Question juridique clé
Whether the 2009 fall remained naturally causal for the insured's knee condition and accident benefits.
Solution extraite
The medical evidence left sufficient doubt on causation to require an independent expert assessment.
Motifs extraits
The opinions of the insurer's medical adviser and the treating physician diverged on whether the accident still caused the relevant knee lesions. Neither opinion could be dismissed outright, so the file was not sufficiently clear.