Medical expenses include registration fee, examination fee, laboratory fee, operation fee, treatment fee, hospitalization fee, medicine fee, etc. Whether these expenses are established should be determined by combining medical records, diagnosis certificates and other relevant evidence. Please pay attention to the comments:
(1) Check whether the medical expenses are for treating injuries. Medical expenses unrelated to injury purchased by the injured person without authorization, such as treatment of other inherent diseases, are not within the scope of compensation. Has been reimbursed by the unit, should not be included in the scope of compensation.
(2) review the amount of medical expenses and determine the actual amount before the end of the debate in the court of first instance. Rehabilitation expenses, appropriate cosmetic expenses and other follow-up treatment expenses necessary for organ function recovery training can be prosecuted separately when they actually occur. However, according to the medical certificate or appraisal conclusion, the inevitable expenses can be compensated together with the medical expenses that have already occurred.
(3) Audit of specific medical expenses:
1. Generally it should be a local hospital. If it is really necessary to transfer to a foreign hospital for treatment, it needs the consent of the local hospital. Without consent, compensation is generally not allowed (this provision is open to question? Forced transfer leads to shock in the later stage of the case, which is not conducive to handling the case).
2. Medical expenses must be for treating diseases caused by trauma or injury, and medical expenses unrelated to trauma shall not be compensated (this provision is also unreasonable. When the basic disease coincides with trauma, it is often necessary to control the basic disease first and then carry out external treatment. At this time, the author thinks that the cost of treating basic diseases is reasonable.
3. Drugs purchased by the parties in medical and pharmaceutical units outside the treatment hospital must be really necessary and approved by the treatment hospital. The injured will not be compensated for buying drugs that are unnecessary for treatment. (★: It is really necessary, and it is necessary for treatment. I don't think it's necessary if it's approved by the hospital. The key depends on the purpose of buying medicine privately, often for convenience, saving money and other reasons)
4. For the review of hospitalization expenses, the premise of hospitalization is limited to the injury and surgical treatment that need to be confirmed by hospitalization. For high-end wards, it should be calculated according to the expenses of ordinary wards. (But the room rate does not belong to the scope of forensic clinical appraisal)
5, inspection, diagnosis and auxiliary inspection fees should review whether there are repeated inspections and high inspections. (This kind of appraisal conclusion often involves the relationship between patients and hospitals and should be handled with caution. )
6. Follow-up treatment costs refer to the re-treatment costs or future costs of those who have not recovered, which shall be subject to the certificates issued by effective medical institutions or the appraisal conclusions issued by relevant appraisal institutions. (The current mode of operation is: medical institutions issue certificates to appraisal institutions, and appraisal institutions will further confirm them, but appraisal institutions often stay in form without substantive examination. )
7. If the insurance contract stipulates that medical expenses are limited to the scope of medical insurance coverage, the agreement shall be understood as reasonable medical expenses. Insurance companies can review the rationality of medical expenses according to law. For the appraisal of the rationality of medical expenses, the court can hire a forensic doctor to conduct an audit according to the unanimous opinion of the parties, and the audit conclusion can be adopted as expert testimony. If the parties have different opinions on the forensic examination opinions, they may apply for forensic identification.
Second, the review matters
(1) rationality review of drug use: it is recommended to use medical insurance drugs, master the principle of symptomatic, moderate, reasonable and timely drug use, and ask the plaintiff to provide prescriptions and doctor's orders when handling, so as to avoid hitchhiking and impersonation, and at the same time facilitate cost review. There are only hospital charge invoices, and the part without medical advice should not be protected. (doctor's advice+charge invoice)
(2) The comprehensive inspection of instruments and equipment and the repeated inspection of expensive instruments without inspection indications are considered as unreasonable medical expenses in principle. If there are inspection indications and the repeated inspection results are negative, only the first time fee can be guaranteed. (This provision is unreasonable)
(3) Reimbursement: Common cases include skull repair, installation and internal fixation of different eyes and teeth, etc. , based on the local secondary medical level; Plastic surgery and visceral adhesion removal surgery must have the consent of the original attending doctor; Whether the scar needs to be repaired depends on whether it affects the function. If scar adhesion affects the function of joints or organs, it needs to be repaired, otherwise the expenses incurred should not be guaranteed. (This provision is unreasonable)
(4) Relationship between injury and illness: 1) Injury has nothing to do with illness. During the post-injury treatment, the treatment of injuries and medical expenses can only guarantee the injured part; 2) There is a certain relationship between injury and disease, that is, injury has a certain aggravating effect on the disease, and the treatment of injury should be completely recognized as reasonable, while the treatment expenditure for disease is usually compensated according to the approximate proportion of participation, but it does not exceed 50%; 3) Injury induces a certain disease, which is a reasonable part of the cure cost. The author thinks that the injurer should compensate 20-30% of the total amount. The reasonable compensation for the recurrence of primary disease caused by trauma should refer to the treatment of trauma-induced diseases.
Third, review methods
The calculation of medical expenses is determined according to the relevant provisions of laws and judicial interpretations, receipts of medical expenses and hospitalization expenses issued by medical institutions, and relevant evidence such as medical records and diagnosis certificates.
It should be noted that the charging voucher here is a legal voucher that conforms to the relevant national financial management norms. If it is not obtained through proper channels, the court may reject the request for medical expenses on the grounds that the evidence cannot prove the medical expenses. For example, if the parties see a doctor in a black clinic or a black drugstore, there is no legal fee voucher, and only the receipt of the agent will not have enough probative force.
Regarding the rationality of the expenses, the evidence of medical expenses mainly includes the receipt of fees from medical institutions, prescriptions, doctor's orders, diagnosis certificates of illness, etc. When determining the amount of medical expenses, we should pay special attention to the consistency of two evidences, namely, the consistency of the items of receipts and prescriptions, and the consistency of diagnosis and prescriptions. The former means that the medical expenses should conform to the doctor's diagnosis and treatment plan, rather than the patient deciding how to buy medicine or whether to be hospitalized. The latter means that the hospital's diagnosis scheme is consistent with the patient's own situation and cannot be a minor illness. The treatment plan is obviously beyond the general medical knowledge, such as only minor injuries, but the hospital's diagnosis and treatment plan includes long-term hospitalization and repeated diagnosis of expensive equipment. , resulting in high costs, these medical expenses requests will be rejected by the court.