On 28 December 2006, the Caisse Primaire d’Assurance Maladie (CPAM) of Vaucluse received a report of an accident at work from Thierry X, 43, director of a company specializing in the sawmill and timber trade.
This declaration, filled in by an employee and signed by the manager, states that the employee – who is then hospitalized – is “fell in the cold woodss”, during the visit of a “construction site”that he fractured his left leg and that only his 16-year-old son witnessed the accident.
For three years, Mr. X receives a daily allowance (40,074 euros). He then gets an annuity (280 euros a month) to be paid quarterly until his death. Alas, on 24 November 2016 his wife, in the process of divorce, reported him to the CPAM: the declaration of an accident at work was false, Mr. X was injured while on leave, he writes.
Occupational injury: Partially tax-free compensation
The worker who is the victim of an accident at work receives daily allowances from the Primary Health Insurance Fund (CPAM) from the day following his absence due to illness and for the entire period of his incapacity (article L. 433-1 of the Social Security Code). These indemnities are proportional to the declared salary: 60% during the first twenty-eight days and 80% from the 29and day (article R. 433-1 of the Social Security Code).
Daily benefits, such as workplace injury annuities, are exempt from CSG and CRDS. For a long time they have not been subject to income tax. From 1and January 2010, are for 50% of their amount (article 81-8° of the general tax codeS).
Disability pensions paid as a result of life injuries are taxable and subject to CSG and CRDS contributions. They can be reviewed, suspended or canceled at any time, depending on the improvement of the state of health or the resumption of professional activity. While the non-revisable occupational accident pension is paid for life.
Martine X, later heard by a sworn agent of the CPAM, explains that, ten years earlier, her husband fell in the woods while hunting. Their son then alerted a neighbor, who alerted the fire brigade – mentioned in the report “fall in the woods hunting”. The false declaration was allegedly completed by the sister of Thierry X (albeit estranged from the company), then signed by the late executive, then 81 years old.
mmyself X says she recently discovered, while searching for a divorce papers, that the event had been disguised as a work-related injury. She denies having taken advantage of the money wrongly paid, since the spouses have separate accounts.
Double Complaint
The CPAM decides to file a complaint for fraud, despite the fact that the crime was committed ten years earlier and the statute of limitations for public action against the crimes is three years. his lawyer, mand Stefano Ceccaldi, in fact, he argues that fraud is time-barred “the last throw” par “to the victims”. However, the last CPAM payment is recent, as Mr. X has an annuity.
The public prosecutor opens an investigation, which barely mobilizes the gendarmes. I am unable to find out whether or not the business was closed on the day of the events. Mr. X claiming to have gone to the “wooded areas » of his former mother-in-law, in order to measure them, at the request of the latter, wanting to sell them, the case is closed without further action, on November 22, 2018.
A second complaint from the CPAM is needed to relaunch the investigation. The neighbor and a firefighter confirm that Thierry X was wearing a combat uniform and that he was carrying a rifle when he fell. The mother-in-law denies having wanted to sell wood to the company. She points out that there are only screws at the scene of the accident.
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