Future medical costs life care planner attorney

Future medical cost is the component of an injury claim most often left out and least often recoverable once it has been. Past bills prove themselves. Future care has to be established affirmatively, by medical opinion, before the case resolves — because a settlement is final and there is no mechanism to return for the surgery that becomes necessary in five years. Law Offices Of SRIS, P.C. handles catastrophic injury claims in Virginia, Maryland, the District of Columbia, New Jersey and New York.

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What has to be proven

Two things, separately. That the care will be needed, which requires a physician’s opinion stated to the applicable standard that it is reasonably certain rather than merely possible. And what it will cost, which requires evidence of actual cost in the relevant market rather than a national average or an estimate. Care that is speculative is not recoverable, so the framing of the medical opinion matters as much as its substance.

The categories most often omitted

Hardware removal and revision surgery. Joint replacement following an intra-articular fracture, and the revision that follows a replacement performed young. Prosthetic replacement cycles. Ongoing medication and its monitoring. Dental work after facial trauma, including replacement of crowns and implants across decades. Psychological treatment. Equipment replacement. Each is foreseeable rather than speculative, and each is routinely absent from claims that settle early.

How the projection is built

The treating physicians establish need, frequency and duration. Cost evidence is gathered for the actual location where the person lives. An economist projects the costs across the relevant period, applies a growth rate appropriate to medical costs, and reduces the total to present value. Where the period is a full lifetime, life expectancy becomes a contested input in its own right.

How carriers attack future care

By characterizing anticipated procedures as speculative rather than reasonably certain — which is why the wording of the medical opinion matters so much. By substituting cheaper alternatives and longer intervals. By disputing the growth and discount rates. By arguing that health insurance will cover it, which overlooks deductibles, coverage limits, exclusions and the possibility of losing coverage. Each of these is anticipated rather than answered late.

Getting it right before you settle

Ask each treating physician explicitly what future care is anticipated and have the answer recorded in writing to the applicable standard of certainty. Identify the categories commonly omitted and address them specifically. Obtain local cost evidence. Where the projection is long or complex, use a life care planner and an economist. And do not allow the claim to resolve until this exists, because the finality of a release is absolute.

Available insurance coverage

What can be recovered is limited by what coverage exists. The at-fault party’s policy is the starting point, but it is frequently not the only source: the injured person’s own uninsured and underinsured motorist coverage, household policies, employer coverage where a vehicle was used for work, umbrella and excess layers, and the coverage of any additional responsible party can all apply. Underinsured coverage typically requires notice and consent before any settlement with the at-fault party — settling first can forfeit it. Identifying every available layer is early work, not closing work.

How damages are categorised and proven

Damages are not a single number that gets negotiated. They are separate categories, each proven by different evidence. Past medical expense is proven by billing records and the reasonableness of the charges. Future medical expense requires a physician’s opinion that the care is reasonably certain to be needed. Lost income is proven by employment and tax records; lost earning capacity is a different and larger question requiring vocational and economic analysis. Non-economic loss — pain, limitation, and the effect on daily life — is proven through the medical record and through testimony from people who can describe specific changes rather than general decline. No one can responsibly tell you what a case is worth before that evidence exists, and any figure offered at the outset is a guess.

Filing deadlines

Every injury claim is governed by a statute of limitations, and the periods differ by state and by claim type. For personal injury actions the period is two years in Virginia under Va. Code § 8.01-243(A), accruing at the date of injury; three years in Maryland under Md. Code, Cts. & Jud. Proc. § 5-101; three years in the District of Columbia under D.C. Code § 12-301(8); two years in New Jersey under N.J.S.A. 2A:14-2; and three years in New York under N.Y. C.P.L.R. § 214(5). These are general periods. Discovery rules, tolling for minors and incapacity, claims against government entities — the District imposes a six-month notice-of-claim requirement for claims against the District government — and claim-specific statutes can shorten or extend them. Do not rely on a general period for your own case; have the deadline confirmed on your facts.

Frequently Asked Questions

Why can I not just deal with future surgery when it happens?

Because a settlement or judgment resolves the entire claim, including future consequences. Once you sign a release you cannot return for a procedure that becomes necessary later, however clearly it flowed from the injury. That finality is why future care must be established before resolution rather than after.

What does reasonably certain mean?

It is the standard a medical opinion generally has to meet for future care to be recoverable — that the care will more likely than not be required, rather than that it might be. A physician who says a procedure is possible has not supported the claim; one who states it is reasonably certain has. The framing of the question to the physician therefore matters.

Will my health insurance cover it anyway?

Possibly in part, but that is not a reason to omit it. Deductibles, co-payments, coverage limits, exclusions and the risk of losing coverage all mean the cost is not fully absorbed. How your recovery interacts with coverage and with any reimbursement claim is a separate question worth addressing deliberately.

What is most commonly left out?

Hardware removal, revision and replacement surgery, prosthetic replacement cycles, dental work after facial trauma, ongoing medication and its monitoring, psychological treatment and equipment replacement. These are foreseeable rather than speculative, and they are routinely absent from claims that resolve quickly.

Do I need a life care planner for every case?

No. In a straightforward claim, treating-physician opinions on anticipated future care with supporting cost evidence may be sufficient. A formal life care plan becomes necessary where needs are extensive, span a lifetime, or involve multiple interacting categories — typically in catastrophic injury.

How are future costs reduced to a present figure?

An economist projects the costs across the relevant period, applies a growth rate reflecting how those particular costs rise over time, and discounts the total back to present value. Both the growth rate and the discount rate are contested inputs, because small changes produce large differences.

My dentist says I will need the implants redone. Does that count?

Yes, and it is one of the most frequently omitted categories. Dental restorations have finite lifespans and require replacement across decades. A dental treatment plan projecting lifetime cost should be obtained where facial or dental trauma occurred, rather than only the cost of the immediate work.

How long do I have to bring a claim?

Two years in Virginia and New Jersey, three years in Maryland, the District of Columbia and New York for personal injury actions, subject to tolling and to much shorter notice requirements where a government entity is involved. Because assembling future-care evidence takes time, start early rather than near the deadline.

About Mr. Sris

Mr. Sris is the owner and founder of Law Offices Of SRIS, P.C., which has practiced since 1997. He is a former prosecutor and is admitted in Virginia, Maryland, the District of Columbia, New Jersey and New York. Of Counsel attorneys contract directly with the firm and handle matters alongside him. In 2019 Mr. Sris testified before the Virginia House Courts of Justice Committee on House Bill 635.

Speak with Mr. Sris

Injury claims are governed by filing deadlines that vary by state and by claim type, and evidence degrades quickly. Request a consultation. Reach our location at (888) 437-7747. Consultations are by appointment.

Last reviewed: August 22, 2026.

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