NO-FAULT SYSTEM OF COMPENSATION FOR OBSTETRIC INJURY - WINNERS AND LOSERS

Objective: To determine whether Florida's implementation of a no-fault system for birth-related neurologic injuries reduced lawsuits and tot al spending associated with such injuries, and whether no-fault was mo re efficient than tort in distributing compensation. Methods: We compa red claims and payments before and after implementation of a no-fault system in 1989. Data came from the Department of Insurance's medical m alpractice closed claim files and no-fault records. Descriptive statis tics were compiled for tort claims before 1989 and for tort and no-fau lt claims for 1989-1991. We developed two projection approaches to est imate claims and payments after 1989, with and without no-fault. We as sessed the program's performance on the basis of comparisons of actual and projected value for 1989-1991. Results: The number of tort claims for permanent labor-delivery injury and death fell 16-32%. However, w hen no-fault claims were added to tort claims, total claims frequency rose by 11-38%. Annually, an estimated 479 children suffered birth-rel ated injuries; however, only 13 were compensated under no-fault. Total combined payments to patients and all lawyers did not decrease, but o f the total, a much larger portion went to patients. Compensation of p atients after plaintiff lawyers' fees rose 4% or 44%, depending on the projection method used. Less than 3% of total payments went to lawyer s under no-fault versus 39% under tort. Conclusion: Some claimants wit h birth-related injuries were winners, taking home a larger percentage of their awards than their tort counterparts. Lawyers clearly lost un der no-fault. Because of the narrow statutory definition, many childre n with birth-related neurologic injuries did not qualify for coverage. (C) 1998 by The American College of Obstetricians and Gynecologists.