COMPENSATION FOR TEMPORARY DISABILITY
LexInter | August 20, 2002 | 0 Comments

COMPENSATION FOR TEMPORARY DISABILITY

Chapter 3: Compensation for temporary incapacity.

Article L433-1

The working day during which the accident occurred, regardless of the mode of

payment of wages, is entirely the responsibility of the employer.

A daily allowance is paid to the victim by the primary fund, from the first

day following the stoppage of work following the accident without distinction between the days

working days and Sundays and public holidays, during the entire period of incapacity for work

which precedes either complete recovery or consolidation of the injury or death as well

only in the event of a relapse or worsening provided for in Article L. 443-2.

The daily allowance can be maintained in whole or in part in the event of resumption of work

slight authorized by the attending physician, if this recovery is recognized by the medical adviser

of the primary fund as likely to promote the healing or consolidation of the

injury. The total amount of the indemnity maintained and the salary may not exceed

normal wages for workers in the same occupational category or, if higher,

the salary on which the daily allowance was calculated. In case of exceeding,

the indemnity is reduced accordingly.

The right to daily allowance is open under the conditions defined in article L. 323-6.

Article L433-2

The daily allowance is equal to a fraction of the daily salary. The latter does not come into

account only within the limit of a percentage of the maximum annual remuneration retained

for the basis of old-age insurance contributions under article L. 241-3.

The period at the end of which the rate of the daily allowance is increased as well as the

methods of determining the basic daily salary are set by decree in Council

of state.

In the event of a general increase in wages after the accident and when

the work interruption lasts beyond a fixed period, the rate of the indemnity

daily may be subject to revision.

Article L433-3

The daily allowance is transferable and seizable only within the limits set by article

  1. 145-1 of the labor code with regard to wages.

Article L433-4

The daily allowance is not due during detention unless the victim has been

admitted by the judge responsible for the application of sentences to benefit from one of the measures provided for in

Article 723 of the Code of Criminal Procedure.

Chapter 3: Compensation for temporary incapacity (Regulatory provisions).

Article R433-1

The fraction of the daily salary mentioned in the first paragraph of article L. 433-2 is

equal to 60%.

Article R433-2

The maximum limit of the annual remuneration mentioned in the first paragraph of the article

  1. 433-2 is equal to 0.834%.

Article R433-3

For the application of the second paragraph of Article L. 433-2, the rate of the daily allowance

is increased to 80% of the daily wage, from the twenty-ninth day after that of the stoppage

of work following the accident.

Article R433-4

The daily salary serving as the basis for the calculation of the daily allowance provided for in article

  1. 433-1 is determined as follows:

1 ° 1/30 of the amount of the last pay or two payments prior to the date of the

work, if the salary is paid monthly or twice a month;

2 ° 1/28 of the amount of the last two or four pays prior to the date of the judgment

working, if the salary is paid every two weeks or every week;

3 ° 1/30 of the amount of pay related to the month prior to the date of the work stoppage, if

wages are paid daily or at regular intervals, at the start or end of a job

;

4 ° 1/90 of the amount of wages for the three months prior to the date of stoppage of work, if this

salary is not paid at least once a month, but is paid at least once a month

trimester ;

5 ° 1/360 of the amount of salary for the twelve months preceding the date of the work stoppage,

when the activity of the company is not continuous or is seasonal or

when the victim exercises a profession intermittently.

The daily allowance calculated on the basis of this daily salary cannot exceed

amount of the net daily gain received by the victim and determined according to fixed terms

by order of the Minister responsible for social security.

Article R433-5

By way of derogation from the provisions of Articles R. 433-4 and R. 436-1, the following conditions

are applied to the sums allocated, either as a reminder of remuneration for a

period, either as remuneration in the form of allowances, bonuses or

gratuities, when they are paid after the main remuneration

pertaining to the same period of work.

These sums are not taken into consideration for determining the base salary of

the daily allowance as long as they were actually paid before the date of

stoppage of work.

They are considered to relate to a period immediately after the

calendar month during which they were actually paid and for a period equal to the

period for which they were allocated.

Article R433-6

In the cases listed below and subject to the provisions provided for in the last

paragraph, the basic daily wage is determined as if the victim had worked

during the month, the twenty-eight days, the three months or the twelve months in the same

conditions:

1 °) the victim had been working, within the meaning of the legislation on industrial accidents, for less than

one month, twenty-eight days, three months or twelve months at the time of the cessation of

job ;

2 °) the victim had not completed the work periods mentioned in the previous article

due to illness, long illness, accident, maternity, total or partial unemployment

noted by the qualified administrative service, closure of the establishment available

of which the person concerned remained, unpaid leave excluding absences not

authorized, military service or call for service;

3 °) the victim, beneficiary of the compensation for change of job provided for in article L.

461-8, was effectively unemployed during the period to be considered;

4) the victim had changed jobs during the period to be considered. In this case, the

base salary is determined on the basis of the salary relating to the job held at the time of

stoppage of work. However, if the base salary thus determined is lower than the

overall amount of remuneration actually received in the various jobs during

of the period to be considered, it is on this overall amount that the compensation must be calculated

Daily ;

5 °) the victim benefited from a replacement income under the conditions provided for in

Articles L. 351-1 et seq. of the Labor Code.

For certain categories of employees or assimilated subject to special conditions

of remuneration resulting from the normally discontinuous nature of the work, the

basic daily mentioned in the first paragraph can be adapted to these conditions

specific remuneration, according to the terms set by order of the minister in charge of

social security.

Article R433-7

In the case provided for in Article L. 443-2, where the aggravation of the injury leads to the victim

a new temporary incapacity, the daily allowance is calculated on the basis of

daily salary for the period mentioned in article R. 433-4, which immediately precedes

the stoppage of work caused by this aggravation. If the date of healing or consolidation has not

not fixed, this compensation is increased to 80% of the salary thus determined from the

twenty-ninth day of sick leave, taking into account the duration of the first interruption

of work following the accident.

In any case, the daily allowance allocated in accordance with the provisions of this

article may not be less than that corresponding respectively to 60 or 80% of the

salary, received during the first interruption of work, taking into account the

appropriate, of the revision carried out, in accordance with the provisions of the third paragraph of

Article L. 433-2.

Article R433-8

The salary used as the basis for the calculation of the daily allowance due to the apprentice cannot

be lower than the salary mentioned in article R. 412-11 of this code. Indemnity

daily calculated on the basis of this salary cannot exceed the net daily gain received by

apprentice and determined under the conditions set out in the last paragraph of article R. 433-5.

Article R433-9

The duration of work interruption mentioned in the third paragraph of article L. 433-2 is

set at three months.

Article R433-10

With a view to the revision provided for in Article L. 433-2, the daily salary that served as the basis for

calculation of the daily allowance is increased, if necessary, by application of the coefficients

increase fixed by interministerial decrees.

However, when there is a collective labor agreement applicable to the profession at

to which the victim belongs, the latter may, if it falls within the scope of

territory of this agreement, request that the revision of the rate of its indemnity

daily wage is carried out on the basis of a daily wage calculated on the basis of the

normal provided for his professional category in the said agreement if this modality

is favorable. The revision takes effect either from the first day of the fourth month of incapacity

temporary, either from the effective date of the coefficient of variation or of the agreement

above if this date is later.

Article R433-11

In the case provided for in the third paragraph of Article L. 433-2, it is up to the victim to

ask the primary fund which provides the daily allowance to revise the rate of

this by producing the necessary justifications, and, in particular, a certificate issued by

the employer who occupied the victim at the time of the accident. In case of doubt, the cashier

primary takes the opinion of the labor inspector.

The fund must, if it considers that a victim is likely to benefit from the provisions

aforementioned and that the latter neglects to make the request, invite him to provide the justifications

useful.

Article R433-12

The primary health insurance fund is not justified in suspending the service of

the daily allowance when the employer maintains the victim, in the event of an accident

work, all or part of his salary or benefits in kind, either under a contract

individual or collective work, either by virtue of the customs of the profession, or of its

own initiative.

However, when the salary is maintained in full, the employer is automatically subrogated.

to the victim, whatever the terms of the contract, in the latter’s rights to

daily allowances due to him.

When, by virtue of an individual or collective employment contract, the salary is maintained in

in whole or in part with the deduction of daily allowances, the employer who pays all

or part of the salary during the period of incapacity without making this deduction may be

subrogated by the victim in his rights to daily allowances provided that the

salary maintained during this period is at least equal to the amount of compensation

due for the same period; in other cases, the employer is only entitled to

pursue from the victim the recovery of the sum corresponding to the

daily allowances within the limit of the salary maintained for the same period.

The employer and the victim who have agreed to maintain benefits in kind

in the event of accidents, may inform the fund and request payment by it, to

the employer, the part of the daily allowance corresponding to the value of

benefits maintained.

Article R433-13

The daily allowance provided for in article L. 433-1 is paid by the fund

primary health insurance upon receipt of any medical certificate attesting to the

need for a work stoppage, without prejudice to the provisions of article R. 433-17.

The daily allowance cannot be combined with replacement income or

allowances mentioned in article L. 311-5.

Article R433-14

The daily allowance provided for in Article L. 433-1 is payable at the times set by the

internal regulations of the primary debtor fund, without the interval between two

payments may exceed sixteen days.

Article R433-15

When the victim resumes before his recovery or the consolidation of his injury a job

light with the permission of her attending physician, she must immediately notify the

primary fund and send it:

1) a certificate from the attending physician granting said authorization;

2) a certificate from the employer indicating the exact nature of the job and the remuneration

corresponding. A new employer’s certificate must be sent by the victim to the

primary fund in the event of any change in the nature of the job held or the

amount of remuneration received.

In the event of disagreement between the attending physician and the medical adviser, a

new examination in accordance with the provisions of Chapter 1 of Title IV of Book I.

If the medical adviser or the medical expert recognizes that the work is likely to

promote healing or consolidation of the injury, the primary fund decides, if there is

place, total or partial maintenance of the indemnity, taking into account the certificate provided for in

first paragraph of this article or, if it has not been produced or appears to him

insufficient, in view of the results of the survey carried out.

The primary fund notifies the victim of its decision by registered letter.

Article R433-16

The primary health insurance fund validly pays the daily allowances due

to the victim in the hands of his spouse or, if the victim is a minor, either in his

hands, or in the hands of any person who can justify having it in his charge.

The victim can delegate to a third party for the collection of compensation

daily.

This delegation is only valid for a single period of temporary incapacity; she does not

not preclude the right of the primary fund to defer payment in order to proceed with

necessary checks and pay compensation by mail.

An employee of a credit union cannot receive delegation from the victim for the collection

daily allowances only if he has been specially accredited for this purpose by the council

administration of the fund.

Article R433-17

Upon receipt of the medical certificate provided for in the second paragraph of Article L. 441-6, the fund

primary fixed, after consulting the medical adviser, the date of healing or consolidation

of the injury.

If the fund disputes the content of the medical certificate, it is ruled on under the conditions

fixed by Chapter I of Title IV of Book I.

In the event that the certificate provided for in the second paragraph of Article L. 441-6 is not provided to

the fund, which, after consulting the medical adviser, notifies the victim by letter

registered with request for acknowledgment of receipt the date it intends

date of healing or consolidation of the injury. She also makes known

this intention to the attending physician. If the medical certificate does not reach him within a

ten days from the notification to the victim, the date, thus notified, becomes

definitive.

The notification of the decision of the primary fund is sent to the victim under cover.

registered with acknowledgment of receipt.

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