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LAA disability rate and AI assessment coordination

ATA/522/1998Cour de justice / Verwaltungskammer01.09.1998Modified

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Von Omnilex extrahiert

Omnilex-Zusammenfassung

The case concerns coordination between invalidity assessments under accident insurance and disability insurance. The court held that an AI disability degree cannot be taken over unchanged for LAA purposes when the AI assessment is based on an economic inquiry method not appropriate under the LAA. At the same time, the LAA disability degree should not depart excessively from the AI degree. In the case at hand, the accident insurer overestimated the insured person's realizable income. The decision recalls case law on the income assessment of an untrained person and stresses that divergence is justified where the AI applied the special method for non-working or partly household-active persons.

Omnilex-Regeste

Art. 6 LAA; coordination of disability assessment between accident insurance and invalidity insurance: the disability degree determined by AI is not binding for LAA purposes if it is based on a method of assessment not relevant under accident insurance, in particular the specific method under Art. 5 para. 1 LAI and Art. 27bis RAI for persons without gainful activity or with only part-time household activity. However, the LAA assessment must remain coherently related to the AI evaluation and may not diverge without reason. In assessing the realizable income of an insured person without vocational training, the insurer must rely on a realistic earning capacity and may not overstate residual income (consid. not specified).

Gesamter Gesetzestext

Descripteurs

ACCIDENT; AA; INVALIDITE(INFIRMITE); ENQUETE ECONOMIQUE; REVENU; COLLABORATION ENTRE AUTORITES; ORGANISATION(PROCEDURE); COORDINATION(ASSURANCE); PROCEDURE; EVALUATION DE L'INVALIDITE; INCAPACITE DE TRAVAIL; ASSURANCE SOCIALE; ASSU

Normes

LAA.6

Résumé

Le taux d'invalidité AI ne peut être retenu tel quel car il se base sur une enquête économique, soit une méthode qui n'est pas pertinente dans le cadre de la LAA. Le taux d'invalidité LAA ne saurait néanmoins s'écarter par trop du taux AI. En l'espèce, le revenu réalisable par l'assurée a été surévalué par l'assureur. Rappel de la JPP du TA en matière d'évaluation du revenu d'une personne sans formation. L'assureur LAA peut s'écarter du degré d'invalidité fixé par l'assurance-invalidité notamment lorsque celle-ci fait application de la méthode spécifique de calcul de l'invalidité prévue à l'article 5 alinéa 1 LAI et 27bis RAI pour les personnes n'exerçant pas d'activité lucrative ou une activité ménagère à temps partiel.

Schlagwörter

accident insuranceinvalidity assessmentcoordination of social insuranceeconomic inquiryrealizable incomeearning capacityuntrained person

Von Omnilex extrahiert

Von Omnilex extrahierte Kernrechtsfragen

Kernrechtsfrage

Whether the AI disability rate could be taken over directly for LAA purposes when it was based on an economic investigation method not suitable under LAA.

Extrahierter Entscheid

The AI disability rate cannot simply be adopted as such in accident insurance if it rests on an economic investigation method that is not relevant under the LAA.

Extrahierte Begründung

The court held that coordination between social insurance schemes does not permit uncritical transfer of an invalidity degree when the assessment method differs. In particular, the AI result is not determinative where the AI applied a specific method for persons without gainful activity or with only part-time household activity.

Kernrechtsfrage

Whether the insurer overestimated the insured person's realizable income for the LAA disability assessment.

Extrahierter Entscheid

Yes. The realizable income was overestimated by the insurer.

Extrahierte Begründung

The court reiterated its case law on the assessment of the income of a person without vocational training and found that the insurer's income determination did not adequately reflect the insured person's actual earning capacity.

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