By Decree N° 78-480 of 8 November 1978, in the event of disagreement between the doctor of the National Social Insurance Fund and the injured person or his or her doctor, a medical assessment is carried out. This is entrusted to either:
– the local occupational health inspector;
– a doctor is chosen by mutual agreement between the victim’s doctor and the medical adviser, from among those listed on the list of doctors.
the medical advisor, from a list, drawn up by the Ministry of Public Health after consultation after consultation with the National Council of the Order of Physicians; this choice must be made within 15 days of the submission of the request for an expert opinion or the report of the medical advisor;
– to a doctor chosen from the list referred to in the previous paragraph by the Labour Inspector of the jurisdiction.
In all cases, the expert doctor may not be the doctor, who treated the victim, the company doctor concerned, or a doctor advising the
National Social Insurance Fund.
The Medical Inspector or the appointed expert doctor may request the opinion of specialists or technicians to help him/her make a decision.
The National Social Insurance Fund and the victim are responsible for initiating the expertise.
If the victim takes the initiative for the expertise, he/she sends the National Social Insurance Fund a reasoned request within 30 days of its decision to refuse to cover the cost of the accident, by registered letter or in return for a receipt, indicating the name and address of the treating doctor.
With a view to the expert assessment, the National Social Insurance Fund sends the following to the designated expert doctor, within 30 days of receiving the request for an expert opinion;
-the conclusions of the treating physician;
-the conclusions of the Fund’s medical advisor
-copies or copies of the request for an expert opinion;
– an information sheet indicating the nature of the expert’s mission.
As soon as the file is received, the Medical Inspector or the expert doctor the victim, within 15 days, indicates the place, date, and time of the examination, and informs the medical advisor and the treating physician who may attend the examination.
Within 30 days of the date of the examination, the occupational health inspector or the medical expert is required to submit his report in duplicate to the National Social Insurance Fund, with a copy to the victim and the attending physician.
The time limit may be extended by 15 days at the request of the Labour Inspector or the expert doctor; after this time limit, except in cases of force majeure, the said doctor shall be replaced.
The travel expenses of the experts, as well as their fees set by the legislation in force, shall be borne by the National Social Insurance Fund.