The French Social Security System II - Accidents at work and occupational diseases

2018

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).

Definitions

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: this term does not have an official definition but can be described as the result of some extent of exposure to a risk while performing work activities. From their date of hire (there is no waiting period), salaried workers and those treated as such are covered for work-related risks. This coverage also applies to a variety of categories (students at technical institutes, apprentices, trainees, participants in job-training programs, detainees performing work in prison, etc.)

Procedure

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.

Compensation

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.

A - Temporary disability benefits

1 - Benefits in kind

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 care (medical, surgical, and pharmacy) is covered by the Fund at a rate of 100%. In the case of a hospital stay, there is no daily fee to be paid and the victim is exempted from paying the €18 flat-rate charge for extensive procedures.

The use of the third-party payment system also exempts the victim from paying any upfront costs. Practitioners, allied health professionals and health care institutions are paid directly by the relevant Fund.

2 - Cash benefits

Daily benefits

Daily benefits are subject to income tax and to social security withholdings at the following rates:

  • A 0.5% social debt repayment contribution (CRDS),
  • A 6.2% general social contribution (CSG)
  • For the day of the accident, the injured worker is entitled to their full daily wage, which is paid by the employer.
  • From the day following the accident, the worker is paid a daily allowance that is calculated based on the wage for the calendar month preceding the leave.
  • From the 29th day of leave: payments are increased to 80% of the daily wage (up to a maximum of 265.09 € per day) 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.

Temporary incapacity benefits

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 1 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.

B - Permanent disability benefits : pensions

Once the worker's condition has stabilized, Assurance Maladie's medical examiner will perform an examination.

Depending on the after-effects, the worker can be assigned a permanent disability severity rating.

A severity rating of less than 10% entitles the worker to a one-time compensation payment, the amount of which:

  • Is based on the disability severity rating.
  • If the permanent disability severity rating is 10% or more, the insured will receive a quarterly pension (for severity ratings between 10 and 50%) or a monthly pension (for a severity rating of 50% or more)

1 - Pension for the injured person

The amount of the pension paid depends on two criteria:

  • the worker’s permanent disability severity rating,
  • and their salary before the accident.

a) Permanent disability severity rating

The local Health Insurance Fund determines the worker's actual level of disability based on several factors: an expert assessment, an official table, and the worker's general health status, age, physical and mental abilities, and professional skills.

The rating obtained is then adjusted by dividing the portion below 50% by two and increasing the portion above 50% by half.

Sample calculation

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%.

b) Pay

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), 1/3 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.

c) Caregiver attendance

When the injured person has a permanent disability rating of at least 80% and is unable to perform activities of daily living, the additional caregiver's benefit ("prestation complémentaire pour recours à tierce personne"/ PCRTP) can be awarded in addition to their permanent disability pension.

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):

  • 553.73 € when the victim cannot complete 3 or 4 tasks on the chart alone
  • 1,107.47 € when the victim cannot complete 5 or 6 tasks on the chart alone
  • 1,661.22 € when the victim cannot complete at least 7 tasks on the chart alone, or when the victim has neurological difficulties that make him/her a danger to him/herself or to others.

2 - Pensions payable to survivors

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:

  • A spouse, partner or person with whom the deceased had entered into a civil union (PACS). Such persons may be entitled to a pension amounting to 40% of the deceased person's wages. Additionally, if the spouse is over 55 years of age or has a disability rating of at least 50%, they are entitled to a pension supplement equal to 20% of the deceased worker's wage.
  • Dependent children or descendants under 20 years of age. The amount of the pension is equal to 25% of the deceased's annual salary for each of the first two children, and 20% for each additional child. If the child has lost both parents, the pension is equal to 30% of the deceased's annual salary.
  • Any ascendants who were the deceased person’s dependents (if the deceased person had a partner or child), or who were eligible for a maintenance allowance (if the deceased person had neither a partner nor children). The pension is generally 10% of the deceased's annual salary and the combined total of pensions paid to ascendants may not exceed 30%.

The amount of pensions paid to all survivors combined may not exceed 85% of the deceased person’s annual salary. Where applicable, the amount of each pension is lowered proportionally.

For more information, visit the accidents at work website.