Facts

Parties and proceedings: The appellant (insured person, born 1967) had been employed as a butcher by [B. AG] since 1 January 2008 and was compulsorily insured against accidents through Branchen Versicherung. Branchen Versicherung is the respondent. Before the Federal Supreme Court is an appeal under public law against the decision of the Administrative Court of the Canton of Glarus of 22 August 2019 (GLA.2019.00008). The subject matter is accident insurance, specifically the causal link.

Accident and initial case: On 21 November 2008, after finishing work, the insured person slipped on a grated steel staircase and sustained a contusion of the right knee. At the [C.] hospital, among other things, a complete rupture of the patellar ligament was diagnosed. On 10 December 2008, a patellar tendon suture was performed, and on 2 March 2009, removal of osteosynthesis material. Branchen Versicherung provided the statutory benefits.

Closure of the case in 2011: Relying on the report of the insurer's medical adviser Dr. med. [D.] (specialist in surgery) of 16 June 2011, the insurer, by decision of 28 July 2011, denied a disability pension because the insured person was again 100% able to work. An integrity award of 5% was granted, as well as a benefit from supplementary insurance (IPA).

Notification of recurrence in 2012: On 13 July 2012, the insured person reported a recurrence, now affecting the left knee. By notice of 7 September 2012 and decision of 25 October 2012, the insurer denied a causal link between the right-sided knee complaints and the accident and refused liability for the left-sided complaints as well, for which no accident event was known. No appeal was lodged against this decision.

New registration in 2014 and decision in 2018: In September 2014, the insured person again applied for a disability pension. Following an examination by the insurer's medical adviser Dr. med. [D.] (report of 22 December 2014) and further medical investigations, the insurer, by decision of 16 October 2018, confirmed by decision on objection of 13 December 2018, denied entitlement to benefits because, with predominant probability, no accident sequelae remained.

Lower court: The Administrative Court of the Canton of Glarus dismissed the appeal by decision of 22 August 2019.

Requests before the Federal Supreme Court: The appellant requested that the lower court's decision be set aside and the case be remitted to the insurer or the lower court, as well as a second exchange of written submissions. Branchen Versicherung and the cantonal court requested dismissal. The FOPH waived a response. Newly submitted reports (Dr. med. [G.] of 20 September 2019; Dr. med. [E.] of 18 February 2020) were not considered as inadmissible novel evidence.

Question in dispute: Whether the lower court correctly denied liability of Branchen Versicherung for the left- and right-sided knee complaints.

Considerations

Standard and causality: The insurer's liability under Art. 6 para. 1 AIA presupposes a natural causal link, which, including in cases of recurrence and late sequelae (Art. 11 AIO), must be proven with predominant probability. The claimant bears the burden of proof. The greater the time elapsed between the accident and the health impairment, the stricter the requirements for proof on the balance of probabilities. The Federal Supreme Court examines the law ex officio but is not bound by the lower court's findings of fact (Art. 97 para. 2, Art. 105 para. 3 FSCA). New reports issued after the lower court's decision are inadmissible novel evidence (Art. 99 para. 1 FSCA).

Probative value of insurer-internal physicians: Insurer-appointed medical advisers are to be treated equivalently to insurer-internal physicians. Their reports have probative value provided they are conclusive, comprehensible and free of contradictions, and there are no indications against their reliability. However, they do not have the same evidentiary weight as independent expert opinions; where even slight doubts exist, supplementary investigations are required (BGE 139 V 225; 135 V 465).

Res judicata, revision and reconsideration: The initial case was closed by the unchallenged decision of 28 July 2011, and the decision of 25 October 2012 denied a recurrence or late sequelae. A different assessment is only possible in the case of new facts or evidence (revision, Art. 53 para. 1 GSSLA), where the decision was manifestly incorrect (reconsideration, Art. 53 para. 2 GSSLA), or where a recurrence or late sequelae has actually occurred. None of these prerequisites is met; the report of Dr. med. [G.] remains immaterial. The question of bridging symptoms therefore does not arise.

Right-sided knee complaints: The lower court rightly relied on Dr. med. [D.] , who identified no…