Filing a Claim
Who is eligible?
Known as NICA, the Florida Birth-Related Neurological Injury Compensation Plan provides a wide range of benefits to a child who has sustained a brain or spinal cord injury caused by oxygen deprivation or mechanical injury during labor, delivery, or in the immediate post-delivery period. See: Section 766.302(2), Florida Statutes.
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
See the Participating Physicians list to see if your obstetrician participates in the NICA program. Please note that new participants are added throughout the year and some healthcare providers may not be listed. The date of the child’s birth is key to determining which year to check for physician participation. Contact NICA if you have any questions about participating physicians.
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.
Covered by NICA
NICA pays for all medically necessary and reasonable expenses throughout each child’s lifetime, but what is medically necessary for one child may not be the same for another. NICA aims to treat every family in the program fairly and equitably, providing the benefits they are entitled to based on their specific individual needs.
Examples of covered expenses may include:
- Medical care
- Nursing care
- Handicap modifications
Supplies that are medically necessary but not covered by another source, such as insurance.
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)
For more details, see the Benefits Handbook.