Accident insurer must follow AI invalidity rate of 50%

ATA/269/1998Tribunal de Justiça / Câmara Administrativa19 de mai. de 1998Annulled

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Extraído pela Omnilex

Resumo Omnilex

The court held that no serious element undermined the invalidity insurance assessment fixing the insured person's degree of invalidity at 50%. As the accident insurer had no reason to depart from that assessment, its decision refusing an accident-insurance invalidity pension could not be maintained and had to be annulled.

Sumário Omnilex

Art. 18 LAA; accident insurance invalidity pension; binding effect of AI assessment: where the invalidity insurance has fixed the degree of invalidity at 50% and the file contains no serious indication casting doubt on that assessment, the accident insurer may not depart from it without own convincing reasons. In such circumstances, a refusal to grant an invalidity pension is unlawful and must be annulled (consid. n.a.).

Texto completo

Descripteurs

ACCIDENT; AA; RENTE D'INVALIDITE; EVALUATION DE L'INVALIDITE; CALCUL; ASSURANCE SOCIALE; ASSU

Normes

LAA.18

Résumé

Dès lors qu'aucun élément ne vient sérieusement remettre en question l'appréciation du degré d'invalidité opéré par l'AI, soit 50 %, et que l'assureur-accident n'a pas de motif pour s'écarter de ce taux, la décision LAA refusant toute rente-invalidité doit être annulée.

Palavras-chave

accident insuranceinvalidity pensioninvalidity assessmentcoordinationsocial insurance

Extraído pela Omnilex

Questões jurídicas principais extraídas pela Omnilex

Questão jurídica principal

Whether the accident insurer could depart from the invalidity degree of 50% assessed by the invalidity insurance.

Decisão extraída

No. In the absence of any serious element calling the AI assessment into question, the accident insurer had no reason to deviate from the 50% invalidity rate.

Fundamentação extraída

The file contained no convincing basis to challenge the AI assessment. The accident insurer therefore had to rely on that degree of invalidity for its own pension decision.

Questão jurídica principal

Whether the refusal to grant an accident-insurance invalidity pension had to be annulled.

Decisão extraída

Yes. Because the invalidity degree of 50% had to be taken over, the refusal of any disability pension could not stand.

Fundamentação extraída

Once the 50% invalidity rate is accepted, the pension refusal is inconsistent with the applicable disability assessment under accident insurance law.

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