What to do in the event of an accident
You must report any accident to our organisation, together with all treatments related to any accident, even an old accident, for which reimbursement may be claimed from your fund.
The accident you suffered may have been caused, intentionally or otherwise, by another person. This is then an accident caused by a third party, which may be a single individual, or even a company or government department. Your report enables your fund to turn to the person responsible, or their insurance company, for reimbursement of the medical benefits paid following your accident.
Examples of accidents caused by third parties
- you have suffered an intentional or unintentional assault (that you have or have not reported to police or the authorities);
- you have been bitten by an animal, a dog for example;
- you have been the victim of a road traffic accident;
- you have had a sporting accident (during a match, training, etc.);
- you have been the victim of a medical accident (injury following an operation, infection contracted in hospital, etc.);
- your child has been the victim of an accident at school (fall in the yard or during a physical education or sports session, etc.);
- you have been the victim of an accident caused by an object belonging to a third party (a flowerpot falling from a balcony, a tile or a tree branch, etc.);
- you have been injured during an act of kindness (lending your help during a move or changing a tyre for example)...
How to report your accident?
This report must be made in writing within fifteen days following the accident.
There is a form available on our website or at any of our reception counters.
ATTENTION: there are two sides to this document, the front must be completed in all cases but the reverse side only needs to be completed if responsibility for the accident can be attributed to a third party.
Where this is not the case, this report must be attached to your first request for payment of medical benefits.
Your fund may request additional information from you about the circumstances surrounding the accident.
Remember to inform your doctor and other healthcare professionals (pharmacist, consultant, physiotherapist, nurse, etc.) that you consult after the accident.
They must check the "accident caused by a third party" box on your treatment form and give the accident date.
For subsequent requests for payment of medical benefits, please ensure that this information clearly appears on your treatment forms.
We recommend that:
- you check that the information given by your doctor or other healthcare professionals on your treatment form states whether the treatment for which reimbursement is claimed relates to an accident caused by a third party or not, and gives the date of this accident,
you keep a photocopy of the documents as proof of your treatment expenses (invoices, statements from the fund for each payment, etc.) so that you can, potentially, reclaim the reimbursement of health expenses that you have to pay from the responsible third party or their insurance company.
An essential action
Your accident report will be used to implement the "recourse against third parties" scheme.
You must provide all the information and supporting documents regarding this type of situation.
The fund will then liaise with the responsible third party or their insurance company to reclaim the health expenses incurred as a result of your accident.
This avoids unnecessary financial burdens on your health insurance scheme.