• Saundra Smyrski

The Florida Birth-Related Neurological Injury Compensation Association (NICA)

Updated: Aug 8




What is NICA?


NICA (Neurological Injury Compensation Association) 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. NICA (2021) proposes, "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."


According to NICA (2021), "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."


History of NICA


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. (NICA, 2021)


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. (NICA, 2021)


NICA Eligibility Criteria:

  • 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

Eligibility Determination:


A potentially eligible family files a petition through the Division of Administrative Hearings. Medical records are reviewed by NICA nurses and two outside medical experts, and if they declare that the case meets all criteria for coverage as defined by Sections 766.301-766.316, Florida Statutes, then an administrative law judge will review the claim.


Examples of covered expenses may include:

  • Medical care

  • Co-pays

  • Equipment

  • Therapy

  • Nursing care

  • Medications

  • Handicap modifications

  • Transportation

Supplies that are medically necessary but not covered by another source, such as insurance.


Expenses not covered by NICA- Expenses or reimbursement for items or services received or entitled to be received:

  • From another state or Federal program

  • From any prepaid health plan or health maintenance organization

  • From any insurance policy or private insurance program

  • (Premiums, co-pays, and deductibles are covered)


Contact:


Florida Birth-Related Neurological Injury Compensation Association (NICA) Post Office Box 14567 Tallahassee, FL 32317-4567

Telephone: 850-488-8191 Toll-free support: 1-800-398-2129 Email: info@nica.com


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