How to precisely define the accident at work?
According to the Social Security Code, “is considered as an accident at work, whatever the cause, the accident occurring by the fact or during the work of any person employed or working in any capacity or in any place whether for one or more employers or entrepreneurs”.
Thus, for the term occupational accident to be recognized, two conditions must be met:
- that the accident may be precisely dated and let him be cause of proven bodily or mental injury ;
- that at the time of the accident there was a subordination link between the victim and his employer.
If the accident at work gives rise to a work stoppage, the employee will then be compensated by the CPAM according to the procedures provided for the payment of daily allowances.
Steps to take after an accident at work
After an accident at work, various steps must be taken:
- within 24 hours: inform the employer (if you are unable to do so, a third party can do so for you) by specifying the circumstances of the accident and the identity of witnesses, if any;
- within 48 hours: the employer must establish the notification of work accident with the CPAM;
- ask your employer for an industrial accident sheet (form S6201) which allows you to obtain 100% coverage of the medical expenses related to your accident.
Please note: if the employer refuses to declare the accident at work or to provide you with the form, you can contact your health insurance fund directly.
- as soon as possible, you must have a initial medical certificate (form S6909) by your usual doctor. On this form, the healthcare professional will specify the nature and location of your injuries as well as the possible consequences that these injuries could have in the more or less long term;
- if your condition requires a work stopping, the doctor will provide you with a work stoppage certificate that you must submit to your employer. This certificate, once returned to the CPAM by the employer, opens the right to the payment of daily allowances;
- within 30 days, you will receive the decision of the Caisse d’Assurance Maladie informing you of whether or not the occupational nature of the accident has been recognized.
Our tips:
If the Caisse d’Assurance Maladie refuses to consider your accident as an accident at work, you can contest its decision and appeal. She will indicate the means of appeal to you in the letter justifying her decision that you will receive.