Background: A medico-legal case (MLC) is characterized as one in which a medical condition or injury occurs, and the law enforcement authorities must conduct an investigation to determine who is responsible for what caused it. The goal of the current study is to determine the workload and profile of medico-legal cases and understand the various forms of MLC, the age and sex wise case distribution that was recorded at the casualty. Materials and methods: This two-year retrospective study is hospital-based and was carried out at the casualty unit of tertiary care hospital in Karaikal between June 2022 and May 2024. 319 medico-legal cases in all were registered throughout this time. Result: Among the 319 cases, 231 (72.41%) were male and 88 (27.59%) were female. The bulk of cases (N = 99; 31.03%) include victims who are between the ages of 21-30. In the present research, road traffic accidents (RTA) account for the bulk of cases (137 cases, or 52.35%). Out of the 119 occurrences, 37.3% happened between 12:01 and 6 p.m. most victims (n = 249: 78.06%) died in an accident, including motor vehicle accidents. Conclusion: MLC increased significantly in the years 2022–2023 and 2023–2024. Implementing road traffic laws strictly, abstaining from alcohol and drugs, wearing seat belts and helmets, refraining from using cell phones while driving and not speeding are all ways to lower the number of road traffic accidents. © 2025 Elsevier B.V., All rights reserved.