🔎 Discover the second edition of our infographic dedicated to occupational risk management
🖊️ Louise-Anne LesaffreG.A.C. Group's professional risk management consultant.
Two ways of recognizing occupational diseases were established by the Social Security Code:
Common law procedure
A disease is presumed to be of occupational origin when it is listed in one of the tables of occupational diseases and contracted under the conditions mentioned in said table.
Article L.461-1 paragraph 2 of the Social Security Code
Referral to the Regional Committee for the Recognition of Occupational Diseases (CRRMP)
- If one or more conditions of the table of occupational diseases are not fulfilled and that there is a direct link between the condition and the usual work ;
- If the disease is not designated in a table and :
- it is essentially and directly caused by the victim's usual work
- that it results in death or a permanent disability rate of at least 25%
The members of the CRRMP
1 regional labour inspector
1 regional health insurance consultant
1 university professor-hospital practitioner
> In case of psychological pathology: the consulting physician or the CRRMP must call upon a psychiatrist
Article R.461-27 of the Social Security Code
The Primary Fund is obliged to inform the employer in case of referral to the CRRMP and to specify the different phases of the consultation procedure.
Article R.461-10 of the Social Security Code
The date of transmission of the file to the CRRMP must appear on the letter sent to the employer
"In the event of a referral to a regional committee for the recognition of occupational diseases, whose opinion is binding on the fund, the employee, his or her dependents and the employer are informed of the investigation procedure and of the points likely to be prejudicial to them before the file is transmitted to the said regional committee. This information shall specify the date on which the file will be transmitted.
(Cass. 2nd civ., Nov. 25, 20-15.574)
The regional committee has 120 clear days from the date of referral to give its reasoned opinion
This notice is binding on the Caisse Primaire
Article L.461-1 of the Social Security Code
Cass. 2nd civ., Oct. 13, 2022, nº 21-10.253
In this case, following the refusal of coverage of his illness under the tables of occupational diseases, an employee was able to make a new claim. This new claim was investigated according to the so-called "off-table" procedure.
The Court of Cassation concludes that this new decision of recognition of the occupational disease is opposable to the employer:
"A first decision to refuse to cover a disease under an occupational disease table, even if it has become final with respect to the employer, cannot prevent the employer from enforcing a second decision of the fund based on a new occupational disease declaration investigated according to the rules applicable to the recognition of the occupational nature of diseases not designated in a table.
(Cass. 2e civ., Oct. 13, 2022, nº 21-10.253)
For more information on this subject, contact our experts!
Louise-Anne LESAFFRE - Occupational Risk Management Consultant