Subsection 3: Complaints

I.-If the employee does not agree with the number of points communicated to him by the management body at local level on the basis of the data declared by the employer, or if he has not received any information by the date mentioned in the same paragraph and this situation is the result of a dispute with his employer about the exposure itself, the employee must, before referring the matter…

When the employer upholds the employee’s claim, it shall inform the local managing body by any means that can be used to certify the date of receipt. It shall correct the data in the declaration referred to in the first paragraph of article D. 4163-31.

When the employee brings a claim to the local managing body following the employer’s rejection of his claim, he must produce to this body a copy of the employer’s rejection decision or, in the event of implicit rejection, a copy of the proof of receipt of his claim. The acknowledgement of receipt sent by the management body to the employee states that if no reply is received within six months…

The commission provided for in Article L. 4163-18 is set up within each managing body at local level. It is made up of: 1° Two members chosen by the employees’ full or alternate representatives on the fund’s Board of Directors, from among themselves or from the technical committees mentioned inarticle L. 215-4 of the Social Security Code ; 2° Two members chosen by the employers’ full or alternate representatives on…

The Commission may validly rule if one of the members mentioned in 1° of Article R. 4163-37 and one of the members mentioned in 2° of the same article are present. Opinions are adopted by majority vote. In the event of a tie, the Chairman shall have the casting vote.

The commission issues a reasoned opinion on the basis of a file comprising: 1° The employee’s claim and the employer’s rejection decision or, in the event of implicit rejection, the acknowledgement of receipt of the claim; 2° Information held by the management body or received from each of the parties; 3° Information provided by the labour administration services and the funds referred to inarticle L. 723-2 of the Rural and…

The body may, if it considers it necessary, ask the employee and the employer to provide it with any document that may be useful in investigating the case. It may also collect any relevant information from the employee or employer or carry out or arrange for an on-site check to verify the extent of the employee’s exposure.

After receiving the reasoned opinion of the committee referred to in Article R. 4163-37, the director of the local managing body notifies the employee and the employer of his decision, indicating the appeal procedures and deadlines, by any means that can be used to certify the date of receipt. It may impose the penalty referred to in article R. 4163-33 as part of its decision. The notification sent to the…

The managing body at national level draws up guidelines to ensure the harmonisation of decisions made by managing bodies at local level.

The director of the managing body at national level may entrust one or more managing bodies at local level with the powers of inspection and complaint provided for in articles L. 4163-16 and L. 4163-18. The implementation procedures are set out in an agreement drawn up between the director of the managing body at national level and the directors of the managing bodies at local level.