Case
The 46-year-old Xu Mou was hospitalized for 151 days due to a comminuted fracture of his left leg caused by a car accident, and spent a total of more than 105,000 yuan on medical treatment, nursing, lost work, and renewal fees. According to the determination of the traffic police department, the vehicle that caused the accident is fully responsible for the accident.
In the mediation process of the traffic police department, the owner and the insurance company believed that Xu exaggerated his condition and had "excessive medical treatment" behavior, and did not agree to pay him high medical expenses. After the mediation failed, Xu filed a lawsuit with the court on the grounds of compensation for personal injury caused by the traffic accident, and in the course of the litigation, the defendant applied for a judicial appraisal to evaluate the degree of Xu's illness.
After appraisal, Xu did have "excessive medical treatment", and the appraisal opinion believed that the medical expenses of more than 52,000 yuan could be excluded. In the end, the court upheld the defendant's request based on the forensic conclusion.
Lawyer answers
Excessive medical treatment is a doctor who violates medical norms and ethical norms, deviates from the actual needs of the disease, and implements inappropriate, irregular, and unethical medical behaviors, such as excessive examination, excessive treatment, and excessive medication. In recent years, disputes over medical treatment have continued, which has seriously damaged the doctor-patient relationship.
In fact, the disease is a process of occurrence and development, the same disease will behave differently at different stages, and the same signs and symptoms may be triggered by different diseases.
Medical staff are also often in a dilemma: a comprehensive examination will increase the cost of the patient; if these problems are not considered, they are worried about missed diagnosis and misdiagnosis.
In general, it is the patient himself who sues the hospital for excessive medical treatment and demands a refund of the overpaid fee. However, insurance companies in traffic accident compensation cases and employers in work-related injury medical disputes will also raise the problem of excessive medical treatment, believing that the victim has deliberately over-treated behavior.
From a legal point of view, the determination of whether a doctor has overmedicined should be based on whether it violates the routine of diagnosis and treatment and whether there is a subjective for-profit purpose for examination or treatment.
When trying a case, the court mainly determines based on two types of evidence: first, the appraisal materials issued by authoritative appraisal institutions can make a scientific and reasonable assessment of the patient's condition and corresponding medical expenses; second, the corresponding case data to see whether the treatment process meets medical norms.
The court will fully consider the degree of disability of the patient in accordance with the requirements of the health management laws and regulations for the practice of medical personnel, and at the same time refer to the corresponding diagnosis and treatment routines and diagnosis and treatment guidelines, and then comprehensively determine the patient's injury.
The division of the burden of proof as to whether there is excessive medical treatment is generally followed by the principle of "who claims and who proves". The court will review the injury report provided by the patient, the medical settlement bill, etc.
For issues involving medical professions, the court may invite and visit medical experts for consultation, and if necessary, will also go to the hospital where the patient is seeking medical treatment for verification.