Case closure without further benefits under the accident insurance whiplash practice: No adequate causation of the dizziness complaints raised after case closure

Facts

The appellant [A.] (born 1984) had worked as a construction worker for [B. AG] since June 2016 and was therefore compulsorily insured against accidents and occupational diseases with the Swiss Accident Insurance Institution (Suva).

On 8 August 2017 he fell down a staircase at a construction site (first accident). He suffered bruising and abrasions, a cervical spine distortion (HWS-Distorsion) and a mild traumatic brain injury (LTHV) with amnesia. The CT scan at [C.] Hospital showed only a subgaleal haematoma. The insured person was discharged home on 10 August 2017. Suva covered the medical treatment and paid daily sickness benefits.

On 3 December 2017 he briefly lost consciousness during a walk, fell and struck his face (second accident, renewed LTHV). After CT investigations and neurological 24-hour monitoring, he was discharged from [D.] Hospital on 5 December 2017.

Suva closed both accidents without consequences as of 3 December 2018 (decision of 29 January 2019; decision on objection of 20 March 2019). The Social Insurance Court of the Canton of Zurich dismissed the appeal by judgment of 4 June 2020 (UV.2019.00110).

Before the Federal Supreme Court, the appellant requested that Suva be ordered to pay daily benefits beyond 3 December 2018 and to cover medical treatment. No exchange of written submissions took place.

The issue is whether the closure of the case without consequences as of 3 December 2018 complied with federal law. The appellant argued that at the time benefits were discontinued he still had dizziness complaints requiring treatment and causally related to the accident. It is undisputed that after 3 December 2018 no organically objectively demonstrable consequences of the accidents could be established.

Considerations

The Federal Supreme Court reviews violations of law under Art. 95 and 96 FSCA and applies the law ex officio (Art. 106 para. 1 FSCA). In proceedings concerning cash benefits of accident insurance, it is not bound by the lower court's findings of fact (Art. 97 para. 2 and Art. 105 para. 3 FSCA).

The accident insurer must close the case under Art. 19 para. 1 AIA if no significant improvement in the state of health can be expected from further medical treatment and any possible integration measures of the disability insurance have been completed. The question must be assessed prospectively; insignificant improvements are not sufficient (BGE 134 V 109). The appellant did not show to what extent a significant improvement could have been expected after 3 December 2018. The neurological treatment, medication and physiotherapy had not reduced the total incapacity for work; the dizziness complaints could not be objectified by the neurologist or the ENT specialist.

The file assessment by Suva's neurologist Dr. med. [G.] of 10 January 2019 has probative value. Pure file assessments can be probative if there is a complete medical record and the matter is primarily the specialist assessment of an established set of facts. Medical findings made within the insurance company must be relied upon unless there are even slight doubts about their reliability and conclusiveness (BGE 139 V 225; BGE 135 V 465). The appellant did not raise any such doubts. The reports of the chiropractor and the general practitioner affirming accident causation did not change this, since treating physicians tend to make statements in favour of their patients when in doubt…