accidents - who pays...

[Patf]

..... for the hospital treatment? CPAM or insurers?

This topic came up on another forum, regarding DIY accidents in the home. It seems that CPAM sometimes don't cover the cost of hospital care, so cover through houshold insurance is recommended.Or CPAM cover the basics but some mutuelles won't cough up the rest.

Other accident situations could be during sporting activities, or driving. I think we have a separate policy for accidents to the driver, but what about passengers?

Can anyone clarify the various situations?

[Jotty]

I would be surprised if the basic care costs weren't met by the CPAM and the daily hospital costs by the Mutuelle.

Perhaps you can tell us more about what you have read?

I asked a question about personal accident insurance in this thread  but have had no replies.

The GAV is an additional payment though, not a cover for the basic costs

[Patf]

I saw your question Jotty and was going to tag mine onto the end but thought it was a bit different.

A case was reported elsewhere by someone who is actually also a member of this forum so perhaps she will comment. Someone she knows had an horrific diy accident and later received a bill for 4000€ either from CPAM or their mutuelle.

Further discussion of the topic revealed that diy accidents in the home, to the home owner, should always be reported to your insurers. Other people said they had had diy accidents and CPAM payed up. For people working for you, they should have their own insurance.

So there seems to be confusion and I think it's important to know the correct thing to do. Pat.

[kizpip]

[quote user="Jotty"]I would be surprised if the basic care costs weren't met by the CPAM and the daily hospital costs by the Mutuelle.

Perhaps you can tell us more about what you have read?[/quote]

I'd agree with Jotty but would add that when claiming from CPAM there is an

obligation to declare whether the injuries sustained are as a result of an

accident, so that CPAM can in turn claim from the insurers of the

responsible party. This would apply for passengers injured in a road traffic accident. See http://www.ameli.fr/assures/votre-caisse-haute-vienne/vous-informer/declarez-votre-accident-a-votre-cpam_haute-vienne.php.

Only guessing, but maybe in the accident case quoted, the CPAM rendered their bill assuming that there was an insurer who would cover it?

[Jotty]

Thanks to both of you. That is something I didn't know, but should.

I note that it should be declared within 15 days.

The Ameli site says:

Dès que votre accident a été déclaré, les circonstances de

l'accident sont étudiées pour déterminer les responsabilités de chacun.

Votre Caisse se met en rapport avec la compagnie d'assurance du ou des

responsables afin d'obtenir le remboursement des frais engagés pour

vous soigner ou vous indemniser.

Votre déclaration d'accident n'a aucune incidence sur vos remboursements

[Panda]

Hello

On a slightly different note, I've taken out separate insurance for horse riding as I could imagine there could be some issues if I had a serious fall doing something considered dangerous, it's cheap and I wouldn't want to rish being without it.

Panda

[kizpip]

[quote user="Jotty"]I note that it should be declared within 15 days.[/quote]

From memory, there's a box to tick on the Feuille de Soins indicating whether the injuries were the result of an accident, together with space to give the relevant insurance company's details.

[Patf]

So it looks as if we must speak to our insurance agent to make sure we are covered for accidents in the home.

Panda - re sporting accidents. Husband broke his leg skiing. CPAM paid some of it and luckily he had taken out a separate policy as well and they paid the shortfall.

Thanks kizpip for the info.