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5th ICOH-WOPS Webinar - Updating of compensation scales for occupational diseases in France: proposal of the working group in charge of work-related mental diseases.
In France, the national health insurance fund is responsible for determining the rate of permanent clinical impairment (PCI) once a claim for an occupational disease has been accepted. Rules for determining the PCI needed revision. A technical group of experts (professors of occupational medicine, psychiatrists, social security medical advisors) has been mandated by the Ministry of Health from 2019 to 2021. We conducted a review of rating guides, and a survey sent to ICOH-WOPS members. The group proposed the adjudication of the PCI on a mixed approach, taking into account the diagnosis and the functional capacity. The diagnostic criteria of the selected diseases are those of the International Classification of Diseases (ICD) or the Diagnostic and Statistical Manual of Mental Disorders (DSM) in their versions in use at the time the application is processed. Substance-use disorders, traumatic brain injuries, schizophrenia were excluded. A ceiling rate has been set for each diagnosis: 40% for mood disorders and post-traumatic disorders, 30% for stress-related disorders. This ceiling rate would be multiplied by a functional capacity coefficient (from 0.2 to 1.2), based on the Global Assessment of Functioning (GAF) scale. A possible increase in PCI rate would take into account the burden of care assessed by the social security medical advisor on the basis of various factors, such as the severity of the treatment, the demanding follow-up, the need for repeated hospitalizations or the difficulty of access to care. These updated guidelines are intended to help ensure that decisions are fair, just and simple. An additional compensation rate similar for all groups of diseases will be added to this compensation rate, based on the age and job status of the claimant. The final report was sent in June 2021 to the Ministry of Health and Social Security, which will decide on its implementation.

Apr 29, 2022 09:00 AM in Edmonton

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