A 30% increase in sick leave in ten years. While there were 6.4 million work stoppages in France in 2012, their number rose to 8.8 million in 2022. A growth that is “unsustainable” in view of the Security budget social, warned Sunday the Minister of Health, Aurélien Rousseau. Expenditure on daily allowances amounted to 13.5 billion euros in 2022, not counting the stoppages linked to Covid-19.
According to Health Insurance, “neither population growth nor rising wages are sufficient to fully explain” this increase. In subtext, the culprits are the “fraudsters” on sick leave. So to control this increase, Aurélien Rousseau wants to carry out “more checks”, in order to verify the veracity of the pathology. But what exactly are these controls, and are they frequent? 20 minutes make the point.
Surprise visit from an investigator
When a person is “arrested”, his doctor gives him a notice of sick leave. On this sheet, some details are given as to his possibility of leaving the home. First possibility: a ban on leaving her home because of her state of health. Second possibility: an authorization to leave his accommodation but a compulsory presence at home from 9 a.m. to 11 a.m. and from 2 p.m. to 4 p.m. Last possibility: authorization to go out freely, “for duly justified medical reasons”. “In this ultimate case, the doctor must justify his decision on the work stoppage notice, intended for the medical service of the primary health insurance fund”, specifies to 20 minutes health insurance.
If sufferers are required not to set their noses outside at certain times, it is partly to be subject to checks. These can be administrative. In this case, a sworn authorized investigation agent goes by surprise to the home of the indisposed person to check his presence outside the authorized exit hours.
Summons to a medical examination
But the control can also be of a medical nature. When the Health Insurance or the employer considers that the work stoppage has a good chance of no longer being medically justified, the medical adviser summons the arrested person to a medical examination to analyze his state of health. Arrested employees have every interest in submitting to it because, in the event of refusal, the social security body may suspend daily allowances. “In 2022, 338,000 people were subject to a check-up with medical examination by a medical adviser”, informs the Health Insurance at 20 minutes.
But doctors are not the only ones who can carry out these checks. Arrested persons may be summoned by a nurse from the medical service or an adviser from the health insurance service (CSAM) to a telephone or physical appointment. In 2022, 433,000 policyholders were subject to this type of action.
Targeted “frequent medical reasons”
“We have evolved our targeting strategy over the past few months, explains to 20 minutes health insurance. The checks carried out by the medical department are targeted on situations or durations of work stoppage such as surgery for such and such an indication, repeated work stoppages or a work accident situation. The organization also targets “frequent medical reasons”, such as low back pain, controlling people arrested for more than 30 days for back pain. “Beyond that, work stoppages are rarely medically justified, apart from specific medical situations”, considers the institution.
The medical advisers can directly contact the prescribing doctors when they consider that work stoppages are no longer justified or that the situation of the arrested person is complex. While nearly one in two French people (42%) was arrested at least once during the year 2022, the Health Insurance contacted 5,000 practitioners in June on the grounds that they would exceed the usual prescription rates of ‘work stopping. Not jealous. Patients and doctors will have the same treatment.