Facts
L. suffered an accident in 1968 that required the amputation of his right leg. Subsequently, he experienced recurrent complications with the stump, requiring medical treatment. In 1990, a new surgical intervention was performed to treat the stump. The IV office refused to cover the costs of this intervention, considering that it was aimed at treating the underlying condition itself and not a rehabilitation measure. However, the cantonal court held that the prosthesis provided by the IV was a partial adequate cause of the health problems that necessitated this intervention, and therefore ordered the IV to cover 20% of the costs. The IV appealed this decision.Considerations
The Federal Insurance Court considers that when a rehabilitation measure ordered by the insurance is an adequate cause, even partial, of damage suffered by the insured, the IV must cover the full treatment costs. Indeed, as the IV is a final insurance aimed at covering the risk of disability regardless of its origin, there is no reason to limit its liability to only the…