Moroccan-born woman wins new medical assessment in four-year dispute over CPAM ruling
Declared recovered by France’s Social Security system after a workplace accident, a woman born in Morocco has been challenging the decision for four years. Her psychiatrist says her condition had not improved. The Avignon court has ordered a new medical assessment.
For the Vaucluse CPAM, she had been recovered since 1 August 2022. Eight days later, her psychiatrist said exactly the opposite. The woman, born in Morocco in 1977 and living in Avignon, has been challenging the Health Insurance Fund’s findings for four years. The Avignon judicial court has just granted her a new medical assessment, according to a ruling dated 23 September 2026 viewed on Pappers Justice.
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It all began on 27 August 2019, when she had a workplace accident. The insured woman felt faint, lost consciousness and fell onto her left side. The medical certificate noted arm pain and an anxiety-depressive state. The CPAM recognized the accident but limited coverage to the fainting episode and arm pain.
In December 2020, her condition deteriorated. A psychiatrist diagnosed “physical and psychological exhaustion” and issued a certificate of relapse. The fund eventually recognized the relapse as related to the workplace accident. But on 4 August 2022, it decided to end coverage, setting the recovery date as three days earlier.
According to the woman, the problem stemmed in particular from the report by the medical adviser. She accuses him of disregarding a medical certificate completed at the CPAM’s request in February 2021 and the findings of another doctor, which had led to recognition of her relapse. She also points to a contradiction in his own observations: the doctor recommended a “transition to sick leave” because of a deterioration in her condition observed that same day.
Her psychiatrist disputes the recovery date
On 8 August 2022, the psychiatrist treating her issued a new certificate. In his view, her exhaustion had neither resolved nor even stabilized by 1 August, or by a week later. Other documents were added to the case file, including a visit to the emergency department on 17 October 2022 following a suicide attempt mentioned in the medical certificate submitted to the judges.
The woman first tried to have the decision overturned by the amicable appeals commission. Her request was rejected on 30 November 2022. She then filed a claim with the Avignon judicial court on 9 February 2023. When her case was reviewed in 2026, the CPAM did not oppose a new assessment. Both parties agreed that a general practitioner should carry it out, with the option of consulting a psychiatrist.
In its 23 September ruling, the court noted “persistent and complex medical difficulties” concerning the recovery date. It appointed an expert to examine the woman, review her medical certificates and determine whether her condition could genuinely be considered recovered on 1 August 2022. The CPAM must advance 900 euros, excluding tax, to fund the assessment. The report is expected within four months of the expert accepting the assignment.
The judges will then have to determine whether the date set by the Health Insurance Fund was justified, or whether the woman’s health should be considered recovered or stabilized on a different date. The case was adjourned until 10 November 2027. The recovery decision has therefore not yet been overturned: the court is awaiting the medical findings before ruling.
