When the illness or accident is recognized as work-related, the health expenses of the victim are covered 100% on the basis of Social Security rates. The victim does not proceed with the advance of the expenses, but it does not escape the medical franchises. This coverage covers medical, pharmaceutical, surgery, rehabilitation, medically justified medical transports. Hiring the work comp lawyer is essential here.
Hospital expenses are also paid 100% (on the basis of the public institution’s tariff on closer) and the victim is exempt from paying the daily fee. Dental prostheses and certain fitting products, included in the list of products covered, are 150% covered by the Health Insurance.
Occupational illness or work accident: 100% health costs
The amount of daily allowances
The daily allowances are paid to the employee on sick leave, from the first day following this stop, until healing, consolidation of the injury, the award of an annuity or his death.
The date of cure is fixed by the CPAM on the advice of the attending physician. The employee receives 60% of his daily salary (fixed from the last gross salary received divided by 30.42) for 28 days, within the limit of 202.78 $ per day (2019 amount). Allowances are increased to 80% of the daily wage from 29th day (maximum: 270.38 $ per day in 2019). The basic daily wage cannot exceed 337.97 euros per day.
- After 3 months of absence from work, the daily allowance may be adjusted in the event of a general increase in wages, but it may not exceed the net daily wage.
- The daily allowances paid in the event of an industrial accident or an occupational disease is submitted to the CSG and the CRDS, and to the income tax for 50% of their amount.
- Many collective agreements provide for full or partial maintenance of wages by the employer. In the absence of an agreement, monthly employees with more than one year of seniority in the company receive a salary supplement identical to that provided in case of sickness. No waiting period applies except for commuting accidents.
- The relapse is compensated as the initial accident if the CPAM takes care of it as an accident at work.
At the end of the treatment, the attending physician draws up a final medical certificate. If the accident or illness has reduced the working capacity of the employee, it indicates that the state of health is “consolidated” that is to say, the employee retains sequels. After consulting the medical adviser, the CPAM sets the rate of permanent disability, informs the employee of this rate and the amount of the pension paid by registered letter with acknowledgment of receipt.