Each year, around 50,000 people have the occupational nature of their illness recognized and are compensated. But the files are not easy to assemble. So, don't be discouraged. How to make a declaration of occupational disease? We explain the steps of the procedure to you.
The number of recognized occupational illnesses is decreasing slightly: it was 46,448 in 2021, which represents a drop of 4.3% compared to 2019 , indicates the National Institute for Research and Safety (INRS) (source 1 ). Indeed, this procedure, to be done yourself, is little known and tedious. So to help you complete the process, here are some tips.
Definition: what is an occupational disease?
The legal concept of occupational illness has existed in France since 1919. To be recognized as of occupational origin, the illness must be the direct consequence of exposure to a nuisance in the context of one's work.
It may be vibrations or shocks linked to the use of certain machines, intense noise, night work , but also chemical substances such as asbestos, or even infectious agents... It must also be listed in one of the tables of occupational diseases of the general regime or the agricultural regime of Social Security, which can be found on the INRS website .
What if the disease is not included in the tables?
It can, despite everything, be recognized as an occupational disease if doctors meeting at the Regional Committee for the Recognition of Occupational Diseases (CRRMP) deem this justified.
Declaration of an occupational disease: how to go about it?
First step: obtain a medical certificate
It can be established by your treating physician , a specialist doctor or an occupational physician.
Once this certificate is given to the employee, the latter has two years to declare their occupational illness. This limitation period should not be confused with those specified in the tables, which represent the maximum period between the discovery of the illness and the date on which the worker ceased to be exposed to the risk, says Alain Prunier, vice-president of the FNATH.
This period is forty years for cancers linked to asbestos.
“We must also ensure that this certificate includes the exact terms of designation of the diseases in the tables. If this is not the case, this could be a reason for refusal,” points out Professor Cécile Manaouil, head of the legal and social medicine department, Hauts-de-France Regional Center for Occupational and Environmental Pathologies (CHU Amiens).
What if the person died before starting the process? Their beneficiaries can request a medical certificate of cause-effect relationship (RCE). This names the illness and states that it is the cause of death. It is also necessary to obtain the medical records of the deceased.
Second step: declare the illness to Social Security
The form is online (Cerfa n° 16130*01 for the general regime, and n° 10131*05 for the agricultural regime). In practice, you must indicate the pathology , complete information on your last employer (date of hire, position held, workplace address, etc.), and briefly detail what risks the victim may have been exposed to. To do this, you must specify the job held, the name of the company and the period of work.
Third step: send your file
Once these documents have been duly completed, the request must be sent to the health insurance to which the worker depends. If a work stoppage is in progress, a salary certificate completed by the employer must be added to the file.
To support your request, you can also produce a copy of your medical examination results, your occupational health file, but also employer certificates or your pay slips, because many refusals are linked to insufficiently qualified requests. substantiated, specifies Professor Cécile Manaouil, head of the legal and social medicine department at Amiens University Hospital.
“It is often at this stage that patients, most of whom are retired when the pathology occurs, or their dependents, become discouraged . Over the years, these documents may have been thrown away or misplaced, the company did not keep its archives or it closed…”.
Request for recognition of an occupational disease: what next?
Health Insurance has 100 days to respond. It then carries out its own survey of the company, and systematically sends a questionnaire to the employee and the employer to assess working conditions. The medical advisor may also ask to see the patient. At the end of this investigation, both parties have access to the file and can share their observations. The final decision comes at the end of this phase.
If the disease does not appear in a table, it is up to the regional committee for the recognition of occupational diseases ( CRRMP ) to decide . He has 110 days to do so. It will recognize it as an occupational illness if it is “essentially and directly caused by usual work” and “if it results in death or foreseeable permanent incapacity of at least 25%”, indicates Social Security.
If the request is accepted, 100% coverage of medical care and higher daily allowances
You benefit from 100% coverage of medical care related to this disease. In the event of work stoppage, you will receive higher daily allowances than in the case of simple sick leave. Furthermore, some collective agreements provide more advantageous provisions, take a look. If your disease is no longer progressing, it is said to be “stabilized”.
At that time, the Health Insurance medical advisor assesses a level of incapacity. Depending on this rate, financial assistance is paid in the form of capital (between €450 and €4,500) in one go, or in the form of a monthly or quarterly annuity paid for life.
And if the request is refused, what happens?
The decision can be contested by contacting the Health Insurance Medical Commission for Amicable Appeal (CMRA) .
If this new request is rejected, it is possible to initiate proceedings with the judicial court, appeal to the court of appeal and/or appeal to the Court of Cassation. Applicants can be supported and defended by associations. Alain Prunier
What are the most recognized occupational diseases?
Sciatica , carpal tunnel syndrome , shoulder tendinopathy... Musculoskeletal disorders (MSDs) represent the majority of occupational illnesses . Next come pathologies due to asbestos (5%). Asthma , hearing damage, dermatological conditions or depression are also common.
Source 1: “ Work accidents and occupational diseases: key figures for 2021 ”, National Institute for Research and Safety (INRS).
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