护理依赖程度在司法实践中的计算

护理依赖程度在司法实践中的计算 ——从交通事故案件增长所想到的 作者:江聪 越何龙 发布时间:2013-05-13 16:29:38 虽然我国汽车保有量的逐年上升为我国汽车消费市场及物流市场带来了很大的经济拉动作用，但交通事故案件频发也给人民群众带来了巨大的悲痛。经济补偿，成为受害人或受害人家属得以安慰的主要方式。而在涉及重特大交通事故案件中，护理费的计算在整个赔偿中占据较大比重。《最高人民法院关于审理人身损害赔偿案件适用法律若干问题的解释》第二十一条规定了护理费的计算方式，其中第四款针对存在伤残的情况，特别规定了“受害人定残后的护理，应当根据其护理依赖程度并结合配制残疾辅助器具的情况确定护理级别”，并依此来计算护理费。然而，对于“护理依赖程度”该司法解释并未给出相应的阐述和规定，而查阅其他法律规定，也无法找到详细的规定。 一、现状:司法实践可参照适用 虽然在法律规定中无法找到详细的依据，但是在相应的部门规章中，可找寻一 二。2006年国务院颁布实施了《职工工伤与职业病致残程度鉴定标准》(以下简称国务院标准)，该标准规定了三种护理依赖程度:1)完全护理依赖;2)大部分护理依赖;3)部分护理依赖。其评定标准主要依据的因素有:进食，Agglutination, Brucella test 2. clinical and immunological analysis of external quality assessment and quality control, method and data analysis. To know: 1. fully-automatic calibration of microplate, standard operating, maintenance and servicing. 2. full/semi-automatic immunological analyser calibration, standard operating, maintenance and servicing. 3 immunofluorescence test specimen preparation, using a fluorescent microscope operation and their own analysis on the examination results of antibody. (Vi) professional master of clinical microbiological examination of: 1. the commonly used staining of microorganisms. (Gram, resistance to acid, ink staining) 2. common nuclear collection, cultivation and identification of specimens. (Blood, CSF, sputum, urine, stool, pus, pleural effusion, secretion) 3. common culture, isolation, identification and drug sensitive test of bacteria. (Golden Staphylococcus, epidermal Staphylococcus, saprophytic Staphylococcus, micro-cocci is, a,, and b, and d group hammer bacteria, and swine hemolytic sex hammer bacteria, and pneumonia hammer bacteria, meningitis, and card he, and gonorrhea Neisseria meningitidis bacteria, produced single nuclear cell Liszt bacteria, and colorectal Escherichia coli bacteria, salmonella bacteria, records he bacteria, Crabb bacteria, hafuniya bacteria is, deformation Bacillus is, sildenafil citrate acid Bacillus is, and puluofei Deng bacteria is, and Pseudomonas aeruginosa fake single cell bacteria, produced alkali fake single cell bacteria, and addicted to malt yellow single cell bacteria, and not moving Bacillus is, and produced alkali Bacillus is) 4. common specimens painted ... Lesions, peptic ulcer bleeding, bleeding from esophageal varices), hepatitis and alcoholic liver cirrhosis 翻身，大、小便，穿衣、洗漱，自我移动。按照此护理依赖程度来计算护理费，比例分别为统筹地区上年度职工月平均工资的50%、40%或者30%。然而该标准的适用范围主要是因工伤导致的身体伤残或者职业病伤残，且在评定项目上存在不够细化、难于操作的情况。 之后，在2009年公安部发布了《人身损害护理依赖程度评定》(以下简称公安部标准)公共安全行业标准。在这一标准中，对护理依赖程度仍然是分为三种程度，即完全护理依赖、大部分护理依赖和部分护理依赖。但在评定因素和评定方式上，比2006年国务院的标准更为详细，且较易操作，如评定因素细化为:进食，床上活动，穿衣，修饰，洗澡，床椅移动，行走，小便始末，大便始末，用厕。其中，与2006年国务院的标准最大的区别体现在计算护理费的比例问题上。按照该标准，护理费以护理依赖程度的高低，分别计算为统筹地区上年度职工月平均工资的100%、80%或者50%。另外，该标准还注明，可适用的范围包括:人为伤害、交通事故、意外事故等造成的人身伤残或精神障碍。 按每项10分计算，在61分以上的不需护理依赖;60-41分为部分护理依赖;40-21 分为大部分护理依赖;20分以下完全护理依赖 Agglutination, Brucella test 2. clinical and immunological analysis of external quality assessment and quality control, method and data analysis. To know: 1. fully-automatic calibration of microplate, standard operating, maintenance and servicing. 2. full/semi-automatic immunological analyser calibration, standard operating, maintenance and servicing. 3 immunofluorescence test specimen preparation, using a fluorescent microscope operation and their own analysis on the examination results of antibody. (Vi) professional master of clinical microbiological examination of: 1. the commonly used staining of microorganisms. (Gram, resistance to acid, ink staining) 2. common nuclear collection, cultivation and identification of specimens. (Blood, CSF, sputum, urine, stool, pus, pleural effusion, secretion) 3. common culture, isolation, identification and drug sensitive test of bacteria. (Golden Staphylococcus, epidermal Staphylococcus, saprophytic Staphylococcus, micro-cocci is, a,, and b, and d group hammer bacteria, and swine hemolytic sex hammer bacteria, and pneumonia hammer bacteria, meningitis, and card he, and gonorrhea Neisseria meningitidis bacteria, produced single nuclear cell Liszt bacteria, and colorectal Escherichia coli bacteria, salmonella bacteria, records he bacteria, Crabb bacteria, hafuniya bacteria is, deformation Bacillus is, sildenafil citrate acid Bacillus is, and puluofei Deng bacteria is, and Pseudomonas aeruginosa fake single cell bacteria, produced alkali fake single cell bacteria, and addicted to malt yellow single cell bacteria, and not moving Bacillus is, and produced alkali Bacillus is) 4. common specimens painted ... Lesions, peptic ulcer bleeding, bleeding from esophageal varices), hepatitis and alcoholic liver cirrhosis 适用范围 职工工伤或职业病 人为伤害、交通事故、意外伤害等公共安全事故 护理费的赔偿标准 上年度职工月平均工资的50%、40%或者30% 上年度职工月平均工资的100%、80%或者50%。 综上可知，护理依赖程度的确定可以在其他法律规范中找到一定依据。 二、困境:标准相差巨大，实践适用混乱 从上文可知，在计算受害人护理费时，因两个标准的赔偿比例不相一致，导致护理费的计算将相差甚远。如在一起致受害人变“植物人”的交通事故案件中，受害人需要完全护理依赖，护理年限为20年。如果按照湖北省2011年护理行业职工在岗平Agglutination, Brucella test 2. clinical and immunological analysis of external quality assessment and quality control, method and data analysis. To know: 1. fully-automatic calibration of microplate, standard operating, maintenance and servicing. 2. full/semi-automatic immunological analyser calibration, standard operating, maintenance and servicing. 3 immunofluorescence test specimen preparation, using a fluorescent microscope operation and their own analysis on the examination results of antibody. (Vi) professional master of clinical microbiological examination of: 1. the commonly used staining of microorganisms. (Gram, resistance to acid, ink staining) 2. common nuclear collection, cultivation and identification of specimens. (Blood, CSF, sputum, urine, stool, pus, pleural effusion, secretion) 3. common culture, isolation, identification and drug sensitive test of bacteria. (Golden Staphylococcus, epidermal Staphylococcus, saprophytic Staphylococcus, micro-cocci is, a,, and b, and d group hammer bacteria, and swine hemolytic sex hammer bacteria, and pneumonia hammer bacteria, meningitis, and card he, and gonorrhea Neisseria meningitidis bacteria, produced single nuclear cell Liszt bacteria, and colorectal Escherichia coli bacteria, salmonella bacteria, records he bacteria, Crabb bacteria, hafuniya bacteria is, deformation Bacillus is, sildenafil citrate acid Bacillus is, and puluofei Deng bacteria is, and Pseudomonas aeruginosa fake single cell bacteria, produced alkali fake single cell bacteria, and addicted to malt yellow single cell bacteria, and not moving Bacillus is, and produced alkali Bacillus is) 4. common specimens painted ... Lesions, peptic ulcer bleeding, bleeding from esophageal varices), hepatitis and alcoholic liver cirrhosis 均工资标准计算，依2006年国务院标准计算得出的护理费为214480元(21448元/年×20年×50%)，而依2009年公安部标准则为428960元(21448元/年×20年×100%)，两者计算得出的数额相差巨大。 司法实践中，法院在适用这两个标准时存在不统一的情况，主要现为:(1)视裁判的可执行性，择一适用;(2)配备残疾辅助器具后，护理依赖程度比例是否酌情扣减;(3)护理费是否一次性裁决。 1、从裁决的可执行性看实践适用 法院在制作裁决时，需要考虑到该裁判文书的执行力问题，而护理费的计算在事故中又占据重大比例，因此法院在选择计算标准方面显得尤为慎重。 如果肇事车辆投保了足额保险或者肇事司机个人较为富有，对以后判决的执行不致造成影响的话，法院有较大可能适用2009年公安部的行业标准。而如果肇事车辆投保的保险不足以赔付受害人的各项损失，肇事司机本人又没钱的话，法院将更加倾向2006年国务院的工伤标准。因公安部标准属于部门规章，法院在适用法律上，只是参照适用，故法院在选择标准上存在较大自Agglutination, Brucella test 2. clinical and immunological analysis of external quality assessment and quality control, method and data analysis. To know: 1. fully-automatic calibration of microplate, standard operating, maintenance and servicing. 2. full/semi-automatic immunological analyser calibration, standard operating, maintenance and servicing. 3 immunofluorescence test specimen preparation, using a fluorescent microscope operation and their own analysis on the examination results of antibody. (Vi) professional master of clinical microbiological examination of: 1. the commonly used staining of microorganisms. (Gram, resistance to acid, ink staining) 2. common nuclear collection, cultivation and identification of specimens. (Blood, CSF, sputum, urine, stool, pus, pleural effusion, secretion) 3. common culture, isolation, identification and drug sensitive test of bacteria. (Golden Staphylococcus, epidermal Staphylococcus, saprophytic Staphylococcus, micro-cocci is, a,, and b, and d group hammer bacteria, and swine hemolytic sex hammer bacteria, and pneumonia hammer bacteria, meningitis, and card he, and gonorrhea Neisseria meningitidis bacteria, produced single nuclear cell Liszt bacteria, and colorectal Escherichia coli bacteria, salmonella bacteria, records he bacteria, Crabb bacteria, hafuniya bacteria is, deformation Bacillus is, sildenafil citrate acid Bacillus is, and puluofei Deng bacteria is, and Pseudomonas aeruginosa fake single cell bacteria, produced alkali fake single cell bacteria, and addicted to malt yellow single cell bacteria, and not moving Bacillus is, and produced alkali Bacillus is) 4. common specimens painted ... Lesions, peptic ulcer bleeding, bleeding from esophageal varices), hepatitis and alcoholic liver cirrhosis 由，且按这一方式作出的裁判也是符合法律规定的。 2、护理依赖程度比例是否可浮动 以上两个标准规定中，均是确定护理依赖程度的整体比例，而不是一个具有可浮动的比例幅度。若是针对“植物人”等需要完全护理依赖的案件，是整体比例还是浮动比例都不致影响护理费的计算。但是，交通事故案件中还有一部分受害人是需要安装假肢等残疾辅助器具的人员。残疾辅助器具的主要功能就是帮助受害人在一定程度上实现独立自主的生活自理。那在裁决中已支持了残疾辅助器具费的话，护理依赖程度比例是否应酌情降低, 司法实践中，各地做法不一。不论是残疾辅助器具费还是护理依赖程度比例，都是通过司法鉴定机构出具司法鉴定意见来加以确定的。因此，有的法院直接采用司法鉴定意见中的意见，而有的法院则认定两标准中的护理依赖程度比例为最高比例，若受害人配备了残疾辅助器具能进行一定生活自理的，可以酌情扣减相应比例。如在一起致未成年人截肢的交通事故案件中，受害人通过司法鉴定后，确定存在部分护理依赖，且配备了残疾辅助器具。后法院在判决时确认了护理依赖最高比例为30%，但因配备了残疾辅助器具，应酌减5%的比例。 Agglutination, Brucella test 2. clinical and immunological analysis of external quality assessment and quality control, method and data analysis. To know: 1. fully-automatic calibration of microplate, standard operating, maintenance and servicing. 2. full/semi-automatic immunological analyser calibration, standard operating, maintenance and servicing. 3 immunofluorescence test specimen preparation, using a fluorescent microscope operation and their own analysis on the examination results of antibody. (Vi) professional master of clinical microbiological examination of: 1. the commonly used staining of microorganisms. (Gram, resistance to acid, ink staining) 2. common nuclear collection, cultivation and identification of specimens. (Blood, CSF, sputum, urine, stool, pus, pleural effusion, secretion) 3. common culture, isolation, identification and drug sensitive test of bacteria. (Golden Staphylococcus, epidermal Staphylococcus, saprophytic Staphylococcus, micro-cocci is, a,, and b, and d group hammer bacteria, and swine hemolytic sex hammer bacteria, and pneumonia hammer bacteria, meningitis, and card he, and gonorrhea Neisseria meningitidis bacteria, produced single nuclear cell Liszt bacteria, and colorectal Escherichia coli bacteria, salmonella bacteria, records he bacteria, Crabb bacteria, hafuniya bacteria is, deformation Bacillus is, sildenafil citrate acid Bacillus is, and puluofei Deng bacteria is, and Pseudomonas aeruginosa fake single cell bacteria, produced alkali fake single cell bacteria, and addicted to malt yellow single cell bacteria, and not moving Bacillus is, and produced alkali Bacillus is) 4. common specimens painted ... Lesions, peptic ulcer bleeding, bleeding from esophageal varices), hepatitis and alcoholic liver cirrhosis 3、护理费是否进行一次性裁决 一般来讲，存在护理依赖程度的受害人，伤情普遍偏重，且需要护理的时间都长达几年之久，按照《最高人民法院关于审理人身损害赔偿案件适用法律若干问题的解释》第二十一条第三款的规定，护理最长时间可以为二十年。那是否应对护理费进行一次性裁决, 有的法官认为，只有先期保障了受害人的护理费用，才能有利于受害人进一步治疗，而且在诉讼程序上也给受害人带来了极大方便，减少了受害人诉累，所以应采取一次性裁决的方式。 而另一些法官认为，若一次性裁决长达几年甚至二十年的护理费，会存在无法使用该护理费的情况。如上例中“植物人”案件，存在受害人家属在得到护理费赔偿后，对受害人放弃治疗，而“侵占”护理费。故应采取分次判决的方式，均待实际发生后才能进行主张。 三、出路:司法实践应理性参照适用 因交通事故导致的人身伤害，对受害人的身心及精神来说都是巨大伤害，且很难得到弥补，唯一的方式就是从经济赔偿上取Agglutination, Brucella test 2. clinical and immunological analysis of external quality assessment and quality control, method and data analysis. To know: 1. fully-automatic calibration of microplate, standard operating, maintenance and servicing. 2. full/semi-automatic immunological analyser calibration, standard operating, maintenance and servicing. 3 immunofluorescence test specimen preparation, using a fluorescent microscope operation and their own analysis on the examination results of antibody. (Vi) professional master of clinical microbiological examination of: 1. the commonly used staining of microorganisms. (Gram, resistance to acid, ink staining) 2. common nuclear collection, cultivation and identification of specimens. (Blood, CSF, sputum, urine, stool, pus, pleural effusion, secretion) 3. common culture, isolation, identification and drug sensitive test of bacteria. (Golden Staphylococcus, epidermal Staphylococcus, saprophytic Staphylococcus, micro-cocci is, a,, and b, and d group hammer bacteria, and swine hemolytic sex hammer bacteria, and pneumonia hammer bacteria, meningitis, and card he, and gonorrhea Neisseria meningitidis bacteria, produced single nuclear cell Liszt bacteria, and colorectal Escherichia coli bacteria, salmonella bacteria, records he bacteria, Crabb bacteria, hafuniya bacteria is, deformation Bacillus is, sildenafil citrate acid Bacillus is, and puluofei Deng bacteria is, and Pseudomonas aeruginosa fake single cell bacteria, produced alkali fake single cell bacteria, and addicted to malt yellow single cell bacteria, and not moving Bacillus is, and produced alkali Bacillus is) 4. common specimens painted ... Lesions, peptic ulcer bleeding, bleeding from esophageal varices), hepatitis and alcoholic liver cirrhosis 得安慰。故不论是从有益于受害人后续治疗、护理方面还是从给予受害人精神抚慰方面来看，依法、公正、合理的计算因护理依赖程度而导致的护理费都显得十分重要。为此，笔者认为，立法和司法实践应从以下几个方面对护理依赖程度规定进行完善，以便做出更加合乎双方当事人的法律裁决。 首先，应补充、完善现有立法中关于护理费计算的规定。因我国现有立法对护理依赖程度比例的规定存在两种标准，而在法律层面上却又没有相关规定，这使得在司法实践中出现适用“法律混乱”的情况。因此，最高人民法院可以在《最高人民法院关于审理人身损害赔偿案件适用法律若干问题的解释》或者《最高人民法院关于审理道路交通事故损害赔偿案件适用法律若干问题的解释》的基础上增加相应的护理依赖程度适用法律规定，甚至可以直接在该两部司法解释中确立护理依赖程度比例应适用的标准。 其次，在司法实践中，法官应采取能动司法方式，综合各种因素确定护理依赖程度比例。因现有法律规定存在冲突，法官对采取何种标准也看法不一。但是，不论是哪种标准，都应该确认标准中规定的比例是最高比例，即2006年国务院标准中的上年度职工月平均工资的50%、40%或者30%和2009年公安部标准中100%、80%或者50%，都是最高赔偿比例。此外，法官还可Agglutination, Brucella test 2. clinical and immunological analysis of external quality assessment and quality control, method and data analysis. To know: 1. fully-automatic calibration of microplate, standard operating, maintenance and servicing. 2. full/semi-automatic immunological analyser calibration, standard operating, maintenance and servicing. 3 immunofluorescence test specimen preparation, using a fluorescent microscope operation and their own analysis on the examination results of antibody. (Vi) professional master of clinical microbiological examination of: 1. the commonly used staining of microorganisms. (Gram, resistance to acid, ink staining) 2. common nuclear collection, cultivation and identification of specimens. (Blood, CSF, sputum, urine, stool, pus, pleural effusion, secretion) 3. common culture, isolation, identification and drug sensitive test of bacteria. (Golden Staphylococcus, epidermal Staphylococcus, saprophytic Staphylococcus, micro-cocci is, a,, and b, and d group hammer bacteria, and swine hemolytic sex hammer bacteria, and pneumonia hammer bacteria, meningitis, and card he, and gonorrhea Neisseria meningitidis bacteria, produced single nuclear cell Liszt bacteria, and colorectal Escherichia coli bacteria, salmonella bacteria, records he bacteria, Crabb bacteria, hafuniya bacteria is, deformation Bacillus is, sildenafil citrate acid Bacillus is, and puluofei Deng bacteria is, and Pseudomonas aeruginosa fake single cell bacteria, produced alkali fake single cell bacteria, and addicted to malt yellow single cell bacteria, and not moving Bacillus is, and produced alkali Bacillus is) 4. common specimens painted ... Lesions, peptic ulcer bleeding, bleeding from esophageal varices), hepatitis and alcoholic liver cirrhosis 积极与当事人、医院、司法鉴定机构进行沟通，发挥能动功效，探索发现应考虑的其他因素，如受害人自身恢复情况、配备残疾辅助器具情况，在最高比例的基础上最终确定合理的赔偿比例。 最后，法官尽量对自由裁量权进行克制。在参照适用的标准上、在护理依赖程度比例的酌情扣减上以及在护理费是否一次性裁决上，法官均有很大的自由裁量权。为此，法官在这些程序中，应尽量克制自身自由裁量权的发挥。如在护理依赖程度比例酌情扣减上，可以在受害人配备了残疾辅助器具后再进行鉴定，以确认应扣减的比例。而在是否一次性裁决的问题上，法官可以就受害人的伤情予以确认。毕竟在《最高人民法院关于审理人身损害赔偿案件适用法律若干问题的解释》第三十二条中，规定了受害人有权继续要求给付护理费等费用的权利。这种计算方法不但不存在损害当事人合法权益的可能性，反而有利于平衡受害人与赔偿义务人之间的利益关系。 参考文献 【1】廖焕国:《道路交通事故侵权责任》，法律出版社2010年4月版。 【2】[德]马克西米利安?福克斯:《侵权行为法》，齐晓琨译，Agglutination, Brucella test 2. clinical and immunological analysis of external quality assessment and quality control, method and data analysis. To know: 1. fully-automatic calibration of microplate, standard operating, maintenance and servicing. 2. full/semi-automatic immunological analyser calibration, standard operating, maintenance and servicing. 3 immunofluorescence test specimen preparation, using a fluorescent microscope operation and their own analysis on the examination results of antibody. (Vi) professional master of clinical microbiological examination of: 1. the commonly used staining of microorganisms. (Gram, resistance to acid, ink staining) 2. common nuclear collection, cultivation and identification of specimens. (Blood, CSF, sputum, urine, stool, pus, pleural effusion, secretion) 3. common culture, isolation, identification and drug sensitive test of bacteria. (Golden Staphylococcus, epidermal Staphylococcus, saprophytic Staphylococcus, micro-cocci is, a,, and b, and d group hammer bacteria, and swine hemolytic sex hammer bacteria, and pneumonia hammer bacteria, meningitis, and card he, and gonorrhea Neisseria meningitidis bacteria, produced single nuclear cell Liszt bacteria, and colorectal Escherichia coli bacteria, salmonella bacteria, records he bacteria, Crabb bacteria, hafuniya bacteria is, deformation Bacillus is, sildenafil citrate acid Bacillus is, and puluofei Deng bacteria is, and Pseudomonas aeruginosa fake single cell bacteria, produced alkali fake single cell bacteria, and addicted to malt yellow single cell bacteria, and not moving Bacillus is, and produced alkali Bacillus is) 4. common specimens painted ... Lesions, peptic ulcer bleeding, bleeding from esophageal varices), hepatitis and alcoholic liver cirrhosis 法律出版社2004年第5版。 【3】孙之智:《护理依赖等级鉴定与定残后护理费的计算》， 载南京医科大学学报(社会科学版)2010年9月第3期。 【4】重庆市第一中级人民法院:《评定人护理依赖的护理费 用的司法判定规则计算标准》，载 。 Agglutination, Brucella test 2. clinical and immunological analysis of external quality assessment and quality control, method and data analysis. To know: 1. fully-automatic calibration of microplate, standard operating, maintenance and servicing. 2. full/semi-automatic immunological analyser calibration, standard operating, maintenance and servicing. 3 immunofluorescence test specimen preparation, using a fluorescent microscope operation and their own analysis on the examination results of antibody. (Vi) professional master of clinical microbiological examination of: 1. the commonly used staining of microorganisms. (Gram, resistance to acid, ink staining) 2. common nuclear collection, cultivation and identification of specimens. (Blood, CSF, sputum, urine, stool, pus, pleural effusion, secretion) 3. common culture, isolation, identification and drug sensitive test of bacteria. (Golden Staphylococcus, epidermal Staphylococcus, saprophytic Staphylococcus, micro-cocci is, a,, and b, and d group hammer bacteria, and swine hemolytic sex hammer bacteria, and pneumonia hammer bacteria, meningitis, and card he, and gonorrhea Neisseria meningitidis bacteria, produced single nuclear cell Liszt bacteria, and colorectal Escherichia coli bacteria, salmonella bacteria, records he bacteria, Crabb bacteria, hafuniya bacteria is, deformation Bacillus is, sildenafil citrate acid Bacillus is, and puluofei Deng bacteria is, and Pseudomonas aeruginosa fake single cell bacteria, produced alkali fake single cell bacteria, and addicted to malt yellow single cell bacteria, and not moving Bacillus is, and produced alkali Bacillus is) 4. common specimens painted ... Lesions, peptic ulcer bleeding, bleeding from esophageal varices), hepatitis and alcoholic liver cirrhosis