ATA/669/1995•Accident insurance liable for delayed spinal relapse
ATA/669/1995Cour de justice / Chambre administrative21 nov. 1995Granted
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The court accepted, on the basis of a medical expert report, that a cyst appearing in the insured person's back eight years after a motorcycle accident was probably causally linked to the accident. It therefore held the accident insurer liable and ordered payment of daily benefits and medical treatment expenses.
LAA art. 6; causal link between an accident and a later relapse or sequela proved by probability on the basis of medical expertise. A long temporal interval between the accident and the subsequent lesion does not preclude accident coverage if the expert evidence renders causation more likely than not. Where such causal nexus is established, the accident insurer must assume the statutory benefits, including daily allowances and treatment costs (consid. 1 ss.).
Descripteurs
ASSURANCE SOCIALE; ACCIDENT; AA; RECHUTE; EXPERTISE; LESION DE LA COLONNE VERTEBRALE; ASSU
Normes
LAA.6
Résumé
Le TA a retenu sur la base d'une expertise médicale que l'apparition d'un kyste dans le dos de l'assuré 8 ans après un accident de moto, était probablement due à ce dernier. Assurance condamnée au paiement d'indemnités journalières et aux frais de traitement.
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Whether the later spinal/back lesion was causally linked to the accident as a relapse or sequela.
The medical expert evidence made it probable that the cyst was caused by the motorcycle accident, so causal coverage was accepted.
The court relied on the expert medical report and accepted the probability of a causal connection despite the long time lapse.
Whether the accident insurer had to pay daily benefits and treatment costs.
Yes; the insurer was ordered to cover daily allowances and medical treatment expenses.
Once the accident-related causality was established on a probable basis, statutory accident insurance benefits followed.
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