Accident insurance: causal link and statu quo ante

ATA/239/1997Court of Justice / Administrative ChamberApr 15, 1997Granted

Extracted by Omnilex

Omnilex summary

The administrative court admitted the appeal to the extent that the claimant had not yet returned to the pre-accident state. It found that her dorsal pain remained in an adequate causal relationship with the fall, so the insurer could not terminate benefits at that stage. The dispute concerned accident insurance and the continuation of daily allowances/benefits under the Accident Insurance Act.

Omnilex headnote

Art. 6 para. 1 LAA; causal link and termination of accident-insurance benefits on the basis of the statu quo ante: benefits may be discontinued only once the insured person has regained the pre-accident condition and the accident no longer has causal significance for the continuing complaints. If residual symptoms remain adequately causally connected to the accident, the insurer must continue benefits; mere improvement is insufficient to establish the statu quo ante.

Full text

Descripteurs

ASSURANCE SOCIALE; ACCIDENT; AA; CAUSALITE NATURELLE; CAUSALITE ADEQUATE; STATU QUO ANTE; LESION DE LA COLONNE VERTEBRALE; INDEMNITE JOURNALIERE; ASSU

Normes

LAA.6 al.1

Résumé

Le TA a admis le recours dans la mesure où le statu quo ante de la recourante n'est pas encore atteint (art. 36 al. 1 LAA) et que ses douleurs dorsales sont manifestement dans un rapport de causalité adéquate avec la chute dont elle a été victime.

Keywords

social insuranceaccident insurancecausal linkadequate causationstatu quo anteback paindaily benefits

Extracted by Omnilex

Key legal questions extracted by Omnilex

Key legal question

Whether the insurer could stop accident-insurance benefits because the claimant had already reached the statu quo ante and the ongoing back pain was no longer causally related to the fall.

Extracted holding

The appeal was upheld because the claimant had not yet reached the statu quo ante and her back pain was still in adequate causal connection with the accident.

Extracted reasoning

The court accepted that the post-accident symptoms remained attributable to the fall; on that basis, termination of benefits was not justified at that stage.

Accident insurance: causal link and statu quo anteAI generated