How are occupational diseases recognised and what is the role of the scientific expert appraisal?
What is an occupational disease?
An occupational disease is a medical condition contracted by a person as a result of prolonged exposure to hazards while doing their job. There are many such hazards, including toxic chemicals, mould, bacteria, extreme heat, loud noise, heavy loads, night work and irregular working hours.
Unlike for work accidents, there is no regulatory definition for occupational disease. A victim's entitlement to compensation relies on official recognition of the disease by a social security scheme.
Recognition in France and the role of tables
In France, recognition of occupational diseases is based primarily on a system of tables, created by the Act of 25 October 1919.
For each disease, these tables specify the conditions of recognition, including:
- a description of the disease, i.e. the symptoms or injuries occurring as a result of carrying out the work: cardiovascular disease, bone disease, skin or mucous membrane disorder, etc.;
- the elapsed time between exposure and medical care: i.e. 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;
- the activities or occupations likely to cause the disease.
When these conditions are met, recognition is automatic and the worker does not need to provide proof of the link between the illness and their work: 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 pathogen concerned and include, for example, lead-related diseases, disorders due to asbestos dust, hearing impairment caused by noise, etc.
Stakeholders in charge of the occupational disease tables
Who decides when tables are created or revised?
Occupational disease tables are created or amended by decree after consultation with the competent authorities:
- For the general scheme: the Steering Committee on Working Conditions (COCT), and in particular its Special Commission No. 4 (CS4).
- For the agricultural scheme: the High Commission on Occupational Diseases in Agriculture (Cosmap).
These committees bring together:
- the ministries concerned,
- the social partners (employers, employees),
- associations representing victims,
- health insurance funds,
- prevention bodies,
- qualified individuals.
Within the COCT, the CS4 is competent for questions about 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 bodies and qualified individuals.
Cosmap carries out these tasks for the agricultural scheme. Just like the CS4, Cosmap is made up of a variety of stakeholders: farmers, employers, trade unions, associations representing victims, the Agricultural Mutual Insurance Scheme (MSA), prevention bodies and qualified individuals.
Regional committees for the recognition of occupational diseases
If a disease is not listed in a table, or if not all the conditions of the table are met, a worker can nevertheless obtain recognition via a regional committee for the recognition of occupational diseases (CRRMP).
In this case, two situations are possible:
- The disease is listed in a table, but the conditions are not met: if a direct link between the work and the disease is proven.
Under paragraph 6 of the French Social Security Code (CSS): if the disease is named in an occupational disease table but one or more conditions in the table are not met, the disease as it is named in the table can still be recognised as being of occupational origin if it is established that it has been directly caused by the worker's regular work; - The disease is not listed: if it is essentially and directly caused by the worker's regular work, and results in death or permanent disability of at least 25%.
Under paragraph 7 of the CSS: if the disease is not named in an occupational disease table, it can be recognised as being of occupational origin if it is established that it has been essentially and directly caused by the worker's regular work and that it has led to this worker's death or 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. This committee is made up of three doctors: a regional medical adviser for social security, a regional medical inspector for occupational health, and a university professor or hospital practitioner specialised in occupational diseases.
Did you know?
It is the responsibility of the worker (or their beneficiaries) to declare the occupational disease. The limitation period is two years from the time when the link between the disease and the work is demonstrated by a medical certificate.
What do ANSES's expert appraisals involve?
Given the growing complexity of occupational exposure and the lack of recognition of certain diseases, the French government and social partners decided to review the details of the expert appraisal phase 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. Since 2022, ANSES has been responsible for conducting these collective, multidisciplinary and independent expert appraisals. The aim is to provide the public authorities with greater insights into the links between occupational exposure and disease, based on the latest scientific data.
What is the purpose of these expert appraisals?
ANSES's work is intended to guide various stakeholders:
- the government and the various ministries responsible for creating occupational disease tables under the current regulations;
- the committees (COCT, Cosmap) consulted by the government prior to the creation or amendment of any occupational disease table;
- social security institutions in charge of implementing the regulations on redress and compensation for occupational diseases, and the recommendations made to the regional committees (CRRMPs).
How is the expert appraisal carried out?
ANSES set up a multidisciplinary working group following a public call for candidates. This group defined a common methodology for establishing the links between exposure and disease. Conclusions are published, together with specific recommendations.
In December 2024, ANSES issued an opinion setting out recommendations for updating several of the tables. The aim was to harmonise the tables for the general and agricultural schemes, and take better account of the latest scientific and medical advances. The Agency also recommended that the lists of occupations be made indicative (rather than restrictive), to enable the inclusion of work involving comparable exposure.
