ATA/254/1996•Accident insurance: psychogenic factors and disability pension reduction
ATA/254/1996Tribunal de Justiça / Câmara Administrativa7 de mai. de 1996Modified
Extraído pela Omnilex
A manual worker became totally unable to earn after an accident that left him with a frozen shoulder. The case turned on whether later psychical problems were causally linked to the accident. The court held that they were not in natural causal relation with the insured event. Because those psychical disorders nevertheless accounted for about half of the incapacity of gain, the disability pension was reduced by 50%.
Art. 6 LAA; natural causal link in accident insurance and apportionment of incapacity of gain. Accident insurance compensates only the loss of earnings that is in natural causal relation with the insured event. If an insured person's incapacity of gain is partly due to psychical disorders that are not causally related to the accident, that non-causal portion is excluded from the insured loss and may justify a proportional reduction of the pension; the compensable share is determined according to the degree to which the accident remains causative (consid. not stated).
Descripteurs
ASSURANCE SOCIALE; LESION DE L'EPAULE; ACCIDENT; AA; AFFECTION PSYCHIQUE; CAUSALITE NATURELLE; ASSU
Normes
LAA.6
Résumé
Incapacité de gain de 100 % d'un travail manuel qui, à la suite d'un accident se retrouve avec une "épaule gelée". Réduction de la rente de 50 % dès lors que le trouble psychiques qui ne sont pas en relation de causalité naturelle avec l'accident, contribuent pour 50 % à l'incapacité de gain.
Whether the insured person's psychical disorder was in natural causal relation with the accident
The psychical disorder was not in natural causal relation with the accident.
The accident-related shoulder injury explained only part of the incapacity; the psychical impairment was treated as an independent factor.
Whether the disability pension had to be reduced because non-causal psychical factors contributed to loss of earnings
The pension could be reduced by 50% because the psychical disorders contributed to the incapacity of gain but were not accident-related.
Only the accident-caused portion of the incapacity is compensable under accident insurance; the remaining incapacity attributable to non-causal psychical disorders does not justify full benefits.
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