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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?

March 3, 2025

Liability and Insurance Law

Open in Omnilex

Definition of the concept of accident in accident insurance

To determine whether the concept of an accident is fulfilled in this case of damage, the criteria of the accident concept according to Art. 4 ATSG should be examined. According to Art. 4 ATSG, an accident exists if the following five elements are cumulatively present: a sudden, unintended harmful impact of an unusual external factor on the human body, which results in an impairment of physical, mental, or psychological health (Art. 4 ATSG).

1. Suddenness: The accident must occur within a short, definable time period. In your case, the injury occurred while playing soccer due to a braking motion, accompanied by a loud bang in the knee. This indicates the suddenness of the impact. 2. Unintendedness: The impact must occur unintentionally. This is clearly an unintended movement, as the insured did not intentionally induce an excessive external rotation of the leg. 3. Harmful impact: There must be a harmful impact. A loud bang in the knee, followed by an injury, indicates a harmful impact. 4. Unusual external factor: An unusual external factor may also consist of an uncoordinated movement if a circumstance based in the external world has influenced the natural process of a body movement "contrary to the program," such as slipping or stumbling (UV 2023/31).

- The case of excessive external rotation can be classified as an uncoordinated movement, which meets the criteria of an unusual external factor. However, the fact that a such an injury can occur while playing soccer presents a particular challenge. If the braking motion were part of the normal athletic activity without unusual external impact, the extraordinary nature of the factor might possibly not be fulfilled.

5. Causality: There must be a connection between the impact and the health impairment. According to the definition of the accident concept, the event must be the primary cause of the health impairment (ATAS/477/2024).

Based on the above considerations, it can be assumed that the essential elements of an accident occurrence are present. In particular, the unusualness of the external impact is given due to the sudden, uncoordinated movement that led to an excessive external rotation and interrupted the natural movement process (UV 2023/31).

Overall, the concept of an accident seems to be fulfilled, but it would be wise to provide additional medical evidence that confirms the immediate and programmatic impact of the movement (Art. 4 ATSG; UV 2023/31; ATAS/477/2024).

Sources

Federal Act of 6 October 2000 on the General Part of Social Insurance 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, resulting in impairment of physical, mental, or psychological health or death.

Federal Act of 6 October 2000 on the General Part of Social Insurance 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, resulting in impairment of physical, mental, or psychological health or death.

sankt_gallen - Insurance Court - August 19, 2024

UV 2023/31

First, it must be assessed whether there is a duty to provide benefits on the part of the respondent based on Art. 6 para. 1 UVG. In this context, it needs to be examined whether an accident in the legal sense actually occurred on September 30, 2019, particularly whether an unusual external factor in the sense of Art. 4 ATSG was present (cf. consideration 2.1). An unusual external factor can also consist of an uncoordinated movement according to doctrine and case law. In uncoordinated movements, the characteristic of unusualness is met when a circumstance based in the outside world has “programmatically” influenced the natural course of body movement, which is the case, for example, when the insured person stumbles, slips, or bumps into an object or when they make or attempt to make a reflexive defensive movement to prevent slipping. The occurrence of an actual fall is therefore not a prerequisite. Where injury is limited to the interior of the body, and it is empirically known to occur as the sole result of illnesses, particularly degenerative changes of a body part within a completely normal course of events, the uncoordinated movement must indeed have been established as the immediate cause of the injury under particularly significant circumstances; for an accident event typically manifests itself in an externally perceptible injury, whereas in the absence of such, there is an increased probability 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, a.a.O., 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 must be assessed whether there is a duty to provide benefits on the part of the respondent based on Art. 6 para. 1 UVG. In this context, it needs to be examined whether an accident in the legal sense actually occurred on September 30, 2019, particularly whether an unusual external factor in the sense of Art. 4 ATSG was present (cf. consideration 2.1). An unusual external factor can also consist of an uncoordinated movement according to doctrine and case law. In uncoordinated movements, the characteristic of unusualness is met when a circumstance based in the outside world has “programmatically” influenced the natural course of body movement, which is the case, for example, when the insured person stumbles, slips, or bumps into an object or when they make or attempt to make a reflexive defensive movement to prevent slipping. The occurrence of an actual fall is therefore not a prerequisite. Where injury is limited to the interior of the body, and it is empirically known to occur as the sole result of illnesses, particularly degenerative changes of a body part within a completely normal course of events, the uncoordinated movement must indeed have been established as the immediate cause of the injury under particularly significant circumstances; for an accident event typically manifests itself in an externally perceptible injury, whereas in the absence of such, there is an increased probability 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, a.a.O., 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 concept 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 these is absent 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 references).

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

The right to benefits resulting from an insured accident requires, first of all, a link of natural causality between the damaging event of an accidental nature and the injury to health. This condition is fulfilled when it is reasonable to assume 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 injury to health: it is sufficient that, possibly associated with other factors, it has caused the injury to health, meaning it appears as the condition sine qua non of this injury (ATF 142 V 435 consid. 1).

Determining whether the insured event and the injury to health are linked by a relationship of natural causality is a question of fact, which the administration or, if applicable, the judge examines based mainly 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 concept 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 these is absent 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 references).

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

The right to benefits resulting from an insured accident requires, first of all, a link of natural causality between the damaging event of an accidental nature and the injury to health. This condition is fulfilled when it is reasonable to assume 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 injury to health: it is sufficient that, possibly associated with other factors, it has caused the injury to health, meaning it appears as the condition sine qua non of this injury (ATF 142 V 435 consid. 1).

Determining whether the insured event and the injury to health are linked by a relationship of natural causality is a question of fact, which the administration or, if applicable, the judge examines based mainly 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


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