[Medicolegal litigation in cases of occupational lung disease: Some practical tips]

Abstract

Recognition and compensation for occupational diseases (OD) is based on the principle of presumption of occupational origin, provided that the disease meets the medical and administrative condition detailed in an OD table appended to the French social security code. A complementary system calling upon a regional committee for recognition of respiratory diseases (CRRMP, in French) attends to cases in which the medical or administrative conditions pertaining to the disease are not fulfilled. Decisions of health insurance funds may be appealed, by employer and employee alike, within the statutory timelines. That said, recent reform of social security litigation and the law of modernization of the justice system have thoroughgoingly modified appeal and redress procedures. Challenge of a decision of non-recognition of the occupational nature of a disease is now addressed to the social pole of the judicial tribunal (JT), which can request the assistance of a CRRMP other than the one that issued the first opinion. As for technical challenges having to do with the date of consolidation (date of the injury) or the degree of partial permanent incapacity (PI), they are put forward in a mandatory preliminary settlement proposal addressed to an amicable settlement board (CRA, in French), whose decisions can be contested face to the social pole of the JT. All judgments regarding medical litigations of social security may be appealed. Information for patients on compensation procedures and available means of remedying decisions by social security is essential to the establishment of the initial medical certificate and to the sequencing of the different phases of expert appraisals, the objectives being to avoid administrative incoherence and inappropriate legal recourse.

Keywords: Compensation; Contentieux médical; Expertises; Litigation; Maladies professionnelles respiratoires; Occupational lung disorders; Recognition procedures; Sécurité sociale.