About NICA
NICA gets birth-injured children and adults the care they need while reducing the financial burden on medical providers and families.
NICA is a statutory organization that manages state funds used to pay for the care of children and adults born with certain neurological injuries. NICA benefits are available to eligible children statewide on a no-fault basis. By eliminating costly civil court proceedings and providing professional management of disbursements, NICA ensures that birth-injured children and adults receive lifetime support and care while reducing the financial burden on medical providers and young families.
Upon admission to the NICA program, a newly accepted family receives an initial payment of $250,000. Along with this initial payment, NICA continues lifetime payments for all medically necessary and reasonable expenses for children born with substantial physical and mental neurological injuries, including whatever is needed to support their care and quality of life.
Numerous government analyses and academic studies have found that the NICA Plan is a successful, generous, and effective model for protecting and supporting eligible families while addressing Florida’s unique needs. Participating families generally report higher satisfaction rates for the care they receive than those who are eligible for NICA but instead choose to go to court.
Today, we are proud to manage one of the state’s most fiscally sound programs that humanely serves many families with prolonged, caring support.
History
Florida faced a medical malpractice crisis in the 1970s and 80s. During that time, obstetrics malpractice claims rose sharply and medical liability insurance skyrocketed.
Therefore, in 1986, the Legislature created a special task force to study the Florida medical malpractice crisis and address the OB-GYN impact on that crisis. The task force evaluated the rising insurance costs and reported that litigation costs and attorney's fees had increased between 1975 and 1986, but there was no particular change in substantive law to account for the change. Moreover, some physicians became reluctant to treat high-risk patients and practice certain high-risk specialties altogether. In 1985, OB-GYNs in Florida paid an average medical malpractice liability premium of $185,460, compared to a national average for OB-GYNs of $23,300.
In response, the Florida Legislature created the Florida Birth-Related Neurological Injury Compensation Association (NICA) in 1988 to promote and protect the health and best interests of children with birth‐related neurological injuries who have been accepted into the plan by striving to ensure that their medically necessary needs are being met. NICA is a no-fault alternative to medical malpractice lawsuits for the kind of injuries that carry the highest cost and system impact. The program shifts those costly cases out of the tort system, which helped to stabilize Florida’s medical malpractice insurance market and encouraged Florida’s obstetricians to continue delivering babies.
By eliminating costly legal proceedings, NICA ensures that birth-injured infants receive the care they need while reducing the financial burden on both medical providers and families.
Frequently Asked Questions
If your child meets ALL of the following criteria, then they may be eligible for the NICA program:
- Born in a hospital in the state of Florida
- Sustained a brain or spinal cord injury caused by oxygen deprivation or mechanical injury occurring in the course of labor, delivery, or resuscitation in the immediate post-delivery period
- Rendered permanently and substantially mentally and physically impaired
- Obstetrical services were provided by a physician who participates in the NICA program or a certified nurse midwife practicing under a participating physician’s supervision in the course of labor, delivery, or resuscitation in the immediate post-delivery period in a hospital
- A live infant weighing:
- at least 2,500 grams at birth for a single gestation
- at least 2,000 grams at birth for a multiple gestation
- Disability or death was not caused by genetic or congenital abnormality
Florida law defines the birth-related neurological injuries for which NICA coverage is provided, and an Administrative Law Judge makes the final determination on whether a child is covered. Full eligibility criteria is documented in Sections 766.301-766.316, Florida Statutes.
All petitions are filed with the state Division of Administrative Hearings. An Administrative Law Judge (ALJ) there has sole authority to determine whether a child qualifies for the Plan. The ALJ issues an order establishing whether the claim is compensable.
Generally, all doctors and hospitals are required by law to inform obstetrical patients whether they participate in NICA by providing a brochure that explains the program. Review the Participating Physicians list to see if your obstetrician participates in NICA. Please note that new participants are added throughout the year and some healthcare providers may not be listed. Contact NICA if you have any questions about participating physicians.
Consulting a lawyer is a personal decision, which we encourage you to make only after a thorough review of your individual circumstances. You are not required to have a lawyer in order to obtain a petition form to file for benefits. NICA will provide the form and help you fill it out and file it with the Division of Administrative Hearings. Contact NICA for further information.
Yes. When the Division of Administrative Hearings receives a petition, copies are mailed to NICA, to the Florida Agency for Health Care Administration’s Consumer Services Unit, to the Florida Department of Financial Services, to the hospital where the child was born, and to the physician who is named in the petition.
Along with an initial payment of $250,000, NICA pays for all medically necessary and reasonable expenses over the child’s lifetime. Examples of covered expenses may include medical care, co-pays, equipment, therapy, nursing care, medications, handicap modifications, transportation, and supplies that are medically necessary but not covered by another source, such as insurance.
NICA aims to treat every family in the program fairly and individually, providing each child with the personalized benefits they are entitled to based on their specific medical needs. What is medically necessary for one child may not be the same for another, so a one-size-fits-all approach does not work for NICA. We strongly urge every family to familiarize themselves with the Benefits Handbook so they fully understand what they are entitled to through the program.
Yes. Visit the Petition for Benefits page, then choose the form that fits your situation. You can either (A) fill out the form online or (B) print a copy, complete it by hand, and mail it to the address on the form. Call NICA at 1-800-398-2129 if you need assistance with filing the petition.
There is a $15 filing fee, payable to the Florida Division of Administrative Hearings.
Yes. The petition must be filed by the child's fifth (5th) birthday.
The petition must be filed by child's parent or legal guardian.
Yes. All available relevant medical records must be provided by the petitioner at the time the petition is filed. Medical records must be filed with NICA, and it is the parents’ responsibility to provide them. You may obtain these records from the hospital where the child was born and from your physicians. Records for both the mother and the child must be sent to NICA. When preparing records for submission, it is very important that the fetal monitor strips are included in the medical records. If you need assistance in obtaining medical records, contact NICA at 1-800-398-2129.
Send your completed Petition for Benefits Form to:
The Clerk of the Division
Florida Division of Administrative Hearings
1230 Apalachee Parkway
Tallahassee, Florida 32399-3060
Remember, a $15 filing fee, payable to the Florida Division of Administrative Hearings, is due with the petition. Please remember to send copies of medical records for both the mother and child to NICA. For assistance completing a petition, contact NICA at the toll-free number 1-800-398-2129.
Please see our Helpful Resources page for sources of information and assistance to help with your child’s needs.
NICA pays for all medically necessary and reasonable expenses over the child’s lifetime. Examples of covered expenses may include medical care, co-pays, equipment, therapy, nursing care, medications, handicap modifications, transportation, and supplies that are medically necessary but not covered by another source, such as insurance.
NICA is a no-fault alternative to medical malpractice litigation for a very narrow set of catastrophic birth-related injury cases that have significant cost and system impact. NICA protects participating providers from tort action in cases where a claimant is eligible for and accepted into the NICA program. A child’s entry into NICA is a matter strictly of whether the child meets the statutory criteria, not an elective choice on the part of their parents or other parties.
No, participation in the Plan covers only the specific neurological injuries described in the statute.
Participating physicians pay an annual assessment of $5,000, while certified nurse midwives, (under the supervision of a participating physician) pay an annual assessment of $2,500. Participating physicians and certified nurse midwives may receive a credit on their professional liability insurance. Resident physicians, assistant resident physicians, and interns who are in approved postgraduate training programs and under the supervision of a participating physician do not have to pay an annual assessment.
No, it is not reported to the National Practitioner Database. However, a copy of the petition is filed with the Florida Department of Health.
Yes. The Florida Office of Insurance Regulation requires every insurer to justify in its rate filings why it would charge the same rate to different classes of doctors. Physicians who participate in the Plan are a different class than those who do not participate. As a result, most insurers offer a credit on insurance to participating providers. The amount of the credit varies depending on the insurance company. In some cases, it may be less than the participating physician fee, but in other cases it may be equal to or more than the fee. Talk with your insurance agent or company to assure that you receive the appropriate credit.
Coverage becomes effective upon receipt of payment of the participating physician’s annual assessment.
No, the assessment is not refundable and is fully applied whenever received to initiate coverage. However, as long as the assessment is received by January 31, coverage is applied from January 1.
Depending on the year, participation has ranged from about 50% to 85% of all practicing (delivering) obstetricians in Florida. The number of participating physicians has increased consistently over many years.
NICA is regulated by statute in a variety of ways, including:
- Section 766.301-316, Florida Statutes, includes specific requirements for the Plan’s operation, and a Plan of Operation is filed with and approved by the Florida Office of Insurance Regulation.
- All admissions into the program are authorized by the Florida Division of Administrative Hearings. The Plan itself does not admit claimants.
- NICA files an annual financial report with the Florida Auditor General and the Legislature, and it is a component unit of the State of Florida’s Comprehensive Annual Financial Report.
- The Florida Chief Financial Officer appoints all governing board members for the Program.
- Actuarial analyses are prepared quarterly and maintained by NICA.
- Management Audits and Actuarial Audits are performed by the Office of Insurance Regulation.
The first criteria is delivery by a participating provider at a hospital. Florida Statute 766.302 (2) defines a birth-related injury as follows::
“Birth-related neurological injury” means injury to the brain or spinal cord of a live infant weighing at least 2,500 grams for a single gestation or, in the case of multiple gestations, a live infant weighing at least 2,000 grams at birth caused by oxygen deprivation or mechanical injury occurring in the course of labor, delivery or resuscitation in the immediate postdelivery period in a hospital, which renders the infant permanently and substantially mentally and physically impaired. This definition shall apply to live births only and shall not include disability or death caused by genetic or congenital abnormalities.