Accident insurance daily benefits and partial work capacity

ATA/283/1996Court of Justice / Administrative ChamberMay 21, 1996Dismissed

Extracted by Omnilex

Omnilex summary

The court held that the insured, although unable to continue as a floor layer after the accident, still had residual capacity for lighter work according to the medical reports. It therefore considered that accident insurance daily benefits could be stopped at the end of June 1995, when he was sufficiently fit to seek adapted employment.

Omnilex headnote

LAMA art. 12 bis; accident insurance daily benefits and partial work capacity. Where medical reports establish that the insured can no longer perform the former occupation but retains capacity for another activity requiring less physical effort, daily indemnity may cease once the insured is physically and mentally able to search for suitable adapted work. The decisive criterion is not the loss of the previous job as such, but the remaining functional capacity to engage in alternative employment (consid. not specified).

Full text

Descripteurs

ACCIDENT; AA; ASSURANCE SOCIALE; INDEMNITE JOURNALIERE; CAPACITE DE TRAVAIL PARTIELLE

Normes

LAMA.12 bis

Résumé

"Il ressort de façon certaine des avis médicaux, notamment ceux des Drs V. et D., que si le recourant ne pouvait plus exercer sa profession de poseur de sol, il restait capable de travailler dans un autre domaine d'activité demandant moins d'effort physique. Le TA estime qu'il faut arrêter à la fin du mois de juin 1995 le versement des indemnités journalières, ce moment correspondant à une capacité physique et psychique de l'intéressé de rechercher une activité appropriée à son état.

Keywords

accident insurancedaily indemnitypartial work capacitymedical evidenceadapted employment

Extracted by Omnilex

Key legal questions extracted by Omnilex

Key legal question

Whether accident insurance daily benefits had to continue despite only partial work capacity in the former occupation.

Extracted holding

Daily benefits had to stop at the end of June 1995, because by then the insured was physically and mentally able to look for suitable alternative employment.

Extracted reasoning

The medical opinions, especially those of Drs. V. and D., showed that although the insured could no longer perform his former job, he retained capacity for other work requiring less physical effort. That residual capacity justified ending the daily indemnity once he could reasonably seek adapted work.

Accident insurance daily benefits and partial work capacityAI generated