How are scientific expert appraisals for occupational diseases conducted?
When a worker exposed to hazards such as toxic substances contracts a disease while doing their job, this disease may be recognised as an occupational disease and give rise to compensation. To improve access to this recognition, the French government has decided to carry out independent, collective scientific expert appraisals. This preliminary expert appraisal stage has been entrusted to ANSES. How are occupational diseases recognised in France? What do the scientific expert appraisals conducted by ANSES involve? Here are some explanations.
What is an occupational disease?
An employee who is or has been exposed to hazards while doing their job can contract a disease. This disease can be recognised as an occupational disease and give rise to compensation provided that it is identified as such by a social security scheme. Unlike for work accidents, there is no regulatory definition of occupational diseases.
Employees are exposed to a wide variety of hazards: toxic chemicals, mould, bacteria, extreme heat, loud noise, heavy loads, night work, and irregular working hours.
How are occupational diseases recognised in France?
Occupational disease tables
In France, the recognition of occupational diseases is mainly based on a table system created in 1919 (French Act of 25 October 1919, extension of the French Act of 1898 on work accidents).
For each disease, these tables specify conditions of recognition, including:
- a description of the disease, i.e. the symptoms or lesions occurring as a result of work activity: cardiovascular disease, bone disease, skin or mucous membrane disease, etc.;
- the time limit for compensation: this is the maximum possible period between the end of exposure and the first medical diagnosis of the disease. In some cases, a minimum period of exposure may be mentioned;
- activities or occupations likely to cause the condition.
If a worker meets all these conditions, they can benefit from "automatic" recognition and do not have to provide proof of the link between their disease and their job: they benefit from the presumption of occupational origin.
There are currently 121 tables for the general social security scheme and 66 for the agricultural scheme. They are organised according to the disease or the responsible pathogen and include, for example, lead-related diseases, disorders related to asbestos dust, hearing impairment caused by noise, etc
Stakeholders in charge of occupational disease tables
Occupational disease tables are created or revised by decree in the Council of State after consultation of the Steering Committee on Working Conditions (COCT) for tables under the general scheme and the High Commission on Occupational Diseases in Agriculture (COSMAP) for those under the agricultural scheme.
Within the COCT, Special Commission No. 4 (CS4) is competent for issues relating to knowledge of the occupational origin of diseases and the link between compensation and prevention in the area of occupational diseases. In addition to the various relevant ministerial departments, the CS4's members include various social partners, representing employees on the one hand and employers on the other, as well as associations representing victims, health insurance funds, prevention organisations, and qualified individuals.
For the agricultural scheme, COSMAP carries out these tasks. Just like the CS4, COSMAP is made up of various stakeholders: farmers, employers, trade unions, associations representing victims, the Agricultural Mutual Insurance Scheme (MSA), prevention organisations, and qualified individuals.
Regional Committees for the Recognition of Occupational Diseases (CRRMPs)
In the event that there is no table for a disease, or when the person does not meet all the conditions in the table, the disease can still be recognised as an occupational disease after consultation of a Regional Committee for the Recognition of Occupational Diseases (CRRMP) (Article L461-1 of the French Social Security Code (CSS)).
There are two possible situations in this complementary system:
- under paragraph 6 of the CSS: if the disease is listed in an occupational disease table but one or more conditions in the table are not met, the disease as it is listed in the table can still be recognised as being of occupational origin when it is established that it has been directly caused by the regular work of the individual worker;
- under paragraph 7 of the CSS: if the disease is not listed in an occupational disease table, it can be recognised as being of occupational origin when it is established that it has been essentially and directly caused by the individual's regular work activities and that it has led to their death or to permanent disability of at least 25%.
The CRRMP is then responsible for carrying out an individual expert appraisal and issuing a reasoned opinion on the link between the victim's regular work and the disease. The appraisal is conducted by three doctors: a regional medical adviser for social security, a regional medical inspector for occupational medicine, and a university professor/hospital practitioner or a hospital practitioner highly qualified in the area of occupational diseases.
Did you know?
It is the responsibility of the victim or their beneficiaries to declare the occupational disease. The time limit is two years from the date on which they are informed, by means of a medical certificate, of the possible link between their disease and their occupational activity.
What do ANSES's expert appraisals involve?
"Helping improve the system of prevention, recognition and compensation for occupational diseases in France".
Three questions for Henri Bastos, Occupational Health Director at ANSES.
Noting that occupational diseases are under-recognised, the French government and social partners decided to review the methods of the expert appraisal stage enabling, among other things, a causal link to be established between occupational exposure to a hazard and one or more diseases. This reorganisation is one of the measures identified to restore the public authorities' ability to revise the list of occupational disease tables based on advances in scientific knowledge and professional practices. It provides for the implementation of independent, multidisciplinary, collective expert appraisals, which it entrusts to ANSES.
With the support of a multidisciplinary working group created following a public call for applications, the Agency has developed a methodology and a framework for identifying and characterising links between occupational exposure or working conditions and health problems. Its primary aim is to inform various stakeholders:
- the government and the various ministries responsible for creating occupational disease tables under the current regulations;
- the committees consulted by the government prior to the creation or modification of any occupational disease table: COCT, COSMAP;
- social security institutions in charge of implementing the regulations on compensation for occupational diseases and recommendations made to CRRMPs.