故死亡者进行全身MSCT扫描,随后进行系统尸体解剖,并将两者的结果进行对比,分析两者在获取交通事故损伤信息方面的优点和不足。结果 MSCT可以清晰显示身体各部位骨折三维形态特征,并可检查到全身各部位的积气,相对于尸体解剖优势明显;但对于器官和软组织损伤的检测,MSCT的分辨率有限。结论对于道路交通事故死者,确定死亡方式和死亡原因的最好方法是联合进行MSCT检查和尸体解剖。     

再现技术在道路交通事故鉴定中的应用

事故再现是近年来交通安全领域研究的热点和难点,利用再现技术重建事故发生的碰撞瞬间及人体运动过程,对于法医分析交通伤致伤方式、损伤特点等具有重要价值。本文从我国道路交通事故鉴定的现状入手,通过对再现技术相关碰撞试验、假人模型和碰撞模型等的介绍,探讨事故再现技术在道路交通事故鉴定中的应用前景,进一步为事故责任认定服务。     

Fulfilling the bargain: how the science of ergonomics can inform the laws of workers' compensation

In the last decade, cumulative trauma disorders have become a significant percentage of reported workplace injuries and litigated workers' compensation claims. Arising from the accumulated impact of daily work activities on the body, these injuries do not fall neatly within either the "accident" or "disease" categories which comprise workers' compensation laws. As a result, courts and legislatures have struggled to properly evaluate workers' compensation claims for these injuries. This Note looks at the legal treatment of cumulative trauma injuries in light of the "original bargain" of workers' compensation, where workers give up a tort remedy against their employers in exchange for guaranteed, but limited, compensation for work-related injuries. In doing so, this Note undertakes a comprehensive comparison of litigated cumulative trauma cases in the tort and workers' compensation systems. Ultimately, this Note argues that judges must use the original bargain as an interpretive less when deciding cumulative trauma cases, and points to ergonomics--the science of the workplace--as a significant new tool for determining whether such injuries are work-related.     

限制性体位窒息死亡的法医学鉴定

限制性体位窒息是一种特殊类型的窒息,其死亡机理、过程复杂,体表损伤轻微,尸体表现缺乏特异性,鉴定难度大,目前还没有一个客观、准确、公认的鉴定标准,通过文献复习总结有关体位性窒息的研究成果,结合窒息死亡的组织病理改变和鉴定实践,提出限制性体位窒息的检验鉴定要点,在确定有长时间限定在某一影响呼吸的体位,且自己不能解脱;有明显的窒息尸体征象;排除损伤、疾病致死;常见毒物检测阴性;膈肌Fn免疫荧光检测阳性或透射电镜检查证明有膈肌损伤的可以诊断。如果合并有损伤或疾病,还应该有肺SP-A检查阳性或HIF1-α免疫组化染色核阳性表达。某些特定部位的损伤检查有助于分析体位关系。     

Application of 3D documentation and geometric reconstruction methods in traffic accident analysis: with high resolution surface scanning, radiological MSCT/MRI scanning and real data based animation

The examination of traffic accidents is daily routine in forensic medicine. An important question in the analysis of the victims of traffic accidents, for example in collisions between motor vehicles and pedestrians or cyclists, is the situation of the impact. Apart from forensic medical examinations (external examination and autopsy), three-dimensional technologies and methods are gaining importance in forensic investigations. Besides the post-mortem multi-slice computed tomography (MSCT) and magnetic resonance imaging (MRI) for the documentation and analysis of internal findings, highly precise 3D surface scanning is employed for the documentation of the external body findings and of injury-inflicting instruments. The correlation of injuries of the body to the injury-inflicting object and the accident mechanism are of great importance. The applied methods include documentation of the external and internal body and the involved vehicles and inflicting tools as well as the analysis of the acquired data. The body surface and the accident vehicles with their damages were digitized by 3D surface scanning. For the internal findings of the body, post-mortem MSCT and MRI were used. The analysis included the processing of the obtained data to 3D models, determination of the driving direction of the vehicle, correlation of injuries to the vehicle damages, geometric determination of the impact situation and evaluation of further findings of the accident. In the following article, the benefits of the 3D documentation and computer-assisted, drawn-to-scale 3D comparisons of the relevant injuries with the damages to the vehicle in the analysis of the course of accidents, especially with regard to the impact situation, are shown on two examined cases.     

Ankle joint injuries as a reconstruction parameter in car-to-pedestrian accidents

The study has assessed the usefulness of ankle joint injuries for deducing about the presumable location of a pedestrian in relation to a motor vehicle at the moment of collision. A statistically significant correlation was found between the direction of impact and the mechanism of ankle joint injuries. Such injuries were found in 113 of 317 pedestrian, fatal victims of road traffic accidents (36%). In the cases of impacts on the medial surface of the lower limb, the injuries associated with the supination mechanism were six times more frequent than the injuries associated with the pronation mechanism, while in the group of impacts on the limbs from the lateral side those connected with the pronation mechanism were four times more frequent. In victims hit from the back, the injuries connected with the plantarflexion mechanism were found almost four times more frequent than the dorsiflexion mechanism and in victims hit from the front in three of the five damaged joints the dorsiflexion component was observed (without any plantarflexion case). Less frequent "pronation injuries" in the limbs hit from the medial side and "supination injuries" in the limbs hit from the lateral side as well as "dorsiflexion injuries" in victims hit from the back predominantly occurred in impacts to the pelvic area, i.e. resulting from collisions with a van or lorry. Injuries of upper ankle joints are, thus, useful for reconstructing the presumable location of the pedestrian in relation to the vehicle at the moment of collision, especially, when the vehicle involved in the accident is known.     

Not by accident: An analytical approach to traffic crash harm reduction

Purpose

This study examines whether a problem-oriented approach used by police in Cincinnati, Ohio called the Crash Analysis Reduction Strategy (CARS) corresponded with a change in the number of traffic crashes that resulted in injuries after implementation onset. Under the CARS model, police developed tactics that focused on targeting high-risk driving behaviors, impaired drivers, and crash hotspot locations within the city.

Methods

Using a two-phase strategy we first assess local impact by examining injury-related traffic crash patterns at targeted locations. Second, we examine whether traffic crashes that resulted in injuries in Cincinnati significantly diverged relative to similar outcomes across a number of comparison sites.

Results

Difference-in-difference negative binomial regression analyses indicates that traffic crashes were significantly lower in Cincinnati - down roughly 5.7% to 10.3% in the post-intervention period - when contrasted with comparison sites.

Conclusions

Our findings suggest that comprehensive problem solving approaches can significantly reduce the risk of life changing events such as automobile crashes that result in injuries beyond traditional policing efforts that explicitly focus on crime and violence.     

交通事故致胸、腰椎损伤致残等级评定447例分析

目的探讨车祸致胸、腰椎损伤程度与伤残程度的关系,总结伤残评定经验,探寻其规律性。方法选择胸、腰椎损伤的鉴定447例,重新审查诊断,分析治疗措施,评价胸腰部活动度丧失程度及神经功能障碍情况,分析损伤程度与后遗障碍之间的关系,综合评定伤残。结果胸、腰椎损伤类型及数量并不决定其胸、腰部活动障碍程度及神经损伤后遗症严重程度;椎体损伤的部位与胸腰部活动度障碍关系密切;神经损伤主要集中在T1至L2段脊柱损伤;椎体损伤医院误诊率较高。结论伤残评定应分析损伤与后遗症严重程度的因果关系,以损伤所致后遗症为评残依据,重点关注脊柱功能的丧失程度。     

道路交通事故伤残状况及其影响因素

目的研究道路交通事故致残的流行病学特点,为预防道路交通事故伤害提供科学依据。方法对2004年7月至2007年12月间深圳市5100例交通事故伤残人员的资料进行回顾性分析,统计研究伤残者的性别、年龄、交通方式、事故地域、致残部位、损伤时间、是否复合伤残等特点。结果在本组伤残人员中,男、女性比例为2.15：1;以青年、中年年龄段比例为最大,占90.3%;交通方式中以自行车、步行为多,共占57.9%;不同年龄段、不同性别和不同地域伤残者的交通方式存在明显差异;损伤部位中以下肢损伤比例为最高,其次为颅脑损伤,但重残多分布于颅脑、脊柱损伤。结论有必要针对不同人群、不同地域、不同交通方式,采取不同的预防措施。