The quick pace, technological changes, and stress often cause chronic fatigue syndrome in certain employees.
The speed of execution, technological changes, and stress often lead to the syndrome of chronic fatigue in some employees. This diagnosis is difficult to understand for many employers and even more so for insurers.
Miss X, having suffered a "quite deep" nervous breakdown, after returning to work over five years ago, experiencing extreme fatigue again, stops working. Her doctor suggests the possibility of a diagnosis of chronic fatigue. Miss X then invokes the collective disability insurance policy provided by her employer.
In the wake of an evaluation marking the end of rehabilitation measures that lasted for a period of three years, two neuropsychologists raise the possibility of simulation. The insurer puts Miss X under surveillance and tailing for a period of five days. A video emerges from this tailing showing certain activities of Miss X. She moves around briskly, without any hesitation, from one shop to another, relentlessly shopping. Based on these findings, the insurer stops paying her any benefits.
Miss X takes her case to court and requests the payment of her benefits. Initially, the court confirms that the surveillance and tailing are admissible as evidence. Secondly, it was proven that all of Miss X's doctors have always advised her to continue her activities during her rehabilitation. The court notes that the short period of tailing corresponds to a good day for Miss X. But what about the afternoon and evening? Should she take a nap or go to bed early? There are good weeks and bad weeks.
The court deems the insurer's evidence to be incomplete and insufficient to determine Miss X's physical condition and states that it does not allow for any medical proof of the situation to be drawn. Therefore, it orders the insurer to pay her monthly benefits, retroactively. As Charles Dickens said, "Do not judge anything by its appearance, never judge anything except by evidence. There is no better rule."
*C.A. 200-09-009221-166
