AGI 0403 Ed 05/2018

*Dominant - ** Non Dominant

1. The disabilities not listed above are compensated in proportion to their severity compared to those of the listed cases.
2. Total functional disability of a limb is treated as its total loss.
3. The disability rate resulting from multiple disabilities arising from the same event is obtained by summing the disabilities, without exceeding the rate applicable in the case of total functional disability. Similarly, if multiple injuries affect the same limb, the disability rate cannot exceed the rate provided for the total loss of said limb.

Specific scale applicable to Midwives

Total functional disability

• Total incurable alienation ________________________
• Total loss of both eyes or vision of both eyes___
• Disarticulation of the shoulder ________________________
• Amputation of the arm, forearm, wrist _______
• Complete paralysis of the brachial plexus_______________ 100%
• Amputation or total functional loss of the hand_____
• Loss of both lower limbs _________________
• Disarticulation of the hip _______________________
• Complete organic hemiplegia____________________

Total and partial functional disability

Head (with or without skull fracture)

• Total incurable alienation ________________________ 100%
• Epilepsy with very frequent seizures (several per month) depending on the frequency of seizures under well-conducted treatment ___________________________________ 30% to 100%
• Psychic disorders and deficits of intellectual functions; objective neurological deficit________________________ 20% to 100%
• Subjective post-concussion syndrome ______________ 5% to 20%

Eyes and ears

• Total loss of both eyes or vision of both eyes __ 100%
• Total loss of one eye _____________________________ 30%
• Alteration of visual function____________________ 3% to 100%
• Total non-correctable bilateral deafness________________ 80%
• Total unilateral deafness__________________________ 20%
• Unilateral hypoacusis__________________________ 3% to 20%

Laryngeal sequelae

• Amputation of the tongue, depending on the degree of speech, chewing, swallowing discomfort________ 10% to 80%

Jaws and teeth

• Loss of the lower jaw_____________________ 100%

Nose

• Total anosmia associated with ageusia_________________ 5% to 15%

Spine (vertebral column)

• Fracture or vertebral dislocation with minor to moderate sequelae______________________ 5% to 30%
• Fracture or vertebral dislocation with significant sequelae _ 40% to 50%

Respiratory system

• Thoracic wall: depending on pain and deformation after fracture__________________ 2% to 15%
• Impairment of respiratory function evidenced by functional tests____________________ 5% to 80%

Pelvis (excluding the hip)

• Depending on sequelae (static, motor, and urinary disorders) _ 10% to 50%

Upper limbs

Hands

Lower limbs

• Loss of both lower limbs _________________ 100%
• Disarticulation of the hip ______________________ 100%
• Disarticulation of the knee depending on the prosthesis ___ 80%
• Amputation of the thigh at the middle third ________________ 80%
• Amputation of the leg at the middle third ________________ 70%
• Amputation of the foot (Lisfranc)______________________ 45%
• Amputation of the five toes________________________ 25%
• Amputation of the big toe _________________________ 20% 12%
• Knee blockage in extension____________________ 40%
• Ankle blockage __________________________ 30%
• Rupture of the Achilles tendon, depending on the repair ________________________________ 0% to 30%
• Complete paralysis of the external popliteal nerve____________ 30%

Miscellaneous

• Complete organic hemiplegia ____________________ 100%
• Total splenectomy, depending on the blood formula ______________________________________ 10% to 30%
• Nephrectomy (increase in rate according to azotemia):
  • without renal failure __________________________ 15% to 20%
  • with renal failure, depending on biology and hemodialysis ______________________________ 50% to 100%

CAP-ARC

Insurer of the contract
Head Office
12 avenue Pierre Mendès France - CS 10144 - 67312 Schiltigheim Cedex
tel. 03 90 23 90 00
Public limited company of insurance brokerage with a capital of 480,000 €
Subsidiary of AXA France Vie
306 843 731 RCS Strasbourg
Orias 07 029 368

Management center for AGIPI insurance contracts
AXA France Vie S.A. with a capital of 487,725,073.50 €
310 499 959 RCS Nanterre
AXA Assurances Vie Mutuelle
Mutual Life Insurance and Fixed Contribution Capitalization Company - Siren 353 457 245
Head offices: 313 Terrasses de l’Arche - 92727 Nanterre Cedex
Companies governed by the Insurance Code
ACPR - Prudential Control and Resolution Authority: 4 place de Budapest - CS 92459 - 75436 Paris Cedex 09 / ORIAS: www.orias.fr

Contracting association
Head Office
12 avenue Pierre Mendès France - CS 10144 - 67312 Schiltigheim Cedex - tel. 03 90 23 90 00
Paris office
52 rue de la Victoire - 75009 Paris - tel. 01 40 08 93 00
Register of Associations of the Schiltigheim District Court - volume 21 - no. 1049
Siren 307 146 308