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sankt_gallen - Insurance Court - August 19, 2024

UV 2023/31

First, it is to be assessed whether there is an obligation to provide benefits of the respondent based on Art. 6 para. 1 UVG. In this context, it must be examined whether an accident in the legal sense actually occurred on September 30, 2019, in particular, whether an unusual external factor in the sense of Art. 4 ATSG was present (cf. consideration 2.1). An unusual external factor can, according to doctrine and jurisprudence, also consist of an uncoordinated movement. In the case of uncoordinated movements, the characteristic of unusualness is fulfilled when a circumstance based in the external world has influenced the natural course of a bodily movement in a way that is “contrary to design,” which is the case, for example, when the insured person stumbles, slips, or bumps into an object or when they perform or attempt to perform a reflexive defensive movement in order to prevent slipping. It is not assumed that a fall actually occurs. Where damage is confined to the interior of the body and, based on experience, can also occur solely as a result of diseases, particularly degenerative changes of a body part within a completely normal process, uncoordinated movement must, however, have been set as the immediate cause of the damage under particularly evident circumstances; for an accident event typically manifests itself in an externally perceivable damage, while in the absence of such damage, there is an increased likelihood of purely disease-related causes (cf. BGE 134 V 80 E. 4.3.2.1 with references; Judgment of the Federal Court of March 25, 2011, 8C_693/2010, E. 5; RKUV 1999 No. U 333 p. 199 E. 3c/aa and No. U 345 p. 422 E. 2b, RKUV 1996 No. U 253 p. 204 E. 4d; KOSS UVG-Nabold, N 32 to Art. 6 UVG; BSK UVG-Hofer, N 38 to Art. 6 UVG; Nabold, op. cit., p. 41 ff.; Alfred Maurer, Swiss Accident Insurance Law, 2nd ed. Bern 1989, p. 176 f.).

Summary

sankt_gallen - Insurance Court - August 19, 2024

UV 2023/31

First, it is to be assessed whether there is an obligation to provide benefits of the respondent based on Art. 6 para. 1 UVG. In this context, it must be examined whether an accident in the legal sense actually occurred on September 30, 2019, in particular, whether an unusual external factor in the sense of Art. 4 ATSG was present (cf. consideration 2.1). An unusual external factor can, according to doctrine and jurisprudence, also consist of an uncoordinated movement. In the case of uncoordinated movements, the characteristic of unusualness is fulfilled when a circumstance based in the external world has influenced the natural course of a bodily movement in a way that is “contrary to design,” which is the case, for example, when the insured person stumbles, slips, or bumps into an object or when they perform or attempt to perform a reflexive defensive movement in order to prevent slipping. It is not assumed that a fall actually occurs. Where damage is confined to the interior of the body and, based on experience, can also occur solely as a result of diseases, particularly degenerative changes of a body part within a completely normal process, uncoordinated movement must, however, have been set as the immediate cause of the damage under particularly evident circumstances; for an accident event typically manifests itself in an externally perceivable damage, while in the absence of such damage, there is an increased likelihood of purely disease-related causes (cf. BGE 134 V 80 E. 4.3.2.1 with references; Judgment of the Federal Court of March 25, 2011, 8C_693/2010, E. 5; RKUV 1999 No. U 333 p. 199 E. 3c/aa and No. U 345 p. 422 E. 2b, RKUV 1996 No. U 253 p. 204 E. 4d; KOSS UVG-Nabold, N 32 to Art. 6 UVG; BSK UVG-Hofer, N 38 to Art. 6 UVG; Nabold, op. cit., p. 41 ff.; Alfred Maurer, Swiss Accident Insurance Law, 2nd ed. Bern 1989, p. 176 f.).

Summary

Geneva - ATAS - June 20, 2024

ATAS/477/2024

The notion of an accident is broken down into five elements or conditions, which must be cumulatively fulfilled: a damaging event, the sudden nature of the event, the involuntary nature of the event, the external factor of the event, and finally, the extraordinary nature of the external factor; it is sufficient that one of them is missing for the event to not be classified as an accident (ATF 142 V 219 consid. 4.3.1 ; 129 V 402 consid. 2.1 and the references).

4.2 The liability of the accident insurer extends, in principle, to all harmful consequences that are in a relationship of natural causality (ATF 119 V 335 consid. 1; 118 V 286 consid. 1b and the references) and adequate with the insured event (ATF 125 V 456 consid. 5a and the references).

The right to benefits resulting from an insured accident assumes, first of all, a natural causal link between the damaging event of an accidental nature and the health impairment. This condition is fulfilled when it can be assumed that, without this accidental event, the damage would not have occurred at all or would not have occurred in the same way (ATF 148 V 356 consid. 3 ; 148 V 138 consid. 5.1.1). It is not necessary for the accident to be the sole or immediate cause of the health impairment: it is sufficient that, possibly associated with other factors, it has caused the health impairment, meaning that it appears as the condition sine qua non for this impairment (ATF 142 V 435 consid. 1).

Whether the insured event and the health impairment are linked by a relationship of natural causality is a question of fact, which the administration or, if applicable, the judge examines based essentially on medical information, and which must be resolved in accordance with the rule of the preponderance of probability, generally applied to the assessment of evidence in social insurance.

Summary

Geneva - ATAS - June 20, 2024

ATAS/477/2024

The notion of an accident is broken down into five elements or conditions, which must be cumulatively fulfilled: a damaging event, the sudden nature of the event, the involuntary nature of the event, the external factor of the event, and finally, the extraordinary nature of the external factor; it is sufficient that one of them is missing for the event to not be classified as an accident (ATF 142 V 219 consid. 4.3.1 ; 129 V 402 consid. 2.1 and the references).

4.2 The liability of the accident insurer extends, in principle, to all harmful consequences that are in a relationship of natural causality (ATF 119 V 335 consid. 1; 118 V 286 consid. 1b and the references) and adequate with the insured event (ATF 125 V 456 consid. 5a and the references).

The right to benefits resulting from an insured accident assumes, first of all, a natural causal link between the damaging event of an accidental nature and the health impairment. This condition is fulfilled when it can be assumed that, without this accidental event, the damage would not have occurred at all or would not have occurred in the same way (ATF 148 V 356 consid. 3 ; 148 V 138 consid. 5.1.1). It is not necessary for the accident to be the sole or immediate cause of the health impairment: it is sufficient that, possibly associated with other factors, it has caused the health impairment, meaning that it appears as the condition sine qua non for this impairment (ATF 142 V 435 consid. 1).

Whether the insured event and the health impairment are linked by a relationship of natural causality is a question of fact, which the administration or, if applicable, the judge examines based essentially on medical information, and which must be resolved in accordance with the rule of the preponderance of probability, generally applied to the assessment of evidence in social insurance.

Summary

Federal Act of October 6, 2000, on the General Part of Social Security Law (ATSG) > Chapter 2: Definitions of General Terms > Accident

Art. 4 ATSG

An accident is the sudden, unintended harmful effect of an unusual external factor on the human body, which results in impairments of physical, mental, or psychological health, or death.

Federal Act of October 6, 2000, on the General Part of Social Security Law (ATSG) > Chapter 2: Definitions of General Terms > Accident

Art. 4 ATSG

An accident is the sudden, unintended harmful effect of an unusual external factor on the human body, which results in impairments of physical, mental, or psychological health, or death.

The 32-year-old insured person injured his left knee while playing football, when he experienced excessive external rotation with his left leg during a braking movement. There was a loud bang in the left knee. Is the concept of an accident fulfilled in this case?