Compensation for birth-related injury - No-fault programs compared with tort system

Objective: To compare compensation systems for birth-related injuries. Design: Retrospective cohort study. Setting: Florida. Participants: Parents of children with birth-related injuries who filed cla ims that closed before August 1, 1995, with Florida's no-fault program (Neu rological Injury Compensation Act [NICA]) or who filed tort claims that clo sed from January 1, 1986, to August 1, 1995. Main Outcome Measures: Compensation for medical and income losses due to bi rth-related injuries. Results: Families who received tort settlements were overcompensated for th e injury, considering all sources of compensation. By contrast, NICA recipi ents broke even. Those who did not receive tort or NICA compensation lost n early $75 000 in the first 5 years following the birth. In the subsample of families of children with cerebral palsy, overcompensation by tort claim w as even greater, whereas NICA recipients were undercompensated. The cost of care for cerbral palsy in both groups was the same. The difference between tort and NICA compensation levels was attributable to payment for income l oss. Overall, NICA recipients were satisfied with compensation received. Conclusions: Medical expenses were adequately covered under NICA, but not i ncome loss. A universal health insurance program for children would not cov er income losses. Similar costs incurred in NICA and tort systems suggests no rationing of care by NICA. Finally, absent some sort of targeted compens ation, the losses experienced by families of children with birth-related-in juries were substantial.