ATA/645/1998•Accident insurance: causation not shown for necrosis and disc herniation
ATA/645/1998Tribunal de Justiça / Câmara Administrativa13 de out. de 1998Dismissed
Extraído pela Omnilex
The appellant sought accident-insurance benefits for two medical conditions. He failed to establish, with preponderant probability, that the disputed injections caused necrosis of his femoral heads. He also failed to show that his disc herniation resulted from the fall on his buttocks. The court therefore rejected the causal-link arguments and denied the claim.
Art. 6 para. 1 LAA; accident insurance coverage requires proof of a natural causal link between the accident and the injury by a degree of preponderant probability. Where the medical evidence does not make it sufficiently likely that injections caused femoral-head necrosis, or that a slip-and-fall caused a disc herniation, the insured event cannot be imputed to the accident. Mere possibility or speculative etiological hypotheses are insufficient; pre-existing predispositions do not replace the need for causal proof (consid. implied by the summary).
Descripteurs
ASSURANCE SOCIALE; ACCIDENT; AA; REMBOURSEMENT DE FRAIS(ASSURANCE); CAUSALITE ADEQUATE; PREDISPOSITION; LESION DE LA COLONNE VERTEBRALE; NECROSE; HERNIE DISCALE; LOMBALGIE; ASSU
Normes
LAA.6 al.1
Résumé
Le recourant n'est pas parvenu à démontrer avec un degré de vraisemblance prépondérante que les injections mises en cause avaient pu produire la nécrose de ses têtes fémorales. De même, son hernie discale n'a pas eu pour origine la chute sur les fesses (glissade) dont il a été victime.
Extraído pela Omnilex
Whether the appellant proved, with preponderant probability, that the injections caused femoral-head necrosis.
No. The causal link was not established to the required degree of probability.
The evidence did not show that the injections could have produced the necrosis with sufficient likelihood.
Whether the appellant proved that the fall on the buttocks caused the disc herniation.
No. The herniation was not shown to have originated in the accident.
The court found no sufficient causal connection between the slip-and-fall and the disc herniation.
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