Formulaire

Claim for compensation from the Conciliation and Compensation Commission for Medical Accidents, Iatrogenic Diseases and Nosocomial Infections (CCI)

  • Public concernéAny person victim or close to a victim of a medical accident, of a iatrogenic disorder or a nosocomial infection
  • CoûtService free
  • Nombre d’étapes3 steps
  • ConnexionHave a email address
  • LangueLanguage French

Fill out the form

To whom shall I send this form ?

Comment faire ?

  1. Fill the form
  2. Provide supporting documents
  3. Address the file by registered letter with acknowledgement of receipt to the conciliation and compensation commission corresponding to the place of performance of the medical act in question (or deposit it at the secretariat of the commission against receipt)

The documents to be provided differ depending on the situation:

Répondez aux questions successives et les réponses s’afficheront automatiquement

General case

You're not the direct victim

  • Any document establishing your relationship with the victim and allowing you to assess your harm

You are entitled to a deceased victim

Entitled

Entitled

  • A death certificate for the victim
  • Any document proving your links with the deceased person (examples: deed of notoriety, family booklet, birth certificate)

You are a legal representative

  • Any document proving your status as a legal representative (examples: family booklet, guardianship judgment)

FYI  

Whenever possible, only address to the ICC copies of your documents and keep your originals.

Ce formulaire concerne :

J'ai réalisé une démarche administrative

Je donne mon avis sur Services Publics +. L'administration concernée me répondra.

Je donne mon avis

Verified 13 March 2026 - Public Service / Directorate of Legal and Administrative Information (Prime Minister)