What Is a Life Care Plan in Personal Injury?

James Wong — Founder & Pharmacist, LienScripts | March 13, 2024 | 7 min read

A life care plan is a comprehensive document projecting all future medical costs for a catastrophically injured plaintiff — including ongoing medications, therapies, equipment, and care. For pharmacy-heavy PI cases, pharmacy records are the clinical foundation of an accurate future drug cost projection.

This post is for informational purposes only and does not constitute legal advice.

Projecting a Lifetime of Future Medical Needs

For plaintiffs with catastrophic injuries — spinal cord injuries, severe traumatic brain injuries, permanent nerve damage, or conditions requiring lifelong care — the most important damages document may not be the past medical bills. It's the life care plan.

A life care plan (LCP) is a comprehensive, evidence-based projection of all future medical and related care costs a plaintiff will require as a result of their injuries. It is prepared by a certified life care planner — typically a registered nurse, rehabilitation specialist, or physician with specialized training in life care planning — and is used to quantify future damages in serious PI and wrongful death cases.

[!KEY] A life care plan projects all future medical costs over a plaintiff's remaining lifetime — and medications are often the second-largest cost category, making the completeness of the pharmacy treatment record a direct driver of future damages value.

What a Life Care Plan Includes

A well-prepared life care plan addresses every category of anticipated future need:

Medical care. Physician visits, specialist consultations, ongoing monitoring, future surgeries or procedures related to the injury.

Medications. All prescription drugs the plaintiff will require for the remainder of their life — identified by name, dose, frequency, and projected duration. For patients with nerve damage, chronic pain, TBI sequelae, or PTSD, this can represent a substantial multi-decade cost.

Therapies. Physical therapy, occupational therapy, speech therapy, cognitive rehabilitation, and psychological counseling.

Durable medical equipment (DME). Wheelchairs, prosthetics, orthotic devices, hospital beds, adaptive equipment for the home, and replacement costs over the plaintiff's lifetime.

Personal care and attendant services. In-home nursing care, personal care attendants, and custodial care for plaintiffs who require assistance with daily activities.

Home and vehicle modifications. Ramps, wide doorways, accessible bathrooms, lift equipment, and adaptive vehicle controls.

Vocational rehabilitation. Assessment and training if the injury changes the plaintiff's ability to work in their prior occupation.

How Pharmacy Records Support the Life Care Plan

For future medication projections — often the second-largest cost category in a catastrophic injury LCP — the treating history is the clinical foundation. A life care planner and the treating physicians rely on the plaintiff's actual medication regimen to project what will be needed going forward.

Pharmacy records from the active treatment phase document:

• Which medications have been effective for managing the plaintiff's condition.
• The doses that have been clinically established.
• The duration of use, establishing that the medications are not temporary.
• The treating physicians' clinical rationale for each medication.

A comprehensive pharmacy record from LienScripts — including the LSR (Lien Summary Report) and POGOS report — provides the organized, prescriber-verified treatment history that life care planners require. Without an organized pharmacy record, life care planners may underestimate medication costs or struggle to identify all medications the plaintiff will need.

For cases involving specialty medications — CGRP inhibitors for permanent post-traumatic migraine, specialized neuropathic pain agents, compound preparations — the pharmacy record is especially important because these medications may not be obvious from medical records alone.

[!KEY] Specialty medications in the pharmacy lien record — CGRP inhibitors, compound preparations, non-formulary neuropathic agents — are the life care plan items most likely to be underestimated if only medical records are reviewed, because physicians often reference medications by mechanism rather than brand name in their notes.

[!TIP] For Attorneys: Provide the life care planner with the LSR and POGOS report from LienScripts before they finalize medication projections — incomplete pharmacy records lead to undercounted future drug costs that are difficult to correct at deposition.

Expert Witnesses and Life Care Plans

A life care plan is a retained expert document. The life care planner will be deposed and may testify at trial. Their projections must be:

• Reliable. Based on current medical literature, clinical guidelines, and the treating physician's documented plan of care.
• Specific. Identified by medication name, dose, frequency, and unit cost.
• Internally consistent. The life care plan medications should match the treating physicians' recommendations and the pharmacy record.

The defense will retain their own life care planner to dispute costs and challenge projections. Defense experts often argue that:

• Cheaper generic alternatives exist (true in some cases, inapplicable for brand-required medications).
• The plaintiff will recover to a point that reduces future medication needs (countered by the treating physician's MMI determination).
• Some medications are not related to the injury (countered by the pharmacy record's diagnosis-coded treatment history).

Medicare Set-Asides and Future Drug Costs

For catastrophic injury cases involving Medicare beneficiaries (or plaintiffs who will become Medicare-eligible during their expected lifetimes), future medication costs may need to be addressed in a Medicare Set-Aside (MSA) arrangement. An MSA sets aside a portion of the settlement to fund future injury-related medical expenses, including prescription drugs, to protect Medicare's interests.

The MSA's pharmaceutical component is derived from the same clinical record used in the life care plan. An organized pharmacy record — showing the plaintiff's ongoing drug needs, doses, and injury-related diagnoses — is the foundation of an accurate and defensible MSA drug cost projection.

[!KEY] An organized pharmacy record from LienScripts is a dual-purpose document for catastrophic injury cases — it supports both the life care plan's medication projections and the MSA's pharmaceutical component, and providing it early to the life care planner prevents costly corrections after the expert report is drafted. See our post on Medicare conditional payments and pharmacy liens for more on how Medicare's interests interact with pharmaceutical treatment costs.

Key Takeaway

A life care plan projects all future medical costs for a catastrophically injured plaintiff over their remaining lifetime. Medications often represent a major cost category, and the treating pharmacy record — organized through a lien administrator like LienScripts — provides the clinical foundation for accurate, defensible future drug cost projections. For every catastrophic injury case, the completeness and organization of the pharmacy record directly affects the life care plan's pharmaceutical cost estimates.