No-fault system of compensation for obstetric injury: winners and losers.

Journal Article (Journal Article)


To determine whether Florida's implementation of a no-fault system for birth-related neurologic injuries reduced lawsuits and total spending associated with such injuries, and whether no-fault was more efficient than tort in distributing compensation.


We compared claims and payments before and after implementation of a no-fault system in 1989. Data came from the Department of Insurance's medical malpractice closed claim files and no-fault records. Descriptive statistics were compiled for tort claims before 1989 and for tort and no-fault claims for 1989-1991. We developed two projection approaches to estimate claims and payments after 1989, with and without no-fault. We assessed the program's performance on the basis of comparisons of actual and projected values for 1989-1991.


The number of tort claims for permanent labor-delivery injury and death fell 16-32%. However, when no-fault claims were added to tort claims, total claims frequency rose by 11-38%. Annually, an estimated 479 children suffered birth-related injuries; however, only 13 were compensated under no-fault. Total combined payments to patients and all lawyers did not decrease, but of the total, a much larger portion went to patients. Compensation of patients after plaintiff lawyers' fees rose 4% or 44%, depending on the projection method used. Less than 3% of total payments went to lawyers under no-fault versus 39% under tort.


Some claimants with birth-related injuries were winners, taking home a larger percentage of their awards than their tort counterparts. Lawyers clearly lost under no-fault. Because of the narrow statutory definition, many children with birth-related neurologic injuries did not qualify for coverage.

Full Text

Duke Authors

Cited Authors

  • Sloan, FA; Whetten-Goldstein, K; Stout, EM; Entman, SS; Hickson, GB

Published Date

  • March 1, 1998

Published In

Volume / Issue

  • 91 / 3

Start / End Page

  • 437 - 443

PubMed ID

  • 9491874

Electronic International Standard Serial Number (EISSN)

  • 1873-233X

International Standard Serial Number (ISSN)

  • 0029-7844

Digital Object Identifier (DOI)

  • 10.1016/s0029-7844(97)00705-9


  • eng