Life Care Plans
By Steve Goren, Esq.
When conducting workers compensation or personal injury
claims for CRPS
you might want to hire a life care planner who will estimate
how much your injury will cost over the course of a lifetime.
This area of expertise is relatively new
and is being used more frequently than in the past.
Life care planners may have a background in medicine, nursing,
vocational rehabilitation, or economics. Generally, they rely
on the recommendations of your treating physician and put
dollar values on the various categories of future
damages. Then an economist adjusts these costs for inflation
on the jurisdiction, reduces the future damages to present
value. The economist
generally uses a governmental actuarial table to determine
how long a person of a given age can be expected to live.There
can be an overlap between the role of the economist and life
care planner, with both having methods of calculating the
value of household services that will now have to be supplied
by someone else (a family member, a friend, or an outside
service). For example, if you cannot clean your home, a life
care planner or economist has methods of estimating the expense
of hiring someone to do it.
The main elements of a life care plan are the costs to pay
for the following goods and services in the future:
1. Health care providers, including doctors, physical therapists,
occupational therapists, psychologists, etc.
3. Loss of household services, such as cooking, cleaning,
repairs, shopping, etc.
4. Personal attendant care, if you need someone to help with
5. Loss of wages or the capacity to earn wages
6. Appliances, such as shower stools, crutches, wheelchairs,
7. Home modifications, needed particularly if you become confined
to a wheelchair
8. Transportation, because even if you can drive, there are
costs associated with numerous visits to doctors and therapists.
Beyond these essentials, life care plans vary. Life care
plans might include detailed introductions explaining the
injury, the physical limitations created by the injury, and
the various problems these limitations create. Some planners
summarize the medical records. They might rely exclusively
on medical reports, although most interview the injured person,
and some use their own medical knowledge to testify as to
the injury costs.
Generally, your lawyer hires the life care planner, provides
the planner with medical records, your phone number, and those
of your treating physicans. Life care plans can be as short
as one page, or more than 30 pages long, depending on what
is included and how the report is laid out.
Cost of future treatment
Putting a dollar value on the cost of your future treatment
can be difficult. Generally, the life care planner relies
on costs in a community similar to yours. To get prices, he/she
may contact vendors, review supply catalogues, call pharmacies,
etc. Your lawyer should ensure the planners method of
determining prices is appropriate for the court where the
evidence is being presented to avoid potential hearsay objections.
The report will list both one time costs and other ongoing
expenses. The goal is to be comprehensive; you cannot go back
later and ask for more. So, for example,
inserting a spinal cord stimulator has costs for the initial
placement that include
the prices of the appliance, the surgeon, the anesthesia fee,
the operating room fee, and others, but the stimulator has
to be monitored, adjusted, and the batteries replaced, every
nine years, for life. All of these costs must be considered.
Medication can be one of the highest cost items on a CRPS
life care plan and generally includes multiple drugs with
a wide range of costs. A general estimate
of $1,000 per month is not unreasonable, particularly if some
of the expensive pain
drugs are being prescribed. Medications for CRPS may include
some (but not all of the following): an antiseizure medication
such as Lyrica® or Neurotin®; opiods such as OxyContin®;
topical anesthetics such as EMLA® lotion, lidoderm patches,
etc., and a tricyclic anti-depressant such as Elavil®,
Cymbalta®, or nortriptyline; vitamins and botox injections
may also be helpful. Each physician has preferred medications
and patients react differently to the same medications. Also,
new medications are constantly being brought onto the market.
To get an idea of what a finished life care plan looks like,
see the Sample Life Care Plan below.
Sample life care plan for a person with CRPS
Janet is a 52-year old nurse who developed CRPS in her
right foot and leg and can no longer work. Her CRPS is
treated by medication, biofeedback, and physical therapy and
she will probably have a spinal cord stimulator implanted
some time in the next year. Nerve blocks were tried, but were
unsuccessful and stopped after the first set of three injections.
She sees her primary care physician once a month (2 miles
away) and goes to her pain center, 10 miles away, every three
months. Janet is married and has two grown daughters, both
of whom live out of state. Her salary as a nurse was $65,000
per year. Janets husband is a self-employed building
contractor. Using U.S. Government statistics as a guide, her
life care planner estimates she will live another 30 years.
Sample Life Care Plan
|Office Visits Family Doctor (Monthly)
|Pain Management Doctor (Quarterly)
|Psychologist/Counselor/Biofeedback (Every other week)
|Physical Therapy/Occupational Therapy
|Massage Therapy/Personal Trainer
|Fitness Club Membership
|Other Specialists (eg Orthopedist, Neurologist)
|Home Health Care/ER Visits/Hospitalizations
|Nerve Blocks (Set of 3)
|Spinal Cord Stimulator
|Spinal Cord Stimulator - Battery Replacement
|Other (eg blood tests, x-rays)
|Cleaning, shopping, meals, laundry
21 hours/week x $10/hour x 52 weeks/year
|Future Wage Loss
(lost wages + benefits x work life expectancy)
$65,00/year x 10
(such as TENS Unit, wheelchair, walker, power scooter,
van with lift, etc)
|Such as hand shower, guard rails, shower chair, wheelchair
ramps, lowered counters, etc.
|Using IRS rate per mile office visit
|Lifetime Total (Annual cost: $32,100 x 30 years)
Annual Cost ($963,000) + One-Time cost (797,500) = $1,760,500
1. This plan does not include many expensive items such as
a morphine pump, which can cost over $20,000/year.
2. Given CRPS is so varied and can hit anywhere from one
to all four extremities, no attempt has been made to accurately
determine appliance or home
3. One of the hardest areas to plan for is the expenses for
any of the many foreseeable complications which may arise
from medical procedures, medications, and disability in the
course of a lifetime, which can cause hospitalizations and
expensive medical treatments. Examples would be infections,
blood clots, embolisms, GI tract problems, etc. The plan also
does not include visits to the emergency room for breakthrough
pain, and other problems.
4. This plan also does not include many of the procedures
that are attempted and may be successful in controlling CRPS
pain, such as tunnel epidural catheter.
Also, it does not include sympathectomy, a surgery to cut
nerves that is limited to a
rare category of CRPS patients, such as those with unremittent
(a major sweating problem).
RSDSA Review. Fall 2006.