Is NICA a No-Fault Program?

The NICA promise of a no-fault program is often just an illusion.  While it is true a family does not have to prove someone was negligent during labor or delivery to get NICA benefits, by definition almost all injuries that will qualify the child for NICA benefits  are injuries that were actually caused by negligence at the time of the delivery.  Why do we say that?

First, for NICA to apply the baby must be born in a hospital, so anything like a true no-fault accidental delivery in a taxicab or at home will not be covered.

The baby must weigh at least 2500 grams (2000 grams for multiple gestation) so true no-fault injuries resulting just from being a tiny premature baby are not covered.

The injury by definition must be caused by oxygen deprivation or mechanical injury during the labor, or during the delivery, or during the immediate post delivery resuscitation period in the hospital. So true no-fault injuries from congenital deformities like spina bifida, downs syndrome, or similar no-fault birth defects are not covered.

So what you are left with is that the only babies covered by NICA are those babies who start out full term and otherwise healthy but then during the birthing process are severely physically and cognitively injured by asphyxiation (suffocation) or mechanical trauma while they are in the hospital and under the direct care of the obstetrician and other hospital personnel.

Most people knowledgeable about malpractice cases will tell you that these types of catastrophic suffocation and mechanical trauma injuries rarely occur to otherwise healthy term newborns who are delivered in a monitored hospital setting unless there was actual malpractice.  So in reality it is only these serious at-fault malpractice cases that are included in the NICA plan definitions and most of the real no-fault injuries are not covered by NICA at all.