The notice brochure and acknowledgment forms are important tools in maintaining protection under the NICA Plan. In order to comply with statutory requirements, notice must be provided in a timely manner. It is also strongly recommended that all acknowledgment forms signed by the patient, the participating physician, and any hospital staff member be kept on file as evidence of compliance.
The brochure for providing notice and examples of forms for documenting acknowledgment by patients can be obtained by
contacting NICA. NICA suggests that each participating physician and hospital develop a system to document the date on which a patient is given notice of the physician's participation in the NICA Plan.
Physicians and hospitals should rely upon their own legal counsel's interpretation of
Section 766.316, Florida Statutes, with regard to the provision and timeliness of notice, and actions to take in the event a patient refuses to acknowledge receipt of this notice.
Please check with your counsel before settling a claim. If a hospital or doctor settles a potential claim, NICA may be precluded from paying benefits.
Downloadable Notice Summary
Downloadable Acknowledgment FormDownloadable Acknowledgment Form (Spanish)
Downloadable Brochure Request Form
Brochures
Forms are in 'PDF' format. If you do not have Adobe Acrobat Reader, click
here to get it.
