How to Challenge a Life Care Plan in a Personal Injury Case
The life care plan is usually the largest number in a catastrophic injury damages model, and it is often the least examined. Counsel reads the total, forms a reaction to it, and moves on to the medical experts. The plan itself goes unchallenged in any structured way until a life care plan rebuttal expert is retained late and given three weeks to work.
That is a mistake, because life care plans are unusually vulnerable documents. They are long, they are built from hundreds of individual assumptions, and each assumption is independently testable. A plan that produces an eight figure total will typically contain enough unsupported line items to move that figure substantially, and finding them is methodical work rather than inspired advocacy.
What follows is the order to work in.
Start with the medical record, not the plan
The first pass should not be reading the plan. It should be building your own list of what the treating physicians actually recommended.
Go through the records and extract every forward looking treatment recommendation with its source and date. Surgeries contemplated, therapies prescribed, follow up intervals stated, equipment ordered, restrictions imposed. This list is the universe of care that has physician support.
Then read the plan against it. Every line in the plan either appears on your list, or it does not. The items that do not are your starting point, because a life care planner is generally not qualified to make treatment recommendations independently. Their role is costing out care that a physician has recommended. When a plan projects a category of care that no treating provider ever mentioned, the planner has either obtained a recommendation outside the record, which they should be able to document, or they have supplied it themselves, which is a problem.
This exercise is tedious and it is where most of the value is. Do it before anything else. For how qualification attaches to that line between costing and recommending, see qualifying an expert witness.
Test frequency and duration separately from the item
An item can be properly supported and still be overstated, because the plan assigns a frequency and a duration that the record does not support.
If the physician wrote that the client should follow up every six months and the plan projects quarterly visits, the item is real and the frequency is doubled. Across a forty year projection that difference is significant, and it is documented in one line of the medical record.
Duration deserves the same treatment. Care that a physician described as ongoing until the client stabilizes is not the same as care projected for the entire life expectancy. Plans frequently extend finite treatment courses indefinitely without noting the assumption.
Work through the plan line by line on these two variables. They compound in a way that individual unit costs do not.
Examine the cost basis
Ask in discovery what sources the planner used for cost data, and get the underlying documentation.
The central question is whether the plan uses billed charges, allowed amounts, or paid amounts. Billed charges are list prices that most patients and payers do not pay, and a plan built on them will overstate realistic cost. Plaintiff planners often have a reasoned position for using them, and you should know what that position is before deposition rather than during it. How those figures are typically built is covered in life care plan cost calculation expert.
Check geography. National average cost data applied to a specific market can be materially wrong in either direction, and the plan should show an adjustment.
Check the age of the data. Cost figures compiled several years ago and applied without update understate the current baseline, which sounds favorable to the defense until you realize the plaintiff's economist may correct for it in a way that is harder to challenge.
Look at equipment replacement schedules
Durable medical equipment lines are frequently aggressive and are among the easiest items to challenge with external evidence.
Manufacturer stated useful life, Medicare reasonable useful lifetime standards, and industry replacement norms all provide reference points. A plan that replaces a power wheelchair every three years against a five year standard has overstated that line by roughly two thirds across the projection.
These items are also cumulative. Wheelchairs, lifts, hospital beds, vehicle modifications, and home modifications all carry replacement schedules, and small adjustments across all of them add up.
Add the plan up yourself
Duplication survives in long plans because nobody totals the components independently.
Case management billed as a separate line where the underlying services already include coordination is double counting. Attendant care hours that overlap with skilled nursing hours in the same period is double counting. Therapy billed both as an itemized service and inside a rehabilitation program is double counting.
None of this is usually intentional. It survives because the plan is long and the reviewer is reading rather than auditing.
Life expectancy is the highest leverage assumption
Every projected cost extends across the assumed life expectancy. If that assumption is wrong, the entire plan is wrong proportionally, which makes it the single most consequential number in the document.
Plans typically apply general population tables. Where the injury itself materially affects longevity, which is the case in high level spinal cord injury and in some severe brain injury presentations, applying general population figures overstates the projection substantially. TBI expert witness work often sits upstream of that analysis.
This is a medical question and requires medical support. A life care planner cannot establish reduced life expectancy on their own, and your rebuttal planner should not try. But the issue should be identified early because it requires a separate expert and a separate disclosure.
Retain the rebuttal expert with time to work
A rebuttal planner given the opposing report and two weeks will check that report for internal consistency. A rebuttal planner given the underlying medical record and adequate time will test the report against the evidence, which is a different and far more effective exercise.
The difference is visible in the report and it is visible on cross. Build the time in. For what that rebuttal role actually involves and how to evaluate a candidate, see life care plan rebuttal expert and the related discussion of life care plan rebuttal.