French Public Health Code
In forceWhen the Regional Commission for Conciliation and Compensation of Medical Accidents, Iatrogenic Conditions and Nosocomial Infections considers that a healthcare professional, a healthcare institution, a healthcare service or a body mentioned in article L. 1142-1 or a producer of a healthcare product mentioned in article L. 1142-2, the insurer who guarantees the civil or administrative liability of the person considered liable by the Commission shall, within four months of receipt of the notice, make an offer of compensation to the victim or his/her beneficiaries for full reparation of the harm suffered, within the limits of the cover provided by the insurance contracts.
This offer will indicate the assessment made, where appropriate on a provisional basis, for each head of loss, as well as the amount of compensation due to the victim or his or her heirs, after deduction of the benefits listed inarticle 29 of law no. 85-677 of 5 July 1985 aimed at improving the situation of victims of road traffic accidents and speeding up compensation procedures, and more generally of compensation of any kind received or to be received from other debtors for the same loss. Benefits and compensation deducted from the amount of the offer are reimbursed directly by the insurer of the party responsible for the damage to the debtors concerned.
Where the offer provides for the payment of an annuity to the victim, this annuity is revalued under the conditions set out inarticle L. 351-11 of the Social Security Code.
The offer is provisional if the insurer has not been informed of the consolidation of the victim's condition. The final offer must be made within two months of the date on which the insurer was informed of this consolidation.
The insurer who makes an offer to the victim is required to reimburse the Office for the expert assessment costs it has incurred.
Acceptance of the insurer's offer constitutes a settlement within the meaning ofarticle 2044 of the Civil Code.
Payment must be made within one month of the insurer receiving the victim's acceptance of its offer, whether the offer is provisional or final. If the victim does not accept the insurer's offer, interest at double the legal rate is automatically payable on any unpaid sums from the expiry of this period until the date of actual payment or, where applicable, the date of the final judgment.
If the insurer who has reached a settlement with the victim considers that the person it insures is not liable for the loss or damage, it has a right of subrogation either against the liable third party or against the National Compensation Office if the provisions of II of article L. 1142-1 are applicable.
If the competent court, seised by the victim who refuses the insurer's offer, considers that the offer was manifestly inadequate, it shall order the insurer to pay to the Office a sum not exceeding 15% of the compensation it awards, without prejudice to any damages owed to the victim as a result.
In the event that the maximum limits of cover under the insurance contracts of the person deemed liable by the Commission are reached, the insurer shall immediately notify this person, the Office instituted by article L. 1142-22 of this Code and, if the person deemed liable is a self-employed healthcare professional, the fund instituted byarticle L. 426-1 of the Insurance Code.
For the application of this article, the State, in respect of the prevention, diagnosis or care activities it carries out, is subject to the obligations incumbent on the insurer.
