Compensation before the Commission de Conciliation et d’Indemnisation […] (CCI)

Anyone who believes they have been the victim of a medical accident, an iatrogenic disorder or a nosocomial infection may refer the matter to the ICC for an opinion, and seek recognition of the injury suffered and the corresponding compensation. In addition to this remit, the Commission de Conciliation et d'Indemnisation des accidents médicaux (CCI) is responsible for ruling on disputes between users and healthcare professionals, healthcare establishments, healthcare services or organisations or producers of healthcare products. The procedure before the Commission de Conciliation et d'Indemnisation des accidents médicaux (Conciliation and Compensation Commission for Medical Accidents) is generally little known and often gives rise to questions which it is important to answer.

• Who can file a claim with the Commission de Conciliation et d'Indemnisation des accidents médicaux?

The ICC can be approached by victims, whether they are adults or minors, through their legal representatives:

• a medical accident
• an iatrogenic condition, i.e. linked to a drug or medical treatment
• or a nosocomial infection, i.e. contracted by the patient in a healthcare establishment

It is important to note that in the event of death, the victim's next of kin are also entitled to refer the matter to the Commission, in their capacity as representatives of the deceased victim, but also as indirect victims.

• Can the Commission de Conciliation et d'Indemnisation des accidents médicaux intervene in all situations?

No, the CCI only has jurisdiction in the situations listed above, i.e. in the event of a medical accident, an iatrogenic condition or a nosocomial infection. Similarly, for the ICC to examine the case, it must be proven that the medical accident, illness or infection was contracted after 5 September 2001. It is also important to note that not all medical accidents, illnesses or infections are eligible for referral to the ICC. Only serious medical accidents can be referred to the Commission de Conciliation et d'Indemnisation (Conciliation and Compensation Commission). The regulations state that a medical accident is serious if it presents :

• a rate of permanent physical or mental injury (PPAI) of more than 24%;
• or temporary cessation of professional activities for a period of at least six consecutive months or six non-consecutive months in any twelve-month period ;
• or temporary discomfort resulting in a temporary functional impairment equal to or greater than 50% for a period of at least six consecutive months or six non-consecutive months in any twelve-month period.

It is also possible to refer a case to the CCI :

• when the victim is declared definitively unfit to carry out the professional activity in which he or she was engaged prior to the occurrence of the medical accident or illness,

• when the medical accident, iatrogenic disorder or nosocomial infection causes particularly serious problems, including economic problems, in the patient's living conditions.

NB / As far as ailments are concerned, they are said to be iatrogenic when they refer to undesirable effects caused by taking a medical treatment. An infection is considered nosocomial if it was not present when the patient was admitted to hospital, i.e. if it is contracted during care. An infection is considered as such when it was absent on admission. When the patient's infectious status on admission is unknown, the infection is classically considered nosocomial if it appears after 48 hours of hospitalization. However, this timeframe is rather artificial and should not be applied without thought. On the other hand, delays are different, particularly in the case of prosthetic devices. These infections may be directly related to care (e.g. a catheter infection) or simply occur during hospitalization, independently of any medical act (e.g. a flu epidemic). For an infection to be considered nosocomial, it must appear more than 48 hours after the patient's hospitalization. Infections that develop within this timeframe are considered to be in germ at the time of the patient's entry into the facility.  

• How long does it take to file a claim with the Commission de Conciliation et d'Indemnisation?

A claim may be lodged with the CCI within 10 years of consolidation of the injuries caused by the medical accident. Please note that consolidation of the state of health is a different concept from recovery. Consolidation occurs when the patient's state of health is considered to have stabilized, i.e. it is no longer likely to evolve favorably or unfavorably. Conversely, recovery implies that the patient returns to the state he or she was in before the accident. When we speak of healing, we mean the absence of after-effects.

• Which Conciliation and Compensation Commission should the victim refer to?

There are several regional Conciliation and Indemnity Commissions. The competent CCI is that of the region in which the healthcare professional or facility concerned is based.

• How do I contact the CCI?

The procedure for bringing a case before the ICC is relatively straightforward and free of charge, in that the aim is to obtain compensation for the loss suffered outside of any legal proceedings. To do this, the request must be sent to the local CCI either by registered letter with acknowledgement of receipt, or handed in against a receipt. The application must be accompanied by a set of supporting documents, including the following:

• Medical documents establishing the link between the damage suffered by the patient and the medical act,
• Documents describing the nature and extent of the damage suffered,
• Steps taken by the patient to obtain compensation for his or her injury (correspondence with the healthcare facility, legal proceedings, expert report, etc.),
• Social security statements,
• …

• What happens once the file has been sent to the CCI?

Referral to the ICC suspends the limitation and appeal periods until the out-of-court settlement procedure has been completed. But beware: the time limits start to run again as soon as the CCI has issued its opinion. CCI members are bound by professional secrecy. When the file reaches the Commission de Conciliation et d'Indemnisation (Conciliation and Compensation Commission), it is examined. The next step in the procedure depends on the severity of the medical accident suffered. In this way, the CCI can invite you to refer the matter to it for conciliation, when the severity threshold is less than 24%. Should the severity threshold exceed 24%, the out-of-court settlement procedure will be triggered.   1/ Conciliation The conciliation procedure will apply if the victim is in one of the following situations:

• The quality of care received by the patient is contested,
• Patients who feel they have been the victim of a dispute with a healthcare professional or facility
• The patient's injury is below the severity threshold (24%).

The ICC, in the person of its Chairman, informs the parties involved (healthcare professional, establishment, etc....) of the procedure and may request additional information. After agreement from the applicant, the CCI :

• forwards the request to the facility's user relations committee
• or delegates the conciliation task to one of its members or to an independent mediator
• or study the facts themselves.

After this examination, the ICC draws up a document indicating the outcome of the conciliation. It is signed by the parties and a copy is given to each of them. 2/ Amicable settlement This procedure is intended to be applied if the seriousness criteria are met. The CCI first checks that this is the case. Once the application is complete, the CCI has 6 months to give its opinion. The CCI may obtain any document, including medical documents, using means that guarantee confidentiality with respect to third parties. Its members are bound by professional secrecy. The exchanges are contradictory to all parties concerned. If the ICC deems the case admissible, the Chairman appoints an expert or a panel of experts, sets the terms of reference for the appraisal and sets a deadline for submission of the appraisal report. As part of the expert appraisal procedure, the expert may take the parties' observations into consideration and, at their request, include all relevant documents in his report. After all parties have commented, the Expert issues his final report and sends it to the Conciliation and Compensation Commission and to the parties. The ICC communicates the report to the victim, specifying the date on which it will examine the case. When the ICC examines the case, the victim can be present to be heard. She can also be accompanied by her lawyer or his medical advisor (only one representative of the victim being admitted to the examination).  

• How long does the CCI have to give its opinion?

Once it has met, the Commission de Conciliation et d'Indemnisation has 6 months to give its opinion. It is important to emphasize that the Commission de Conciliation et d'Indemnisation (Conciliation and Compensation Commission) only issues an opinion. The CCI is not a court of law. The victim is therefore not bound by the ICC's decision. The same applies to those who may be liable, and their insurance companies. Under these conditions, compensation for the loss suffered can be obtained through the courts.  

• What happens when the Commission de Conciliation et d'Indemnisation recognizes a right to compensation?

There are two possible scenarios: Responsibility of the healthcare professional/institution : When the ICC considers that a fault has been committed by the healthcare professional or institution, it is up to the professional concerned and his or her insurer to present an offer of compensation to the victim or his or her next of kin or beneficiaries. The offer of compensation must be made to the victim or, in the event of death, to the victim's next of kin or heirs, no later than 4 months after receipt of the CCI's opinion. There is a special case when the victim is not consolidated. In such a situation, the offer of compensation must be made no later than 2 months after the Commission has issued another opinion. When an offer of compensation is made, the victim can accept or refuse it. Acceptance of the offer by the victim removes the possibility of appealing to an administrative or civil court, or receiving compensation from another organization. If the victim accepts the compensation offer, the insurer has one month to settle the claim.   If the insurer refuses to compensate the patient, or remains silent after the 4-month deadline, you can ask the Office National d'Indemnisation des Accidents Médicaux, des Affections Iatrogènes et des Infections Nosocomiales (ONIAM) to pay compensation. THERAPEUTICAL RISK When the CCI recognizes the existence of a medical accident but concludes that there was no fault on the part of the healthcare professional or establishment, compensation is paid through the ONIAM. The ONIAM, under the supervision of the French Ministry of Health, is responsible for organizing the amicable, rapid and free compensation of victims of medical accidents. It is important to specify that the compensation offer made by ONIAM is based on a scale drawn up by ONIAM itself. If the patient accepts the offer, compensation is paid by ONIAM within one month. * In both cases, if the offer is refused, or if ONIAM does not make an offer, the victim can obtain compensation for his or her loss before a court of law. The court of jurisdiction will depend on the nature of the case: Administrative Court for public institutions, Judicial Court for self-employed healthcare professionals, Criminal Court for misdemeanors or felonies.

• Don't I need a lawyer to take my case to the Commission de Conciliation et d'Indemnisation?

  You don't need a lawyer to take your case to the CCI. Nevertheless, it is highly recommended to engage the services of this legal and procedural professional. An incomplete or imprecise file may be rejected, and consequently not examined by the Conciliation and Compensation Commission. It would therefore be a shame to miss out on compensation to which a victim could legitimately lay claim. Similarly, if the compensation procedure via the CCI fails, the victim can take the matter to court to obtain compensation for his or her loss. In this case, a lawyer is required.   Sources :

• Law no. 2002-303 of March 4, 2002 on patients' rights and the quality of the healthcare system
• Public Health Code (articles L1142-1 to L1142-24)
• oniam.fr