Occupational disease: compensation for permanent incapacity

Verified 01 April 2023 - Legal and Administrative Information Directorate (Prime Minister)

Are you suffering from an occupational disease and would you like to know if you can receive compensation when your working capacity is permanently reduced due to that disease?

Do you want to know if additional compensation can be paid to you in case of very serious (inexcusable) fault on the part of the employer?

Here are some useful things to know.

If you are suffering from an occupational disease, you may suffer a lasting decrease in your physical or mental capacity. In this case, your Social Security organization (CPAM: titleContent or MSA: titleContent) determines a rate of permanent disability (PPI)which allows you to receive compensation in the form of capital or life annuity.

Forecast Incapacity

You may be granted a projected disability rate if you meet the following 2 conditions:

This rate shall be fixed on a provisional basis, until the instruction to grant you a final PPI is complete.

Permanent permanent disability

The CPAM or MSA determines your final PPI based on the information collected. Your Social Security organization seeks the advice of its medical officer and, in some cases, the occupational physician (especially when permanent incapacity could make you unfit for work).

You and your employer are informed and can request the advice of the medical officer within 10 days following the notification of the decision.

Please note

the final PPI level may be adjusted as your health status changes.

Criteria used to determine the rate of disability

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

  • Nature of your disability
  • Your overall health
  • Your age
  • Your physical and mental faculties
  • Your professional skills and qualifications

Appeals

You and your employer may challenge the decision of the CPAM or the MSA to the Medical Amicable Appeals Board, within 2 months of its notification of the PPI rate.

Amount

The method of compensation by CPAM or MSA depends on the PPI rate:

  • if your PPI level is below 10%, you receive a lump sum capital allowance paid in one installment,
  • if your PPI level is equal to or greater than 10%, you get a life annuity until you die.

Warning  

if you have an occupational disease related to asbestos, you will benefit from a specific compensation scheme.

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Disability rate below 10%

If the CPAM or MSA sets a PPI below 10%, you receive a capital allowance, the amount of which varies as follows:

Tableau - Amount of the paid capital allowance based on your disability rate

Rate of permanent disability

Amount of the capital allowance

1%

€450.83

2%

€732.77

3%

€1,070.78

4%

€1,690.06

5%

€2,141.01

6%

€2,648.07

7%

€3,211.25

8%

€3,831.24

9%

€4,507.29

Disability rate between 10% and 80%

You receive an annuity, the amount of which is calculated on the basis of your annual salary, multiplied by the disability rate.

Your annual salary is the total actual remuneration received in the 12 months preceding the work stoppage due to the accident or illness.

The annual reference salary taken into account shall be at least 20,048.80 and not more than €160,390.42.

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

Tableau - Fraction taken into account according to your annual salary

Annual salary

Wage fraction taken into account

Salary less than €40,097.60

Full consideration

Salary between €40,097.60 and €160,390.42

Consideration by a third party

Salary above €160,390.42

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 is set to 75%, the rate used to calculate your annuity is 62.5% (i.e. (50:2) + (25 x 1,5)).

Disability rate from 80%

You receive an annuity, the amount of which is calculated on the basis of your annual salary, multiplied by the disability rate.

Your annual salary is the total actual remuneration received in the 12 months preceding the work stoppage due to the accident or illness.

The annual reference salary taken into account shall be at least 20,048.80 and not more than €160,390.42.

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

Tableau - Fraction taken into account according to your annual salary

Annual salary

Wage fraction taken into account

Salary less than €40,097.60

Full consideration

Salary between €40,097.60 and €160,390.42

Consideration by a third party

Salary above €160,390.42

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 is set to 75%, the rate used to calculate your annuity is 62.5% (i.e. (50:2) + (25 x 1,5)).

If your medical condition requires you to have the assistance of a third person to perform the ordinary acts of everyday life (e.g. getting up, dressing, etc.), you are entitled to the payment of the Third Party Complementary Benefit (TPRB).

Payment of the annuity

The incapacity pension is paid quarterly (or monthly in the case of a PPI of at least 50%).

However, you can ask the CPAM for a portion of your annuity:

  • is paid to you in the form of capital,
  • and/or is used to constitute a life annuity that can be paid (for up to half) to your spouse in the event of death.
You depend on CPAM

To request the conversion of the annuity, you must contact your CPAM: titleContent the following application form:

Application for conversion of a permanent incapacity pension into a capital or a reversible annuity on the head of the spouse (general scheme)

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

CPAM has 2 months to respond.

If no reply is received within this period, your request shall be deemed to have been accepted.

If you claim both the capital conversion and the benefit of the reversible annuity conversion, the 2 decisions taken by the fund must be the subject of separate notifications.

The conversion of your annuity into capital or a reversible annuity is final.

Your occupational disease may be the result of a so-called fault inexcusable from your employer.

Inexcusable fault is recognized when 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's up to you to prove your employer's inexcusable fault.

If the inexcusable fault is recognized, it allows you to obtain:

  • an increase in your permanent disability pension,
  • full compensation for the damage suffered and not compensated by the annuity (e.g. physical and moral suffering, aesthetic and pleasure damage, damage resulting from the loss or reduction of your opportunities for professional promotion).

Claims for compensation and compensation for damage must be made to the CPAM or the MSA.

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