You went into a French hospital or clinic for a routine operation and came out worse than you went in: an infection that will not clear, a nerve damaged during surgery, a diagnosis missed for months while the illness spread. As a British resident or long-stay visitor in France after Brexit, you face the same French medical-accident system as everyone else, but in a second language and without the reflexes French patients learn from family experience. France has something England does not: a free, fast, lawyer-free first track for victims of medical accidents, run by regional commissions called the CCI (commissions de conciliation et d’indemnisation, the conciliation and compensation commissions), backed by a national payer called ONIAM (Office national d’indemnisation des accidents médicaux, the national office for medical-accident compensation). This guide explains, with the exact statutory texts and two recent Court of Cassation rulings, how to get your full medical file within days, how to file the free CCI claim, who pays in cases of fault, hospital-acquired infection or sheer therapeutic bad luck, and — the part that matters most — how to challenge a refusal, a silent insurer or an offer that undervalues your injury.
I. Getting the File and Getting the Case Heard: Your Records, the Free CCI Claim and the Independent Expert Examination
A. Your Medical Records in Eight Days and the Consent Trail: What to Ask For, What the Hospital Must Hand Over, and How to Challenge a Refusal
Everything starts with paper. Before any commission, any expert or any court can judge what happened to you, you need your dossier médical (medical file): the operation report, the anaesthesia record, the nursing charts, the prescriptions, the test results and the correspondence between the practitioners who treated you. French law gives every patient a direct right of access to the whole of this file, and it sets hard deadlines that hospitals regularly miss. Article L.1111-7 of the Public Health Code provides that you may obtain communication of the file, directly or through a doctor you appoint, “au plus tard dans les huit jours suivant sa demande” — no later than eight days after your request — once a forty-eight-hour cooling-off period has passed. Where the records are more than five years old, the same article states: “Ce délai est porté à deux mois lorsque les informations médicales datent de plus de cinq ans” — the deadline is extended to two months. For a British patient, the practical lesson is simple: send the request immediately, in writing, by lettre recommandée avec accusé de réception (registered letter with recorded delivery) to the hospital director or the clinic manager, keep the receipt, and diary the eight-day deadline from the day after receipt. Ask expressly for “l’ensemble des informations concernant ma santé”, the complete file, including the operation report (compte rendu opératoire), the anaesthesia sheet, the monitoring charts (feuilles de surveillance) and all correspondence between practitioners, because those are the documents the statute lists and the ones experts read first.
If the hospital stalls, sends an incomplete file or claims the documents are unavailable, do not accept the refusal at face value. Write again, cite the eight-day rule, and ask for the name of the person handling your request and the reason for the delay in writing. A refusal or an incomplete disclosure is itself evidence: the independent expert and later the court will note that you were denied the documents the law requires the establishment to give you. Where records have genuinely disappeared, French courts draw the consequences against the establishment that was under a duty to keep them, because the whole medical-accident system assumes the file exists and punishes those who lose it. Keep copies of everything you send and receive, in both directions, and keep a dated diary of phone calls with the names of the people you spoke to. For a British claimant whose French is hesitant, bring a bilingual friend or instruct counsel at this stage for correspondence only: the file you obtain now determines the value of everything that follows, and a file requested precisely and early is worth months of argument later.
The second document trail to secure is the consent trail. French law requires the doctor to inform you before treatment of what is proposed, why it is useful, how urgent it is, what it involves, the frequent or normally foreseeable serious risks, the alternatives and what refusal would mean. Article L.1111-2 of the Public Health Code states this information duty in those exact terms, and a failure to inform is a fault in its own right, separate from any technical error during the operation. In practice, ask the establishment for a copy of the signed consent form (consentement éclairé, informed consent), the pre-operative information sheet and any anaesthesia consultation record. If nobody warned you of the very complication that has now materialised, that missing warning founds its own head of claim, even where the surgery itself was performed correctly. Note carefully what you were told, by whom and when, while the memory is fresh: write it down now, with dates, because two years later your note will carry more weight than your recollection.
Finally, record the damage itself as a lawyer would: photographs of wounds and scars with dates, every prescription, every sick-leave certificate (arrêt de travail), every receipt for care, travel, home help and adaptations, and a short weekly note on pain, sleep, mobility and work capacity. The French compensation system pays by heads of loss (chefs de préjudice), each proved separately, so the claimant who arrives with an organised bundle is valued precisely while the claimant who arrives with a story is valued approximately. If the injury may be linked to a device or medicine rather than to a gesture — a defective hip prosthesis, a contaminated blood product — keep the implant card, the batch numbers and the pharmacy receipts untouched, because a different liable party, the producer, may join the case. These first weeks of paperwork decide whether your case is a file or a fog.
B. Taking the Case to the Free CCI Claim: the Severity Threshold, the Six-Month Opinion and the Independent Expert Examination
Once you hold, or have formally requested, your file, the natural forum for a British victim of a medical accident in France is the CCI of the region where the care was given. Article L.1142-5 of the Public Health Code tasks these commissions in each region with facilitating the amicable settlement of disputes about medical accidents, treatment-caused illnesses (affections iatrogènes) and hospital-acquired infections (infections nosocomiales), sitting either as a settlement body or as a conciliator depending on severity. The procedure is free, it requires no lawyer, the forms exist in plain language, and the official English-language guidance on service-public.fr walks foreign residents through it step by step. You file by post with a standard claim form, a medical certificate describing precisely the nature and gravity of the harm, your records or proof you requested them, and every document showing the scale of the loss. Name every practitioner and establishment involved, give exact dates, and state clearly what you allege: a technical fault, a missing warning, an infection caught in the clinic, or an outcome nobody could have avoided. Precision at filing shapes the expert mission that follows, so describe the facts in dated order and attach the diary and photographs you built in the first weeks.
The commission first checks a gateway called the gravity threshold (seuil de gravité). Where the harm exceeds the threshold, the case follows the settlement track with a full expert examination and a reasoned opinion on liability and compensation; where it falls below, the commission steers you to conciliation between you and the practitioner. The English version of the official guidance explains the line plainly: a permanent physical or psychological impairment rate above 24% opens the settlement track, while lesser harm goes to conciliation. Do not self-censor your filing because you assume your injury is too small: the rate is measured by the expert on a specific statutory scale, victims routinely underestimate it, and conciliation itself produces enforceable outcomes. Even death, prolonged temporary incapacity for work and serious disruption of private and professional life can cross the threshold without any permanent impairment figure at all, so file and let the commission qualify the case. The threshold decides the track, never your right to be heard.
The heart of the procedure is the expertise, the independent medical assessment. The commission appoints an expert from outside the establishment, all parties are summoned, and you attend — with your own medical adviser if you can arrange one — while the expert examines you, questions the practitioners and reviews the file. The official ONIAM guidance confirms this examination is free and fully adversarial, meaning every party is heard and can comment. Prepare for it as the decisive day it is: bring your dated diary, your photographs, your prescriptions and your list of what you can no longer do, and tell the expert in plain terms how the injury changed an ordinary week — the stairs you cannot climb, the shifts you cannot work, the grandchildren you cannot lift. If the expert report seems to miss a document or misunderstand a fact, say so in writing immediately: the official guidance confirms you may seek a friendly counter-assessment or an additional assessment, and before the courts you may demand a court-ordered assessment with the assistance of your lawyer. An expert opinion is influential, never untouchable, and the victim who answers it precisely and quickly protects the value of the whole case.
Within six months of receiving your complete file, the commission issues its reasoned opinion (avis) on the circumstances, causes, nature and extent of the harm and on which compensation track applies. Article L.1142-8 of the Public Health Code states: “L’avis de la commission régionale est émis dans un délai de six mois à compter de sa saisine” — the regional commission opinion is issued within six months of referral. The same article adds a sentence British victims should read twice: “Cet avis ne peut être contesté qu’à l’occasion de l’action en indemnisation introduite devant la juridiction compétente par la victime” — the opinion can only be challenged in the compensation action the victim brings before the competent court. In plain terms, you cannot appeal the opinion itself, but nothing in it binds the court that will finally value your loss, and an unfavourable opinion is the starting point of the court case, not the end of the road. Calendar the six months from the commission acknowledgement of your complete file, chase politely if it slips, and use the waiting time to complete your loss bundle rather than waiting passively for the post.
II. Who Pays and How to Fight Back: Fault, Hospital-Acquired Infections, the ONIAM Offer and the Courts
A. Fault, Hospital-Acquired Infections and No-Fault Cases: Who Pays Under the Statute and What the Court of Cassation Decided in January 2026
The commission opinion answers one question before all others: on which legal basis should you be paid. French medical-accident law runs on three tracks, and knowing yours changes whom you sue and what you must prove. The first track is fault (faute): a doctor or establishment answers for the harmful consequences of prevention, diagnosis or care only where fault is proved. Article L.1142-1 of the Public Health Code states: “les professionnels de santé mentionnés à la quatrième partie du présent code, ainsi que tout établissement, service ou organisme dans lesquels sont réalisés des actes individuels de prévention, de diagnostic ou de soins ne sont responsables des conséquences dommageables d’actes de prévention, de diagnostic ou de soins qu’en cas de faute” — health practitioners and care establishments are liable for the harmful consequences of acts of prevention, diagnosis or care only in case of fault. A faulty gesture, a delayed diagnosis, a missing warning about a foreseeable serious risk: the expert report identifies them, the commission names them, and the practitioner or the establishment insurer pays. Against a private clinic or a self-employed surgeon, the action lies before the civil courts on the general fault principle of Article 1240 of the Civil Code: “Tout fait quelconque de l’homme, qui cause à autrui un dommage, oblige celui par la faute duquel il est arrivé à le réparer” — any act whatever of man which causes damage to another obliges him by whose fault it occurred to repair it. Against a public hospital, the same fault logic runs before the administrative courts, because the statute expressly contemplates civil or administrative liability — and every practitioner and establishment in the system must by law carry liability insurance for exactly this risk under Article L.1142-2 of the Public Health Code. Your practical task on the fault track is therefore to make the fault visible: the file, the consent trail and the expert mission you helped shape at the CCI stage.
The second track is the hospital-acquired infection, and it is the most claimant-friendly corner of French medical law. Where the harm comes from an infection nosocomiale — an infection caught during or just after care, neither present nor incubating when care began — the establishment is strictly liable, and only proof of an outside cause (cause étrangère) releases it. The same Article L.1142-1 provides: “Les établissements, services et organismes susmentionnés sont responsables des dommages résultant d’infections nosocomiales, sauf s’ils rapportent la preuve d’une cause étrangère” — those establishments are liable for harm resulting from hospital-acquired infections unless they prove an outside cause. In January 2026 the Court of Cassation gave this rule its sharpest recent expression in a knee-prosthesis case with direct echoes for any operated British patient. The patient had developed a golden staphylococcus infection days after the implant, the appeal court had blamed him for failing to prove the link with the clinic, and the First Civil Chamber quashed that reasoning. Court of Cassation, First Civil Chamber, 7 January 2026, No 24-20.829 holds, word for word: “Doit être regardée, au sens de ces dispositions, comme présentant un caractère nosocomial une infection qui survient au cours ou au décours de la prise en charge d’un patient et qui n’était ni présente, ni en incubation au début de celle-ci, sauf s’il est établi qu’elle a une autre origine que la prise en charge” — an infection occurring during or after the care of a patient, neither present nor incubating at its start, is deemed hospital-acquired unless another origin is established. The ruling continues: “c’est à l’établissement de santé qu’il incombe d’apporter la preuve que la contamination ne s’est pas produite lors des soins qu’il a prodigués au patient et procède ainsi d’une cause étrangère” — it is for the health establishment to prove the contamination did not occur during its care and comes from an outside cause. For a British claimant, the message is concrete: if your infection appeared during or shortly after French hospital care and was not incubating before, the burden is on the clinic to exonerate itself, not on you to incriminate it — and a court that asks you to prove the unprovable will be quashed.
The third track covers the cases nobody caused: the therapeutic accident (aléa thérapeutique), the treatment-caused illness and the serious hospital-acquired infection where no fault is established. Here the French Republic itself pays, through national solidarity (solidarité nationale) via ONIAM, provided the harm is directly attributable to the care, abnormal in light of your prior condition and foreseeable course, and grave under the statutory scale. For hospital-acquired infections specifically, Article L.1142-1-1 of the Public Health Code opens national-solidarity compensation for “Les dommages résultant d’infections nosocomiales dans les établissements, services ou organismes mentionnés au premier alinéa du I de l’article L. 1142-1 correspondant à un taux d’atteinte permanente à l’intégrité physique ou psychique supérieur à 25 %” — harm from hospital-acquired infections corresponding to a permanent impairment rate above 25%, plus deaths caused by such infections. Note the boundary the Court of Cassation polices strictly: ONIAM pays only where nobody’s liability is engaged. Court of Cassation, First Civil Chamber, 15 June 2022, No 21-16.022 states: “l’ONIAM n’est chargé d’indemniser les victimes d’accidents médicaux résultant d’actes individuels de prévention, de diagnostic ou de soins que lorsque la responsabilité d’un professionnel de santé, d’un établissement, service ou organisme de santé ou d’un producteur de produits n’est pas engagée” — ONIAM compensates victims of medical accidents only where the liability of a practitioner, establishment or producer is not engaged. In practice the commission opinion routes you: fault or strict hospital liability points to the insurer, neither points to ONIAM, and if the commission sends you down the wrong track, the court re-routes you — but only if you challenge in time, which is the subject of the final section.
B. The ONIAM or Insurer Offer, the Four-Month Clock and How to Challenge a Refusal or a Low Figure
A favourable commission opinion converts into money through a formal offer (offre d’indemnisation) that must repair the whole of each head of loss. Where the commission finds the harm compensable under national solidarity, Article L.1142-17 of the Public Health Code requires ONIAM to send the victim or dependants “dans un délai de quatre mois suivant la réception de l’avis, une offre d’indemnisation visant à la réparation intégrale des préjudices subis” — within four months of receiving the opinion, an offer aimed at full reparation of the harm suffered. The offer must value each head of loss separately, deduct only the listed social benefits and other indemnities received for the same harm, and state the figures openly. Where liability lies with a practitioner, the mirror mechanism applies: the commission opinion goes to the insurer, which must make its own offer, and the Court of Cassation in the June 2022 ruling recalls that where the commission finds liability engaged, the guaranteeing insurer makes an offer whose acceptance counts as a binding settlement. The official ONIAM guidance confirms the tempo for the whole system: four months to make the offer once the opinion arrives, one month to pay once you accept, and a fresh two-month round for the definitive offer after your condition stabilises (consolidation) if the first offer was provisional. Diary every one of these deadlines from the written dates on the documents, and chase in registered letters the day each expires, because delay by the payer is the most common and most curable failure in the system.
Accepting an ONIAM offer ends the dispute by settlement (transaction), so never accept a figure you have not had independently checked. The statute is explicit: Article L.1142-17 provides that acceptance of the office offer “vaut transaction” — counts as a settlement within the meaning of Article 2044 of the Civil Code. A settlement closes the file, including heads of loss you forgot to claim, so before signing, have every line of the offer tested against your bundle: the temporary functional deficit, the permanent impairment rate, the pain and suffering (souffrances endurées), the aesthetic harm, the loss of enjoyment (préjudice d’agrément), the professional and household losses, and the future care costs. The most frequent under-valuations concern the future: assistance by a third person, adaptations to home and car, and loss of promotion chances are routinely omitted or cut, and they are precisely the items an independent medical-legal adviser prices correctly. If the offer is low, refuse it in writing with reasons, point by point, and either negotiate or go to court: refusal never forfeits your rights, it simply moves the valuation from the office to the judge.
Where the insurer stays silent for four months, refuses to offer, or the practitioner turns out uninsured, the statute provides a substitute payer rather than a dead end. The official English-language guidance states plainly that if the insurer has made no offer within four months — refusal or silence — or the practitioner is uninsured, the victim or dependants may apply to ONIAM by registered letter with acknowledgement of receipt, and ONIAM steps into the insurer shoes to make the offer and pay within the same time limits. Use this substitution deliberately: send the registered application the week the four months expire, attach the commission opinion and proof of the insurer silence, and keep ONIAM to the same four-month clock. Symmetrically, where the commission itself declines your case or routes it to conciliation when the gravity plainly warranted settlement, challenge by filing before the competent court within the limitation period rather than arguing with the commission, whose opinion, as seen, can only be contested in that court action. The court hears the expert evidence afresh, appoints its own expert where needed, and values the loss without being bound by the commission figures — which is why the file, the diary and the photographs you built in part one matter more than any single opinion.
That limitation period is the one deadline you must never miss. Article L.1142-28 of the Public Health Code provides that actions against practitioners and public or private establishments, and compensation claims before ONIAM, “se prescrivent par dix ans à compter de la consolidation du dommage” — are time-barred ten years after stabilisation of the harm. Ten years from stabilisation, not from the operation: where the injury evolves, the clock runs from when the condition stopped evolving, and each fresh aggravation can reopen the analysis. But do not read generosity as an invitation to wait. Memories fade, clinics merge, insurers change, and the expert assessment is sharper on a recent injury than on a five-year-old one. File the CCI claim while the facts are fresh, keep the procedure moving with registered letters, and if the outcome disappoints, see a lawyer early about the court action — because the system rewards the organised victim at every stage and quietly buries the passive one. If your dispute is about the hospital bill rather than the care itself, the emergency-cover rules for British visitors are a different matter, explained in our guide to hospital bills and GHIC refunds; where the care itself harmed you, this medical-accident track is your remedy.
Conclusion
A medical accident in a French hospital need not leave a British patient powerless, provided the case is built in the right order. Secure the full file within the eight-day rule and the consent trail while memories are fresh; file the free CCI claim with a dated, photographed, receipted bundle; attend the independent expert examination as the decisive day it is; then follow the money along the track the law assigns — the insurer where fault or a hospital-acquired infection is found, ONIAM under national solidarity where no liability is engaged — and challenge every refusal, silence or low offer in writing and in time. The ten-year clock from stabilisation protects you, but speed protects you better. Keep every deadline in registered letters, never sign a settlement you have not had checked line by line, and remember that the commission opinion advises while only the court decides. Treated this way, the French system that first looks like a maze turns out to be a machine: records, commission, expert, opinion, offer, and, where needed, the judge — each step feeding the next, each document earning its place in the final figure.
Need a quick opinion on your case.
If a French hospital stay, operation or diagnosis has left you or a relative harmed, send us the dates, the establishment and the commission or insurer letters you have received. A lawyer of the firm will review your file and call you back with a telephone consultation within 48 hours to tell you which track — fault, hospital-acquired infection or national solidarity — fits your case and what to do next. Call +33 6 46 60 58 22 or write via our contact page, and keep your medical file, your diary and your receipts ready for the call.