Déclaration d'un dommage corporel causé par un tiers

This declaration must be completed if you have suffered bodily injury caused by a third party (for example, if you are the victim of a road accident, assault, medical malpractice, or if you have been injured by an animal or an object). It enables the National Health Fund to examine the facts and, if necessary, to exercise its rights of recourse against the third party responsible in accordance with Articles 82 and 374 of the Social Security Code.
This declaration does not affect the National Health Fund's coverage of your incapacity for work or other benefits.