Accident insurance: remand for assessment of earning capacity

ATA/362/1995Court of Justice / Administrative ChamberJul 3, 1995Remanded

Extracted by Omnilex

Omnilex summary

In an accident insurance dispute concerning a shoulder lesion and cervical syndrome, the Federal Insurance Tribunal found that the medical record contained conflicting expert opinions. It therefore remanded the matter to the cantonal court for a new assessment of the appellant's earning capacity on the basis of the existing file.

Omnilex headnote

LAA art. 18; where the file contains diverging medical opinions on the insured person's work and earning capacity, a final judicial assessment is not possible without further evaluation. The court must ensure a sufficiently reliable medical basis before fixing the loss of earning capacity; if the evidence is inconsistent, the case is to be remitted for additional assessment (consid. not stated).

Full text

Descripteurs

ASSURANCE SOCIALE; ACCIDENT; AA; LESION DE L'EPAULE; SYNDROME CERVICAL; EXPERTISE; RAPPORT MEDICAL; MOTIVATION

Normes

LAA.18

Résumé

Renvoi du TFA au TA pour la fixation de la capacité de gain du recourant, sur la base d'avis médicaux différents versés au dossier de la Cour de justice.

Keywords

social insuranceaccidentshoulder injurycervical syndromemedical evidenceexpert opinionearning capacityremand

Extracted by Omnilex

Key legal questions extracted by Omnilex

Key legal question

Whether the insured's earning capacity had to be determined on the basis of the medical evidence in the file.

Extracted holding

The case had to be sent back for a new assessment of earning capacity because the medical opinions in the record were divergent.

Extracted reasoning

The existing medical reports were not sufficiently concordant to permit a final determination; a fresh evaluation was therefore required.

Accident insurance: remand for assessment of earning capacityAI generated