(1) Upon determining that an infant has sustained a birth-related neurological injury and that obstetrical services were delivered by a participating physician at the birth, the administrative law judge shall make an award providing compensation for the following items relative to such injury:(a) Actual expenses incurred since the date of birth for medically necessary and reasonable:1. Medical and hospital care and services;
2. Habilitative services;
3. Dental services;
4. Family residential or custodial care;
5. Professional residential care;
6. Professional custodial care;
7. Drugs;
8. Special equipment; and
9. Related travel.
(b) At a minimum, compensation must be provided for the following actual expenses:1. Psychotherapeutic services for family members and other relatives who have resided with the participant, which are obtained from a psychiatrist licensed under chapter 458 or chapter 459, a provider licensed under chapter 490 or chapter 491, or a psychiatrist or provider who has equivalent licensure by another jurisdiction. This benefit for such family members and relatives shall be up to a total of $10,000 annually during the participant’s lifetime and up to a total of $20,000 subsequent to the participant’s death.
2. For the life of the participant, providing family members with a reliable method of transporting the participant and the participant’s wheelchair and medically necessary equipment. The plan may not limit such transportation assistance based on the participant’s age or weight. The plan must replace any vehicle purchased by the plan every 7 years or 150,000 miles, whichever comes first.
3. Housing assistance of up to $100,000 for the life of the participant, including, but not limited to, a down payment on a new home, moving expenses, and home construction and modification costs.
4. Legal costs associated with establishing and maintaining guardianship for a participant.
(c)1. The costs of a health insurance policy or health maintenance contract that provides major medical or similar comprehensive health insurance coverage for the participant obtained pursuant to subsection (3), including, but not limited to, the premium and out-of-pocket costs. For participants enrolled in the state Medicaid program, the plan must reimburse fee-for-service paid claims and capitation payments, as applicable, for services provided to such participants pursuant to this section and for the administrative and support costs associated with the provided medical assistance. Such funds shall be credited to the Agency for Health Care Administration’s Medical Care Trust Fund.
2. By December 31, 2026, the plan shall reimburse any participant for reasonable, medically necessary care received by the participant on or before June 30, 2026, which was reduced or not paid by the plan because such participant did not have comprehensive or major medical health insurance coverage through an insurer or a health maintenance organization.
(d) However, the following expenses are not subject to compensation:1. Expenses for items or services that the participant has received, or is entitled to receive, under the laws of any state or the Federal Government, except to the extent such exclusion may be prohibited by federal law.
2. Expenses for items or services that the participant has received, or is contractually entitled to receive, from any prepaid health plan, health maintenance organization, or other private insuring entity.
3. Expenses for which the participant has received reimbursement, or for which the participant is entitled to receive reimbursement, under the laws of any state or the Federal Government, except to the extent such exclusion may be prohibited by federal law.
4. Expenses for which the participant has received reimbursement, or for which the participant is contractually entitled to receive reimbursement, pursuant to the provisions of any health or sickness insurance policy or other private insurance program.
5. Expenses for family residential or custodial care provided by a family member while:a. Care and supervision of the participant is simultaneously being provided by another person or entity; or
b. The family member receives compensation from another source for work performed during the same time for which compensation is sought from the association.
(e) Expenses included under paragraphs (a) and (b) are limited to reasonable charges prevailing in the same community for similar treatment of injured persons when such treatment is paid for by the injured person.
(f)1. A family member receiving benefits under the plan may file a petition with the division to dispute the amount of actual expenses reimbursed or a denial of reimbursement.
2. In the case of an alleged overpayment of an expense reimbursement by the association to a family member, if the family member does not agree that an overpayment has occurred, the association may file a petition for division review of the overpayment for a determination of the amount, if any, to be recouped by the association.
(g)1. Periodic payments of an award to the family members of the participant, which award may not exceed $100,000. However, at the discretion of the administrative law judge, such award may be made in a lump sum. Beginning on January 1, 2021, the award may not exceed $250,000, and each January 1 thereafter, the maximum award authorized under this paragraph shall increase by 3 percent.
2. Death benefit for the participant in an amount of $50,000.
(h) Reasonable expenses incurred in connection with the filing of a claim under ss. 766.301-766.316, including reasonable attorney fees, which shall be subject to the approval and award of the administrative law judge. In determining an award for attorney fees, the administrative law judge shall consider the following factors:1. The time and labor required, the novelty and difficulty of the questions involved, and the skill requisite to perform the legal services properly.
2. The fee customarily charged in the locality for similar legal services.
3. The time limitations imposed by the claimant or the circumstances.
4. The nature and length of the professional relationship with the claimant.
5. The experience, reputation, and ability of the lawyer or lawyers performing services.
6. The contingency or certainty of a fee.
If there is a final determination of compensability, and the claimants accept an award under this section, the claimants are not liable for any expenses, including attorney fees, incurred in connection with the filing of a claim under ss. 766.301-766.316 other than those expenses awarded under this section.
(3) A family member must continuously maintain a health insurance policy or health maintenance contract that provides comprehensive major medical health insurance coverage for the participant.(a) If the participant does not have such coverage at the time of entry of a final order by an administrative law judge approving a claim for compensation, the family member must obtain coverage within 60 days after entry of such order or apply for Medicaid coverage within 30 days after entry of such order.
(b) If the participant is determined to be ineligible for Medicaid, the family member must obtain other coverage within 60 days after receiving the Medicaid application denial.
(c) A family member of an individual who is a participant on June 30, 2026, must obtain the required coverage for the participant by January 1, 2027.
