Supplementary investigation ordered on work incapacity for daily allowance

ATA/24/1998Court of Justice / Administrative ChamberJan 27, 1998Remanded

Extracted by Omnilex

Omnilex summary

The court held that the accident insurer had not sufficiently established how far the insured person's pain limited her ability to carry out her profession. Because the medical and factual findings were incomplete, the matter was sent back for supplementary instruction and reassessment of entitlement to daily accident insurance benefits under Art. 16 para. 1 LAA.

Omnilex headnote

Art. 16 al. 1 LAA; daily allowance and incapacity for work: the decisive question is the extent to which health impairments concretely affect the insured person’s ability to perform her occupation. If the factual findings do not permit a reliable assessment of the functional limitations and their impact on work capacity, the authority must complete the evidentiary record and cannot finally decide entitlement; remand for supplementary instruction is appropriate.

Full text

Descripteurs

ASSURANCE SOCIALE; ACCIDENT; AA; INDEMNITE JOURNALIERE; INCAPACITE DE TRAVAIL; ASSU

Normes

LAA.16 al.1

Résumé

Renvoi pour instruction complémentaire, l'assurance n'ayant pas suffisamment déterminé dans quelle mesure les douleurs ressenties par l'assurée l'empêchaient d'exercer sa profession.

Keywords

social insuranceaccident insurancedaily allowancework incapacitypainremandevidence assessment

Extracted by Omnilex

Key legal questions extracted by Omnilex

Key legal question

Whether the file sufficiently established the insured person's work incapacity for daily accident insurance benefits under Art. 16 para. 1 LAA.

Extracted holding

No. The case had to be remanded for supplementary investigation because the extent to which the pain impaired the insured person's professional activity was not adequately established.

Extracted reasoning

The evidentiary basis was insufficient to assess the functional impact of the pain on the insured person's ability to work in her occupation.

Supplementary investigation ordered on work incapacity for daily allowanceAI generated