Detective report alone cannot end social insurance incapacity

ATA/175/1997Court of Justice / Administrative ChamberMar 11, 1997

Extracted by Omnilex

Omnilex summary

The dispute concerned the insurer's attempt to deny ongoing incapacity benefits based on a detective report. The report showed the insured working only a few hours, but the investigations established that she merely helped her sister from time to time. The decision holds that such limited surveillance is insufficient to prove that the insured is no longer unable to work.

Omnilex headnote

Art. 6 LAA; proof of cessation of incapacity to work by surveillance evidence. A private detective report observing only occasional, short-duration activity does not by itself establish restored earning capacity or the end of incapacity. Where the overall evidentiary record shows merely sporadic assistance to a relative, the insurer may not infer regular gainful work from isolated observations; the assessment must be based on the complete factual findings and not on selective surveillance excerpts.

Full text

Descripteurs

ASSURANCE SOCIALE; CAUSALITE; ACCIDENT; AA; AFFECTION PSYCHIQUE; TRAVAIL; ASSU

Normes

LAA.6

Résumé

L'assurance ne peut se fonder sur un rapport de détective ayant vu l'assurée travailler quelques heures (pour considérer que celle-ci n'est plus incapable de travailler), les enquêtes ayant démontré qu'elle n'a fait qu'aider sa soeur de temps à autre.

Keywords

social insurancecausationaccidentpsychic conditionwork incapacitysurveillance evidence

Extracted by Omnilex

Key legal questions extracted by Omnilex

Key legal question

Whether a private detective report showing a few hours of work is sufficient to conclude that the insured is no longer incapable of work under social insurance law.

Extracted holding

No. The insurer cannot rely on that report alone where the investigations show only occasional help to the insured's sister.

Extracted reasoning

A few observed hours of activity did not establish restored work capacity; the broader investigation contradicted the inference that the insured had resumed regular work.

Detective report alone cannot end social insurance incapacityAI generated