ATA/485/1995•Tooth fracture is not a bone fracture under accident insurance rules
ATA/485/1995Tribunal de Justiça / Câmara Administrativa26 de set. de 1995Dismissed
Extraído pela Omnilex
The claimant challenged the refusal of accident insurance benefits for a fractured tooth. The court held that the case did not involve an accident because an extraordinary external cause was not established: a small bone could not be excluded in the veal roast. It further ruled that a tooth fracture is not a fracture of a bone under Art. 9 OLAA. The appeal was dismissed and coverage denied.
Art. 9 OLAA; dental fracture and concept of accident; a tooth fracture does not constitute a bone fracture within the meaning of the regulation. For the qualification of an accident, an extraordinary external cause must be established; where it cannot be excluded that a foreign hard object was present in food, the requirement of extraordinariness is not met. The mere occurrence of a dental fracture during mastication is insufficient to bring the case under the enumerated bodily injuries.
Descripteurs
ASSURANCE SOCIALE; ACCIDENT; AA; AFFECTION DENTAIRE; NOTION; CAUSE EXTERIEURE EXTRAORDINAIRE; LESION CORPORELLE; ASSU
Normes
OLAA.9 al.1
Résumé
Casuistique de fractures de dents. Accident refusé pour la fracture de la dent de la recourante dès lorsqu'il n'est pas exclu de trouver un petit os dans un rôti de veau. La fracture d'une dent ne peut entrer dans la définition de la fracture d'un os au sens de l'art.9 al.2 OLAA.
Extraído pela Omnilex
Whether the tooth fracture constituted an accident within the meaning of compulsory accident insurance law.
The fracture was not shown to result from an extraordinary external cause; it was not an accident.
It was not excluded that a small bone could be present in a veal roast, so the external cause was not extraordinary.
Whether a fractured tooth can be treated as a fracture of a bone under Art. 9 OLAA.
No. A tooth fracture does not fall within the definition of a bone fracture for purposes of Art. 9 OLAA.
The court held that a tooth is not an osseous structure in the sense required by the regulation.
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