Q. What coverage does NICA provide?
A. As a participating provider, if a claim is accepted into the Plan no tort action is allowed. The entry of a child into the Plan is a matter strictly of whether the child meets the criteria, not an elective choice on the part of the parents or other parties. The first criteria for is delivery in a hospital by a participating physician. (See later question for the definition of a birth-related injury.)
Once the claim is accepted, the child is provided unlimited medical coverage for life. There is no cap on the benefits the child may receive.
Q. Does participation in the Plan replace my malpractice insurance?
A. No. Participation in the Plan only covers the specific neurological injuries described in the statute. NICA then pays medically necessary care for the child for life.
Q. What does it cost to participate in NICA?
A. The annual fee is set by state law at $5,000 per provider. However, remember a participating physician may also receive a credit on their malpractice insurance.
Q. Is an accepted claim reported to the National Practitioner Database?
A. No, it is not reported to the National Practitioner Database. However, a copy of the Petition is filed with the Department of Health.
Q. 5. Is there some sort of insurance credit for participating?
A. Yes. The 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. Participating and non-participating are different classes. 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. Please talk with your insurance agent or company to assure that you receive the credit.
Q. When does NICA coverage become effective?
A. Upon receipt of payment of the participating assessment.
Q. If I do not participate for the entire year, is the assessment prorated?
A. 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.
Q. How many obstetricians participate in NICA?
A. Depending on the year, the range has been from about 50 percent to 85 percent of all practicing (delivering) OBs in the State. The number of participating physicians has consistently increased over the past 5 years.
Q. Who regulates the Florida Birth-Related Neurological Injury Compensation Program?
A. NICA is regulated by statute in a variety of ways including:
- Section 766.301-316, Florida Statutes has specific requirements for operation of the Plan. A Plan of Operation is filed with and approved by the Office of Insurance Regulation.
- All admissions into the program are through the 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 Chief Financial Officer appoints all governing board members for the Program.
- Actuarial analysis are prepared quarterly and maintained by NICA.
Q. What qualifies a claim for coverage?
A. First, being delivered by a participating provider at a hospital.
The definition of a birth-related injury is:
(From �766.302(2), Florida Statutes)
“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 a multiple gestation, 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 t live births only and shall not include disability or death caused by genetic or congenital abnormality.
