What is Not Covered by NICA?

NICA only covers what is “medically necessary,” so families sometimes have disputes with NICA over what is really medically needed for the child and what is not.  Another drawback with this program is that NICA does not pay for what might otherwise be covered by insurance or any  similar private or  governmental programs.  Since many severely injured children in Florida are either insured or covered by other programs like Medicaid or Children’s Medical Services, in reality, while the statutory description of NICA benefits sounds great, the program frequently offers less to families than first meets the eye, and it may offer substantially less than what could be recovered in a traditional medical malpractice case arising out of the birth injuries.

There are very significant elements of damages that NICA never covers under any circumstances and the child and family just forfeit by the loss of the ability to file a malpractice claim.   These forfeited elements of damages include things like compensation for pain, mental anguish, disfigurement, loss of ability to enjoy life, and the economic losses from the inability of the injured child to ever be able to work for a living.  These damages (that NICA  will never pay) can run into the millions of dollars for a catastrophically injured child.

On the other hand, every case should be considered on its own facts, and the fact that these days many obstetricians are opting for no or minimal malpractice insurance, for some families, NICA is a very good program.