projets
ATA/502/1997 ΓÇó Vertebral fracture and accident-equivalent injury under insurance law
ATA/502/1997Cour de justice / Chambre administrative26 août 1997
The case concerns social insurance coverage for an alleged vertebral fracture. The decisive question was whether the fracture was medically established and, if so, whether it had to be treated as an accident-equivalent bodily injury under Art. 9 para. 2 lit. a OLAA. The fracture was denied on the evidence, so no coverage could be derived from the provision on accident-equivalent injuries.
Art. 9 para. 2 lit. a OLAA; accident-equivalent bodily injury; proof of vertebral fracture. Coverage as an accident-equivalent injury presupposes that the alleged bodily lesion is established on the evidence. If the existence of the fracture is not proven, the claim fails without further examination of the accident-equivalent qualification. The insurer is therefore not liable where the medical findings do not sufficiently demonstrate a vertebral fracture (cf. consid. not specified).
Descripteurs
ASSURANCE SOCIALE; ACCIDENT; AA; FRACTURE; LESION CORPORELLE ASSIMILEE A UN ACCIDENT; ASSU
Normes
OLAA.9 al.2 litt.a
Résumé
Question de l'existence d'une fracture vertébrale - niée en l'espèce - et de sa prise en charge éventuelle au titre de lésion assimilée à un accident.