Natural causality for shoulder tendon rupture after fall

ATA/23/1997Tribunal de Justiça / Câmara Administrativa15 de jan. de 1997Dismissed

Extraído pela Omnilex

Resumo Omnilex

The administrative court dismissed the claimant's challenge to the denial of accident-insurance coverage. It held that the shoulder injury, namely a rupture of the rotator cuff, was not sufficiently linked to the fall by predominant natural causality. A merely possible causal relationship did not satisfy the requirements of Art. 9(2) OLAA for an assimilated bodily injury.

Sumário Omnilex

Art. 9 al. 2 OLAA; assimilated bodily injury and natural causality; the insured event is covered only if the listed bodily injury is caused by an accident with predominant natural causal probability. A merely possible causal connection, or an explanation based on predisposition without sufficient probability of accident-related origin, does not meet the proof standard. The claimant bears the burden of establishing the requisite causal link; if the fall is only one possible cause among others, coverage must be denied (consid. not specified).

Texto completo

Descripteurs

ASSURANCE SOCIALE; ACCIDENT; AA; LESION DE L'EPAULE; LESION DES TENDONS; CAUSALITE NATURELLE; PREDISPOSITION; LESION CORPORELLE ASSIMILEE A UN ACCIDENT; ASSU

Normes

OLAA.9 al.2

Résumé

Le TA a dénié à la recourante le bénéfice de l'art. 9 al. 2 OLAA, la rupture de la coiffe des rotateurs dont elle a été victime n'étant pas liée à sa chute de manière prépondérante (cause possible et non vraisemblable).

Palavras-chave

social insuranceaccidentnatural causalityshoulder injurytendon rupturepredispositionassimilated bodily injury

Extraído pela Omnilex

Questões jurídicas principais extraídas pela Omnilex

Questão jurídica principal

Whether the claimant is entitled to benefits under Art. 9(2) OLAA for the shoulder tendon injury as an assimilated bodily injury.

Decisão extraída

The rupture of the rotator cuff was not shown to be predominantly caused by the fall; a possible causal link was not sufficient and causation was not made probable.

Fundamentação extraída

The court required a predominant natural causal connection between the fall and the tendon injury. It considered the fall only a possible cause, but not a sufficiently probable one, and therefore denied the application of Art. 9(2) OLAA.

Natural causality for shoulder tendon rupture after fallGerado por IA