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ATA/48/1998•Accident insurance: 100% invalidity pension and assessment of IPAI
ATA/48/1998Court of Justice / Administrative ChamberFeb 3, 1998Modified
Extracted by Omnilex
The insured was injured in a serious car accident that caused a spinal fracture, long-lasting pain, and a work incapacity lasting about three years. The court upheld entitlement to a 100% invalidity pension against the accident insurer. It also held that the assessment of the impairment-of-integrity compensation had to be redone by the insurer, with the insured's psychological problems taken into account.
LAA art. 24 al. 1; accident insurance benefits and assessment of impairment of integrity; where a serious traffic accident causes spinal injuries, prolonged pain and equally prolonged incapacity for work, a full invalidity pension may be warranted. For the IPAI, the relevant bodily and psychological consequences must be comprehensively assessed; if the record is incomplete in that respect, the matter is to be remitted to the insurer for a new determination.
Descripteurs
ASSURANCE SOCIALE; ACCIDENT; AA; INDEMNITE POUR ATTEINTE A L'INTEGRITE; TENDANCE A LA REVENDICATION; LESION DE LA COLONNE VERTEBRALE; ATTEINTE A L'INTEGRITE; AFFECTION PSYCHIQUE; ACCIDENT GRAVE; INCAPACITE DE TRAVAIL; DEPRESSION; CALCUL; PRESTATION D'ASSURANCE(EN GENERAL); LIMITATION; DOMMAGE; FRACTURE; ASSU
Normes
LAA.24 al.1
Résumé
L'assureur-accidents a été condamné au versement d'une rente invalidité de 100 %, l'assuré ayant subi un accident de voiture qualifié de grave. Les lésions subies, soit une fracture de la colonne vertébrale, ont été qualifiées de moyennes à graves, d'autant que les douleurs générées par celles-ci ont duré trois ans, à l'instar de l'incapacité de travail. Pour le surplus, le Tribunal a renvoyé le dossier à la caisse pour qu'elle statue sur le montant de l'IPAI en tenant compte des problèmes psychiques de l'assuré.
Extracted by Omnilex
Whether the insured was entitled to a 100% invalidity pension after the car accident.
Yes. The accident was treated as serious, and the spinal injuries, pain lasting three years, and equally long incapacity for work justified a full disability pension.
The court qualified the accident as grave and the injuries as moderately severe to severe. The duration and intensity of the pain and work incapacity supported full invalidity.
How the compensation for impairment of integrity (IPAI) should be assessed in light of the insured's psychological problems.
The file was sent back to the insurer so it could determine the IPAI amount while taking the insured's psychological problems into account.
The court found that the assessment had to include the insured's mental health issues and therefore required a new determination by the insurer.
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