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Two avenues of compensation

When a medical accident, a hospital-acquired (nosocomial) infection or a therapeutic hazard (aléa thérapeutique) has left you with serious after-effects, two avenues exist side by side:

  • The amicable procedure before the Conciliation and Compensation Commission (CCI — Commission de Conciliation et d'Indemnisation), which brings in ONIAM (the French national office for the compensation of medical accidents, iatrogenic conditions and hospital-acquired infections).
  • Litigation before the administrative court (public healthcare establishment) or the judicial court (private clinic, self-employed practitioner).

The two avenues are not mutually exclusive: the CCI procedure can be started in parallel with court proceedings, or precede litigation if the amicable offer is insufficient.

The severity threshold for access to ONIAM

Access to the ONIAM procedure (non-negligent medical accident) is subject to a high severity threshold. At least one of the following conditions must be met:
  • Permanent partial disability rate (IPP) ≥ 24%
  • Total temporary incapacity (ITT) exceeding 6 consecutive months, or 6 non-consecutive months within 12
  • Permanent unfitness for the previous occupation
  • Particularly serious disruption to living conditions (assessed on a case-by-case basis)

Below this threshold, liability rests with the establishment or the practitioner (their insurer or the healthcare professionals' guarantee fund — SHAM/Relyens, MACSF, etc.), not with ONIAM.

How the CCI procedure works

  1. Filing the case with the competent CCI (one per region). The file comprises the complete medical records, supporting evidence of losses and an account of the circumstances.
  2. Adversarial medical assessment (expertise) ordered by the CCI. The expert examines the victim, reviews the medical evidence and reaches conclusions on causation, the nature of the event (negligence or hazard) and the after-effects.
  3. The CCI's opinion: the Commission rules on liability and, where appropriate, refers the matter to ONIAM for compensation of the hazard, or to the practitioner's/establishment's insurer in the event of negligence.
  4. Compensation offer within 4 months of the opinion. The victim may accept it (final settlement) or refuse it and take the matter to court.

The ONIAM indicative framework

ONIAM has its own indicative compensation framework, setting value ranges for each head of loss (pain and suffering, permanent functional deficit — DFP, loss of amenity…). This framework is a basis for negotiation, not a ceiling:

  • Where an offer is insufficient, the victim can refuse it and take the matter to court, which applies the ordinary-law scales (nomenclature Dintilhac) — often more favourable.
  • ONIAM may also contribute in addition to the practitioner's insurer (apportionment of liability between negligence and hazard).

The limitation period

A medical liability claim is time-barred after ten years from consolidation of the injury (art. L. 1142-28 of the Public Health Code — CSP). This period is suspended during the CCI procedure.

Why be assisted by a lawyer before the CCI?

The assistance of a lawyer (avocat) is not mandatory before the CCI. It is nevertheless strongly recommended, for several reasons:

  • The amicable offer is final once accepted — there is no going back, even if new after-effects appear.
  • Preparing for the medical assessment is decisive: framing reservations, challenging the proposed IPP rate, requesting a specialist assessor (sapiteur) in the event of disagreement.
  • The analysis of the negligence/hazard apportionment determines which avenue to favour and the final amount of compensation.
  • If the offer is refused, the file must be immediately ready for litigation — which requires preparation upstream.

The firm assists victims at every stage: filing the CCI case, preparing for and attending the medical assessment, analysing the offer and, where necessary, bringing court proceedings to obtain full compensation.

Have you suffered a medical accident?

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Official source: ONIAM — the French national office for the compensation of medical accidents →