01/12/2019: change in the procedure for examining declarations of Workplace Accidents and Occupational Diseases

EXPERT ARTICLE - By Charlotte Launay, Consultant HR performance, at GAC Group

At 1er December 2019 will apply the provisions of decree n ° 2019-356 of 23 April 2019, the objective of this text is:

  • Clarify rights and obligations of each actor (primary fund, employee, employer),
  • Reinforce the adversarial nature of the procedure to allow primary funds to make more qualitative and less questionable decisions.

Infographic of the AT recognition procedure

Infographic of the PM recognition procedure

1. The procedure for recognizing the professional nature of the accident

The employer now has ten clear days from the work accident declaration to issue justified reservations to the fund.

The investigation period in the event of justified reservations by the employer and, consequently, additional investigations conducted by the fund remains set at three months.

As part of this survey, the CPAM sends a questionnaire to the employee and the employer. This questionnaire is returned in a twenty clear days from the date of receipt.

At the end of its investigations and at the latest seventy clear days From the date on which it has the accident declaration and the initial medical certificate, the fund makes the file mentioned in article R. 441-14 available to the victim or his representatives as well as to that of the employer. These have a ten clear days to consult it and make known their observations.

At the end of this period, the victim or his representatives and the employer can consult the file without making any observations.

2. The procedure for recognizing occupational diseases

The fund has a period of 4 months to rule on the professional nature of the disease or refer the matter to the regional committee for the recognition of occupational diseases mentioned in Article L. 461-1.

As part of this investigation, the fund sends, by any means conferring a certain date on its receipt, a questionnaire to the victim or his representatives as well as to the employer to whom the decision is likely to adversely affect. The questionnaire is returned in a thirty clear days from the date of receipt. The fund may also resort to an additional survey.

At the end of the investigation, the victim or his representatives and the employer have a ten clear days to consult the file and make known their observations, which are annexed thereto. At the end of this period, the victim or his representatives and the employer can consult the file without making any observations.

The fund informs the victim or his representatives and the employer of the opening and closing dates of the period during which they can consult the file as well as that during which they can make observations, by any means conferring certain date on receipt of this information and at the latest ten clear days before the start of the consultation period.

In the event of a referral to the regional committee for the recognition of occupational diseases, it has a new deadline of one hundred and twenty clear days from this referral to rule on the professional nature of the disease.

Provision of the file

The fund makes the file available to the victim or their representatives as well as to the employer for forty clear days.

During the first thirty days, they can consult it, supplement it with any element they deem useful and make known their observations, which are annexed to it. The fund and the medical control service have the same time to complete this file.

Over the next ten days, only consultation and the formulation of observations remain open to the victim or his representatives and the employer.

The fund informs the victim or his representatives and the employer of the expiry dates of these various phases when it contacts the regional committee for the recognition of occupational diseases, by any means conferring a certain date on receipt of this information.

3. The procedure for recognizing a relapse or a new injury following an industrial accident or an occupational disease

In these cases, the fund has a sixty clear days from the date on which it receives the medical certificate mentioning the relapse or the new injury to rule on its attribution to the accident or occupational disease.

The employer has a period of ten clear days from the reception of the medical certificate to issue to the fund, by any means conferring a certain date on their receipt, justified reservations. The fund forwards them to the medical adviser without delay.

The medical adviser, if he considers it necessary or in the event of justified reservations, sends a medical questionnaire to the victim or his representatives. It attaches to it, where applicable, the reasoned reservations formulated by the employer. The questionnaire is returned in a twenty clear days from the date of receipt.

The emergence of new deadlines should prompt increased vigilance on the part of employers. Do not hesitate to contact a consultant.

 

We invite you to review our webinar on this topic:

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