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

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

Occupational diseases: A disease is considered “occupational” if it is attributable to some extent of exposure to a risk incurred while performing work activities. France has an official list of occupational diseases. However, it is possible to have a disease recognized as occupational on a case-by-case basis even if it does not appear on the official list.

Salaried workers or those treated as salaried are covered for industrial accidents and occupational diseases from their date of hire (no waiting period applies). This coverage also applies to a variety of other categories (students at technical schools, apprentices, trainees, job-entry program participants, detainees working while incarcerated, etc.)

Accident at work covers any accident resulting from work or occurring during work. It also includes accidents occurring during the commute to or from work, or between the workplace and the place where the worker usually has their meals.

Required paperwork

If diagnosed with an occupational illness, the worker must fill out and submit the occupational illness report form to their local Health Insurance Fund within 15 days following the start of any doctor-prescribed medical leave.

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 entitles the employee to use the third-party payment system as well as free medical care at government-regulated rates.

Compensation

A temporary period of (total or partial) incapacity for work 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 - Benefits for temporary incapacity for work

1 - Coverage of care

The eligibility rules for accident-at-work benefits in kind 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 €24 flat-rate charge for extensive procedures. Certain care, such as dental and other types of prostheses and devices, are covered at a rate of 150%.

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

• For the day of the accident, the injured worker is entitled to their full daily wage, which is paid by the employer.
• For the first 28 days of prescribed medical leave, the worker is paid a daily allowance amounting to 60% of their daily wage (calculated based on the wage for the calendar month preceding the leave divided by 30.42). This allowance cannot exceed €232.03 per day.
• From the 29th day of leave: payments are increased to 80% of the daily wage (up to a maximum of €309.37 per day) and there is no requirement for the employee to have a dependent child as in the case of health insurance.
• After 3 months of medical leave, the claimant's benefit rate can be revised upward in the event of a general wage rise.

This daily benefit can never exceed the worker's daily net salary.

Temporary incapacity for work benefits

If an insured member is declared unfit to perform the work for which they were employed due to an occupational illness, they can receive a temporary incapacity for work benefit for up to 1 month from the issuance of the certificate of inability to work, provided that they meet the eligibility requirements and do not draw any pay over that period.

This benefit is payable at the same rate as the last daily accident at work – occupational illness benefit they were paid during the medical leave they were prescribed in connection with the occupational illness to which the incapacity for work is attributable.

This benefit is generally paid for 1 month but the payment period can be reduced under the following two circumstances:

• If the employee draws wages during the period for which the temporary incapacity for work benefit is paid
• If the employment is offered a job reclassification or made redundant less than a month later.

B - Permanent disability benefits: pensions

Once the worker's condition has stabilized, Assurance Maladie's medical examiner will perform an examination and assign the worker a permanent disability severity rating if necessitated by their ongoing after-effects. This is based on a specific set of criteria and rates.

The one-time compensation payment is exempt from CSG and CRDS withholdings and is not liable to income tax.

• A severity rating of less than 10% entitles the worker to a one-time compensation payment. Its amount, which is a flat rate set by decree, is determined by the worker's disability severity rating (from 1% to 9%).

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

1 - Worker's disability pension

The amount of the pension paid depends on two criteria: the worker's permanent disability severity rating and their salary before the accident. This is a life-long pension and is paid until the disabled worker's death.

a) Permanent disability severity rating (“IPP”)

This rating is determined as follows:

• The local Health Insurance Fund first 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 and qualifications.
• The rating obtained is then adjusted by dividing the portion below 50% by two and increasing the portion above 50% by half.

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 €20,971.34 as from April 1st, 2024.

For annual earnings up to 2 times the salary 'S' (€20,971.34 x 2 = €41,942.68), 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' (€167,770.72), 1/3 of the salary is taken into account.

The fraction above 8 times the minimum salary taken into account is left off.

c) Caregiver attendance

In addition to a permanent disability pension, the injured person can also be awarded the additional caregiver's benefit (prestation complémentaire pour recours à tierce personne/ PCRTP) if s/he has a permanent disability severity rating of at least 80% and is unable to perform at least 3 activities of daily living without assistance.

The amount of the PCRTP 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, 2024) :

•  €633.25 when the victim cannot complete 3 or 4 tasks on the chart alone
•  €1,266.55 when the victim cannot complete 5 or 6 tasks on the chart alone
•  €1,899.87 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, domestic 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%, their lifelong pension amount is increased to 60% of the deceased member's yearly earnings.
  Conversely, if the above relationship had ended in divorce, legal separation, or dissolution, requiring the deceased to pay child or spousal support, or if the deceased had been living with a new spouse, civil union (PACS), or domestic partner, the amount of the pension will be reduced by 20%.
• Legitimate or adopted children 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 eligible for a maintenance allowance if the deceased person had neither a partner nor children. If the deceased person had a partner or child, any ascendants must have been the deceased person's dependents. 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 will be lowered proportionally.

For more information, visit the work-related risks section of the Ameli website