Compensation for the therapeutic hazard
This compensation can be obtained by referral to the CCI – ONIAM system.
CRCI and ONIAM
The CCI – ONIAM system was created by the Kouchner law of March 4, 2002 to facilitate compensation procedures related to therapeutic hazards.
The CCI, or CRCI (Commission Régionale de Conciliation et d'Indemnisation) is the Commission responsible for examining the files of medical accidents in order to determine whether compensation can be obtained (by ONIAM or by the doctor's insurance). /of the establishment).
The ONIAM (National Office for the Compensation of Medical Accidents) is the organization which compensates the victims of therapeutic hazards according to the opinion of the CRCI.
The immediate payment of a provision
In order to benefit from compensation for damages related to a non-faulty medical accident, the law provides for certain severity criteria (non-cumulative) to be met:
AIPP or DFP greater than 24%
This is the Attack on Physical and Psychic Integrity also called Permanent Functional Deficit.
It is a prejudice linked to the sequelae that you keep.
This rate is calculated at consolidation, when your state of health is no longer likely to change.
For example, the loss of vision of one eye or the total loss of use of a limb generally causes at least 24% of AIPP.
ITT greater than 6 months
Temporary Incapacity for Work corresponds to periods of work stoppage.
If because of the medical accident, you had to stop working for at least 6 consecutive months (or at least 6 non-consecutive months over a period of 12 months) you can obtain compensation from ONIAM.
DFT greater than 50% for at least 6 months:
The Temporary Partial Functional Impairment corresponds to the temporary discomfort caused by the medical accident.
If you are the victim of an incapacity greater than 50% for at least 6 months (or 6 non-consecutive months over a period of 12 months) related to the therapeutic hazard, you can benefit from compensation by ONIAM.
Serious disturbances in living conditions
Following the medical accident, you are unable to continue your professional activity or carry out a family life project, then you are entitled to compensation by ONIAM.
The therapeutic hazard resulting from an act of cosmetic surgery cannot give rise to compensation from ONIAM.
Request for compensation from the CRCI
You must submit a claim for compensation for the therapeutic hazard to the CRCI. The commission is responsible for examining your file and determining whether you are the victim of a therapeutic hazard or medical malpractice.
The CRCI will have 6 months to respond to you and will decide on:
- Liability of the practitioner or establishment
- The circumstances and causes of the damage as well as the nature and extent of the damage
- The possible compensation scheme
Examination of the file by the CRCI
During the examination of the file by the commission, the latter may:
- Rejected the file if it does not meet the conditions provided (no link with the medical act or insufficient severity threshold).
- Send the file to a medical expert who will study the file on documents or call you for a medical expertise.
Medical expertise: damage assessment
The CRCI will ask an expert doctor to carry out a free contradictory medical expertise (with all the parties present) in order to determine whether the conditions for access to compensation have been met. An assessment of the damage suffered and the origin of the damage will then be carried out.
Opinion of the CRCI
Once the medical expert has submitted his medical expert report, the ICC will issue its opinion.
Depending on the opinion of the commission, several scenarios may arise:
A medical malpractice is recognized
When a medical malpractice is established by the CRCI, it is up to the insurance of the health establishment or the practitioner to compensate you. The insurance will therefore have 4 months to send you a compensation proposal. If the insurance does not recognize the medical fault and refuses to compensate you, you can set up a legal procedure or seize the ONIAM which can replace the insurance. Your request will be sent by registered letter with A/R. Attach a copy of the refusal letter from the insurer.
The CRCI recognizes a serious therapeutic hazard
The therapeutic hazard is recognized by the CRCI and presents the necessary conditions for compensation by ONIAM. Your file is then sent to ONIAM, which will make you a compensation offer. Nevertheless, it may happen that ONIAM does not agree with the opinion of the CRCI and decides not to compensate you for damages related to the therapeutic hazard. You can then go to court to challenge this notice.
The therapeutic hazard is not “serious” enough in the eyes of the CRCI
If the CRCI considers that your damages are not significant enough to allow compensation by ONIAM, a conciliation can be carried out between the victim of the therapeutic hazard and the insurer.
Compensation offer
ONIAM draws up a compensation offer based on the damages retained by the CRCI. The deadline for drawing up the offer is 4 months. An offer of provisional compensation corresponding to temporary damage is made if the victim is not consolidated. If you are consolidated and ONIAM has all the necessary documents, it will send you a compensation offer.
You can accept this offer or discuss it.
Mattheva vous accompagne pour faire valoir vos droits lors d’un aléa thérapeutique ou d’une faute médicale au court de la procédure crci-oniam ou lors d’une procédure judiciaire.
