Accident insurance: remand for expert assessment

ATA/14/1995Court of Justice / Administrative ChamberJan 13, 1995Partially Granted

Extracted by Omnilex

Omnilex summary

In an accident insurance case, the court found that the insurer's investigation was insufficient. Distinguishing a prior decision in which remand to the CNA for an expert report was refused, the court held that the present file justified a remand and ordered the insurer to obtain an expert assessment at its own expense.

Omnilex headnote

Art. 6 LAA; when the accident insurer's fact-finding is insufficient, the case may be remanded for further investigation, including an expert assessment at the insurer's expense. Remand is not justified where the evidentiary basis is already sufficient and no investigatory deficiency can be reproached. The decisive criterion is the adequacy of the administrative instruction of the case; only a proven gap in the medical or factual record warrants referral back for supplementary evidence.

Full text

Descripteurs

ASSURANCE SOCIALE; ACCIDENT; AA; EXPERTISE; DECISION DE RENVOI

Normes

LAA.6

Résumé

Instruction du cas insuffisante de la part de l'assurance-accident. Dans une autre affaire, le TFA a refusé d'admettre le renvoi à la CNA pour ordonner une expertise dans un cas où on ne pouvait lui reprocher une instruction insuffisante (SJ 1993 p.559). Cas différent en l'espèce. Affaire renvoyée à l'assureur pour qu'il effectue une expertise à ses frais.

Keywords

social insuranceaccident insurancemedical expertiseremandinvestigation

Extracted by Omnilex

Key legal questions extracted by Omnilex

Key legal question

Whether the accident insurer had conducted an insufficient investigation requiring remand for an expert assessment.

Extracted holding

Yes. The court held that the investigation was insufficient in this case and that the matter had to be remanded so the insurer could order an expert report at its own expense.

Extracted reasoning

Unlike another case in which remand to the CNA for an expert assessment was denied because no deficient investigation could be criticized, the present file showed an inadequate fact-finding basis.

Accident insurance: remand for expert assessmentAI generated