Key Benefits:
Publics concerned: insured of the general regime and of wage and non-salarie schemes of agricultural professions where the permanent incapacity of which they suffer as a result of one or more occupational accidents or diseases obliges them to use the assistance of a third person to perform the ordinary acts of life; beneficiaries of a disability pension served by the non-employee scheme of agricultural occupations.
Subject: modalities for the application of the supplementary benefit for third-party recourse instituted by theArticle 85 of Act No. 2012-1404 of 17 December 2012 Social Security Funding for 2013.
Entry into force: the text comes into force on March 1, 2013.
Notice: the Order sets out the conditions for the amount of the supplementary benefit for third-person recourse, depending on the degree of inability of the insured to perform the ordinary acts of life alone. It specifies the effective dates of the benefit and the terms and conditions for revision of the amount. Finally, it adapts the provisions of Social Security Code and the rural code and the marine fishery mentioning the increase for assistance of a third person in order to take into account the replacement of this benefit by the supplementary benefit for third-person use.
References: this decree is taken for the application of theArticle 85 of Act No. 2012-1404 of 17 December 2012 Social Security Funding for 2013. The texts amended by this decree can be consulted, in their drafting, on the website Légifrance (http://www.legifrance.gouv.fr).
The Prime Minister,
On the report of the Minister of Social Affairs and Health and the Minister of Agriculture, Agri-Food and Forestry,
Considering the rural code and the maritime fisheries;
Vu le Social Security Codeincluding article L. 434-2;
Vu la Act No. 2012-1404 of 17 December 2012 Social Security Funding for 2013, including Article 85;
Considering the opinion of the Central Board of Directors of the Agricultural Social Mutuality dated 7 February 2013;
Considering the opinion of the Industrial Accidents and Occupational Diseases Commission of 13 February 2013;
The State Council (Social Section) heard,
Decrete:
The Social Security Code is thus amended:
1° In R. 413-4, the word "majoration" is replaced by the words "additional benefit for third-person recourse";
2° In the second paragraph of section R. 413-7, the words: "the increase for assistance of a third person" are replaced by the words: "the supplementary benefit for third-person recourse";
3° In 2° of Article R. 413-8, the words: "the ordinary acts of life" are replaced by the words: "the ordinary acts of life of which he specifies, if any, the number and nature of life";
4° Section R. 434-3 is replaced by the following provisions:
"Art. R. 434-3.-I. ― The disability rate in the third paragraph of Article L. 434-2 is set at 80%.
“II. ― The annual amount of the supplementary benefit for third-person appeal is set by order.
"It cannot be less than one third of the minimum wage amount referred to in the first paragraph of Article L. 434-16 where the victim cannot perform only three or four of the ordinary acts of life on the grate appreciation of assistance needs by a third person provided for in Article D. 434-2.
"It cannot be less than two thirds of the minimum wage when the person cannot perform five or six of these acts alone.
"It cannot be less than 100% or more than 133% of the amount of this minimum wage when the person cannot perform at least seven of these acts alone or, when due to neuropsychic disorders, his or her condition presents a danger to himself or others. » ;
5° In R. 434-19, after the words: "work accident annuities", the words are inserted: "and the supplementary benefit for third-party recourse provided for in L. 434-3";
6° The last paragraph of Article R. 434-34 is deleted;
7° After the article R. 434-34, an article R. 434-34-1 is inserted as follows:
"Art. R. 434-34-1.-I. ― The additional third-party benefit shall be effective under the following conditions:
« 1° On the same date as the annuity when it is attributed simultaneously to it;
« 2° On the date of revision of the annuity when it is assigned on the occasion of a change in the permanent incapacity rate;
« 3° As of the day the victim's doctor's finding of the victim's inability to perform the ordinary acts of life or, if the incapacity is found by the counseling physician without prior examination by the victim's doctor, on the date of filing the claim for the benefit when the victim is not simultaneously assigned to the annuity or on the occasion of a change in the permanent disability rate.
“II. ― It ceases to be due from the first day of the month following the one in which the victim is informed, by any means to determine the date of receipt of the decision of the credit union, that it no longer meets the terms and conditions of attribution of the benefit.
"III. ― Where, as a result of a re-investigation of the victim, at the initiative of the victim or the caisse, a change in the ability of the victim to perform the ordinary acts of life justifying a review of the amount of the benefit is noted, the new amount of the benefit is applied:
« 1° If the benefit is reduced, on the first day of the month following the month in which the victim is informed of the decision, which is addressed to the victim by any means to determine the date of receipt;
« 2° In the event of an increase in the benefit, from the date of revision of the annuity if the re-examination of the victim results in a change in the incapacity rate or, if not, on the day of the finding by the victim's doctor of the victim of the inability of the victim to perform the ordinary acts of life or, if the incapacity is found by the doctor-in-council,
"IV. ― When the benefit comes into effect in the course of months, the amount is reduced due to the number of days elapsed between the beginning of this month and the effective date.
"V. ― In the case of hospitalization of the insured, the supplementary benefit for third-party recourse is paid up to the last day of the calendar month following the one in which he was hospitalized; beyond this period, his service is suspended. » ;
8° In the first paragraph of section R. 757-1, after the words: "the constant assistance of a third person," the words are inserted: "the complementary benefit for third-person recourse,"
9° At the 6th of R. 815-22, the words: "The majorations" are replaced by the words: "The supplementary benefit for third-person recourse and majorations";
10° At the 4th of R. 861-10, the words: "The majorations" are replaced by the words: "The supplementary benefit for third-person recourse and majorations".
The Rural and Maritime Fisheries Code is amended as follows:
1° In the second paragraph of Article R. 732-4, after the words: "as provided for in Article L. 434-2 of the Social Security Code", the words are inserted: "in its writing before March 1, 2013";
2° In the first paragraph of article R. 751-40, after the words "D. 434-1", the words "D. 434-2, D. 434-3", are inserted;
3° In the second paragraph of section R. 751-145, the words: "the increase for assistance of a third person" are replaced by the words: "the supplementary benefit for third-person recourse";
4° In the second paragraph of article R. 751-146, the words: "the ordinary acts of life" are replaced by the words: "the ordinary acts of life of which he specifies, if any, the number and nature".
The provisions of this Decree shall apply effective 1 March 2013.
Individuals who benefit from the third-person increase referred to in the third paragraph of Article L. 434-2 of the Social Security Code and in the seventh paragraph of Article L. 752-6 of the Rural and Maritime Fisheries Code, in their drafting prior to March 1, 2013, and which did not opt for the benefit of the supplementary benefit for third-person recourse, continue to receive this increase under the conditions and in accordance with the revalorization rules effective February 28, 2013.
The Minister of Social Affairs and Health and the Minister of Agriculture, Agri-Food and Forestry are responsible, each with respect to it, for the execution of this Order, which will be published in the Official Journal of the French Republic.
Done on 2 April 2013.
Jean-Marc Ayrault
By the Prime Minister:
Minister of Social Affairs
and Health,
Marisol Touraine
Minister of Agriculture,
agri-food and forest,
Stéphane Le Foll
