Work accident

What is work accident insurance?

Every employer has the obligation to take out workers' compensation insurance. If the employer fails to take out this insurance, he is automatically affiliated to the Federal Agency for Occupational Risks (Fedris). Fedris is a public body with different missions in the area of ​​industrial accidents.

Who is covered by this insurance?

The purpose of workers' compensation insurance is to protect workers from accidents that may occur while they are working. This insurance extends to other people such as temporary workers, artists, people employed under an apprenticeship contract (sheltered workshops for example), students within the framework of school placements etc.
We will only speak here of the salaried workers regime. The schemes for the self-employed and for civil servants are more specific.

In which cases does accident insurance cover work?

There are two types of accidents covered by this insurance:

- occupational accidents proper

That is to say any accident (not an illness for example) which occurred during the performance of the work, but also by the fact of the performance of the work. The cause of the event must be external to the victim's body. For example, imagine a worker making photocopies in the room provided for this purpose. Suddenly, he collapsed, struck down by a heart attack. The cause of this event is not due to making photocopies: making photocopies does not create such stress, even when the machine is not working well. Rather, the cause of this event is a heart problem. This accident is therefore not a work accident: the cause of the event is probably to be found in the body of the victim.

In addition, the accident must have caused injuries (physical or mental) to the worker, injuries that prevent him from working.

- accidents on the way to work

This is the normal route a worker uses to get from home to work. If the worker makes a minor detour from his normal journey, he will always be considered as being on his way to work. This will be the case, for example, if you are going to drive your children to school before going to work and go and find them before going home. This will also be the case if you stop at a store near you to do a shopping before returning. If the detour is more important than the normal route, you will have to justify that the detour was legitimate. For example, you absolutely had to go for a short run before returning. Unable to do this race at another time. If, on the other hand, you wish to go to the sales after work, the reason will not be considered legitimate.

The accident must, as in the case of accidents at work, be caused by an event external to the victim's body.

What is compensated by the industrial accident insurer?

1. The costs incurred by the worker:

These are generally the following costs:

- Medical costs (recognized by INAMI as reimbursable to the patient);
- Travel costs (example: the worker has a cast in his leg and is forced to come to work by taxi). A prior agreement from the insurer on this trip will generally be necessary; prosthesis costs.

2. Worker's incapacity for work:

It is an indemnity paid by the insurer when the worker cannot work following an industrial accident.

This disability can be temporary (this means that the worker's injuries will still progress to recovery) or permanent (the worker's condition will not change, even if he is not completely healed).

The compensation will consist of an annuity, i.e. a sum of money which the insurer pays periodically (for example every month) during a period determined in the contract (for example until the age of retirement). The victim thus receives replacement income.

It may also be that the person can no longer perform certain tasks of daily life (for example cleaning, climbing stairs etc.), and must have someone help them. Compensation for the help of an outside person is therefore also possible in the context of work accident insurance.

3. The death of the worker:

In the event of the worker's death, the insurer will pay the family a sum which must be used to finance the funeral expenses. In addition, an annuity will be granted to the beneficiaries (spouses, children, parents or siblings depending on the family situation).

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