Life Care Plans in Massachusetts Injury Cases

The plan answers the forum's two questions about future care: what the person will need, and what it will cost where the person lives. It lists each item of care the medical record and the treating providers support, from physician follow-up, therapies, medications and diagnostic testing to durable medical equipment and supplies, home and vehicle modification, transportation, attendant care and case management, with the surgeries and procedures the record anticipates, and for each item it states how often the item recurs, for how long and what its price rests on. Every line traces to the record or to the published standard of practice that supports it, and the plan is read as a whole against the person's life expectancy. It is written for two readers at once: the forum, which asks whether each need is supported and each price is real, and the forensic economist, who takes the finished plan and reduces its items to present value for the damages claim. The plan is prepared for the person's own region, because the price of a therapy visit or an hour of attendant care is set by the market the person will buy it in, and a plan for a Boston resident, a Worcester resident and a Cape Cod resident is priced separately for that reason. The life care plan guide defines the plan and its components without reference to a state; what this guide adds is the Massachusetts forums, the steps at which the plan is used in each, and the way the plan is priced for a resident of the Commonwealth.

The Superior Court states on its page that it is a trial court of general jurisdiction for Massachusetts and that its justices sit in courthouses in every county. A personal injury, medical malpractice or wrongful death action for which a KWVRS plan is retained can be filed there, and the plan is served in that action as the court's expert disclosure practice provides. The same page states that the Superior Court has exclusive authority to convene medical malpractice tribunals; it describes nothing further about them, and this guide says nothing further either. Whether, when and in what form a life care plan is placed before a tribunal is a question for counsel, and the plan KWVRS prepares is prepared for the action in which it is served. The Appeals Court's page describes that court as the Commonwealth's intermediate appellate court with general appellate jurisdiction over the decisions of the trial judges, and the Supreme Judicial Court's page describes it as the Commonwealth's highest appellate court. A federal matter that carries a claim for future care is heard in the United States District Court for the District of Massachusetts, whose page lists divisional offices in Boston, Worcester and Springfield, with the John Joseph Moakley United States Courthouse in Boston; the plan for a federal matter is the same document organized to that court's disclosure practice. Nothing here says that every civil action is heard in the Superior Court; the court's own page, not this guide, describes its jurisdiction.

The Probate and Family Court's page says the department handles court matters that involve families and children, like divorce, child support and wills, and that it has jurisdiction over family-related and probate matters such as divorce, paternity, child support, custody, parenting time, adoption, ending parental rights, abuse prevention, wills, estates, trusts, guardianships, conservatorships and name changes; guardianship appears again among the services the page lists. A life care plan reaches this court where the future care of a child or an adult with a disability enters one of those matters: a child support question in which a parent's documented care of a disabled child is at issue, or a guardianship or conservatorship in which counsel raise the person's future needs and their cost. The court's page says nothing about life care plans, and this guide does not say how the court weighs one; it says only that counsel in such matters ask KWVRS the same question the Superior Court action asks, what this person will need and what it will cost, and receive the same document. Where the plan is paired with an earning capacity assessment of a parent, the Massachusetts alimony earning capacity guide describes that assessment. The court sits in divisions, and the plan is organized to the disclosure practice of the division in which the matter is pending.

The Department of Industrial Accidents states on its page that it oversees the Massachusetts workers' compensation system; its main office is in Boston, and its page lists offices elsewhere in the Commonwealth. Where an injured worker's future medical treatment and its cost are contested, the life care plan addresses that treatment, and the department's page on the steps in its dispute resolution process fixes where the plan can be used. The page lists conciliation, an informal meeting with a conciliator from the department; a conference, an informal discussion before an administrative judge, who issues a temporary order if the issues are not resolved; a pre-hearing conference held before the hearing opens; the hearing, which the page calls the trial phase of the case, at which Massachusetts rules of evidence apply, witnesses are called and a stenographer records testimony; and the Reviewing Board, which hears appeals of hearing decisions and whose administrative law judges examine the hearing transcripts. A further appeal goes to the Appeals Court, whose own page counts final decisions of the Industrial Accident Board, as that page names it, among the appeals it hears. KWVRS matches the plan to the step. For conciliation and the conference the deliverable is a summary of the contested treatment, its basis in the record and its cost, short enough to be read at an informal step; for the hearing it is the full plan, every item with its frequency, duration, cost basis and source, written knowing that the planner may be among the witnesses called and that the transcript is what the Reviewing Board later examines. The department's pages describe no written submission at the informal steps beyond the medical documentation the page asks the worker to bring, and they do not mention life care plans; whether to place one before the conciliator or the judge is counsel's decision, and the plan states no view on what benefit follows.

Plans are prepared by the roster's certified life care planners, with physician support for the items that fall within the scope of medical practice; the planners and the physicians behind each plan are named with their credentials on the life care planning practice page, never in a guide. The work runs in one order. The medical record is read in full and a chronology of diagnoses, treatment and current status is built. The evaluee and the family are interviewed, so that the plan reflects how the person lives and what the household already does, and the treating providers are consulted where the assignment calls for it, their recommendations recorded with the provider named. Future needs are then projected to the published standards of practice for life care planners: medical follow-up by specialty, therapies, medications, diagnostic testing, durable medical equipment and supplies, home and vehicle modification, transportation, attendant care, case management, and the surgeries and procedures the record anticipates, with the life expectancy over which the plan runs taken from the published life tables unless a treating physician states a different one in the record. Each item states how often it recurs, for how long and what its cost rests on, and each is traced to the record or the standard that supports it, so that a reader can follow every line back to its source. The plan is revised when new records arrive or the clinical picture changes, and the revision is served. The life care plan development method page describes the steps in detail.

Pricing follows the person's region. Each item is priced from provider and supplier pricing and published fee data for the region where the person lives, and the plan states which region it priced to and why, so that the price of a therapy visit, a wheelchair or an hour of attendant care can be set beside what that market charges. Price, frequency and duration are kept as separate figures on every line, so that an opposing planner can test each on its own and the economist can carry each into the present value calculation without reworking the plan. The plan prices in current dollars and leaves growth and discounting to the forensic economist, who takes the finished plan and reduces its items to present value; the future medical costs guide and the present value method page describe that step, and the Massachusetts forensic economics page carries the series the economist uses for the Commonwealth. The plan does not address collateral sources, which are a matter for counsel and the forum; it does not state what any party should pay; and it does not say what the forum should award. It states what the care will cost where the person lives, with each price traceable to a provider, a supplier or a published fee schedule.

The written plan follows the expert disclosure practice of the forum hearing the matter, and the Massachusetts expert disclosure page summarizes that practice for the Superior Court, the department and the Probate and Family Court as the pages it cites state it. Deposition and trial testimony on the plan follow the case calendar, and the plan is written so that the planner's testimony and the document say the same thing: the testimony walks the same items in the same order with the same sources. Plaintiff and defense counsel retain KWVRS with one method, so a plan prepared for an injured person's counsel and a plan prepared for a defendant's or an insurer's counsel rest on the same record review, the same standards of practice and the same regional pricing, and the opinion may be that the record supports less care than is claimed or more. A review of an opposing life care plan applies the same discipline to that plan: whether each item is supported by the record or a provider recommendation, whether frequency and duration are stated and supportable, whether the pricing is regional and sourced, and whether the life expectancy applied is the published one or a stated medical one. The Massachusetts life care planning page carries the forums, the roster and the engagement terms for the Commonwealth. Attorneys confirm the governing rule for their case.

The Massachusetts pages that carry the forums, the practice and the method this guide describes, with the guides that define the plan and the present value step without reference to a state:

• Life care planning in Massachusetts
• Expert disclosure in Massachusetts
• Massachusetts
• Boston
• What is a life care plan?
• Future medical costs in personal injury cases