ATA/35/1997•Broken dental crown while eating chicken is not an accident
ATA/35/1997Tribunal de Justiça / Câmara Administrativa15 de jan. de 1997Dismissed
Extraído pela Omnilex
The insured person broke a dental crown on a bone while eating chicken and claimed accident insurance coverage for the resulting dental expenses. The court held that the event was not an accident within the meaning of Art. 9(1) OLAA because the extraordinary external factor was lacking. The appeal was therefore dismissed and no reimbursement of dental costs was ordered.
Art. 9 al. 1 OLAA; accident definition; extraordinary external factor: the mere breaking of a dental crown on a bone while eating does not constitute an accident, as the prerequisite of an extraordinary external factor is lacking. Ordinary mishaps in the course of eating are not sufficient to trigger accident insurance coverage for dental treatment costs.
Descripteurs
ASSURANCE SOCIALE; ACCIDENT; AA; AFFECTION DENTAIRE; CAUSE EXTERIEURE EXTRAORDINAIRE; REMBOURSEMENT DE FRAIS(ASSURANCE); ASSU
Normes
LAA.9 al.1
Résumé
Le fait de se briser une couronne dentaire sur un os en mangeant du poulet ne saurait être qualifié d'accident au sens de l'art. 9 al. 1 OLAA, la condition du facteur extérieur extraordinaire faisant défaut.
Extraído pela Omnilex
Whether the broken dental crown while eating chicken qualifies as an accident under Art. 9(1) OLAA.
No. The required extraordinary external factor was absent.
Breaking a dental crown on a bone while eating is an ordinary eating mishap and does not involve an extraordinary external factor within the meaning of the accident definition.
Whether the insurer must reimburse the dental expenses as accident-related treatment.
No reimbursement is owed because the event is not an insured accident.
Without an accident within the meaning of the ordinance, there is no basis for accident insurance coverage of the dental costs.
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