Florida/Georgia Personal Injury & Workers Compensation

...As the Birnies did here, the injured infant or his personal representative may seek compensation under the Plan by filing a claim for compensation with the Division of Administrative Hearings (DOAH) within five years of the infant's birth. See §§ 766.302(3), 766.303(2), 766.305(1), and 766.313....

...NICA, which administers the Plan, has "45 days from the date of service of a complete claim ... in which to file a response to the petition and to submit relevant written information relating to the issue of whether the injury is a birth-related neurological injury." § 766.305(3). If NICA determines that the injury alleged in a claim is a compensable birth-related neurological injury, it may award compensation to the claimant, provided that the award is approved by the hearing officer to whom the claim has been assigned. § 766.305(6)....

...nancial benefits without regard to fault. Id. § 766.31. CLAIMANTS FOR NICA BENEFITS Section 766.302(3) defines the class of claimants who can seek NICA benefits on behalf of injured infants: "Claimant" means any person who files a claim pursuant to s. 766.305 for compensation for a birth-related neurological injury to an infant. Such a claim may be filed by any legal representative on behalf of an injured infant.... And section 766.305(1) provides in pertinent part: All claims filed for compensation under the plan shall commence by the claimant filing with the division a petition seeking compensation....

...766.301-766.316 and shall exercise the full power and authority granted to him in chapter 120, as necessary, to carry out the purposes of such sections. The statutory language clearly limits the jurisdiction of the hearing officer to determining the nature of an infant's injury only when a claim for benefits under section 766.305(1) is filed alleging that the infant has suffered a NICA injury....

...The NICA Plan is administered by the Association. [9] When an infant suffers what may be a birth-related neurological injury, [10] NICA provides that the claimant (usually the infant's parent) [11] must file a claim for compensation *711 under the NICA Plan with the Association. § 766.305, Fla....

...The Fergusons filed suit on May 26, 1999. [5] As explained below, NICA claims are initially filed with the Association, the administrator of the NICA Plan. The Association makes an initial recommendation on whether the claim is compensable. See § 766.302(1), Fla. Stat. (1997); §§ 766.305, .308, .315, Fla....

...postdelivery period in a hospital, which renders the infant permanently and substantially mentally and physically impaired. § 766.302(2), Fla. Stat. (1997). [11] "Claimant" is defined in applicable part as "any person who files a claim pursuant to s. 766.305 for compensation for a birth-related neurological injury to an infant....

...McDonald, 395 So.2d 203, 209 (Fla. 1st DCA 1981). The Plan embodies this concept to a limited extent. While it requires that claims for compensation must be filed, it also contemplates payment of claims without resort to a formal administrative hearing process. Section 766.305(6) provides that "[a]ny claim which the association determines to be compensable may be accepted for compensation, provided that the acceptance is approved by the hearing officer to whom the claim for compensation is assigned." Finall...

...In that regard, the Plan clearly contemplates that a hearing officer's jurisdiction under section 766.304 is limited to determining and hearing all claims filed pursuant to the Plan. Section 766.302(3) defines a claimant to mean "any person who files a claim pursuant to s. 766.305 for compensation for a birth-related neurological injury to an infant." The McKaughans, through their supplementary petition, obviously did not meet the statutory definition of a claimant because they were not seeking compensation for a bi...

...injury occurs...." [2] The defendants argue that pre-delivery notice must not be a condition precedent because the presence or absence of proper notice is not one of the ten items of information claimants must file when they bring a NICA claim. See § 766.305(1)(a)-(j), Fla.Stat....

...Claims under the act are commenced by a "claimant" who files a petition seeking compensation. The Division of Administrative Hearings of the Department of Management Services is charged with providing the administrative hearings for the participating health care providers and the claimant. § 766.305, Fla. Stat. (1993). Claimants are defined by section 766.302(3): (3) "Claimant" means any person who files a claim pursuant to s. 766.305 for compensation for a birth-related neurological injury to an infant....

...The NICA Plan is administered by the Association. 9 When an infant suffers what may be a birth-related neurological injury, 10 NICA provides that the claimant (usually the infant’s parent) 11 must file a claim for corn- *711 pensation under the NICA Plan with the Association. § 766.305, Fla....

...The Fergusons filed suit on May 26, 1999. . As explained below, NICA claims are initially filed with the Association, the administrator of the NICA Plan. The Association makes an initial recommendation on whether the claim is compensable. See § 766.302(1), Fla. Stat. (1997); §§ 766.305, .308, .315, Fla....

...e postdelivery period in a hospital, which renders the infant permanently and substantially mentally and physically impaired. § 766.302(2), Fla. Stat. (1997). . "Claimant” is defined in applicable part as "any person who files a claim pursuant to s. 766.305 for compensation for a birth-related neurological injury to an infant....

representative on behalf of an injured infant.... And section 766.305(1) provides in pertinent part: All claims filed

...is that an administrative law judge (“ALJ”) assigned by the Division of Administrative Hearings (“DOAH”)—an agency performing exclusively quasi-judicial functions within the executive branch 3—must first determine that a claim under the Plan is compensable. See § 766.305(1), Fla....

...alleged to have a birth-related neurological injury shall be barred.”). The association that administers the Plan—NICA 4— responded that the claimed injury met the definition of BRNI but that the claim was not being accepted because it was time-barred. § 766.305(4), (7), Fla....

petition and such allegation is mandated by Section 766.305(l)(a), Fla. Stat. (1993). “8. Petitioners filed

...tracing back to complications at birth. His parents filed a claim under the Plan, a claim NICA disputed after reviewing it—NICA concluding the injury did not satisfy the statutory definition of a birth-related neurological injury (“BRNI”). See § 766.305, Fla....

with [DOAH] a petition seeking compensation.” § 766.305(1), Fla. Stat. (emphasis supplied); cf. id. (3)(c)

...under the Plan, through the executive branch. To be clear, it is they (or another legal representative of the infant) as claimants who initiate this executive-branch regime, “claimant” being defined as “any person who files a claim pursuant to s. 766.305 for compensation.” § 766.302(3), Fla. Stat. (emphasis supplied). The claimant files that claim “under the plan” by “filing with [DOAH] a petition seeking compensation.” § 766.305(1), Fla. Stat. (emphasis supplied); cf. id. (3)(c) (requiring claimant to submit “documentation of expenses and services incurred to date which identifies any payment made”). DOAH then provides the petition to NICA, and NICA must respond to the claim. § 766.305(2), (4), Fla. Stat. If NICA determines the claim to be compensable, it may accept it for compensation, provided the ALJ assigned to the petition approves that acceptance. § 766.305(7), Fla....

...physicians, one whom opined that that G.C. did “not fulfill criteria of a substantial mental impairment.” Based on the reviews, NICA denied that the Chavezes’ claim was compensable because G.C.’s injury did meet the definition of a BRNI. See §766.305(4), Fla....

...Ass’n v. McKaughan, 668 So. 2d 974, 978 (Fla. 1996) (observing that this specific “statutory language [in section 766.304] clearly limits the jurisdiction of the hearing officer to determining the nature of an infant’s injury only when a claim for benefits under section 766.305(1) is filed alleging that the infant has suffered a NICA injury” (first emphasis supplied)). 9  The parties to this appeal responded to our invitation to submit supplemental briefing on the jurisdictional question, and we took oral argument as well....

...4 Shands and UF acknowledge that the Chavezes are not “claimants” against the Plan, and that neither NICA nor a healthcare provider may initiate a proceeding regarding compensation under NICA. Cf. § 766.302(3), Fla. Stat. (defining “claimant” in terms of filing “a claim pursuant to s. 766.305 for compensation for a [BRNI]” and allowing such a claim to be filed on behalf of the infant “by any legal representative”); § 766.305(1), Fla....

...representative”) is permissive and does not exclude a provider from seeking benefits for the infant. Id. at 977. The court observed that this subsection three “defines the class of claimants who can seek NICA benefits.” Id. It also looked at a second statutory provision, section 766.305(1), Florida Statutes, which requires that “[a]ll claims ....

...�— that is, of the Plan. Id. This statutory text, too, “clearly limits the jurisdiction of the hearing officer to determining the nature of an infant’s injury only when a claim for benefits under section 12 766.305(1) is filed alleging that the infant has suffered a NICA injury.” Id. (first emphasis supplied). Pulling this all together, we see the supreme court relied on a close textual treatment of the four statutory provisions just mentioned, sections 766.301(2), 766.302(3), 766.304, and 766.305(1); and its conclusion that these provisions limit the Plan and the ALJ’s authority thereunder to “claims” by parents affirmatively seeking compensation; to hold that an administrative hearing officer/ALJ does not have “exclusive jurisdiction ....

...do not read the 1998 amendments as attempting to do so. 6 Indeed, the 1998 amendments, remarkably, left untouched the exact text on which the McKaughan Court relied for its holding: all four provisions (sections 766.301(2), 766.302(3), 766.304, and 766.305(1)) limiting the Plan’s application to claims for compensation based on a BRNI. 6 To be sure, we are not passing on the constitutionality of any of these 1998 amendments....

...The Legislature established a fund with treasury dollars and created a public right 26 to compensation from that fund for those infants suffering “a limited class of” statutorily defined, “catastrophic” BRNIs. §§ 766.301(2), 766.302(2), (3), 766.303(1), 766.305, Fla....

...claims for compensation under the plan” to DOAH giving ALJs (rather than judicial officers) the exclusive authority to determine whether a claimant asserting a public right to compensation in fact meets the statutory criteria for enforcement of that right. §§ 766.304, 766.305(1), Fla....

...conclusions of law bearing on that claim. See § 766.304, Fla. Stat. (providing the ALJ “the full power and authority granted” by chapter 120); § 766.309(1), Fla. Stat. (requiring the ALJ to make “determinations based upon all available evidence”); but cf. § 766.305(7), Fla....

...a BRNI must seek compensation under the Plan, through the executive branch. To be clear, it is they (or another legal representative of the infant) as claimants who put this executive- branch regime into motion, “claimant” being defined as “any person who files a claim pursuant to s. 766.305 for compensation.” § 766.302(3), Fla. Stat. (emphasis supplied). The claimant files that claim “under the plan” by “filing with [DOAH] a petition seeking compensation.” § 766.305(1), Fla....

...NICA investigated the claim and obtained medical reviews by two physicians, one whom opined that that G.C. did “not fulfill criteria of a substantial mental impairment.” Based on the reviews, NICA denied that the Chavezes’ claim was compensable because G.C.’s injury did meet the definition of a BRNI. See § 766.305(4), Fla....

...2d 974, 978 (Fla. 1996) (observing that this specific “statutory language [in section 766.304, Florida Statutes,] clearly limits the jurisdiction of the hearing officer to determining the nature of an infant’s injury only when a claim for benefits under section 766.305(1) is filed alleging that the infant has suffered a NICA injury” (first emphasis supplied)). The parties responded to the court’s invitation to submit supplemental briefing on the jurisdictional question....

...initiate a proceeding regarding compensation under NICA. Cf. 5 The question was further addressed on rehearing. 11 § 766.302(3), Fla. Stat. (defining “claimant” in terms of filing “a claim pursuant to s. 766.305 for compensation for a [BRNI]” and allowing such a claim to be filed on behalf of the infant “by any legal representative”); § 766.305(1), Fla....

...representative”) is permissive and does not exclude a provider from seeking benefits for the infant. Id. at 977. The court observed that this subsection three “defines the class of claimants who can seek NICA benefits.” Id. It also looked at a second statutory provision, section 766.305(1), Florida Statutes, which requires that “[a]ll claims ....

...necessary, to carry out the purposes of [sections 766.301 through 766.316]”—that is, of the Plan. Id. This statutory text, too, “clearly limits the jurisdiction of the hearing officer to determining the nature of an infant’s injury only when a claim for benefits under section 766.305(1) is filed alleging that the infant has suffered a NICA injury.” Id. (first emphasis supplied). Pulling this all together, the reader can see that the supreme court relied on a close textual treatment of the four statutory provisions just mentioned, sections 766.301(2), 766.302(3), 766.304, and 766.305(1)—and its conclusion that these provisions limit the Plan and the ALJ’s authority thereunder to “claims” by parents affirmatively seeking compensation—to hold that an administrative hearing officer/ALJ does not have “exclusive jurisdiction ....

...98 amendments should not be read as attempting to do so. 7 Indeed, the 1998 amendments, remarkably, left untouched the exact text on which the McKaughan Court relied for its holding: all four provisions (sections 766.301(2), 766.302(3), 766.304, and 766.305(1)) limiting the Plan’s application to claims for compensation based on a BRNI....

...The Legislature established a fund with treasury dollars and created a public right to compensation from that fund for those infants suffering “a limited class of” statutorily defined, “catastrophic” BRNIs. §§ 766.301(2), 766.302(2), (3), 766.303(1), 766.305, Fla....

...claims for compensation under the plan” to DOAH—giving ALJs (rather than judicial officers) the exclusive authority to determine whether a claimant asserting a public right to compensation in fact meets the statutory criteria for enforcement of that right. §§ 766.304, 766.305(1), Fla....

...conclusions of law bearing on that claim. See § 766.304, Fla. Stat. (providing the ALJ “the full power and authority granted” by chapter 120); § 766.309(1), Fla. Stat. (requiring the ALJ to make “determinations based upon all available evidence”); but cf. § 766.305(7), Fla....