French-speaking Switzerland-Insurance: Controversy over the psychiatric sequelae of a fall from a bicycle

Published

A bicycle messenger confiscated a federal court and claimed a disability pension and recognition of the causal link between his two accidents and mental illness. His complaint was partially granted.

The man fell twice while working as a bicycle deliveryman.

The man fell twice while working as a bicycle deliveryman.

AFP (illustration image)

A worker injured in an accident and a medical adviser to an insurance company that makes a diagnosis that points in the direction of the ability to return to work, at least in part … The pattern is classic. His stubbornness to protect his rights was rewarded, except in the case of Alain *, a bicycle courier in his 40s.

Since 2014, the Quadra has been competing with SUVA after two falls from a bicycle that caused injuries and psychiatric consequences. In February 2018, the insurer recognized a 14% disability pension right based on an insured annual profit of CHF 16,779. Alain opposed this decision. Insurance has revised up its offer by offering a 40% pension. However, Alain claimed a 100% pension.

Simultaneously with this procedure in accident insurance, the courier takes steps to obtain a pension from AI (decompensation insurance) by wielding reports from a psychiatrist who asserts that the two accidents are his origin. The current decompensation “. However, the expertise commissioned by the AI ​​office in Valais invalidates this paper. As part of that, SUVA revised the guaranteed profits to CHF 46,814, but stated that “mental illness was not properly causally linked to the two accidents.” The courier has appealed to the Valais State Court, which dismissed it in April 2021. The state court accepted the opinion of psychologists that the sequelae of the accident did not prevent 100% recovery of adapted professional activity. Low physical load, lotus type that can freely alternate between sitting and standing. ” Instead of being discouraged, Alain went to federal court (TF) and claimed a 100% disability pension based on an annual salary of CHF 65,152. In particular, he provided the expertise of another expert who noticed the persistence of chronic pain in the pelvis. “It seems hard to imagine the ability to work in any activity,” the expert predicted, a state judge had not heard.

Psychological expertise recommended by the judges

“The right to benefit from an accident presupposes a natural causal relationship between the accident and the injury to health. Therefore, from a legal point of view, the existence of such an obstacle, the ability to work. Without reliable medical information about the effects of the accident and its causal relationship to the accident, it cannot be said that the accident could cause mental illness. “, TF estimated.

“It is not admitted to recognize the validity of possible mental disorders before the factual question of the nature of these disorders (diagnosis, disabling of personality) and the natural causal relationship with the accident in question is elucidated. “The TF continued. Therefore, a federal judge recommended “psychiatric expertise to assess the nature of mental illness disorders.”

“It’s correct to annualize the salary received by a state judge at a crucial moment, which means it’s related to the employment relationship just before the accident,” the TF declared. .. However, the judge also said that SUVA’s decision should be overturned because it “denies the plaintiff’s right to benefit from mental illness.” This partially granted complaint will satisfy Alain’s lawyer. “This is proof that our legal system is working,” said MeMichel De Palma.

In September 2014, the 40-year-old approached the worst when he fell off a bicycle with one wheel stuck on the rails of a Geneva tram. The accident caused him several fractures of the pelvis in particular, and he remained in the hospital and rehab clinic until October 2015. SUVA was in charge of the case. However, in December 2016, when he resumed part-time bicycle delivery activities, his new fall injured his left wrist. In April 2017, SUVA’s medical adviser noticed that his health condition had deteriorated significantly and recommended a new stay at a rehabilitation clinic with global, physical and psychological care. At the end of this one-month stay, doctors declared that the situation was stable at the level of his pelvis and that stability of his left wrist was expected within two months. For them, the prognosis for reintegration was good. And at the spiritual level, they found that there was no disorder while advocating psychological support. However, in January 2018, another psychiatrist contradicted his colleague by reporting “mixed reactions, depression and anxiety, adjustment disorders with prolonged periods”. He also considered the insured’s work capacity to be “near zero.”

((((apn).