Recognition of an accident at work
The victim will receive compensation covering all costs if the accident is recognised as accident at work by the Primary Sickness Insurance Fund (called in French Caisse primaire d’assurance maladie, CPAM).
An accident at work is a fortuitous event causing bodily harm that is usually easily observable. It is also something that has happened at a specific time and a known place.
An initial descriptive medical certificate made out by the doctor and the employer’s initial accident notification must be sent to the Caisse primaire d’assurance maladie (French local health insurance fund) .
The French local insurance funds has a period of 30 days to begin investigations if it seems to be necessary : if it is, the Social security informs the victim and the employer.
According to the French social security, article R. 441-10, when the Social security does not give any answer within 30 days of the notification date, the accident is considered an occupational accident.
In case of administrative rejection
- First, the victim takes the matter of the amicable settlement commission (called in French, Commission de recours amiable, CRA),
- if the appeals board rejects the application, the victim can bring the case before the Social Security Court (called in French, Tribunal des affaires de sécurité sociale, TASS) within two months.
In case of medical rejection
When the Social security considers the injuries are not related with the occupational accident, the victim ask for a medical expertise.
The victim is entitled to receive compensation if the accident is recognised as accident at work by the Primary Sickness Insurance Fund (called in French Caisse primaire d’assurance maladie, CPAM)
When the accident is recognised as occupational accident :
- all the costs of care are covered by the Social security (all medical care are free of charge),
- the victim receives daily benefits from the day after the injury for each day of disability (including weekends), until recovery, that is equivalent to a normal wage,
- in case of a hospital stay there is no minimal charge to pay.
In case of after-effects, the victim will receive a partial permanent disability but only when the occupational accident is consolidated. The physician of Social security set the rate for the partial permanent disability, he uses an indicative scale for disability following an occupational accident : barème indicatif d’invalidité accident du travail.
Accident is consolidated means :
For any work-related or occupational disease, the practitioner issues a medical certificate that states the victim has been cured or his condition stabilized and what the final consequences are.