|
J.S.I.S.
Joint Sickness Insurance Scheme
ACCIDENT AND OCCUPATIONAL DISEASE INSURANCE
NEW RULES ENTERING INTO FORCE
ON 1 JANUARY 2006
Following the reform of the Staff Regulations, the common rules on
cover against the risk of accident and occupational disease (Article 73)
have been amended. The new rules will enter into force on 1 January 2006.
REMINDER OF THE MAIN ASPECTS OF ACCIDENT INSURANCE
Who is covered?
Officials, temporary staff and contract staff.
Not covered: retired staff and the family members of staff. Pursuant to
Article 85a of the Staff Regulations, however, these persons must report
an accident if they are covered by the JSIS and if a third party is
responsible.
What is covered?
- Occupational and private accidents (24 hours a day
throughout the world).
- Occupational diseases listed in the European Schedule of
Occupational Diseases annexed to the Commission recommendation of 19
September 2003, or any other illness which is proven to have been caused
by working for the Communities.
What do the insurance benefits comprise?
- Medical expenses are reimbursed at 100% (the insurance defrays the
balance not reimbursed by the Joint Sickness Insurance Scheme).
- A lump sum is paid in the event of total or partial permanent
invalidity.
- A lump sum is paid in the event of accidental death.
What must you do in the event of (a) accident or (b) occupational
disease?
- (a) Submit an accident declaration (form available at the website
referred to below) together with a confirmatory medical certificate
within 10 working days (this is in addition to the medical certificate
stating that you are unable to work, which must be sent to the Medical
Service).
- (b) Submit an occupational disease recognition request (there is no
form for this) by sending a note specifying the nature of the condition
together with a medical certificate.
- Submit the medical expenses relating to the accident or occupational
disease on a separate form, stating the date of (a) the accident or (b)
the occupational disease recognition request.
CHANGES UNDER THE NEW RULES The purpose of the changes is to clarify, simplify and modernise the
existing provisions. Some changes derive from the new Staff Regulations,
others from Court of Justice case law. The main changes are outlined
below.
Terms of cover
The definition of an accident has been clarified and a number of
exclusions specified (e.g. maximum blood alcohol level, list of dangerous
sports).
Scales for calculating the permanent invalidity lump sum and additional
allowance
Permanent invalidity payments will be calculated using a new European
physical and mental disability rating scale, instead of the Belgian
official invalidity scale – because the latter is old, difficult to use,
and not European in scope.
In the interests of consistency with the new European scale, the terms for
granting an additional allowance have been reformulated. Also, in order to
specify the parameters of this allowance, an assessment table has been
annexed to the rules.
Medical committees
Where an insured person lodges an appeal, his/her doctor must specify the
points being disputed. Before confirming the relevant medical committee’s
terms of reference for examining the case, the institution will inform the
insured person of the fees and expenses liable to be borne by him/her in
connection with the appeal.
Monitoring cases
In the interests of sound administrative management, it will be possible
to close a case if the insured person fails to attend medical examinations
or submit documents when requested to do so. TRANSITION FROM THE OLD TO THE NEW RULES The old rules will continue to apply to any draft decision adopted before
1 January 2006, except where a case is reopened due to a worsening of the
insured person’s condition. REFERENCES AND CONTACTS Detailed information on the relevant legislation, procedures and contacts
is available at:
http://www.cc.cec/pers_admin/sick_insur/accident/index_en.html
Postal address: SC 27 03/35,
tel.: (+32-2-29) 60595,
fax: (+32-2-29)
66643,
e mail: accidents-maladies-prof@ec.europa.eu (external) - PMO
ACCIDENTS & MALADIES P (internal). |
