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sankt_gallen - Insurance Court - September 8, 2024

UV 2023/57

The medical department of Suva has developed additional assessment criteria in tabular form (so-called fine grids) as a continuation of the federal government's scale. These tables contain guide values that are intended to ensure equal treatment of all insured persons; they are compatible with Annex 3 of the UVV (BGE 124 V 32 E. 1c with a note). Despite the fine grid of the Suva tables, there are integrity damages that cannot be directly assigned to a position on the scale of Annex 3 of the UVV or the Suva tables. In such cases, the degree of severity for specific or unlisted integrity damages must be derived from the scale value or positions of the Suva tables according to a direct or analogous application of Section 1 para. 2 of Annex 3 of the UVV. First, it must therefore be checked whether an integrity damage is included in the scale of Annex 3 of the UVV. If this is not the case, a suitable position must be sought in the Suva tables. If the search yields a negative result, the severity of the integrity damage should ultimately be derived by comparison with the values in the scale of Annex 3 of the UVV or the Suva tables (KOSS UVG-Free, N 17 f. to Art. 25). In particular, the classification of non-listed and combined cases provides the doctor with a wide discretion, in which the administration or the (social insurance) court should not intervene without necessity, and only when the accident medical assessment regarding the list in Annex 3 UVV is not justifiably founded and would result in offensive inequalities (Judgment of the Federal Court dated August 14, 2008, 8C_660/2007, E. 4.2). The specialists at Clinic E.___ stated in their report that the complainant is permanently impaired in her physical and mental integrity. The consequences of the accident have led to a change in the shape of the spine.

Summary

sankt_gallen - Insurance Court - September 8, 2024

UV 2023/57

The medical department of Suva has developed additional assessment criteria in tabular form (so-called fine grids) as a continuation of the federal government's scale. These tables contain guide values that are intended to ensure equal treatment of all insured persons; they are compatible with Annex 3 of the UVV (BGE 124 V 32 E. 1c with a note). Despite the fine grid of the Suva tables, there are integrity damages that cannot be directly assigned to a position on the scale of Annex 3 of the UVV or the Suva tables. In such cases, the degree of severity for specific or unlisted integrity damages must be derived from the scale value or positions of the Suva tables according to a direct or analogous application of Section 1 para. 2 of Annex 3 of the UVV. First, it must therefore be checked whether an integrity damage is included in the scale of Annex 3 of the UVV. If this is not the case, a suitable position must be sought in the Suva tables. If the search yields a negative result, the severity of the integrity damage should ultimately be derived by comparison with the values in the scale of Annex 3 of the UVV or the Suva tables (KOSS UVG-Free, N 17 f. to Art. 25). In particular, the classification of non-listed and combined cases provides the doctor with a wide discretion, in which the administration or the (social insurance) court should not intervene without necessity, and only when the accident medical assessment regarding the list in Annex 3 UVV is not justifiably founded and would result in offensive inequalities (Judgment of the Federal Court dated August 14, 2008, 8C_660/2007, E. 4.2). The specialists at Clinic E.___ stated in their report that the complainant is permanently impaired in her physical and mental integrity. The consequences of the accident have led to a change in the shape of the spine.

Summary

sankt_gallen - Insurance Court - April 15, 2024

UV 2023/38

Special disabilities of the affected person will remain disregarded. The assessment of integrity damage does not depend on the particular circumstances of the individual case; it is rather about the medical-theoretical determination of the impairment of physical and/or mental integrity, whereby subjective factors should be disregarded (cf. the judgments of the Federal Court of January 14, 2021, 8C_658/2020, E. 2.2, and April 23, 2014, 8C_49/2014, E. 4.3, each with references). According to Art. 36 para. 2 of the Ordinance on Accident Insurance (UVV; SR 832.202), the integrity compensation is calculated according to the guidelines of Annex 3 to the UVV. This annex contains a scale that is recognized as lawful and not exhaustive. The medical department of Suva has developed additional assessment bases in tabular form (so-called fine grids) as an extension of the federal scale. These tables contain guidelines that are intended to ensure equal treatment of all insured persons; they are consistent with Annex 3 to the UVV (BGE 124 V 32 E. 1c with reference). Despite the fine grid of the Suva tables, there are integrity damages that cannot be directly assigned to a position of the scale of Annex 3 to the UVV or the Suva tables. In these cases, the degree of severity for special or unlisted integrity damages must be derived from the scale value or from positions of the Suva tables by direct or analog application of No. 1 para. 2 of Annex 3 to the UVV. First, it must therefore be checked whether an integrity damage is included in the scale of Annex 3 to the UVV. If this is not the case, a suitable position should be sought in the Suva tables. If the search results negatively, the severity of the integrity damage must ultimately be derived by comparison with the values in the scale of Annex 3 to the UVV or the Suva tables (KOSS UVG-Free, N 17 f. to Art. 25).

Summary

sankt_gallen - Insurance Court - April 15, 2024

UV 2023/38

Special disabilities of the affected person will remain disregarded. The assessment of integrity damage does not depend on the particular circumstances of the individual case; it is rather about the medical-theoretical determination of the impairment of physical and/or mental integrity, whereby subjective factors should be disregarded (cf. the judgments of the Federal Court of January 14, 2021, 8C_658/2020, E. 2.2, and April 23, 2014, 8C_49/2014, E. 4.3, each with references). According to Art. 36 para. 2 of the Ordinance on Accident Insurance (UVV; SR 832.202), the integrity compensation is calculated according to the guidelines of Annex 3 to the UVV. This annex contains a scale that is recognized as lawful and not exhaustive. The medical department of Suva has developed additional assessment bases in tabular form (so-called fine grids) as an extension of the federal scale. These tables contain guidelines that are intended to ensure equal treatment of all insured persons; they are consistent with Annex 3 to the UVV (BGE 124 V 32 E. 1c with reference). Despite the fine grid of the Suva tables, there are integrity damages that cannot be directly assigned to a position of the scale of Annex 3 to the UVV or the Suva tables. In these cases, the degree of severity for special or unlisted integrity damages must be derived from the scale value or from positions of the Suva tables by direct or analog application of No. 1 para. 2 of Annex 3 to the UVV. First, it must therefore be checked whether an integrity damage is included in the scale of Annex 3 to the UVV. If this is not the case, a suitable position should be sought in the Suva tables. If the search results negatively, the severity of the integrity damage must ultimately be derived by comparison with the values in the scale of Annex 3 to the UVV or the Suva tables (KOSS UVG-Free, N 17 f. to Art. 25).

Summary

bern - Administrative Court of Bern - July 4, 2024

200 2024 297

The relevant factor is the medically-theoretical impairment of physical or mental integrity (Decision of the Federal Supreme Court of February 11, 2020, 8C_756/2019, E. 4.2). 2.2.3 According to Art. 25 Para. 2 UVG, the Federal Council regulates the assessment of compensation. It has exercised this authority in Art. 36 of the Ordinance of December 20, 1982 on accident insurance (UVV; SR 832.202). According to Para. 2 of this provision, the guidelines in Annex 3 apply for the assessment of integrity compensation. In this, the Federal Council has assigned percentages to frequently occurring and typical damages on a non-exhaustive scale recognized as lawful (BGE 124 V 29 E. 1b S. 32). The medical department of Suva has developed further assessment criteria in tabular form (so-called detailed grid) based on the federal scale. Although these tables published by the administration do not represent legal principles and are not binding for the court, as far as they contain only guidelines that ensure the equal treatment of all insured persons, they are in accordance with Annex 3 to the UVV (Decision of the Federal Supreme Court of January 31, 2023, 8C_316/2022, 8C_330/2022, E. 6.1.1). 2.2.4 If multiple events, partly insured and partly uninsured (pre-existing condition, uninsured accident), cause an integrity damage, i.e., there is a symptom picture that cannot be divided into separate, distinguishable impairments medically-diagnostically, then the integrity damage must be assessed as a whole according to Annex 3 to the UVV or, if necessary, according to the mentioned guidelines following the tables of the Medical Department of Suva. In a second step, the compensation must be reduced according to Art. 36 Para. 2 UVG in accordance with the causal share of the uninsured events in the total integrity damage (BGE 116 V 156 E. 3c S. 157; Federal Supreme Court 8C_316/2022, 8C_330/2022, E. 6.1.2.2).

Summary

bern - Administrative Court of Bern - July 4, 2024

200 2024 297

The relevant factor is the medically-theoretical impairment of physical or mental integrity (Decision of the Federal Supreme Court of February 11, 2020, 8C_756/2019, E. 4.2). 2.2.3 According to Art. 25 Para. 2 UVG, the Federal Council regulates the assessment of compensation. It has exercised this authority in Art. 36 of the Ordinance of December 20, 1982 on accident insurance (UVV; SR 832.202). According to Para. 2 of this provision, the guidelines in Annex 3 apply for the assessment of integrity compensation. In this, the Federal Council has assigned percentages to frequently occurring and typical damages on a non-exhaustive scale recognized as lawful (BGE 124 V 29 E. 1b S. 32). The medical department of Suva has developed further assessment criteria in tabular form (so-called detailed grid) based on the federal scale. Although these tables published by the administration do not represent legal principles and are not binding for the court, as far as they contain only guidelines that ensure the equal treatment of all insured persons, they are in accordance with Annex 3 to the UVV (Decision of the Federal Supreme Court of January 31, 2023, 8C_316/2022, 8C_330/2022, E. 6.1.1). 2.2.4 If multiple events, partly insured and partly uninsured (pre-existing condition, uninsured accident), cause an integrity damage, i.e., there is a symptom picture that cannot be divided into separate, distinguishable impairments medically-diagnostically, then the integrity damage must be assessed as a whole according to Annex 3 to the UVV or, if necessary, according to the mentioned guidelines following the tables of the Medical Department of Suva. In a second step, the compensation must be reduced according to Art. 36 Para. 2 UVG in accordance with the causal share of the uninsured events in the total integrity damage (BGE 116 V 156 E. 3c S. 157; Federal Supreme Court 8C_316/2022, 8C_330/2022, E. 6.1.2.2).

Summary

The Suva has created its own integrity damage tables and has also published them. Should these be understood as a supplement to the table in Appendix 3 of the UVV, or do the Suva tables replace the provisions in the UVV?