What medical-social expertise is and what the status of limitation of capability means
Medical-social expertise is a sphere of interdisciplinary activity that embraces medical-biological, sociological, social, psychological, economic and other aspects. Its principal task is to determine the degree of a person's limitation of functional capacity and, arising from it, to establish the cause of the limitation of capability, the term of re-examination and the time of onset, as well as to determine the various types of social protection of persons with limited capabilities established by the legislation of Georgia. The leading position in this sphere is considered to be the determination of the violation of a person's medical and social status, or of the degree of its loss, and the identification of the capacity to retain them and of compensatory-adaptive capabilities, the realization of which promotes the person's medical, professional and social rehabilitation and his or her becoming a full member of society.
The determination of a person's status of limitation of capability, and the resolution of other questions of medical-social expertise, are founded upon a complex assessment of clinical-functional, social-household, professional-labor and psychological data. In practical terms this means that the decision is not made on the basis of a diagnosis alone: the experts take into account, together with the state of health, the person's household, social and working situation as well, which is why two persons with the same diagnosis may receive a different degree and a different re-examination term. That is precisely why it matters that complete medical and social information be submitted to the expertise.
The key concepts applied by the expertise
The law defines with precision the terms that operate in the process of medical-social expertise. For you these definitions matter because it is from them that the determination of the status, of the re-examination term and of the corresponding types of social protection derives:
- a person with limited capabilities — a person with stable physical, mental, intellectual or sensory impairments whose interaction with various barriers may hinder his or her full and effective participation in public life on an equal basis with others;
- functional capacity — the capacity for self-care, movement, orientation, communication, self-control, learning and work activity, while the limitation of functional capacity is a deviation from the norm of a person's activity caused by a health disorder;
- the degree of limitation of functional capacity — the magnitude of the deviation from the norm of a person's activity caused by a health disorder;
- an expert physician — a physician holding a state certificate in the specialty who possesses special knowledge in medical-social expertise;
- the representative of a person with limited capabilities — the legal representative (parent, adopter, guardian, custodian or entrusted person);
- specially created conditions for work, household and public activity — special sanitary-hygienic, organizational, technical, technological, legal, economic and micro-social factors that make it possible for the person to perform such activity in accordance with rehabilitative potential;
- the corresponding medical establishment — a medical establishment that provides specialized medical services for diseases, anatomical or mental defects determined by a subordinate normative act of the minister.
The degrees of limitation of functional capacity
Limitation of capability is such stable physical, mental, intellectual or sensory disorders as condition the temporary or permanent limitation of functional capacity. According to the severity of the limitation, it is determined in the following degrees: mildly expressed; moderately expressed; significantly expressed; sharply expressed. Each of these degrees has direct practical significance, since the frequency of re-examination of the status depends on it.
Periodic re-examination: why it is conducted and at what intervals
In the presence of unstable, reversible morphological changes and functional disorders of the systems and organs of the body, for the purpose of observing the course of the disease and the effectiveness of the rehabilitation measures carried out, a periodic re-examination of a person's status of limitation of capability is conducted. The law sets different intervals for different degrees: in the case of a moderately or significantly expressed limitation of functional capacity the re-examination is conducted once a year, while in the case of a sharply expressed limitation of functional capacity it is conducted once every two years. This differentiation is logical, since with a sharply expressed limitation the changes are, as a rule, more stable and observation requires less frequent verification.
The duration of the status is likewise fixed by law: a person's status of limitation of capability is established until the first day of the month following the month in which the re-examination is scheduled. In other words, the operation of the status extends until the first day of the following month, which also allows time for the organization of the re-examination. If questions arise in connection with the status in situations not regulated by these norms, they are governed by other acts of Georgian legislation — these provisions themselves do not create a special rule for every such case.
The duties of the establishment toward the person examined
The determination of the status of limitation of capability takes place in the corresponding medical establishment, whose duties are framed precisely by law. The establishment is obliged to:
- determine the person's status of limitation of capability;
- establish the causal connection with respect to the status of limitation of capability, determine the term of re-examination and the period of onset;
- assign to a person under 18 the category of "child with a status of limited capability";
- determine, for an employed person who, in the performance of work duties, received an injury, an occupational disease or other damage to health, the percentage of the degree of loss of professional work capacity, and also the provision of additional assistance;
- determine the existence of a causal connection of the breadwinner's death with a work injury, service at the front and other circumstances, for the extension to the deceased's family of the benefits established by the legislation of Georgia, for the appointment of a pension and for the compensation of the damage caused;
- examine the person for the purpose of determining the medical indications for receiving a means of movement (a wheelchair, a hand-bike);
- render assistance to the person in procuring the documents necessary for conducting the medical-social expertise, the submission of which is imposed on the person examined by the legislation of Georgia;
- conduct an outgoing session at the patient's residence for the examination of a severely ill patient who, due to his or her state of health, cannot appear at the establishment;
- submit to the agency, immediately upon its request, all information (documents) necessary for the exercise of control.
The rights of the establishment
At the same time the law grants the establishment corresponding rights: where necessary, to send the person to another medical establishment for the clarification of the diagnosis and the determination of the degree of impairment of the function of the body (organs); to extend the term of treatment of a person who applies to the establishment for the determination of a status of limitation of capability, where a ground for this exists; and to demand and receive the data and certificates necessary for conducting the expertise and for the performance of its other functions from a medical establishment, an enterprise or an organization, regardless of their organizational-legal form. This means that information significant for the expertise may be requested independently of you, which creates a fuller basis for the decision.
What you should know before a re-examination is scheduled
The institution of periodic re-examination exists so that the status always corresponds to the actual state of health: upon improvement the degree may be changed, and upon deterioration additional capabilities may be considered. It is therefore important to appear on the scheduled date and to submit complete medical documentation. Remember that in the case of severe illness it is possible to request an outgoing session at the place of residence, and that the establishment is obliged to assist you in procuring documents as well. For other questions connected with the status that are not determined by these norms, including the procedure for the specific grants of social protection, other acts of Georgian legislation apply.