Law firm specialising in employment law
and social security law.
Law firm specialising in employment law
and social security law.
In accordance with articles R.313-1 and R.313-3 of the French Social Security Code, in order to be entitled to sickness insurance daily benefits during the first six months of work interruption, the insured person must provide proof, on the day of the work interruption :
The longer the period of sick leave, the more restrictive the conditions.
If they meet the conditions laid down by law, insured persons may be covered by the health insurance scheme while they are off work.
To calculate the daily social security benefits (IJSS) to be paid to the employee, the Caisse primaire d'assurance maladie (CPAM) must take into account the employee's previous earnings. Eligibility for IJSS is assessed on the first day of work stoppage.
The Court of Cassation regularly issues rulings defining the remuneration to be included in the basis for calculating this reference remuneration.
According to articles L.313-1 and R.313-1 2° of the French Social Security Code, only salaries actually received during the reference period are taken into account.
In this context, the rule is that wage arrears received after the first day of sick leave are excluded from the reference period. Entitlement to daily sickness benefit is assessed on the basis of wages actually paid during the period preceding the interruption of work.
The 2nd Civil Division of the French Supreme Court (Cour de cassation) issued a ruling on March 21, 2024, reminding us that the conditions laid down by law must be met, and denying an insured person the benefit of daily allowance payments insofar as he did not meet these conditions.
In this case, the insured was trying to obtain the inclusion, in the calculation of the reference salary, of salary arrears received after the work stoppage, on the grounds that these salaries corresponded to work carried out during the reference period.
In vain (Cass. 2nd civ, March 21, 2024, n°21-18.015).
This reasoning is consistent with the texts and is in line with Supreme Court case law on the subject.
It should be noted that the ruling concerned a stay of 6 months or less, but in our view the solution could be transposed to longer stays.
No.
We note in particular a ruling in which the Supreme Court refused to recalculate an insured person's benefits in order to integrate the wage arrears due for the reference period, as these had been received subsequent to his stoppage (Cass. civ. 2, October 8, 2020 n°19-21.128).
It is important to note that this restrictive assessment in social security law cannot be transposed to labor law. Indeed, in the event of a dispute before the Labour Court, it is possible for the litigant to obtain a revision of the sums due to him or her, and to include additional remuneration such as bonuses, gratuities or overtime, when these are judicially recognized and cover the reference period concerned.