Petition for Benefits

There are two ways to complete a Petition for Benefits form, which must be filed by the child's legal parent or guardian by the child's fifth (5th) birthday:

  1. Fill out the form online
  2. Print a copy, complete it by hand, and mail it to:

    The Clerk of the Division
    Florida Division of Administrative Hearings
    1230 Apalachee Parkway
    Tallahassee, Florida 32399-3060

No Attorney Involved Forms

Call NICA at 1-800-398-2129 if you need assistance with filing the petition or obtaining medical records.

Don’t forget...

  • 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.
  • There is a $15 filing fee, payable to the Florida Division of Administrative Hearings, due upon filing of the petition for benefits.

Attorney Represented Forms

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.