As accident physicians, the physicians at our MVZ receive a high number of orders for the preparation of expert opinions from the various insurance carriers. Dr. Scherer is a certified expert of the Professional Association of German Surgeons (BDC).
The social safety net in Germany is exemplary. We are envied for this by the “rest of the world”. In the case of accidents, health insurance companies cover the costs of treatment (GKV and PKV), for which insurance is compulsory by law. There are also statutory and private accident insurance providers. By law, every employee must be insured by his or her company with an accident insurance carrier (Berufsgenossenschaft – BG) against accident damage. Taking out private accident insurance is voluntary. These insurances provide financial compensation in case of disability and death (dependents) due to any kind of accident, i.e. also in case of non-work-related events during leisure time or sports.
If the accident leaves a permanent damage, a medical expert (assessor) is required, who examines the insured and estimates the amount of the damage. The result of the examination is communicated to the insurance company in the form of a written report. This activity requires many years of experience and, if possible, special qualifications. In principle, any physician can prepare an expert opinion. However, the quality of the expert opinion varies considerably depending on the experience and ability of the expert. Cost units therefore usually prefer experienced experts, to whom they distribute the assignments at their own discretion.
In the case of occupational accidents, the insured person can choose from a list of three experts. He even has the right to suggest an expert of his choice, if none of the three doctors agrees with him. Expert opinions commissioned by the insured person himself are of little value, as they are considered biased in court. In addition, the insured person would have to bear the costs himself.
For the expert, the preparation of an expert opinion is always a challenge. The physician leaves his traditional role as healer and helper and slips into the role of the expert, who must do justice to both sides in a neutral and professionally correct manner: The insured person with his actual or alleged permanent damage and the insurance company as the cost bearer. Often, large sums of money are involved. For this reason, experts at the insurance headquarters always check the plausibility and accuracy of the expert opinions before they are used as a basis for decision-making.