ATA/112/1996•Accident insurance: natural causation and impairment benefit
ATA/112/1996Tribunal de Justiça / Câmara Administrativa5 de mar. de 1996Confirmed
Extraído pela Omnilex
An insured person claimed accident insurance benefits for cervical and psychological sequelae after an accident. The court accepted that, even if natural causation existed for the psychiatric complaints, the medical evidence showed a syndrome influenced by several factors and by a pre-existing psychological disposition. The insurer's assessment of the impairment benefit at 20% was therefore upheld.
Art. 6 LAA; natural causation of psychological sequelae after an accident and assessment of impairment benefit (IPAI). Natural causation may be assumed without that leading automatically to a higher impairment rating. Where the medical evidence characterizes the complaints as a multifactorial sinistrosis-like syndrome with a pre-existing psychological component, the insurer may rely on the documented residual impairment assessment if no convincing contrary medical basis exists.
Descripteurs
ASSURANCE SOCIALE; ACCIDENT; AA; SYNDROME CERVICAL; TENDANCE A LA REVENDICATION; AFFECTION PSYCHIQUE; CAUSALITE NATURELLE; INDEMNITE POUR ATTEINTE A L'INTEGRITE
Normes
LAA.6
Résumé
"En l'espèce, et même si un lien de causalité naturelle entre l'accident et les troubles psychiques dont souffre l'accusé était avéré, la sinistrose dont ont fait état les médecins, est liée à un ensemble de facteurs, à une composante psychologique, antérieure à l'accident". IPAI évaluée à 20 %
Extraído pela Omnilex
Whether the insured's psychological complaints were naturally causally linked to the accident.
Even assuming natural causation, the psychiatric symptoms were part of a broader syndrome with multiple contributing factors and a pre-existing psychological component.
The doctors described a tendency to complain and a sinistrosis-like presentation tied to several factors rather than solely to the accident.
Whether the insured was entitled to an impairment benefit assessed at 20%.
The impairment degree of 20% was upheld.
The medical assessment of the remaining impairment was accepted; no basis was shown to depart from the 20% evaluation.
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