In summary
| 📄 Section | Detailed description |
|---|---|
| 📋 Introduction | When an employee suffers a work-related accident, they may be entitled to daily allowances to compensate for their loss of income. |
| 🛡️ Conditions for eligibility | Daily allowances are only paid if the accident is recognized as a work-related accident by Social Security. |
| 🚑 Recognition of the accident | The accident must be sudden and unforeseen, causing a physical or psychological injury. Examples include a fall or a cut with a tool. |
| 📝 Declaration by the employer | The employer must declare the accident to the CPAM within 48 hours, providing details about the circumstances of the accident. |
| 🏥 Prescribed work stoppage | A doctor must prescribe the work stoppage and provide an initial medical certificate certifying the incapacity resulting from the accident. |
| 📬 Sending documents to CPAM | The employee sends parts 1 and 2 of the medical certificate to CPAM, along with the work accident forms, to initiate the processing of allowances. |
| 🔍 Control by CPAM | CPAM verifies the compliance of the information and approves the case file, possibly requesting additional information if necessary. |
| 🗂️ Importance of documentation | It is crucial to keep all documents related to the accident for potential disputes or re-examinations of the case. |
| 💰 Calculation of allowances | The allowances are based on the reference salary, calculated from the average salary of the three months prior to the accident. |
| ⏳ Payment duration | The daily allowances are paid for the duration of the work stoppage, up to a maximum of three years, after which other schemes like disability pension may take over. |
| 🏛️ Employer obligations | The employer must not only declare the accident but also provide the employee with a work accident sheet, facilitating coverage of medical care. |
| 🔄 Conclusion | Daily allowances play a crucial role in protecting employees in case of a work-related accident, compensating for lost income and providing necessary medical care. |
When an employee suffers a work accident, they may be entitled to daily allowances (DA) to compensate for their loss of income. These allowances are paid by Social Security and are intended to support the employee during their leave of absence.
Conditions for obtaining DA
To benefit from daily allowances in case of a work accident, certain conditions must be met. These conditions are essential to ensure coverage and financial support for the employee during their period of absence.
Recognition of the work accident
First, the accident must be recognized as a work-related accident by Social Security. This means the event must have occurred during or due to work. The accident must be sudden and unforeseen, causing a physical or psychological injury to the employee. For example, a fall at the workplace, a cut with a tool, or an commuting accident between home and work can be considered work-related accidents.
Declaration of the accident by the employer
The employer must declare the accident to the Primary health insurance fund (CPAM) within 48 hours of the event. This declaration is crucial as it formalizes the accident and initiates the recognition procedure by Social Security. The employer must provide a detailed description of the circumstances of the accident, including any witnesses, to facilitate the assessment by CPAM.
Work stoppage prescribed by a doctor
The employee must be on a work stoppage prescribed by a doctor. The doctor must issue an initial medical certificate, which certifies the nature of the accident and the temporary or permanent incapacity to work resulting from it. This medical certificate is fundamental because it serves as the basis for calculating and paying daily allowances. The doctor may also indicate the expected duration of the work stoppage and any necessary care or treatments for recovery.
Sending documents to CPAM
The employee must send to CPAM parts 1 and 2 of the initial medical certificate, along with the work accident forms provided by the employer. These documents should be transmitted promptly to allow CPAM to process the case quickly and start paying the daily allowances. Compliance with these administrative steps is critical to avoid delays in coverage.
Verification and validation by CPAM
CPAM then verifies the information provided and validates the case. It may request additional information or conduct further investigations if necessary. Once the case is validated, CPAM informs the employee and employer of its decision. If the accident is recognized as a work accident, the daily allowances are calculated and paid based on the employee’s reference daily salary.
Importance of documentation
It is essential to keep all documents related to the work accident, including medical certificates, employer declarations, and all correspondence with CPAM. This documentation can be useful in case of disputes or a request for case review. Rigorous management of documents also helps track the situation’s evolution and ensure all procedures have been properly followed.
Calculation of daily allowances
The calculation of daily allowances in case of a work accident is based on a precise methodology that considers the employee’s reference salary. This reference salary is vital because it determines the amount of DA the employee will receive during their absence from work.
Determining the reference salary
The reference salary is calculated based on the average of the gross salaries of the last three months preceding the accident. This includes all elements of remuneration received during that period, such as bonuses, overtime hours, and other advantages in kind. To obtain the reference daily salary, this average is divided by 30.42, which corresponds to the average number of days per month.
Example: If an employee received a gross total salary of €9,000 over the last three months, their reference daily salary will be €295.92 (€9,000 / 30.42).
Daily allowance rates
Daily allowances are paid based on the reference daily salary, with rates varying depending on the duration of the work stoppage:
- 60% of the reference daily salary for the first 28 days of absence.
- 80% of the reference daily salary starting from the 29th day.
These percentages aim to partially compensate the employee’s lost income during their incapacity to work.
Application of net daily gain
The net daily gain is used to cap the amount of daily allowances. It is calculated by subtracting 21% of the base daily salary, representing social charges.
Example: If the reference daily salary is €295.92, the net daily gain will be €233.28 (€295.92 – 21%).
Cap on daily allowances
Daily allowances are subject to a ceiling. They cannot exceed 0.834% of the Annual Ceiling of Social Security (PASS). In 2024, this amount is:
- 232.03 € per day for allowances paid from the 1st to the 28th day of absence.
- 309.37 € per day starting from the 29th day of absence.
Example calculation
Let’s consider an employee who received a gross monthly salary of €3,000 before their accident.
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Calculation of the reference daily salary:
- Reference daily salary = €3,000 / 30.42 = €98.62
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Allowances for the first 28 days:
- Daily amount = €98.62 x 60% = €59.17
- Total for 28 days = €59.17 x 28 = €1,656.76
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Allowances from the 29th day:
- Daily amount = €98.62 x 80% = €78.90
- If the leave extends by an additional 10 days, total = €78.90 x 10 = €789
Social deductions
Daily allowances are subject to CSG (Generalized Social Contribution) at a rate of 6.2% and CRDS (Contribution for the Repayment of the Social Debt) at a rate of 0.5%.
Example: If an employee receives €1,656.76 in allowances for the first 28 days:
- Net amount after deductions = €1,656.76 – (€1,656.76 x 6.7%) = €1,545.68
Duration of DA payment
Daily allowances (DA) are paid throughout the entire duration of the work stoppage, providing continuous financial support to the employee. However, there is an upper limit for this payment. Understanding these aspects is crucial to knowing what to expect in case of prolonged leave.
Maximum duration of daily allowances
Daily allowances are paid for a maximum period of three years. This period begins on the first day of work stoppage and includes all extensions related to the same work accident. This maximum duration aims to provide adequate support while encouraging the employee to return to work as soon as possible.
Conditions for continuous payment
During these three years, the employee must continue to provide medical certificates justifying their incapacity to work. Each certificate must be validated by the Primary health insurance fund (CPAM) for allowances to be maintained. The employee must also undergo regular medical controls organized by CPAM to assess their health status.
Dispositions beyond three years
If the work stoppage extends beyond three years, other support schemes may be implemented:
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Disability pension: If the employee’s health does not allow them to return to work, they may be eligible for a disability pension. This pension is intended to compensate for income loss due to partial or total incapacity. The disability pension application must be made with CPAM, accompanied by medical evidence.
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Permanent incapacity pension: If the work accident results in permanent sequelae, the employee may receive a permanent incapacity pension. The amount of this pension is calculated based on the degree of incapacity determined by a social security medical examiner.
Example of transition to other schemes
Let’s take the example of an employee who, after three years of work stoppage, is still unable to resume their professional activity. Here are the typical steps they might take to switch to another support scheme:
- Medical evaluation: A doctor assesses their health and prepares a detailed report.
- Application for disability pension: The employee submits a request for a disability pension to CPAM, along with the medical report.
- Case review: CPAM reviews the case and determines the degree of incapacity. If this rate is sufficient, a disability pension is granted.
- Receiving the pension: The employee begins receiving the disability pension, which replaces DA.
Procedures to Follow
To obtain daily allowances (DA) in the event of a work accident, the employee must follow a series of important administrative steps. These steps are crucial to ensure the validation of the claim and prompt payment of allowances. Here are the procedures to follow:
Reporting the accident to the employer
The employee must immediately inform their employer of the work accident. This declaration can be made in writing, by phone, or in person. The employer must be informed of the circumstances of the accident and any potential impact on the employee’s health.
Obtaining the initial medical certificate
The employee must see a doctor as soon as possible after the accident. The doctor will issue an initial medical certificate in three parts. This certificate certifies the employee’s incapacity to work and describes the injuries or health condition resulting from the accident.
Sending the parts of the medical certificate
The employee must send parts 1 and 2 of the initial medical certificate to their primary health insurance fund (CPAM). These documents are essential to start the work accident recognition process and to begin calculating daily allowances.
Declaration of the accident by the employer
The employer must declare the accident to CPAM within 48 hours of being informed. This declaration is made using the “Work or occupational disease accident sheet” form, which must be accurately completed and signed. The employer then gives the employee the work accident sheet, which allows coverage of medical expenses without any upfront payment.
Verification by CPAM
CPAM verifies the compliance of the case. It examines medical certificates, the employer’s declaration, and all relevant documents. If necessary, CPAM may request additional information or organize a medical examination to evaluate the employee’s health.
Notification of decision
Once the case is validated, CPAM informs the employee and employer in writing of its decision. If the accident is recognized as a work-related accident, daily allowances are calculated based on the employee’s reference daily salary. CPAM then proceeds with the payment of allowances according to the established schedule.
Medical follow-up and extension certificates
During the entire period of work stoppage, the employee must regularly visit a doctor to evaluate their health. The doctor may issue extension certificates, which must be sent to CPAM to continue receiving daily allowances.
Example of procedure
Here is an example of the procedure for an employee involved in a work accident:
- Notify your employer immediately about the accident.
- See a doctor to obtain the initial medical certificate.
- Send parts 1 and 2 of the medical certificate to CPAM.
- Provide your employer with the work accident sheet.
- Ensure that your employer declares the accident to CPAM within 48 hours.
- Follow CPAM instructions for any additional information required.
- Receive notification of the decision from CPAM and the schedule of allowance payments.
Obligations of the employer
The employer also has obligations in case of a work accident. They must declare the accident to CPAM within 48 hours and provide the employee with a work accident sheet. This sheet allows the employee to benefit from coverage of medical expenses related to the accident without any advance payment.
Conclusion
Daily allowances are an essential scheme to protect employees in case of a work accident. They help compensate for lost income and ensure appropriate medical coverage. It is important to understand the procedures to follow and the conditions for eligibility to benefit fully.
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