Guide to Life Care Planning

A life care plan is a dynamic document that sets forth the anticipated future medical, rehabilitative, and related needs of an individual who has sustained a catastrophic or significant injury or illness. It translates physician recommendations, therapist assessments, and medical literature into a projected schedule of care needs with associated costs over the individual's expected lifetime.

Life care plans are most commonly developed in cases involving traumatic brain injury, spinal cord injury, severe orthopedic trauma, burn injuries, birth-related neurological injuries, and significant medical malpractice. The document is typically prepared by a certified life care planner, often in conjunction with a physiatrist, neurologist, or other treating or evaluating physician who provides the medical foundation for the care recommendations.

The plan is not aspirational - it is grounded in the individual's actual diagnosis, functional limitations, and documented needs. A properly prepared life care plan references the specific recommendations of treating and evaluating physicians, summarizes the research basis for any recurring care items, and provides sufficient detail to allow a forensic economist to calculate the present value of the projected costs.

Life care plans are organized by category of need. Common categories include: projected medical evaluations and treatments; medications (prescription and over-the-counter); diagnostic procedures; surgical interventions and revisions; physical, occupational, and speech therapy; psychological and psychiatric services; home health and attendant care; home modifications; durable medical equipment; orthoses and prostheses; wheelchairs and mobility aids; transportation modifications; educational and vocational services; and institutional or residential care.

For each item, the plan specifies the frequency of need (how often the service or item will be needed), the duration (through what age or for what period), the unit cost (based on actual pricing research in the relevant geographic area), and any escalation assumptions. Cost data is typically obtained from medical billing databases, supplier catalogs, and direct market research.

A well-prepared plan distinguishes between items that have already been provided and future needs that have not yet been addressed. It also identifies items that may vary depending on the course of the individual's condition - for example, a plan for a spinal cord injury patient may include a contingency analysis for potential surgeries depending on whether the individual develops certain complications.

Projecting future costs in a life care plan involves methodological choices that can significantly affect the total cost figure presented to a jury or mediator. The planner must determine base costs, frequency and duration of each care item, life expectancy, and whether costs should be adjusted for medical cost inflation.

Life expectancy is typically based on standard actuarial tables (such as those published by the National Center for Health Statistics) adjusted for any evidence that the individual's condition reduces their life expectancy below the general population norm (Arias et al., 2025). Physicians specializing in the relevant condition (e.g., spinal cord injury medicine) are the appropriate source for modified life expectancy opinions; the life care planner is not qualified to independently deviate from standard tables without a supporting medical opinion.

Medical cost inflation is a contested area. Some experts apply the historical rate of medical consumer price index increases (U.S. Bureau of Labor Statistics, n.d.) to project future costs, while others argue that present-value discounting applied to nominal costs adequately accounts for this factor. The interaction between medical cost inflation and the discount rate used by the forensic economist is a critical area of analysis in large damages cases, and counsel should ensure that the life care planner and forensic economist coordinate their methodological assumptions.

The primary credential in the field is the Certified Life Care Planner (CLCP), issued by the International Commission on Health Care Certification (ICHCC). Candidates must hold a qualifying clinical background (typically nursing, rehabilitation counseling, physical therapy, occupational therapy, or a related field), complete required coursework, accumulate supervised case hours, and pass a certification examination (International Commission on Health Care Certification, n.d.). The credential is renewed on a continuing education basis.

Life care planners typically come from one of several clinical backgrounds. Nurses who have specialized in rehabilitation or critical care often develop expertise in life care planning. Vocational rehabilitation counselors with a clinical focus on catastrophic injury also practice in this field. Physical and occupational therapists who transition into a consulting role may similarly obtain CLCP credentials. The clinical background of the planner is relevant when evaluating the plan, since it affects which sections of the plan the planner can independently assess versus areas that require reliance on physician recommendations.

A well-qualified life care planner can defend each line item in their plan, identify the source of every recommendation, explain how costs were researched, and address alternatives presented by opposing experts. In deposition, counsel should be prepared to probe the foundation of each significant cost item - particularly high-cost areas such as attendant care, specialized equipment, and residential placement.

In litigation, the life care plan serves multiple functions. It provides the jury with a concrete, itemized representation of the injured person's future needs, translating abstract medical testimony into tangible dollar amounts. It also provides the framework for the forensic economist's present value analysis, which converts the projected annual costs into a single lump-sum figure representing the cost of care in today's dollars. Jones & Laughlin Steel Corp. v. Pfeifer, 462 U.S. 523 (1983).

Life care plans are typically introduced through the testimony of the certified life care planner, who explains the methodology and defends the individual recommendations. The forensic economist then uses the plan as the basis for the damages calculation. In some cases, a physiatrist or treating physician is called as a separate witness to establish the medical foundation for the care needs described in the plan.

Defense experts commonly challenge life care plans on several grounds: (1) lack of foundation for specific recommendations - i.e., the treating physicians did not recommend the item; (2) inflated cost figures not reflecting what care actually costs in the relevant market; (3) inclusion of items the plaintiff has not historically used; and (4) life expectancy assumptions. A robust plan anticipates these challenges by thoroughly documenting the basis for each recommendation and the source of cost data.