Administrative compensation of medical injuries: a hardy perennial blooms again

Periods in which the costs of personal injury litigation and liability insurance have risen dramatically have often provoked calls for reform of the tort system, and medical malpractice is no exception. One proposal for fundamental reform made during several of these volatile periods has been to relocate personal injury disputes from the tort system to an alternative, administrative forum. In the medical injury realm, a leading incarnation of such proposals in recent years has been the idea of establishing specialized administrative "health courts." Despite considerable stakeholder and policy-maker interest, administrative compensation proposals have tended to struggle for broad political acceptance. In this article, we consider the historical experience of administrative medical injury compensation proposals, particularly in light of comparative examples in the context of workplace injuries, automobile injuries, and vaccine injuries. We conclude by examining conditions that may facilitate or impede progress toward establishing demonstration projects of health courts.     

从侵权角度看保险人的恶意拒赔——以美国保险法中的恶意侵权为例

在美国,保险人没有合理的基础却恶意地拒赔或拖赔被保险人的索赔时,可以适用恶意侵权责任对其进行规制。该责任是以合同中当事人应善意而公平交易的默示约定为基础的,它于合同之外而构成独立的侵权责任。恶意侵权责任最早见诸于第三方保险之中,其后扩展到第一方保险,表现为保险人将自己的利益凌驾于被保险人之上而拒绝赔付保险索赔或者拒绝与第三方原告进行和解,因而造成被保险人的损失。在责任范围上,恶意侵权责任包括保险金、律师费、精神损害赔偿和惩罚性赔偿等。尽管还没有得到完全一致的认可,但是保险人的恶意侵权责任在美国已经得到了长足的发展,对于我国实践也有借鉴意义。     

Compensating victims for harms caused by pollution and other hazardous substances: a comparison of American and Japanese policies

This paper reviews recent American proposals to reform the system for compensating victims of pollution and compares them with the Japanese approach. American proposals fall into three categories: balanced approaches that combine administrative relief with tort reform; proposals that would provide administrative relief but eliminate tort remedies; and proposals to reform tort law which have nothing to say about administrative relief. While American policy-makers are still groping for a solution, in Japan tort law changes provided the rationale for a system of administrative relief that preserves the victims' right to sue. While the Japanese approach is not perfect, the early development of a policy reduced legal and political uncertainties and provided a stable environment for economic growth.     

论纯粹经济损失的概念

纯粹经济损失概念的意义在于构建一个过滤可赔偿损害的特别法律范畴。纯粹经济损失概念产生的历史缘由为近代法确定的以有形财产为基础的损害赔偿制度。从法技术的维度看,纯粹经济损失概念的产生是德国侵权法以绝对权为基础确定严格限定的可赔偿损害范围模式的直接结果,非限定性的法国模式没有也不需要这一概念。纯粹经济损失概念在法律政策上有以下重要意义：将受害者与他人利益联系切断,而＂塑造一个利益独立的个人＂;为维护行为人的自由而免除加害人过重的负担;改变投射损失的光源点而大幅度地缩小可请求赔偿的间接损失范围,扩大不可赔偿的纯粹经济损失范围。我国损害赔偿法对纯粹经济损失的立法应采德国模式和法国模式的混合模式。     

Decriminalisation of abortion performed by qualified health practitioners under the Abortion Law Reform Act 2008 (Vic)

In 2008, the Victorian Parliament enacted the Abortion Law Reform Act 2008 (Vic) and amended the Crimes Act 1958 (Vic) to decriminalise terminations of pregnancy while making it a criminal offence for unqualified persons to carry out such procedures. The reform legislation has imposed a civil regulatory regime on the management of abortions, and has stipulated particular statutory duties of care for registered qualified health care practitioners who have conscientious objections to terminations of pregnancy. The background to, and the structure of, this novel statutory regime is examined, with a focus on conscientious objection clauses and liability in the tort of negligence and the tort of breach of statutory duty.     

侵权行为之债及其立法路径辨析

侵权行为之债的路径为罗马法所开辟,该路径为多数国家的立法所接受。侵权行为之债有其独特性,发挥着缓解、调整和保护复杂社会关系的价值功用。债在我国有其存在的社会法律和思想文化基础,侵权行为之债的路基宽广厚实、安全可靠、科学合理,并可不断拓展和加载新的容量,有利于中国民法法典化。侵权行为之债的路径不是赔偿损失的狭路窄道,而是坚实广阔的光明大道,可以承载侵权行为的一般规则和条件、各类侵权行为及责任方式、一般侵权行为类型和特殊侵权行为类型等内容。     

中国侵权法四十年

改革开放至今四十年,中国侵权法立法与司法解释的制定经过了四个发展阶段,当下正在进行的是作为第四个阶段的民法典分编侵权责任编的编纂。四十年来,中国侵权法的研究也取得了丰硕的成果,出版了大量的教科书、体系书与专著,也翻译了不少美国、日本以及欧洲的重要侵权法著作。理论创新方面,主要体现在侵权法与债法分离、一般条款理论、违法性与过错的关系、相当因果关系说的引入、多数人侵权责任体系的建构与完善、死者人格利益的保护、安全保障义务理论、医疗损害责任的统一、机动车交通事故责任以及损害赔偿法等方面。     

Is there an acceptable answer to rising medical malpractice premiums?

This article explores the key issues involved in the attempts at reform of the present medical malpractice system. Investigating the effects that federal tort reform legislation would have on physicians, patients, lawyers, and the medical malpractice insurers, Dr. Gunnar succinctly outlines the issues surrounding the present "crisis in healthcare" and explores the separate interests involved. The article examines the economic forces influencing the medical malpractice insurance industry, reviews previous tort reform, and predicts the future of federal tort reform legislation. Dr. Gunnar concludes by proposing alternatives for malpractice reform.     

The Standardisation of Tort Damages

This article explores the nature, scope, rationale and merits of the standardisation of compensatory damages in tort law, ie the fact of giving the claimant not the value (subject to ordinary limiting principles) of his own loss, but that of the loss which an ordinary claimant placed in the same circumstances would have suffered. Standardisation happens in respect of pecuniary and non‐pecuniary losses, direct and consequential losses, and also normative losses. Its two main spurs are either that the orthodox award would not give the desired result—typically ‘too little’ damages—or that it runs into evidentiary difficulties, which the award of a typical sum overrides. While epistemic standardisation (which is not strictly standardisation) might be acceptable, the avowed granting of compensatory damages which do not aim to correspond to the claimant's own loss should be resisted, and is in any event impossible because consequential losses can never be meaningfully standardised.     

Whither Suffering? The Potential Impact of Tort Reform on the Emotional and Existential Healing of Traumatically Injured Chronic Pain Patients

Approximately half of the state legislatures in the USA have enacted tort reform, generally focused on reducing noneconomic damages such as those awarded for pain and suffering of traumatically injured parties. Traumatic injury has been empirically associated with the development of chronic pain, which in turn has been associated with the concept of human suffering. This analysis examines the meaning of suffering within the context of traumatically induced chronic pain, recognizing that this population is at heightened risk of experiencing long-term emotional as well as physical pain. Factors contributing to profound suffering include the potential development of post-traumatic stress disorder, depression and anxiety, role/identity loss, maltreatment by a medical system generally inept in its management of chronic pain, and the negative manner in which personal injury victims are often treated by the legal system. While the American medical system struggles to identify suffering, the legal system—through tort reform—has chosen to simply ignore it, demonstrating little concern for the integrity of the vulnerable chronic pain sufferer. In doing so, the “destructed” chronic painient is further “deconstructed”. We argue that by limiting the size of settlements and jury awards, tort reform serves to potentially deny personal injury victims of a critical vehicle for finding meaning in their suffering, and accordingly limits their likelihood of achieving relief.     

Tort Reform and Manufacturer Payout - An Early Look at the California Experience*

Manufacturers actively lobbied in the 1980s for legislative intervention in the tort system that would ease the burden on defendants in products liability cases. In response, all states enacted some type of general tort reform. California eliminated joint and several liability for noneconomic damages with the approval by voters in 1986 of Proposition 51. This paper evaluates the effectiveness of the California reform on manufacturer outcomes in products liability cases. The results suggest that manufacturers are paying a lower proportion of plaintiff awards than they would have in the absence of Proposition 51.     

Medical liability and health care reform

We examine the impact of the Affordable Care Act (ACA) on medical liability and the controversy over whether federal medical reform including a damages cap could make a useful contribution to health care reform. By providing guaranteed access to health care insurance at community rates, the ACA could reduce the problem of under-compensation resulting from damages caps. However, it may also exacerbate the problem of under-claiming in the malpractice system, thereby reducing incentives to invest in loss prevention activities. Shifting losses from liability insurers to health insurers could further undermine the already weak deterrent effect of the medical liability system. Republicans in Congress and physician groups both pushed for the adoption of a federal damages cap as part of health care reform. Physician support for damages caps could be explained by concerns about the insurance cycle and the consequent instability of the market. Our own study presented here suggests that there is greater insurance market stability in states with caps on non-economic damages. Republicans in Congress argued that the enactment of damages caps would reduce aggregate health care costs. The Congressional Budget Office included savings from reduced health care utilization in its estimates of cost savings that would result from the enactment of a federal damages cap. But notwithstanding recent opinions offered by the CBO, it is not clear that caps will significantly reduce health care costs or that any savings will be passed on to consumers. The ACA included funding for state level demonstration projects for promising reforms such as offer and disclosure and health courts, but at this time the benefits of these reforms are also uncertain. There is a need for further studies on these issues.     

人身侵权债权在破产清偿顺位中优先受偿之思辩

在调整人身侵权债权的各种制度中,为人身侵权债权在破产清偿顺位中找寻优先清偿点是次优制度选择,因为无论人身侵权债权定位在哪一个清偿层面都是后序债权人为破产企业的非法行为买单。为此,在其他法律制度足以保护人身侵权债权人权益的前提下,在破产清偿顺位中为人身侵权债权人设置优先受偿权实属不必要。但是其他法律制度不足以保护人身侵权债权人的权益时,我们可以考虑在破产清偿顺位中采用将人身侵权债权与劳动者债权同序的方式来保护人身侵权债权人的合法权益。     

State Legislative Solutions to Silica/Mixed-Dust Claims

Ohio has enacted comprehensive silica and mixed-dust legislation in an effort to prevent these claims from becoming the latest mass tort. The legislation attempts to eliminate the use of experts who spend the majority of their professional time providing medical and exposure consulting services to the plaintiffs' bar. By avoiding the worst abuses of the asbestos tort system and requiring individuals to establish certain minimum medical criteria before pursuing a personal injury claim, the Ohio legislation serves as a model for comprehensive state and federal tort reform legislation.     

Moral theories of torts: Their scope and limits: Part I

One approach to legal theory is to provide some sort of rational reconstruction of all or of a large body of the common law. For philosophers of law this has usually meant trying to rationalize a body of law under one or another principle of justice. This paper explores the efforts of the leading tort theorists to provide a moral basis — for the law of torts. The paper is divided into two parts. In the first part I consider and reject the view that tort law is best understood as falling either within the ambit of the principle of retributive justice, a comprehensive theory of moral responsibility, or an ideal of fairness inherent in the idea that one should impose on others only those risks others impose on one. The second part of the paper distinguishes among various conceptions of corrective or compensatory justice and considers arguments — including previous arguments by the author himself — to the effect that tort law is best understood as rooted in principles of corrective justice. This paper argues that although the use of principles of justice may render defensible many (but by no means all) of the claims to repair and to liability recognized in torts, it cannot explain why we have adopted a tort system as the approach to vindicating those claims. Some other principle — probably not one of justice — is needed to explain why it is that the victims claims to repair is satisfied by having his losses shifted to his injurer — rather than through some other means of doing so. The paper concludes that the law of torts cannot be understood — in the sense of being given a rational reconstruction — under any one principle of morality.     

《民法典》环境侵权惩罚性赔偿制度之功能剖辨

《民法典》侵权责任编第1232条规定的环境侵权惩罚性赔偿制度,是一项新增制度.从内在机理审视,惩罚主义理论或功利主义理论均难以为环境侵权惩罚性赔偿制度的"惩罚"功能提供理论支撑.从规则体系审视,若赋予该制度"惩罚"功能,则错置了侵权责任的保护客体,混同了生态环境保护中私法机制与公法机制,忽视了"环境损害"救济法律机制体...     

Moral theories of torts: Their scope and limits: Part II

One approach to legal theory is to provide some sort of rational reconstruction of all or of a large body of the common law. For philosophers of law this has usually meant trying to rationalize a body of law under one or another principle of justice. This paper explores the efforts of the leading tort theorists to provide a moral basis - in the sense of rational reconstruction based on alleged moral principles - for the law of torts. The paper is divided into two parts. In the first part I consider and reject the view that tort law is best understood as falling either within the ambit of the principle of retributive justice, a comprehensive theory of moral responsibility, or an ideal of fairness inherent in the idea that one should impose on others only those risks others impose on one. The second part of the paper distinguishes among various conceptions of corrective or compensatory justice and considers arguments — including previous ones by the author himself — to the effect that tort law is best understood as rooted in principles of corrective justice. This paper argues that although the principles of justice may render defensible many (but by no means all) of the claims to repair and to liability recognized in torts, it cannot explain why we have adopted a tort system as the approach to vindicating those claims. Some other principle — probably not one of justice — is needed to explain why it is that the victim's claim to repair is satisfied by having his losses shifted to his injurer — rather than through some other means of doing so. The paper concludes that the law of torts cannot be understood — in the sense of being given a rational reconstruction — under any one principle of morality.     

再论传染病传播者的民事责任

传染病传播行为首先是一种会损害他人身体健康的行为,对此种行为的民事责任问题缺乏规范,不仅使受害者所受损害得不到救济,而且也不利于传染病防治立法目的的实现。传染病传播者所承担的民事责任,在性质上主要是一种侵害自然人健康权的侵权责任,其归责原则和构成要件,应在遵循侵权法基本原理的前提下,结合传染病传播侵权行为的特殊性予以确定。     

Getting the Big Picture on Nanotechnology Insurance Issues: Addressing Coverage Issues for Long Tail Claims Can Help Prevent Big Headaches

The possible applications of nanotechnology seem limitless and span across a wide variety of industries including manufacturing, agriculture, environment, pharmaceuticals, health care, security, information technology, communications, energy, chemicals, and even space exploration. However, the potential loss scenarios could go far beyond anything experienced to date and could bring about a new dimension in personal injury, property damage, and third-party liability risks.

Insurers and re-insurers have been keeping a close eye on the development of nanotechnology. Of particular concern is the prospect that nanotechnology may give rise to “long tail” liabilities such as the asbestos, environmental, and toxic tort liabilities that have plagued insurers, policyholders, and society in the United States. Businesses involved in any aspect of nanotechnology should be prepared for possible liabilities arising out of progressive injuries by conducting meaningful risk management and familiarizing themselves with their insurance coverage programs to avoid having big, uninsured problems if they are confronted with losses arising from nanoscale materials.     

No long-term solutions in current health care reform proposals

As this article goes to press, it is nearly impossible to predict what sort of health reform plan will ultimately be passed, if any, and whether any form of long-term care coverage will be included. The need for such coverage will not, however, diminish with the close of the current congressional session and is likely to be a topic of debate for some time. The entire process of health reform legislation has been one of paring down initial hopes and expectations, and it may take many more years, until an even larger segment of our population is aged, before log-term care coverage becomes politically and fiscally desirable enough to withstand the political process.