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).
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.)
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.
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 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.
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.
Daily benefits are subject to income tax and to social security withholdings at the following rates:
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 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.
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 the after-effects of the accident
The amount of the pension paid depends on two criteria: the worker's permanent disability severity rating and their salary before the accident.
This rating is determined as follows:
For an actual disability rating of 70%, for example, the adjustment applied will be as follows:
The minimum annual salary ('S') used to calculate the disability pension for a disability rating of 10% or above, has been set at €18,575.56 as from April 1st, 2019.
For annual earnings up to twice the salary 'S' (€18,575.56 x 2 = €37,151.12), 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' (€148,604.57), 1/3 of the salary is taken into account.
The calculation does not factor in any earnings above 8S.
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 the 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, 2019):
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 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