ATA/671/1998•No adequate causal link for somatoform pain disorders after accident
ATA/671/1998Tribunal de Justiça / Câmara Administrativa20 de out. de 1998Modified
Extraído pela Omnilex
The court held that the insured person’s somatoform painful disorder and hysterical complaints were not in adequate causal relation to the accident. As a result, the accident insurer was not liable for those psychical sequelae. The matter was remitted to the health insurer so that the daily allowances could be determined.
Art. 6 LAA; adequate causal relation between an accident and psychical sequelae: somatoform pain disorders and hysterical affections do not give rise to liability unless the accident is of such a nature that, according to ordinary experience and the course of events, it is apt to cause the complained-of psychical consequences. Where adequate causation is denied, the accident insurer’s duty to pay ceases; remaining daily allowance questions may be referred to the health insurer (consid. 3 ff.).
Descripteurs
ASSURANCE SOCIALE; AM; ACCIDENT; AA; AFFECTION PSYCHIQUE; CAUSALITE ADEQUATE; ASSU
Normes
LAA.6
Résumé
Troubles somatoformes douloureux et hystériques sans lien de causalité adéquate avec l'accident. Renvoi à la caisse-maladie pour fixation des indemnités journalières.
Extraído pela Omnilex
Whether the somatoform and hysterical psychical disorders are in adequate causal relation to the accident.
The disorders were not in adequate causal relation to the accident.
The court found the accident consequences insufficient to establish the required adequate causal nexus for the psychical complaints.
Whether the matter must be remitted to the health insurer for determination of daily allowances.
Yes. The case was remitted so the daily allowances could be fixed by the health insurer.
Because the accident insurer was not responsible for the psychical sequelae, the remaining financial consequences had to be addressed by the health insurer.
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