Florida District Appellate Court Looks At Birth-Related Neurological Injury Compensation Benefit Award

In Florida car accident cases, it is commonplace to see an insurance company indemnify, or take on a personal injury action on behalf of its insured. It is not often a hospital takes on a claim on behalf of a patient, but it happened in the recent Florida Court of Appeal case, Putnam Community Medical Center v. Florida Birth-Related Neurological Injury Compensation Association (aka NICA), No.1D16-32. The appellate court certified the hospital’s ability to sue as an interested third party because it had a direct economic interest in avoiding civil litigation and liability for injuries that might otherwise be covered by NICA, § 766.302(2), Fla. Stat., an Act that provides benefits to qualifying infants with birth-related neurological injuries.

NICA issues benefits to infants who suffer an injury to the brain or spinal cord caused by oxygen deprivation or a mechanical injury during delivery that results in a permanent and substantial mental or physical impairment.  A baby from a single gestation must weigh at least 2,500 grams (approximately 5.51 pounds) at birth. A baby from a multiple gestation must weigh 2,000 grams (approximately 4.41 pounds) at birth. A disability or death due to a genetic or congenital abnormality is not covered by NICA.

This lawsuit tackles the question of whether or not FICA violates state and federal equal protection clauses by using weight minimums to determine whether or not compensation is issued. The hospital filing the appeal argued that FICA discriminates between multiple and single births by doing so. The infant at the center of this litigation was born at 39.5 weeks gestation and weighed 2,440 grams. The mother sought benefits under protest, and the hospital intervened, appealing the Association’s denial of benefits. The hospital argued that the normal-weight child was born to a mother with small stature and should not be held to the minimum threshold of 2,500 grams because it would thwart the purpose and intent of the legislature.

To support this argument, the hospital provided the affidavit of an obstetrician-gynecologist (OB-GYN), who thought the 2,500-gram requirement was unreasonable and arbitrary. The doctor felt that the child would otherwise qualify, but for the weight requirement. His analysis was that the weight requirement was an attempt to exclude extremely pre-mature infants and those diagnosed with cerebral palsy and affected by intrauterine growth retardation. The doctor pointed out that this infant had neither of these conditions. Despite this, the Administrative Law Judge granted the Association’s motion for summary judgment, ruling that a deviation from a clear statutory requirement was not permitted. The hospital appealed, raising constitutional claims.

The appellate court affirmed the determination of the ALJ, ruling there was no violation of the equal protection clause. The court felt that the hospital did not show that the single gestation and multiple gestation babies were “similarly situated” under the equal protection analysis. The court noted that even if it did apply, the weight distinction is rationally related to the actuarial soundness of the plan. The court felt that it was conceivable that the legislature made the weight distinction due to the fact that multiple gestation infants share limited womb space and nutrition. The court pointed to the legislature’s consideration and rejection in 2004 of reducing the single gestation infants’ weight requirement to 2,000 grams. Part of this rejection was based on the anticipated annual claims increasing by between $18.5 million and $24.2 million. The District Court of Appeals felt that this met the rational basis test, and it upheld the denial of benefits.

The Florida serious injury attorneys at Donaldson & Weston can assist you with your claim. Our experienced counsel understand the challenges one may face in a similarly complicated scenario and will tirelessly pursue all of the legal options available. For a free, confidential consultation, call 772-266-5555 or 561-299-3999.

More Blog Posts:

Florida District Court of Appeal Reviews Drunk Driver Motorcycle Accident Case, South Florida Injury Lawyer Blog, August 4, 2016

Wrongful Death Appeal Discusses Statutory Requirements for Expert Witnesses in Florida, South Florida Injury Lawyer Blog, July 13, 2016