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accident at work: compensation for permanent incapacity

Verified 01 avril 2022 - Legal and Administrative Information Directorate (Prime Minister)

If you are a victim of a accident at work, you can receive compensation if your work capacity is permanently reduced as a result of this accident. Additional compensation is paid under conditions (very serious or intentional fault of the employer, lack of a person outside the company).

If you are a victim of a accident at work, you may be left with a lasting loss of physical or mental capacity. In this case, your social security agency (CPAM or MSA) determines a permanent disability rate (PPI) that allows you to collect compensation. Depending on your PPI rate, this allowance is paid as capital or life annuity.

Procedure

The CPAM or the MSA sets your final PPI rate based on the information collected. Your social security agency seeks advice from its medical advisor and, in some cases, the occupational physician (especially when permanent disability may render you unfit for work).

You and your employer are informed of this and may request the advice of the medical advisor within 10 days of the notification of the decision.

  Please note : The final PPI rate can be revised to reflect changes in your health.

Criteria

To determine your PPI rate, CPAM or MSA is based on the following criteria:

  • Nature of your infirmity
  • Your general state
  • Your age
  • Your physical and mental faculties
  • Your professional skills and qualifications

Appeal

You and your employer can challenge your social security agency's decision with the Medical Board of Appeal, in 2 months following its PPI rate notification.

Amount

Disability rate below 10%

If CPAM or MSA sets a PPI rate below 10%, you receive a lump sum payment.

The amount varies under the following conditions:

Amount of the capital allowance paid according to your disability rate

Permanent Disability Rate

Amount of capital allowance

1%

€426.92

2%

€693.91

3%

€1,014.00

4%

€1,600.44

5%

€2,027.47

6%

€2,507.64

7%

€3,040.96

8%

€3,628.07

9%

€4,268.27

Between 10% and 80%

You receive a life annuity until you die.

Its amount is calculated on the basis of your annual salary, multiplied by the disability rate.

Your annual salary is the total effective remuneration received in the 12 months preceding the work stoppage following the accident or illness.

The reference annual salary shall be at least 18,985.61 and not more than €151,884.87.

To determine the amount of the annuity, your annual salary is taken into account to a certain limit. Beyond that, part of your compensation is either partially or not at all. The portion of salary taken into account or not is determined under the following conditions:

Amount taken into account based on your annual salary

Annual salary

Salary fraction taken into account

Salary below €37,971.21

Integral

Salary between €37,971.21 and €151,884.87

Third party coverage

Salary greater than €151,884.87

No account taken

Your disability rate is determined by cutting it in half to 50% of incapacity and increasing it by half for the part of the rate exceeding 50%.

Example :

If your PPI rate is set at 75%, the rate used to calculate your pension is 62,5% (50: 2) + (25 x 1.5).

From 80%

You receive a life annuity until you die.

Its amount is calculated on the basis of your annual salary, multiplied by the disability rate.

Your annual salary is the total effective remuneration received in the 12 months preceding the work stoppage following the accident or illness.

The reference annual salary shall be at least 18,985.61 and not more than €151,884.87.

To determine the amount of the annuity, your annual salary is taken into account to a certain limit. Beyond that, part of your compensation is either partially or not at all. The portion of salary taken into account or not is determined under the following conditions:

Amount taken into account based on your annual salary

Annual salary

Salary fraction taken into account

Salary below €37,971.21

Integral

Salary between €37,971.21 and €151,884.87

Third party coverage

Salary greater than €151,884.87

No account taken

Your disability rate is determined by cutting it in half to 50% of incapacity and increasing it by half for the part of the rate exceeding 50%.

Example :

Example 1

Let's assume, for the calculation of your disability pension, that your salary over the last 12 months is €35,000 and your PPI rate is 20%:

  • Your salary will be taken into account in full as it is less than €37,299.82 (basic minimum wage).
  • The PPI rate used to calculate your pension will be 10% (20: 2), as PPI rates below 50% are halved.

Your pension will be calculated as follows: 35,000 x 10%. Your disability pension will then be €3,500.

Example 2

Let's assume, for the calculation of your disability pension, that your salary over the last 12 months is €45,000 and your PPI rate is 75%:

  • Your salary will be taken into account until €37,299.82 (basic minimum wage).
  • The fraction exceeding € 37,299.82, or € 7,700.18 (45,000 - 37,299.82) will be taken into account at 1/3. €2,566.73 in addition to the 37,299.82 €39,866.55.
  • The PPI rate used to calculate your pension will be 62,5% (50: 2) because the PPI rates below 50% are reduced by half + (25 x 1.5) because the fraction of the PPI rate above 50% must be increased by half, that is x 1.5).

Your pension will be calculated as follows: €39,866.55 (37,299.82 + 2,566.73) x 62.5% [50: 2 + (25 x 1.5) or 25 + 37.5].

Your disability pension will then be €24,916.59.

If your health condition requires you to seek assistance from a third party, you are entitled to payment of third-party complementary benefit (PCRTP). This person helps you carry out the ordinary acts of everyday life (example: get up, go to bed, get dressed,...).

Payment of annuity

The incapacity pension is paid quarterly (or monthly for PPI of at least 50%).

You can request that a portion of your life annuity be paid (up to half) to your Civil partnership or spouse, in case of death.

The application procedure varies depending on whether you are covered by the general scheme (CPAM) or the general agricultural scheme (MSA).

You depend on CPAM

To apply for the annuity conversion, you must contact your CPAM the following application form:

Application to convert a permanent disability pension into a capital or a survivor pension on the head of the spouse (general plan)

Cerfa n° 12045*01 - National Health Insurance Fund (Cnam)
Other number : S6102a

Who shall I contact

This request may be made at any time, from the date of the notification of the award of the annuity.

The CPAM has 2 months to respond.

If no reply is received by the end of this period, your request shall be considered accepted.

The conversion of your annuity into a reversible annuity (i.e., income that will be paid on your death to your spouse) is final.

You depend on the MSA

To apply for the annuity conversion, you must contact your caisse at MSA the following application form:

Application to convert a permanent disability pension into a capital or a reversible pension on the head of the Civil partnership, partner or partner (farm plan)

Cerfa n° 11818*02 - Central Fund of the Agricultural Social Mutual (MSA)

Allows the insured person to apply to the Farm Social Mutuality (MSA) for the conversion of a permanent incapacity annuity into capital or a reversible annuity on the head of the Civil partnership, partner or partner.

Who shall I contact

Very serious (inexcusable) misconduct of the employer

Your accident can be the result of a mistake said inexcusable your employer. This fault is recognised if it is established that the employer was (or should have been) aware of the danger to which you were exposed and did not take the necessary measures to protect you from it. It is up to you to prove the existence of a damage and your employer did not put in place the means to ensure your safety.

If the inexcusable fault is recognised, it allows you to get an increase in your permanent disability pension. It also allows you to obtain full compensation for the damages suffered and not compensated by the annuity.

Example :

physical and moral suffering, aesthetic and pleasure damage, damage resulting from the loss or decrease of your professional promotion opportunities.

You must apply to the CPAM or the MSA for compensation and damages.

Intentional misconduct of the employer

If the employer has wilfully sought to cause injury (e.g., physical abuse), you can have the employer's intentional misconduct recognised by the correctional court. You can get compensation for this mistake.

Failing a person outside the company

If your accident was caused by someone outside the company, you can claim compensation for the damage caused from the correctional court (unless the loss is already compensated by the incapacity annuity).