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I 2018 18 • VG SZ I 2018 18 Généré par l'IA

Insurance Claim Denial Over Rotator Cuff Rupture Causation

Numéro de cause I 2018 18
Autorité / Tribunal
Juridiction Suisse · Canton de Schwytz (CH-SZ)
Date de la décision
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Synthèse Legislator

Généré par l'IA

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.

Regeste Legislator

Généré par l'IA

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.

Mots-clés

Généré par l'IA
demande de prestation d'assurance causalité de l'accident moyens de preuve médicaux lésion à l'épaule lien de causalité surassurance
Généré par l'IA
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Texte complet

\n \n \n \n \n

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

\n \n \n \n \n

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

\n \n \n \n \n \n

\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

\n \n \n \n \n \n

\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

\n \n \n \n \n \n

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

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