ATA/26/1998•Health insurer medical reports insufficient against full AI expertise
ATA/26/1998Tribunal de Justiça / Câmara Administrativa27 de jan. de 1998Dismissed
Extraído pela Omnilex
In a social insurance matter, the court held that medical reports gathered by the health insurer were not sufficient to establish the relevant facts. Their probative value was undermined by a comprehensive disability-insurance expert opinion, which the court preferred. The insurer therefore failed to displace the contrary expert evidence.
LAMA 6; evidentiary assessment of medical reports in social insurance proceedings. Medical reports produced by a health insurer do not necessarily carry decisive evidentiary weight. Where they are contradicted by a complete and well-founded expert assessment from another insurance file, the judge may refuse to rely on them and prefer the latter, provided the latter is more comprehensive and persuasive.
Descripteurs
ASSURANCE SOCIALE; AM; TENDANCE A LA REVENDICATION; ASSU
Normes
LAMA.6
Résumé
Les rapports médicaux récoltés par la caisse-maladie n'emportent pas, en l'occurence, la conviction du juge. Ils sont notamment contredits par une expertise AI complète.
Extraído pela Omnilex
Whether the medical reports obtained by the health insurer were sufficient to prove the insured person’s condition.
No. The court found that the insurer’s reports did not persuade the judge because they were contradicted by a comprehensive AI expert report.
The insurer’s medical material lacked persuasive force in light of the broader, more complete expert assessment from the disability insurance file.
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