Life-Care Plans: How Catastrophic-Injury Cases Prove a Lifetime of Future Costs

Published June 25, 2020 · Injury Law Basics

When a 34-year-old leaves the rehabilitation hospital in a wheelchair after a truck crash, the medical bills from the first six months are the smallest part of what that crash cost. The real cost is spread across the next forty years: attendant care, replacement wheelchairs, a van with a lift, a bathroom rebuilt for access, surgeries that have not happened yet, and medications that will be refilled thousands of times.

None of that has a bill yet. An insurance company is happy to settle on the bills that exist. The document that puts a fair number on everything else is called a life-care plan, and in a catastrophic-injury case it is often the most important piece of evidence in the file.

What a life-care plan is

A life-care plan is a detailed, itemized projection of the medical care, equipment, services, and support a seriously injured person will need for the rest of his or her life, and what each item will cost. It is organized by category and by time: what is needed now, what must be replaced and how often, and what will be needed as the person ages with the injury.

Life-care plans are used most often in cases involving:

• Spinal-cord injuries and paralysis
• Traumatic brain injuries with lasting cognitive or behavioral effects
• Amputations
• Severe burns requiring years of reconstructive surgery
• Multiple orthopedic injuries with expected arthritis, joint replacement, or fusion

Who prepares it

A credible plan is a team effort.

• A life-care planner. Usually a nurse or rehabilitation professional with specialized training and certification, the planner gathers the records, interviews the injured person and family, visits the home, and assembles the plan.
• Physicians. The plan must rest on medical opinions. Often a physiatrist (a physician specializing in physical medicine and rehabilitation) examines the patient and reviews the plan, along with the treating surgeons and specialists. A planner cannot simply decide that someone needs a future surgery; a doctor has to say so.
• A vocational expert, when the injury affects the ability to work, to explain what jobs, if any, remain possible.
• An economist, who takes the plan's costs and the vocational expert's conclusions and calculates their value over the person's life expectancy.

What it covers

A thorough plan for a catastrophic injury addresses far more than doctor visits:

• Attendant and nursing care. Hours per day of help with bathing, dressing, transfers, and medication, and the level of skill required. For many catastrophic injuries this is the single largest item.
• Equipment and replacement cycles. Wheelchairs, cushions, hospital beds, lifts, prosthetics, braces, and communication devices, each with an expected useful life and replacement schedule.
• Home modification. Ramps, widened doors, roll-in showers, lowered counters, or a different home altogether.
• Transportation. An accessible vehicle, hand controls, and their replacement over time.
• Future surgeries and procedures. Revisions, hardware removal, joint replacements, skin grafts, and the hospital stays that go with them.
• Medications and supplies. Ongoing prescriptions, catheters, wound-care supplies, and the like.
• Therapies. Physical, occupational, speech, and cognitive therapy, and psychological counseling for the injured person and sometimes the family.
• Monitoring for complications. Regular evaluations and the predictable complications of the injury, such as pressure sores, infections, and respiratory problems.

Turning the plan into a number

A plan lists future costs year by year. An economist does two things with that list. First, the economist accounts for the fact that medical costs tend to rise over time. Second, the economist reduces the total to present value: the amount of money that, if received today and invested safely, would pay for those future costs as they come due. The result is the figure a jury or a mediator actually considers.

This matters under Ohio's damages statute. R.C. 2315.18(B)(1) places no limit on economic damages, which include the cost of future medical care and lost earning capacity. Non-economic damages, such as pain and suffering, are generally capped under R.C. 2315.18(B)(2), but the cap is tied in part to economic loss, and R.C. 2315.18(B)(3) removes the cap entirely for permanent and substantial physical deformity, loss of use of a limb, loss of a bodily organ system, or a permanent injury that prevents a person from independently caring for himself or herself. I explained that exception in a 2018 post on the catastrophic-injury exception. In practice, the same medical evidence that supports a life-care plan often proves the exception as well.

For how the categories of damages fit together, see our guide chapter on what your case is worth.

How insurers attack life-care plans

Defense lawyers and insurers know that a well-supported life-care plan can dwarf every other number in the case, and they attack it in predictable ways:

• "Not medically necessary." The defense argues that items in the plan are comfort, not care. The answer is a physician who has examined the patient and will testify that each item is needed.
• Cheaper substitutes. The defense planner proposes family care instead of paid attendants, or less frequent equipment replacement. Unpaid family care is still care, and the family's sacrifice has value.
• Shortened life expectancy. Paradoxically, the defense may argue that the injury will shorten the person's life, so fewer years of care are needed. This argument must be met with careful medical evidence.
• Unsupported items. If a planner includes something no doctor has recommended, the defense will use it to discredit the whole plan. That is why a plan should be built from medical opinions outward.

The plan and settlement

A life-care plan is not only for trial. It is the backbone of serious settlement negotiations, and it is the starting point for deciding how a settlement should be paid. In catastrophic cases, part of a recovery is often placed in a structured settlement, which provides guaranteed payments over time that track the person's projected needs. The plan also helps identify how health insurance, Medicare, or Medicaid may be involved in future care, and how their claims to be repaid from the settlement must be addressed. Our guide chapter on medical bills, health insurance, and liens explains those repayment claims.

A catastrophic case settled without a life-care plan is settled blind. The injured person is usually the one who pays for that mistake, years later, when the money runs out and the needs do not.

What this means for you

• If someone in your family suffered a catastrophic injury, do not discuss settlement until the long-term needs have been evaluated by the right experts.
• Keep a record of everything family members are doing to provide care, including hours and tasks.
• Save every recommendation from doctors and therapists about future care and equipment.
• Large verdicts in catastrophic cases are built on this kind of proof; my post on a $42 million Cleveland truck-crash verdict shows what is possible when the evidence is there.

Commercial-vehicle crashes are a common cause of catastrophic injury; our truck accident page explains how those cases differ.