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I 2018 18 • VG SZ I 2018 18 AI generated

Insurance Claim Denial Over Rotator Cuff Rupture Causation

Case Number I 2018 18
Court / Authority
Jurisdiction Switzerland · Canton of Schwyz (CH-SZ)
Decision Date
Open official source Entscheidsuche mirror Machine-readable Markdown (.md)

Legislator summary

AI generated

A claimant appealed a decision by an insurance entity concerning a claim for benefits related to a rotator cuff rupture sustained in an accident. The core of the dispute involved whether the injury constituted an insured event under accident insurance provisions. The court reasoned that while the claimant suffered a fall, the medical evidence, including expert opinions, did not establish a sufficient causal link between the fall and the subsequent rotator cuff rupture, concluding that the rupture was likely degenerative rather than traumatically caused by the accident, thereby upholding the denial of benefits.

Legislator headnote

AI generated

Insurance Claim Denial Over Rotator Cuff Rupture Causation: The core of the dispute involved whether the injury constituted an insured event under accident insurance provisions. The court reasoned that while the claimant suffered a fall, the medical evidence, including expert opinions, did not establish a sufficient causal link between the fall and the subsequent rotator cuff rupture, concluding that the rupture was likely degenerative rather than traumatically caused by the accident, thereby upholding the denial of benefits.

Keywords

AI generated
claim for insurance benefits accident causation medical evidence shoulder injury causal link over-insurance
AI generated
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Full text

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\n\n| | | |\n I 2018 18 |\n |\n \n\n

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\n\n| | | |\n |\n Entscheid vom 12. November 2018 |\n \n\n

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\n\n| | | |\n Besetzung |\n Dr.iur. Vital Zehnder, Vizepräsident |\n \n|\n |\n Dr.med. Urs Gössi, Richter Dr.med. Pierre Lichtenhahn, Richter |\n \n|\n |\n MLaw Stefan Getzmann, Gerichtsschreiber |\n \n\n

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\n\n| | | |\n Parteien |\n A.________, \n Beschwerdeführer, \n vertreten durch Rechtsanwalt lic.iur. B.________, |\n \n|\n |\n gegen |\n \n|\n |\n Suva, Rechtsabteilung, Fluhmattstrasse 1, Postfach 4358, 6002 Luzern, \n Vorinstanz, |\n \n\n

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\n\n| | | |\n Gegenstand |\n Unfallversicherung (Leistungsanspruch bei Rotatorenmanschettenruptur) |\n \n\n

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