Medical Providers
NICA ensures that birth-injured children and adults receive the care they need while reducing the financial burden on medical providers and families.
Page at a Glance
Guidelines for Participating Providers
Participation in the NICA program provides eligible children with lifetime benefits for catastrophic claims resulting from certain birth-related neurological injuries, without involving the child’s family and physicians in the expense or ordeal of lengthy litigation. Claims are resolved in a timely manner without assessment of fault. In order to participate, a physician must:
- Be licensed to practice medicine in Florida
- Practice obstetrics or perform obstetrical services on a full- or part-time basis; and
- Have paid, or been exempted from paying, the required assessment when the incident occurred.
The NICA Plan is funded by annual assessments to participating physicians and hospitals. OB/GYN physicians and midwives are eligible to participate in the NICA Plan by paying the required $2,500 fee each calendar year. Participating medical providers can now pay online.
Florida law requires that participating physicians and hospitals that have participating physicians on staff give notice of NICA program participation to all obstetrical patients. NICA’s Peace of Mind Brochure satisfies the notice requirement of Florida law. The brochure is available free of charge from NICA in 13 different languages.
- ‘Peace of Mind’ Brochure in 13 Languages
- Brochure Request Form
- Welcome Brochure PDF
- Participating Physician Request for Information
- Fill out the Participating Physician Request for Information form if you are or are planning to become a participating physician to ensure proper delivery of the participating physician certificate.
Physicians and hospitals should rely upon their own legal counsel’s interpretation of Section 766.316, Florida Statutes, with regard to providing notice and timeliness of notice, and actions to take in the event a patient refuses to acknowledge receipt of this notice.
NICA is an innovative and effective alternative to costly malpractice litigation.
Notice brochures and acknowledgment forms are important tools in maintaining protection under the NICA program. In order to comply with statutory requirements, notice must be provided in a timely manner. NICA strongly recommends that all acknowledgment forms signed by the patient, the participating physician, and any hospital are kept on file as evidence of compliance.
Brochures for providing notice and examples of forms for documenting acknowledgment by patients, participating physicians, and hospitals are provided in this section of the NICA website.
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 776.316, Florida Statutes, with regard to providing notice and timeliness of notice, and actions to take in the event a patient refuses to acknowledge receipt of this notice.
Forms in other languages, including Spanish, Creole, and 9 other languages, are available by calling NICA. In the future, forms will be provided in additional languages on request in order to help NICA participants follow statutory requirements.
Additional forms to assist you with office procedures are available from the American College of Obstetricians and Gynecologists (ACOG) website.
- ‘Peace of Mind’ Brochure in 13 Languages / Brochure Request Form
- Physician & Hospital Acknowledgement Forms (English, Spanish)
- Notice Summary
The Freedom to Focus on Patient Care
Thank you for participating in the NICA Plan. We hope you never need the services to which you are entitled, but if you do, we can help resolve catastrophic claims for birth-related injuries without lengthy and costly malpractice litigation.
Awards made through the NICA Plan are exclusive. If an injury is covered by NICA, the child and his/her family are not entitled to compensation through lawsuits. The cost of lifetime care for birth-injured children is paid by NICA without assessment of fault.
By providing an alternative to malpractice lawsuits, NICA participation offers the freedom to focus on patient care.
NICA Plan Coverage
- Pay the annual NICA participation fee.
- Inform your patients of your participation in the NICA Plan by using the brochure provided by NICA, entitled “Peace of Mind” – and obtain their signed acknowledgment of this notice.
- In the event a patient should decline to sign an acknowledgment form, you or your office administrative staff should document the time, date, and the person who gave the brochure provided by NICA to the patient.
- Maintain files documenting the fact that you have given every patient timely notice of your participation in the NICA Plan.
Make The Most Of Your NICA Participation
Paying the annual NICA participation fee is the first step in obtaining NICA coverage. But it’s not the only requirement. Florida courts have ruled that physicians must give timely notice of their participation in the NICA Plan to their patients. This notice must be documented in your files.
Sample acknowledgment forms are available from NICA for your use in complying with these requirements.
These forms may be ordered from NICA or downloaded from the NICA website.
Acknowledgment forms should be signed by both the patient and the participating physician, or a member of the physician’s staff. Copies of all signed forms should be kept on file in the physician’s office to document that notice of NICA participation has been provided.
With the exception of certain emergencies, notice of NICA participation must be “timely.” While Florida Statutes provide no specific definition of this requirement, NICA recommends that notice be given as soon as reasonably possible.
In order to help physicians provide notice of NICA participation to patients whose native language is not English, NICA can provide brochures and acknowledgment forms in Spanish, Haitian, and other languages. These are also available on request from NICA, or they may be downloaded here.
FAQ
What benefits does NICA provide to eligible birth-injured children?
NICA pays for all medically necessary and reasonable expenses over the child’s lifetime. Examples of covered expenses may include medical care, co-pays, equipment, therapy, nursing care, medications, handicap modifications, transportation, and supplies that are medically necessary but not covered by another source, such as insurance.
How do participating providers benefit from NICA coverage?
NICA is a no-fault alternative to medical malpractice litigation for a very narrow set of catastrophic birth-related injury cases that have significant cost and system impact. NICA protects participating providers from tort action in cases where a claimant is eligible for and accepted into the NICA program. A child’s entry into NICA is a matter strictly of whether the child meets the statutory criteria, not an elective choice on the part of their parents or other parties.
Does participation in the Plan replace my malpractice insurance?
No, participation in the Plan covers only the specific neurological injuries described in the statute.
What does it cost to participate in NICA?
Participating physicians pay an annual assessment of $5,000, while certified nurse midwives, (under the supervision of a participating physician) pay an annual assessment of $2,500. Participating physicians and certified nurse midwives may receive a credit on their professional liability insurance. Resident physicians, assistant resident physicians, and interns who are in approved postgraduate training programs and under the supervision of a participating physician do not have to pay an annual assessment.
Is an accepted claim reported to the National Practitioner Database?
No, it is not reported to the National Practitioner Database. However, a copy of the petition is filed with the Florida Department of Health.
Is there any sort of insurance credit for participating in the Plan?
Yes. The Florida 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. Physicians who participate in the Plan are a different class than those who do not participate. 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. Talk with your insurance agent or company to assure that you receive the appropriate credit.
When does NICA coverage become effective?
Coverage becomes effective upon receipt of payment of the participating physician’s annual assessment.
If I do not participate for the entire year, is the assessment prorated?
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.
How many obstetricians participate in NICA?
Depending on the year, participation has ranged from about 50% to 85% of all practicing (delivering) obstetricians in Florida. The number of participating physicians has increased consistently over many years.
Who regulates the Florida Birth-Related Neurological Injury Compensation Program?
NICA is regulated by statute in a variety of ways, including:
- Section 766.301-316, Florida Statutes, includes specific requirements for the Plan’s operation, and a Plan of Operation is filed with and approved by the Florida Office of Insurance Regulation.
- All admissions into the program are authorized by the Florida 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 Florida Chief Financial Officer appoints all governing board members for the Program.
- Actuarial analyses are prepared quarterly and maintained by NICA.
- Management Audits and Actuarial Audits are performed by the Office of Insurance Regulation.
What qualifies a claim for coverage?
The first criteria is delivery by a participating provider at a hospital. Florida Statute 766.302 (2) defines a birth-related injury as follows:
“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 multiple gestations, 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 to live births only and shall not include disability or death caused by genetic or congenital abnormalities.