For all cases recognized by the Accident Insurance Association (Association d'assurance accident - AAA), the coverage of benefits in kind is limited.
It can be automatically limited without the need for an opinion from the Social Security Medical Board (Contrôle médical de la sécurité sociale) or a decision to intervene on their part:
- 3 months after the occurrence of an accident which did not cause total work incapacity exceeding 8 consecutive days;
- 12 months after the occurrence of an accident resulting in a greater total work incapacity, unless the Social Security Medical Board issues an opinion to the contrary.
The Social Security Medical Board decides to close the file if it finds that the consequences of the accident or occupational disease no longer justify benefits provided by the accident insurance.
In order to claim new benefits in connection with the accident, the insured must request the reopening of the file and obtain a favourable opinion from the Social Security Medical Board.
Who is concerned
Any insured whose coverage of benefits has been limited either automatically or by presidential decision in a specific file may request a reopening of the file.
Unless the medical situation has changed, the application is not receivable before the expiry of one year from the notification of the decision limiting the reimbursement on a certain date, or from the rejection of a previous application for reopening.
The insured person must wait one year before being able to request the reopening of his file, except if their medical situation has changed.
The period of one year begins on the day after the notification of the decision:
- limiting support from a certain date; or
- dismissing a previous application for reopening.
How to proceed
Submitting the application
The person concerned must complete the application form for reopening an accident file for medical treatment. The duly completed and signed application must then be returned to the AAA.
The insured must indicate the reason(s) for their request on the form.
The medical officer of the Social Security Medical Board assesses the reason(s) for the reopening request:
- the doctor decides directly on the basis of the documents in his possession; or
- the doctor asks the insured to provide him with other medical reports needed to process the file.
If the file is reopened, the medical officer may grant the reopening of the file for an indefinite period. In this case, the insured is informed of the reopening of the file by letter.
If the medical officer either refuses or grants the reopening with a new time limit the insured is always informed by presidential decision of the outcome of his request.
Interested parties have several means of appeal at their disposal to assert their rights.
Forms / Online services
Informations concernant la demande de réouverture d’un dossier pour traitement médical (accidents survenus ou maladies professionnelles déclarées à partir du 01.01.2011)
Informationen zum Antrag auf Wiedereröffnung einer Unfallakte (Arbeitsunfälle, die sich ab dem 01.01.2011 ereignet haben, oder Berufskrankheiten, die ab dem 01.01.2011 gemeldet wurden)