Regulatory thresholds and their impact on medico-legal disability assessment: a comparative analysis of French and Turkish traffic injury systems

Abstract Background Compensation for road traffic injuries is not determined solely by clinical severity but is profoundly shaped by the regulatory frameworks governing medico-legal disability recognition. The French system, operationalized through the Badinter Law, Dintilhac nomenclature, and barème-based assessment, recognizes low-grade permanent functional impairment (Déficit Fonctionnel Permanent, DFP) and pain-related harm (Souffrances Endurées, SE) as independently compensable categories. By contrast, the Turkish traffic insurance framework requires objectively demonstrable and permanent anatomical or functional loss as a precondition for compensation. To quantify the impact of these regulatory differences, a retrospective, simulation-based comparative analysis was conducted on 46 road traffic accident cases evaluated at a French forensic medicine unit between 2020 and 2024. Turkish compensation outcomes were simulated by re-evaluating identical clinical data according to national disability regulations. Results Under the French system, 25 cases (54.3%) received permanent functional impairment ratings (mean DFP 3.4%, SD ± 1.8). Under simulated Turkish criteria, only 14 cases (30.4%) qualified for permanent disability compensation (mean 1.8%, SD ± 1.2). McNemar’s test confirmed statistically significant asymmetry in paired compensability (χ²(1) = 11.00, p = 0.0009); Cohen’s κ = 0.537 (95% CI: 0.299–0.776) indicated moderate inter-system agreement. These estimates should be interpreted within the limitations of a relatively small sample size. Soft tissue and whiplash-associated injuries received compensation universally under French practice but were systematically excluded under Turkish criteria (rejection rate = 100%). A Compensation Gap—defined as cases receiving positive compensation in France but assigned zero compensation under Turkish criteria—was observed in 11 cases (23.9%) based on DFP criteria alone (narrow definition), and in 21 cases (45.7%) when cases compensated exclusively via SE in France, for which no equivalent pain compensation pathway exists under Turkish law, were additionally included (broad definition). Conclusions Traffic injury compensation outcomes are strongly influenced by regulatory eligibility thresholds rather than clinical severity alone. The Turkish framework operates as a high-threshold anatomical exclusion model that restricts access to compensation for low-grade and non-anatomical injuries, whereas the French barème-based system enables recognition of functional impact and pain-related harm. These structural differences have direct implications for cross-jurisdictional forensic assessment and insurance medicine practice.