The saying that “work is health” is far from always true. According to Health Insurance statistics, there were 655,715 work accidents in 2019, i.e. a frequency of 33.5 incidents per 1,000 employees, as well as 50,392 occupational diseases, 88% of which are related to musculoskeletal disorders.
But what exactly are we talking about?
A complex definition
The question is whether or not the worker’s poor state of health is related to his occupation. In the event of an accident, you must prove that the accidental fact occurred in the course of professional activity, in other words when you were under the authority of your employer, and that it resulted in the sudden appearance of a any lesion. From cuts to cardiac illness, muscle pain or emotional shock following an assault committed in the company, the impact can be physical or psychological.
On the other hand, the demonstration is less obvious for an affection, since the latter develops over time. Social Security has therefore drawn up tables of illnesses which are presumed to be of occupational origin when they are contracted under certain conditions. This is for example the case with sciatica caused by the handling of heavy loads, or even ailments linked to exposure to lead or carbon. For each pathology, it is specified the timeframe for treatment and a list of the types of work that can cause the disorder.
As soon as you do not get into the nails, the deal gets complicated. If all the criteria are not met, it must be established that the pathology was directly caused by the employee’s usual work. And if the disease does not appear in one of these tables, it will be necessary, in addition, to prove that it has resulted in a permanent disability of at least 25% or the death of the employee for it to be considered of professional origin.
What is the procedure ?
This recognition of the impact of work on health constitutes a major financial stake, since it gives the right to free care related to your accident or illness, but also to increased daily allowances in the event of sick leave and specific compensation in the event of permanent incapacity.
In the event of an accident, you generally have 24 hours to inform your employer on site or by registered mail. The latter then has 48 hours to declare it to the Primary Health Insurance Fund (CPAM). For your part, you must have your condition noted by a doctor, who will draw up a medical certificate describing the injuries suffered and send it to the CPAM. Unless there is a further investigation, the Health Insurance slices within 30 days.
If your doctor considers that your pathology is related to your work, it is on the other hand for you to ask for the recognition of its professional origin by sending the appropriate form to the CPAM (available on Ameli.fr), accompanied by the medical certificate and ” a salary certificate. The Fund has three months to rule. During this period, she will conduct her investigation by asking you to complete a questionnaire on your working conditions, and by imposing additional medical examinations. In addition, if your condition does not meet the conditions required by the Social Security tables or does not appear there, your file will be submitted to the Regional Committee for the Recognition of Occupational Diseases (CRRMP).
A decree published in Official newspaper of September 15, 2020 created new occupational disease tables relating to “Acute respiratory conditions linked to SARS-CoV2 infection”. Healthcare workers can thus automatically benefit from this recognition if they have contracted a severe form of coronavirus. For liberal practitioners and people who do not work in the health sector, the file is examined by a committee of independent experts.
You can make your request online on Declare-maladiepro.ameli.fr, attaching a medical certificate, a hospitalization report attesting to the seriousness of your condition, proof of professional activity and a certificate from the employer on your work periods in 2020.