Application for review in the event of a fundamental change of circumstances

The ADEM Medical Commission will grant or deny recognition of disabled worker status.

The applicant may request a review due to a fundamental change in the facts and circumstances related to their capacity.

The review will pertain to:

• the decision to deny or withdraw disabled worker status;
• the decision on a decrease in the person's capacity for work and state of health;

The application for review is submitted by the interested party or their legal representative before the Medical Commission, accompanied by the required documentation.

It should be noted that no application for review will be accepted in the following cases:

• if an appeal before the Social Security Arbitration Tribunal (Conseil arbitral de la sécurité sociale - CASS) has been filed; or
• earlier than 6 months after the notification of an initial decision that became final.

Application for reassessment before the Social Security Arbitration Tribunal (CASS)

The following may also be appealed before the Social Security Arbitration Tribunal (CASS):

• decisions pertaining to the denial or withdrawal of disabled worker status;
• a decision relating to a decrease in the employee's capacity for work and worsening state of health;

Appeals must be filed within 40 days of notice of the contested decision.

The appeal presented to the CASS does not have suspensive effect: the decision of the court of first instance is applicable.

Decisions of the High Council of Social Security (CSSS)

An appeal against a decision of the CASS may be made before the High Council of Social Security (Conseil supérieur de la sécurité sociale - CSSS).

The appeal must be filed within 40 days of notification of the CASS' decision.

The appeal does not have suspensive effect.

Appeals before the Court of Cassation

Final decisions handed down by the CASS, or orders by the CSSS, may be taken before the Court of Cassation.

Reassessment before the Special Reassessment Committee

After the Medical Commission assigns disabled worker status, the file is sent to the Occupational Counselling and Redeployment Board (Commission d’orientation et de reclassement professionnel - COR).

The COR will decide to direct the disabled worker:

• either to the mainstream labour market;
• or to work in sheltered workshops.

Decisions of the COR may be subject to reassessment before the Special Reassessment Committee (Commission spéciale de réexamen).

The application for reassessment must be submitted by registered letter within 40 days from notification of the COR's decision.

The Special Committee will issue its decision within 3 months of the day of the referral.

Appeals before the Social Security Arbitration Tribunal (CASS)

An appeal against the rulings of the Special Reassessment Committee may be made before the Social Security Arbitration Tribunal (Conseil arbitral de la sécurité sociale - CASS).

The appeal must be filed within 40 days of notification of the Special Committee's decision.

The appeal does not have suspensive effect.

Appeals before the High Council of Social Security (CSSS)

An appeal against a decision of the CASS may be made before the High Council of Social Security (Conseil supérieur de la sécurité sociale - CSSS).

The appeal must be filed within 40 days of notification of the CASS' decision.

The appeal does not have suspensive effect.

Appeals before the Court of Cassation

Final decisions handed down by the CASS, or orders by the CSSS, may be taken before the Court of Cassation.

Appeals before the Social Security Arbitration Tribunal (CASS)

If the National Solidarity Fund (Fonds national de solidarité - FNS) refuses to grant the allowance for persons with severe disabilities, the decision may be appealed before the Social Security Arbitration Tribunal (Conseil arbitral de la sécurité sociale - CASS).

The appeal must be made within 40 days of notification of the FNS' decision.

The appeal does not have suspensive effect.

Appeals before the High Council of Social Security (CSSS)

An appeal against a decision of the CASS may be made before the High Council of Social Security (Conseil supérieur de la sécurité sociale - CSSS).

The appeal must be filed within 40 days of notification of the CASS' decision.

The appeal does not have suspensive effect.

Appeals before the Court of Cassation

Final decisions handed down by the CASS, or orders by the CSSS, may be taken before the Court of Cassation.

Procedures

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