Spinal Cord Injury

Considering an expert: matching the expert complement to the neurological level

The neurological level and the completeness of the injury decide almost everything that follows, so the considering stage is a reading of the medical record before any expert is approached. A complete cervical injury implies attendant care, equipment and home modification on a scale that only a life care plan can organize, and an economist to reduce it to present value. An incomplete lower injury may leave a person able to work at a desk with accommodation, which makes the vocational question live and the care plan smaller. Counsel who identify which of these cases they have can retain the right experts once rather than add them piecemeal.

The other decision at this stage is timing against the medical course. Plans written before the person has left inpatient rehabilitation describe needs that will change; plans written after the first year of community living rest on observed function, equipment use and care hours. Where the calendar allows, the later plan is the stronger one for either side.

Retaining: the planner, the physician and the shared facts

Retention in a spinal cord injury matter is the point at which the life care planner's relationship with the treating physiatrist is set up. The plan's recommendations for therapy, equipment, supplies, home and vehicle modification and attendant care carry weight when a treating or consulting physician endorses them, so the engagement should name who will supply the medical foundation and how the planner will document it. KWVRS life care planners work with the roster's physician on that foundation and coordinate the vocational and economic engagements so that the care hours, the work restrictions and the earnings projection describe the same person.

The records the experts need go beyond the charts: the durable medical equipment history with dates and vendors, the current home layout and vehicle, the pattern of paid and unpaid care the household already provides, and the pre-injury work and earnings history. An engagement that gathers those before the first expert conference shortens the report and removes the most common grounds for a supplemental.

Preparing for deposition: the sources behind every line of the plan

A life care plan is deposed line by line, so the preparation is an audit of sources. For each item the expert should be able to state who recommended it, how often it recurs, what it costs in the person's own market and where that cost came from. Attendant care draws the sharpest questioning, and the expert defends it with the functional assessment behind the hours, the split between skilled and unskilled care, and the rate source for each. The vocational expert, if one is retained, prepares on the same footing: the restrictions adopted, the accommodations assumed and the labor market evidence for any occupation identified.

Counsel on either side should also prepare the expert for the opposing plan or critique, so that the differences can be explained as choices of source or assumption rather than left as unexplained gaps.

Trial: walking a jury through a lifetime of care

Trial testimony in these matters is a guided tour of the plan. The expert groups the items into categories a jury can hold in mind, explains why each exists at this neurological level, and lets the economist convert the totals to present value in a separate, shorter appearance. Photographs or diagrams of equipment and modifications, and a timeline of replacements over the life expectancy, do the work that a table of figures cannot. The testimony has to reconcile with the deposition and with what the treating physicians said on the stand, so the trial preparation ends with a check of the plan against the medical testimony already given.