By Michele Earney, VP of Operations and Marilyn R. Litwin, Senior Director of Rehabilitation Consulting.
When evaluating future medical expenses for an injured party in a legal or insurance context, two commonly used tools are Medical Cost Projections (MCPs) and Certified Life Care Plans (LCPs). Though both aim to estimate future medical needs and costs, they differ significantly in purpose, depth, methodology, and certification requirements. Understanding these distinctions is essential for attorneys, adjusters, and settlement planners involved in personal injury, workers’ compensation, or medical malpractice cases.
1. Purpose and Use
Medical Cost Projection (MCP):
- A preliminary planning tool used to estimate future medical costs based on current records.
- Typically used for settlement negotiations, early case valuation, reserve setting, or budgeting.
- Best suited for non-catastrophic injuries or when a full life care plan isn’t yet justified.
- On site visit not required.
Certified Life Care Plan (LCP):
- A comprehensive, legally defensible document that outlines the lifetime medical and non-medical needs of a catastrophically injured individual.
- Commonly used in litigation, mediation, or trial, and often presented as expert evidence.
- Tailored for cases involving long-term or permanent disability, such as spinal cord injuries, traumatic brain injuries, or severe burns.
2. Scope and Detail
MCP:
- Provides a limited snapshot or “present day value” baseline of future care.
- Based solely on existing medical records and standard pricing references (like Medicare fee schedules).
- Focuses on direct medical expenses such as physician visits, medications, and diagnostics.
- Can be based on actual age/rated age
LCP:
- Involves a comprehensive assessment, including:
- Clinical evaluations
- Interviews with the injured party and care providers including MDs.
- Review of medical, psychological, educational, and vocational records
- Projects costs over the entire lifespan and includes:
- Medical and assistive devices
- Home modifications
- Transportation
- Case management
- Caregiver support
- Vocational or educational support (if appropriate)
- Medications
- Can be based on Fee Schedule or U&C
3. Credentials and Legal Weight
MCP:
- Typically prepared by a nurse, case manager, or medical billing specialist.
- Not considered an expert report; not intended for use as formal evidence in court.
LCP:
- Must be developed by a Certified Life Care Planner (CLCP), Certified Nurse Life Care Planner )equivalent credentialed professional.
- Holds greater credibility in litigation and is often admissible in court proceedings.
- Subject to cross-examination and scrutiny as expert testimony.
4. Cost and Time Commitment
MCP:
- Faster and more affordable to produce (often completed in days).
- Ideal for quick turnarounds or when budget constraints exist.
- Need 3-5 years of previous medical, entire copy of claim payment history and RX drug history.
LCP:
- More time-intensive and costly, often requiring several weeks or months to complete.
- Justified by its thoroughness and long-term utility in major cases.
- Need entire copy of medical records, billing and/or claim payment history, present medication list.
Conclusion
While both tools play valuable roles in the claims and litigation process, a Medical Cost Projection is best suited for early-stage assessments or non-catastrophic cases, while a Certified Life Care Plan provides a detailed, expert-backed roadmap for long-term care and costs in serious injury cases. The right choice depends on the complexity of the injury, the stage of the case, and the intended use of the report.
For more information please contact Michele Earney at 321-277-4143 or Marilyn Litwinat 386-216-5565, or we can be reached via email at mearney@specialtyallocations.com or mlitwin@specialtyallocations.com. Our website is www.specialtyallocations.com.