On 25 August 2026, the social security division (pôle social) of the Bayonne Judicial Court (tribunal judiciaire) recognised the occupational origin of the breast cancer of a former flight attendant who had become a cabin manager. A rare decision, since this disease does not appear in any table of occupational diseases. Its recognition could therefore only follow one route: the supplementary system, open since 1993 to diseases not listed in the tables. A demanding system, which requires a permanent incapacity of at least 25% and an essential and direct causal link with the employee’s usual work.
These conditions sit uneasily with multifactorial diseases, which has long confined this route to rare cases, hence the attention given to the Bayonne judgment. Its media coverage, based for now solely on statements by the claimant employee’s lawyers, may have suggested that cancers fall outside the tables. Yet many already appear in them, from asbestos to ionising radiation.
How the tables work: a presumption subject to strict conditions
A table does not, however, designate a disease on its own. It links it to a hazard, to a time limit for coverage and to a list of work activities, which are interpreted strictly where the list is exhaustive. The presumption of occupational origin therefore only benefits employees whose situation meets all the conditions of the table. Failing that, the supplementary system distinguishes between two situations:
- Where the disease is listed in a table but one of the conditions relating to the time limit, the duration of exposure or the list of work activities is not met, occupational origin may be recognised if it is established that the disease is directly caused by the employee’s usual work, with no incapacity threshold required.
- Where it does not appear in any table, as is the case for breast cancer, the 25% incapacity rate and an essential and direct causal link must both be established.
A supervised procedure before the regional committee for the recognition of occupational diseases (CRRMP).
This second branch is the more demanding and follows a specific procedure. The health insurance fund (caisse) investigates the claim, in particular by means of a questionnaire sent to the employee and the employer, and then refers the file to the regional committee for the recognition of occupational diseases (CRRMP). An adversarial phase of forty clear days then allows the parties to consult the file and, during the first thirty days, to add to it; the last ten days are reserved for consultation and observations.
The CRRMP issues a reasoned opinion on whether there is an essential and direct link between the disease and the employee’s usual work, which is binding on the fund. If the occupational origin is challenged in court, the court obtains the opinion of a second CRRMP before ruling, without being bound by these opinions. Successive unfavourable opinions therefore do not close the case.
The method of proof: reconstructing an exposure history
The method used in this context consists in reconstructing an exposure history over an entire career, and then comparing it with international classifications, which list night shift work, the issue in this case, among the agents probably carcinogenic to humans. The employer can only counter this with its own documents.
It should be stressed in this respect that the reasoning is not specific to air transport. It applies in every sector and to all organisations in which night work, the issue here, is structural and combined with other hazards: healthcare and social care first and foremost, but also three-shift industry, transport or the food industry, by way of example.
A decision creating no new obligation, but raising documentation requirements
This decision, which has the merit of highlighting the method used, does not, however, create any new obligation. The employer’s safety obligation (obligation de sécurité) remains what it was; it is rather the documentation requirements placed on the employer and, with them, the foreseeable cost of such litigation that could change.
Prevention: two levers to anticipate the risk
Two lessons emerge in terms of prevention:
- First, risk assessments would benefit from taking into account the cumulative exposures of each employee, rather than reasoning solely hazard by hazard.
- Second, night work deserves to be treated as a risk factor in its own right, and not merely as a way of organising working time.
Next, the need to resort to night work deserves to be re-examined post by post, and rotation can prevent entire careers being spent on night shifts. This is the most direct way of reducing exposure itself. Posts in which night work is combined with chemical agents, radiation or cytotoxic substances call for a specific review, as does the effectiveness of medical monitoring.
Record-keeping and defence: anticipating the unforeseeable
Then there is record-keeping: the single risk assessment document (document unique) and its successive versions must be kept, and individual exposure data are subject to their own retention periods, which are often particularly long. This requires a designated person in charge and a procedure capable of surviving changes of payroll software and occupational health service.
These documentation requirements also directly determine the company’s defence. Challenging an exposure means producing, sometimes thirty years later, the individual count of nights worked, dosimetry monitoring, measurement results or the reports of end-of-exposure medical examinations.
These documents cannot be reconstructed once the dispute has arisen, and they must be gathered as early as the investigation stage, since the regional committee will only know of the case what has been placed on file. The answers to the fund’s questionnaire, often drafted in haste, are then produced in the court proceedings, where they readily turn against their author.
These documents do not, however, serve the same purpose depending on the issue in dispute. Prevention is not a condition of recognition, which depends on exposure and the causal link; it does, however, come into play in relation to inexcusable fault (faute inexcusable), where the measurements it has generated are also used to argue the extent of exposure. Lastly, challenges relating to coverage or its financial consequences follow separate avenues of appeal.
An issue set to evolve
This pressing issue is all the more so as the occupational disease regime is itself undergoing major change: the reforms expected in the coming months will alter both the cost of recognised claims and the conditions for recognition. All the more reason for the businesses concerned to know, starting today, what they would be able to prove.
