Benefits for accidents at work and occupational diseases are paid by the local Health Insurance Fund (in the case of Metropolitan France) or the General Social Security Fund (in the case of the Overseas Departments).
Employees or categories treated as such are covered for occupational risks. Such coverage is also provided to certain categories of the population, including students of technical schools, apprentices and vocational trainees.
Accident at work covers any accident "resulting from work or occurring during work". It also includes accidents occurring during the journey to or from work, or between the workplace and the place where the individual usually has their meals.
Occupational diseases: the law classifies the occupational diseases itemized on a special list in the same category as accidents at work.
Any accident at work must be reported to the employer within 24 hours. The employer must report the accident to the employee's local Health Insurance Fund within 48 hours and give the employee a special form ("feuille d'accident") which the employee then gives to their doctor in order to be exempted from any upfront medical costs.
A temporary period of (total or partial) disablement starts immediately after the injury or diagnosis of the disease and ends with the worker's recovery or effective stabilization of the injury. Payment of accident-at-work and occupational-disease benefits is not contingent on registration with the social security system or periods of contributions.
The conditions governing the payment of benefits in kind for accidents at work are the same as those for in-kind health insurance benefits, with the exception that all benefits are covered by the Fund at a rate of 100%. In the case of a hospital stay, there is no daily fee to be paid, nor the €18 flat-rate charge for extensive procedures.
The victim is also exempted from payment of any upfront costs. Practitioners, allied health professionals and health care institutions are paid directly by the relevant Fund (direct settlement system).
The injured worker is entitled to their full wage for the day of the accident, which is paid by the employer. Thereafter, the worker is paid a daily allowance amounting to 60% of the daily wage taken as 1/30.42 of the wage for the calendar month preceding the leave (maximum daily payment: €196.30). From the 29th day of leave, payments are increased to 80% of the daily wage (maximum: €261.73) and there is no requirement for the employee to have a dependent child as in the case of health insurance.
This daily benefit can never exceed the worker's daily net salary.
If an accident-at-work victim is deemed by the workplace physician as incapable of performing the work for which they were employed, the worker can receive a temporary incapacity benefit for up to one month from the issuance of the certificate of inability to work, on condition that the worker not be receiving any pay.
This benefit is payable at the same rate as the sickness benefits paid while the employee was on sick leave prior to their incapacity being established. If the employee is awarded a disability pension due to the injury sustained at work, the temporary incapacity benefits are deducted from the average monthly amount of the disability pension. Temporary incapacity benefits are payable for a maximum period of one month.
Once the worker's condition has stabilized, Assurance Maladie's medical examiner will perform an examination to determine whether a permanent disability severity rating should be assigned.
If the severity rating is less than 10%, a one-time compensation payment is made. The amount of this lump-sum payment is set by decree and is based on disability severity rating (amounts are listed online).
If the permanent disability severity rating is 10% or more, the insured will receive a permanent-disability pension.
Permanent-disability pensions are paid each quarter when the permanent disability severity rating is between 10% and 50%, or on a monthly basis when the severity rating is 50% or more.
The amount of the pension paid depends on two criteria:
The local Health Insurance Fund determines the worker's actual level of disability on the basis of an expert evaluation and the worker's general health status, age, physical and mental abilities and professional skills. For this purpose, an official table is used.
The level obtained is then adjusted by dividing the portion below 50% by two and increasing the portion above 50% by half.
For an actual disability rating of 70%, for example, the adjustment applied will be as follows:
(50 /2) + (20 x 1.5) = 25 + 30 = 55. The applicable rating is thus 55%.
The minimum annual salary ('S') used to calculate the disability pension for a disability rating of 10% or above, has been set at €18,336.64 as from April 1st, 2017.
For annual earnings up to twice the salary 'S' (€18,336.64 x 2 = €36,673.28), the total salary of the injured worker is taken into account. For the portion of the worker's annual earnings higher than two times 'S' but lower than eight times 'S' (€146,693.16), one third of the salary is taken into account.
The calculation does not factor in any earnings above 8S.
Both the one-time compensation payment and the permanent disability pension are exempt from CSG and CRDS contributions and are not subject to income tax.
When the injured person has a permanent disability rating of at least 80% and is unable to perform activities of daily living, they qualify for a supplementary benefit in addition to their permanent disability pension: the additional caregiver's benefit ("prestation complémentaire pour recours à tierce personne"/ PCRTP). The amount of this benefit is calculated based on the insured's caregiving needs, which are determined by the pension payer's medical department using a chart to evaluate ten activities that the victim cannot perform by him or herself.
The three fixed rates are as follows (as from April 1st, 2017):
When an accident at work or occupational disease results in the death of the employee, some of the employee's dependents may be entitled to a survivor's pension. Such dependents include:
The amount of pensions paid to all survivors combined may not exceed 85% of the annual salary on the basis of which they were determined (where applicable, the amount of each pension is lowered proportionally).
For more information, visit the accidents at work website.