Life Care Plan Review: 5 Common Flaws in Plaintiff Life Care Plans

As certified life care planners, we review and critique life care plans prepared for plaintiffs in personal injury litigation. To do this, we apply the Standards of Practice for Life Care Planners,[1] Consensus and Majority Statements,^[2] and other best practices that guide the life care planning process. The same standards apply to life care plan reports prepared for defendants, subject to limitations on data available to defendant’s life care planners.

In this blog, we discuss five ways in which plaintiff life care plans often violate these standards.

1. Considering pre-event injuries and conditions when making future care recommendations related to a specific event.

The Standards of Practice for Life Care Planners say a life care planner must “consider factors such as pre-existing conditions and causally related needs in forensic cases.” [3] A plaintiff’s life care plan should include only the additional costs incurred due to the event; it should not include costs for care the person would have needed had the event not occurred. For example, if the plaintiff had a knee injury and surgery that pre-dated the event in question, and the plaintiff life care plan includes medical services for the same knee without providing an explanation of how the pre-existing injury was exacerbated or the knee was reinjured due to the event, then care for the knee should not be included in the cost of the life care plan if the plaintiff would have likely needed the care had the event not occurred.

The best way to ensure only costs incurred due to the event are included in the life care plan is by reviewing medical records to evaluate if there is any mention of injuries or conditions that pre-dated the event. The existence of such records will often be noted in post-event medical records and in the plaintiff’s discovery responses and deposition. A plaintiff life care planner should request pre-event medical records and pre-event workers’ compensation and disability claim files. During the life care planning interview, the plaintiff’s life care planner can also ask the plaintiff if they had any injuries or chronic conditions before the event.

However, they often do not cite any pre-event medical records and do not document inquiring about pre-event injuries and chronic conditions. When reviewing plaintiff life care plans, medical records, and other documents, one will often find the plaintiff has pre-existing injuries and chronic conditions the plaintiff’s life care planner never mentioned. And if they are mentioned, the plaintiff’s life care planner may not have considered them when making future care recommendations.

If there are pre-existing injuries or chronic conditions, it is the responsibility of the plaintiff’s life care planner to request the relevant medical records and claim files. When a life care planner consults treating or consulting doctors to obtain their opinions on future care needs, they should make those doctors aware of pre-existing injuries or chronic conditions and if they were exacerbated by the event.

2. Consulting with treating and/or consulting doctors to obtain their opinions on future care needs.

The Standards of Practice for Life Care Planners say life care planners must “seek recommendations from other qualified professionals and/or relevant sources for inclusion of items and services outside the life care planner’s scope of practice.”[4] Plaintiff life care planners often do not consult or try to consult the plaintiff’s treating physicians about future care needs. Often a physician life care planner will base an entire lifetime of future medical treatment on a relatively brief in-person, or even remote, evaluation of the plaintiff. They may review medical records, but not consult the actual treating doctors to obtain their opinions on future care needs due to the event. Obtaining the opinions of treating physicians is necessary whether the plaintiff’s life care planner is a physician or from another discipline.

Plaintiff life care planners often recommend lifetime services and medications treating physicians have never prescribed and the plaintiff has never received. It would be prudent for the plaintiff’s life care planner to discuss with a treating physician if the plaintiff did not receive a service or medication in the past why it would be necessary in the future. It is almost never reasonable to recommend a lifetime course of injections, medications, or other services until the plaintiff has had a trial to identify the outcomes and any positive or negative effects.

We often see plaintiff life care planners who are physicians to recommend services outside their specialty. All physicians have a medical specialty, and each medical specialty has its area of expertise. While physician life care planners can recommend medical services and medications that are within the scope of practice for their specialty, they should not independently recommend services outside their specialty. For example, a plaintiff’s life care planner who is a physiatrist is not qualified to recommend surgery. They are only qualified to recommend a consultation with a surgeon to find out if surgery is medically necessary and appropriate. Likewise, a physiatrist is not qualified to recommend lifetime psychiatric or psychological services or medications without input from a clinician in these specialties.

3. Stating a reasonable basis for all recommendations in the life care plan.

The Standards of Practice for Life Care Planners and the Consensus and Majority Statements say life care planners must state a reasonable basis for all recommendations in a life care plan.[5] This is also a requirement for any opinion to be offered by an expert witness under state or federal law.

Before a life care planner can offer a reasonable basis for a recommendation for future care, the future service must be specifically defined. For example, there can be no reasonable basis for a recommendation for “essential services” if the life care plan has no definition of those services and why they are needed.

If the service is properly defined, the life care plan must explain why the service is medically necessary and appropriate to treat a condition arising from the event, and why the quantity, frequency, and duration recommended for that service is reasonable. For example, some life care planners believe it is appropriate to recommend a lifetime of medical and rehabilitative services, including services the plaintiff has never tried, based only on a review of medical records and a brief interview with the plaintiff, without providing a narrative explanation.

A plaintiff’s life care planner has a heavier burden when recommending a service or medication the plaintiff has never been prescribed or received since the event. If this is because the plaintiff lacks financial access to the service or medication, the plaintiff’s life care planner should document this. If financial access was not a barrier to treatment, the plaintiff’s life care planner should explain why the plaintiff’s treating physicians did not recommend, prescribe, or provide the treatment or medication.

Sometimes a plaintiff’s life care plan was prepared a year or years before the date of trial. The plaintiff may have had treatment since the life care plan was prepared, and the plaintiff’s condition may have changed substantially. Even if the plaintiff’s life care plan stated a reasonable basis for its recommendations when written, that basis may no longer be consistent with the facts of the case. Basing recommendations on outdated information can affect their validity and reliability.

Costs are only supposed to be included in a life care plan if they are reasonably certain (more likely than not) to be incurred.^[6] Some plaintiff life care plans for young and middle-aged plaintiffs who are ambulatory, function independently, and have no cognitive impairments include recommendations for home health and assisted living services starting 30 to 50 years in the future. Recommended home health and assisted living services can cost millions of current dollars and are often the largest cost in a life care plan. Most plaintiff life care plans that recommend these services give no explanation of what future condition the plaintiff will have that requires these services, what specific services will be provided, and how the plaintiff life care planner knows with reasonable certainty when and if the plaintiff will develop that condition.

A life care planner should have an objective basis for recommendations, instead of relying only on subjective information from the plaintiff. While the plaintiff’s subjective complaints should be considered, it is seldom reasonable to rely solely on the plaintiff’s statements. A plaintiff has an economic incentive to exaggerate symptoms and impairments to increase a damage award. Medical records, independent medical examinations, independent functional capacity evaluations, and cognitive tests with validity checks are usually a more reliable basis for opinions on future care needs, regardless of whether they support or contradict the plaintiff’s subjective statements.

Physician life care planners have the same responsibility as non-physician life care planners to state a reasonable basis for their recommendations in a life care plan. A physician must explain the facts and reasoning that show a recommendation is medically necessary and is needed due to the event. “Because I am a physician” or “because I say so” is not a sufficient basis for an opinion by a physician life care planner or any other life care planner.

4. Averaging the cost of brand-name medications with the cost of generic medications.

When providing costs for recommended future care needs in a life care plan, a life care planner should use the most reasonable and “geographically relevant and representative costs.”[7] For medication costs, some life care planners average the unit cost of a recommended brand-name medication with the unit cost for the equivalent generic medication and use the averaged unit cost in the life care plan. If there is a generic version of a drug, the reasonable cost of the drug is the lower cost of the generic, unless there is a medical reason to specify the more expensive brand-name drug. Any medical reason for the plaintiff to receive the brand-name drug should be stated and supported in the plaintiff’s life care plan. If there is a medical reason the plaintiff needs the brand-name drug, the reasonable cost is the cost of the brand-name drug. The average price of the generic and brand-name versions of a drug is never the reasonable cost. Where the generic version of a drug is medically appropriate, averaging the generic cost with the brand-name cost serves only to unnecessarily inflate the cost in the life care plan.

5. Identifying sources of costs in the life care plan.

The Standards of Practice for Life Care Planners say life care planners must “cite verifiable cost data.”[8] Some plaintiff life care planners cite no sources of the costs they included in their life care plans. This is a material violation of standards as all produced life care plans should be reproduceable and verifiable by another life care planner. If the plaintiff life care planner does not cite the sources of costs, another life care planner cannot verify the life care plan costs without making assumptions or guesses. Besides citing the sources of costs, the life care planner should identify services and medications by classification systems such as the International Classification of Diseases (ICD), Healthcare Common Procedure Coding System (HCPCS), and the National Drug Code (NDC). Current Procedural Terminology (CPT) codes,[9] a subset of HCPCS codes, are the generally accepted way to specify medical services in life care plans. Other coding systems specify services at hospitals and other facilities, durable medical equipment, and prescription drugs. If a life care planner uses a code from one of these coding systems, that code must be included in the life care plan, so another life care planner can verify that the correct code was used, and the correct cost was obtained. If the plaintiff life care planner does not use these code sets to specify services, it forces other life care planners and triers of fact to guess or assume things about the costs in the plaintiff life care plan.

Conclusion

When retained to review and critique the work of a plaintiff life care planner, one should rely on the Standards of Practice for Life Care Planners, Consensus and Majority Statements, and other best practices that guide the life care planning process. Failing to comply with these standards reduces the reasonableness and reliability of a life care planner’s opinion.

Learn more about RPC’s life care planning and expert witness services here and contact Michael Scullin, MHS, CRC, LRC, CVE, CLCP. To discuss a case, contact Athenna Dill, CPC, Personal Injury Case Manager at 512.371.8005 or adill@rpcconsulting.com.

[1] International Association of Rehabilitation Professionals, Standards of Practice for Life Care Planners, 4^th ed. (Glenview, IL: IARP, 2022), p. 12, https://cdn.ymaws.com/rehabpro.org/resource/collection/D5B16132-B4BE-4918-BA5A-1BABE8C2E1A4/iarp-standards-of-pratice.pdf, accessed October 6, 2022.

[2] Cloie Johnson, Caroline Williams, Amy MacKenzie, and Brook Feerick, “Consensus and Majority Statements Since 2000: Updated at the 2025 Life Care Planning Summit,” Journal of Life Care Planning 23, no. 2 (2025): 72-79.

[3] International Association of Rehabilitation Professionals, Standards of Practice for Life Care Planners, 4^th ed., Standard No. 11-i.

[4] International Association of Rehabilitation Professionals, Standards of Practice for Life Care Planners, 4^th ed., Standard No. 12-a.

[5] International Association of Rehabilitation Professionals, Standards of Practice for Life Care Planners, 4^th ed., Standard No. 11-a and 11-h.

[6] International Association of Rehabilitation Professionals, Standards of Practice for Life Care Planners, 4^th ed., Standard No. 11-k.

[7] International Association of Rehabilitation Professionals, Standards of Practice for Life Care Planners, 4^th ed., Standard No. 14-b.

[8] International Association of Rehabilitation Professionals, Standards of Practice for Life Care Planners, 4^th ed., Standard No. 14-f.

[9] American Medical Association, CPT 2024 Professional Edition (Chicago: American Medical Association, 2023).