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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 and, depending
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.
2. Medications
3. Loss of household services, such as cooking, cleaning, repairs, shopping, etc.
4. Personal attendant care, if you need someone to help with bathing, dressing,
transportation, etc.
5. Loss of wages or the capacity to earn wages
6. Appliances, such as shower stools, crutches, wheelchairs, etc.
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 planner’s 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. Janet’s 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

NOTES

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
modification needs.

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 hyperhydrosis
(a major sweating problem).

RSDSA Review. 2006;19(4):11-12.