On December 28, 2006, the Caisse Primaire d’Assurance Maladie (CPAM) of Vaucluse received the report of an industrial accident from Thierry X, 43, director of a company specializing in the sawmill and the timber trade.
This declaration, completed by an employee and signed by the manager, specifies that the employee – then hospitalized – is « fell on frosty woodss”, during the visit of a ” construction site “that he fractured his left leg, and that only his 16-year-old son witnessed the incident.
For three years, Mr. X receives daily allowances (40,074 euros). He then obtains an annuity (280 euros per month) to be paid to him every quarter until his death. Alas, on November 24, 2016, his wife, in the process of divorcing, denounces him to the CPAM: the declaration of an accident at work was false, Mr. X having injured himself during his leave, she writes.
Accident at work: partially tax-exempt compensation
The employee who is the victim of an accident at work receives the daily allowances from the Primary Health Insurance Fund (CPAM) from the day after his sick leave, and for the entire period of his incapacity (article L.433-1 of the Social Security Code). These allowances are proportional to the declared salary: 60% during the first twenty-eight days and 80% from the 29e day (article R.433-1 of the Social Security Code).
Daily allowances, such as annuities for accidents at work, are exempt from CSG and CRDS. For a long time, they were not subject to income tax. Since 1er January 2010, they are for 50% of their amount (article 81-8° of the general tax codes).
Disability pensions paid following life accidents are taxable and subject to CSG and CRDS contributions. They may be revised, 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 work accident pension is paid for life.
Martine X, then heard by a sworn agent of the CPAM, explains that, ten years earlier, her husband fell in the woods, during a hunting party. Their son then warned a neighbour, who alerted the firefighters – whose report mentions “fall in the woods on the hunt”. The false declaration would have been completed by the sister of Thierry X (although dismissed from the company), then signed by the late manager, then 81 years old.
Mme X claims to have recently discovered, while looking for a document for the divorce, that the event had been disguised as an accident at work. She denies having taken advantage of the money unduly paid, the couple having had separate accounts.
Double Complaint
The CPAM decides to file a complaint for fraud, although the offense was committed ten years earlier and the prescription for public action against the offenses is three years. His lawyer, Me Stephane Ceccaldi, maintains in fact that the fraud is time-barred from “the last remittance” by ” the victim “. However, the last payment of the CPAM is recent, since Mr. X has a life annuity.
The public prosecutor opens a preliminary investigation, which hardly mobilizes the gendarmes. They are unable to find out if the company was closed or not on the day of the events. Mr. X stating that he went to the “wooded areas » of his ex-mother-in-law, in order to measure them, at the request of the latter, wishing to sell them, the case is closed without further action, on November 22, 2018.
It takes a second complaint from the CPAM for the investigation to be relaunched. The neighbor and a firefighter confirm that Thierry X was dressed in combat fatigues and that he had his rifle when he fell. The mother-in-law denies having wanted to sell wood to the company. She specifies that at the place of the accident, there are only vines.
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