Opinion ID: 1945193
Heading Depth: 3
Heading Rank: 1

Heading: The Purpose and Structure of NICA

Text: NICA was enacted in 1988 to address the adverse impact that the high cost of medical malpractice insurance premiums was having on the delivery of obstetric services in Florida. See § 766.301, Fla. Stat. (Supp.1998). In NICA, the Legislature established the NICA Plan, § 766.302(8), Fla. Stat. (1997), for the purpose of providing compensation, irrespective of fault, for birth-related neurological injury claims. § 766.303(1), Fla. Stat. (1997). The NICA Plan is administered by the Association. [9] When an infant suffers what may be a birth-related neurological injury, [10] NICA provides that the claimant (usually the infant's parent) [11] must file a claim for compensation under the NICA Plan with the Association. § 766.305, Fla. Stat. (Supp. 1998). [12] The claim is then reviewed by a medical advisory panel. The panel makes a written recommendation as to whether the claim is compensable under the NICA Plan. § 766.308, Fla. Stat. (Supp.1998). After the panel makes its recommendation, the claim is then heard and determined in an administrative hearing before an ALJ. § 766.307, Fla. Stat. (1997). [13] The ALJ must consider, but is not bound by, the recommendation of the medical advisory panel. § 766.308(1), Fla. Stat. (Supp.1998). Under the 1998 version of NICA, the ALJ is expressly required to make three independent findings based upon all available evidence. § 766.309(1), Fla. Stat. (1997). First, the ALJ must determine whether the claim is a birth-related neurological injury. § 766.309(1)(a), Fla. Stat. (1997). Second, the ALJ must determine whether the injury was caused by a participating health care provider, as defined in section 766.302(7). § 766.309(1)(b), Fla. Stat. Finally, if the first and second requirements are met, the ALJ must determine the amount of the award without any regard for fault. §§ 766.309(1)(c), 766.31(1), Fla. Stat. (1997). If the ALJ determines that a claim is compensable, compensation under the NICA Plan becomes the claimant's exclusive remedy. See § 766.303(2), Fla. Stat. (1997) (The rights and remedies granted by this plan . . . shall exclude all other rights and remedies of such infant . . . at common law or otherwise, against any person or entity directly involved with the labor, delivery, or immediate postdelivery resuscitation during which such injury occurs.). A claimant may not bring or maintain a civil suit in violation of NICA's exclusive remedy provision. § 766.304, Fla. Stat. (Supp.1998). ([N]o civil action may be brought or continued in violation of the exclusiveness of remedy provisions of s. 766.303.). If the claim is ultimately determined to be compensable, NICA's exclusive remedy provision shields participating health care providers from a civil tort action based upon the same claim. See § 766.302(6)-(7), Fla. Stat. (1997). However, as previously determined by this Court, there is a condition precedent to NICA's exclusivity. Predelivery notice of the health care provider's participation in the NICA Plan must be given as required by section 766.316. See Galen of Fla., Inc. v. Braniff, 696 So.2d 308, 309-10 (Fla.1997) ([T]he only logical reading of the statute is that before an obstetrical patient's remedy is limited by the NICA plan, the patient must be given pre-delivery notice of the health care provider's participation in the plan. . . . [T]he purpose of the notice is to give an obstetrical patient an opportunity to make an informed choice between using a health care provider participating in the NICA plan or using a provider who is not a participant and thereby preserving her civil remedies.). Section 766.316 provides that, except in the case of emergency or impracticability, a participating health care provider is required to furnish each obstetrical patient with notice that the NICA Plan's limited no-fault alternative for birth-related neurological injuries may be the patient's exclusive remedy or means of receiving compensation for those injuries. This notice must be made using a form provided by the Association.