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 itemised on a special list (98 charts) in the same category as accidents at work because they are work-related. If it is moreover established that the occupational injury is caused primarily by the victim's work and results in the death or permanent disablement (to a degree of 66.66%) of the victim, the latter is entitled to compensation under accident-at-work law.
Any accident at work must be reported to the employer within 24 hours. The employer must give the employee a special form ("feuille d'accident") which the employee then gives to their doctor. (The employee is thus exempted from any upfront medical costs.) The employer is also required to report the accident within 48 hours to the employee's local Health Insurance Fund, which in turn notifies the Labour Inspectorate.
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 healing 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 sickness 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 previous month’s wage up to a limit of 0.834% of the annual social security ceiling (maximum daily payment: €176.90). From the 29th day of leave, payments are increased to 80% of the daily wage (maximum: €235.87) and there is no requirement for the employee to have a dependent child as in the case of sickness insurance.
The amount of the daily benefit may not exceed the worker's net daily wage prior to the injury.
If an accident-at-work victim is deemed by the workplace physician as incapable of performing the work for which they were employed, the employer has one month in which to propose an alternative position or, failing that, must dismiss the employee on the grounds of incapacity.
In the period during which the employee is drawing neither a salary nor daily sickness benefits, they may be entitled to temporary incapacity benefits. These are 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 drawing 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.
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, 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 used to calculate the disability pension for a disability rating of 10% or above, is determined each year by executive order. As of 1st April 2010, this minimum annual salary 'S' is set at €17,192.
For annual earnings up to twice the salary 'S' (17,192 x 2 = 34,384), 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' (€34,384) but lower than eight times 'S' (€137,536), one third of the salary is taken into account. The calculation does not factor in any earnings above this last level.
When the injured person has a permanent partial disability rating of at least 80% and is unable to perform activities of daily living, they qualify for a 40% increase of their permanent disability pension. This increase cannot be lower than an annual minimum decided by government order (€12,460.37 as of 1st April 2010).
When an accident at work or occupational disease results in the death of the employee, some of the employee's dependants may be entitled to a survivor's pension. Such dependants include:
The total amount of pensions paid to all survivors combined may not exceed 85% of the annual salary on which they were determined.
For more information, visit the accidents at work website.
