projetos
ATA/616/1996 ΓÇó Causality assessed separately for each dental injury element
ATA/616/1996Tribunal de Justiça / Câmara Administrativa29 de out. de 1996Partially Granted
In an accident-insurance dispute concerning dental injuries, the court examined causal coverage separately for each damaged element. It denied accident causality for a badly damaged tooth because of insufficient care, but accepted causality for the fracture of the row of teeth supporting a bridge. The fact that the bridge had created a rupture line could not be held against the insured person, and irregular use of a mandibular appliance did not remove coverage, even if it may have contributed to weakening the prosthesis.
Art. 16 LAA; causal linkage for dental damage after an accident must be assessed item by item. Where several distinct dental structures are affected, accident causality may be admitted for one lesion and denied for another if the evidentiary and factual basis differs. A pre-existing weakness or insufficient care excludes causal attribution only for the damage element for which it is decisive. Conversely, a prosthetic arrangement or irregular appliance use does not sever causality where the accident-triggered fracture concerns a specifically identifiable structural break and the insured person cannot be reproached for the causally relevant configuration (consid. unspecified).
Descripteurs
ASSURANCE SOCIALE; ACCIDENT; AA; CHUTE; AFFECTION DENTAIRE; CAUSALITE; ASSU
Normes
LAA.16
Résumé
Examen détaillé de la causalité pour chaque élément du dommage : si celle-ci ne doit pas être admise dans le cas d'une dente très abîmée faute de soins, en revanche, tel doit être le cas de la fracture d'une rangée de dents soutenant un pont; le fait que la pose dudit pont avait crée un point de rupture en ligne, ne peut être reproché à l'assurée, pas plus que le port irrégulier d'un appareil mandibulaire (quand bien même cette négligence a pu entraîner une fragilisation de cette prothèse).