{"id":660811,"date":"2026-04-23T15:54:59","date_gmt":"2026-04-23T13:54:59","guid":{"rendered":"https:\/\/kohenavocats.com\/cour-dappel-le-3-juillet-2025-n21-02361\/"},"modified":"2026-04-23T15:54:59","modified_gmt":"2026-04-23T13:54:59","slug":"cour-dappel-le-3-juillet-2025-n21-02361","status":"publish","type":"post","link":"https:\/\/kohenavocats.com\/zh-hans\/cour-dappel-le-3-juillet-2025-n21-02361\/","title":{"rendered":"Cour d’appel, le 3 juillet 2025, n\u00b021\/02361"},"content":{"rendered":"
\n

La Cour d’appel, dans un arr\u00eat du 3 juillet 2025, statue sur une demande d’indemnisation au titre d’une garantie invalidit\u00e9 absolue et d\u00e9finitive. L’assur\u00e9, victime d’un accident vasculaire c\u00e9r\u00e9bral en 1997, a d\u00e9clar\u00e9 le sinistre en 1998 puis ult\u00e9rieurement en 2018. L’assureur oppose la d\u00e9ch\u00e9ance pour d\u00e9claration tardive et l’absence de preuve de l’\u00e9tat invalidant. La juridiction confirme le rejet de la demande, retenant la d\u00e9ch\u00e9ance de garantie pour le premier sinistre et l’absence de justification pour le second.<\/p>\n

La mise en \u0153uvre de la garantie invalidit\u00e9 et la charge de la preuve<\/p>\n

L’exigence d’une preuve actuelle et conforme \u00e0 la d\u00e9finition contractuelle<\/p>\n

La cour rappelle que la garantie est conditionn\u00e9e par une d\u00e9finition contractuelle stricte. Le contrat pr\u00e9cise que l’assur\u00e9 doit \u00eatre “reconnu inapte \u00e0 tout travail et d\u00e9finitivement incapable de se livrer \u00e0 la moindre activit\u00e9 susceptible de lui procurer salaire, gain ou profit”. L’assur\u00e9 produit divers certificats m\u00e9dicaux et administratifs pour \u00e9tablir son \u00e9tat. La cour estime que ces pi\u00e8ces “ne permettent pas d’\u00e9tablir qu’en 1998, l’\u00e9tat de sant\u00e9 correspondait \u00e0 la d\u00e9finition contractuelle de l’\u00e9tat d’invalidit\u00e9 absolue et d\u00e9finitive”. Elle rel\u00e8ve notamment que des certificats post\u00e9rieurs ne renseignent pas sur l’\u00e9tat ant\u00e9rieur ou ne d\u00e9montrent pas une impossibilit\u00e9 absolue de toute activit\u00e9. Cette analyse rejoint la jurisprudence exigeant une appr\u00e9ciation stricte des clauses d\u00e9finissant l’invalidit\u00e9. La Cour d’appel, le 3 juillet 2025, a ainsi jug\u00e9 que la d\u00e9finition exigeant l’impossibilit\u00e9 d’exercer “toute activit\u00e9 g\u00e9n\u00e9ratrice de r\u00e9mun\u00e9ration ou de profit” n’\u00e9tait pas objectiv\u00e9e par les seuls \u00e9l\u00e9ments m\u00e9dicaux produits (Cour d’appel, le 3 juillet 2025, n\u00b021\/08955). La port\u00e9e de cette exigence est de confirmer que la charge de la preuve incombe \u00e0 l’assur\u00e9, qui doit rapporter des \u00e9l\u00e9ments pr\u00e9cis et contemporains du sinistre.<\/p>\n

La d\u00e9ch\u00e9ance pour d\u00e9claration tardive et ses conditions d’opposabilit\u00e9<\/p>\n

La cour applique la clause contractuelle pr\u00e9voyant une d\u00e9claration dans un d\u00e9lai de six mois. Elle constate que la d\u00e9claration initiale, bien que faite en 1998, n’a pas \u00e9t\u00e9 suivie des justificatifs requis, et que l’assur\u00e9 a sollicit\u00e9 la garantie “pour un sinistre intervenu en novembre 1997 alors qu’il lui incombait de fournir les justificatifs de son \u00e9tat de sant\u00e9 dans les six mois et il encourt donc la d\u00e9ch\u00e9ance de garantie”. L’assur\u00e9 invoquait l’absence de pr\u00e9judice pour l’assureur. La cour rejette cet argument en estimant que “la d\u00e9claration effectu\u00e9e 25 ans apr\u00e8s la survenance du sinistre cause un pr\u00e9judice \u00e0 l’assureur qui est priv\u00e9 de la possibilit\u00e9 de proc\u00e9der utilement aux investigations”. La valeur de cette motivation est de rappeler le caract\u00e8re substantiel du d\u00e9lai de d\u00e9claration dans les contrats d’assurance. Elle consacre le pr\u00e9judice d\u00e9coulant de l’impossibilit\u00e9 d’une expertise en temps utile, renfor\u00e7ant ainsi l’effectivit\u00e9 des clauses de d\u00e9ch\u00e9ance.<\/p>\n

Les effets de la r\u00e9siliation du contrat et la temporalit\u00e9 du sinistre<\/p>\n

La distinction entre survenance et d\u00e9claration du sinistre<\/p>\n

L’assur\u00e9 a \u00e9galement d\u00e9clar\u00e9 un sinistre en 2018, post\u00e9rieurement \u00e0 la r\u00e9siliation de son contrat intervenue en mars 2018. La cour rappelle le principe selon lequel “si la d\u00e9claration de sinistre est post\u00e9rieure \u00e0 la r\u00e9siliation du contrat, les garanties sont n\u00e9anmoins applicables aux sinistres survenus pendant la dur\u00e9e d’application de la garantie”. Elle identifie le sinistre comme \u00e9tant “l’\u00e9tat de sant\u00e9 qui s’est vu attribuer, le 22 mars 2018, par le d\u00e9partement une carte mobilit\u00e9 inclusion avec mention invalidit\u00e9”. Le contrat doit donc en principe recevoir application pour un sinistre survenu avant sa r\u00e9siliation. Ce point confirme la dissociation entre la date de manifestation de l’\u00e9tat invalidant et la date de sa reconnaissance administrative. La port\u00e9e en est de prot\u00e9ger l’assur\u00e9 contre la perte de sa garantie pour un sinistre survenu durant la vie du contrat, m\u00eame d\u00e9couvert ou officialis\u00e9 post\u00e9rieurement.<\/p>\n

La condition d’ant\u00e9riorit\u00e9 \u00e0 l’\u00e2ge limite de la garantie<\/p>\n

La garantie n’est cependant due que si l’\u00e9tat d’invalidit\u00e9 absolue et d\u00e9finitive est survenu avant le soixante-cinqui\u00e8me anniversaire de l’assur\u00e9. La cour constate que l’assur\u00e9 a atteint cet \u00e2ge en 2011. Or, elle rel\u00e8ve qu'”il ne justifie nullement d’une aggravation de son \u00e9tat de sant\u00e9 avant son 65\u00e8me anniversaire, les aggravations successives qu’il a invoqu\u00e9es n’ayant d’ailleurs fait l’objet d’aucune d\u00e9claration de sinistre”. D\u00e8s lors, “le sinistre du 22 mars 2018 \u00e9tant largement post\u00e9rieur \u00e0 l’expiration des garanties, la demande ne peut prosp\u00e9rer”. La solution souligne le caract\u00e8re cumulatif des conditions : la garantie ne joue que pour un \u00e9tat survenu et constitu\u00e9 avant la limite d’\u00e2ge, peu importe que sa reconnaissance formelle soit ult\u00e9rieure. La valeur de cet arr\u00eat est de pr\u00e9ciser les contours de l’exigence d’ant\u00e9riorit\u00e9, en la liant \u00e0 la survenance de l’\u00e9tat pathologique invalidant et non \u00e0 sa simple constatation.<\/p>\n<\/div>\n","protected":false},"excerpt":{"rendered":"

La Cour d’appel, dans un arr\u00eat du 3 juillet 2025, statue sur une demande d’indemnisation au titre d’une garantie invalidit\u00e9 absolue et d\u00e9finitive. 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