Michael Pines | August 1, 2026 | Catastrophic Injuries \ Personal Injury
Quick Insights
- Future medical expenses may include decades of treatment, rehabilitation, medication, equipment, personal care and accessibility needs following a catastrophic injury.
- A life-care plan is a detailed, individualized assessment of the medical services, supplies and support an injured person is reasonably expected to need.
- The plan may address future surgeries, physician visits, rehabilitation, medications, assistive technology, home modifications and attendant care.
- Treating physicians, life-care planners, rehabilitation professionals, vocational experts and economists may contribute to the calculation.
- Costs are not estimated simply by multiplying today’s bills by the number of years remaining. The analysis may also consider frequency, replacement schedules, life expectancy, medical-cost inflation and present value.
- Under California law, future medical expenses must be reasonably necessary and reasonably certain to occur – not merely possible or speculative.
- Insurance companies may challenge the need, frequency, cost or duration of proposed care, making detailed medical support essential.
- Resolving a claim without accounting for future care could leave the injured person and their family responsible for substantial expenses later.
A catastrophic injury can change nearly every part of a person’s life. The injured individual may need repeated surgeries, years of rehabilitation, prescription medication, mobility equipment, home assistance and modifications that make everyday activities possible.
Those needs may continue long after a personal injury case ends.
That is why calculating future medical expenses is one of the most important – and most complicated – parts of a catastrophic injury claim. A settlement or verdict should not be based solely on the bills incurred during the first few months after an accident. It should consider the care the injured person is reasonably expected to require over the remainder of their life.
In serious cases, attorneys often work with medical professionals, life-care planners and economic experts to develop a detailed projection. This process is designed to answer two critical questions:
- What future care will the injured person probably need?
- How much money will be required to provide that care when it is needed?
What Are Future Medical Expenses?
Future medical expenses are the reasonable costs of accident-related healthcare and support that an injured person is expected to require after a claim is resolved.
They are different from past medical expenses, which generally consist of treatment already received and bills already incurred.
Future expenses may include:
- Physician and specialist appointments
- Hospital care
- Diagnostic testing
- Surgery
- Physical, occupational or speech therapy
- Psychological or neuropsychological treatment
- Prescription medication
- Medical supplies
- Prosthetics and orthotics
- Wheelchairs and other mobility devices
- Home healthcare
- Attendant or personal-care assistance
- Accessible transportation
- Home modifications
- Replacement medical equipment
- Long-term residential or skilled nursing care
The projected needs depend on the injury. Someone with a spinal cord injury may require mobility equipment, skin-integrity care, home assistance and periodic treatment for complications. A person with a severe traumatic brain injury may need cognitive therapy, behavioral care, supervision and help managing daily activities.
There is no single formula that applies to every catastrophic injury claim.
What Must Be Proven Under California Law?
California’s civil jury instructions allow an injured person to seek the reasonable cost of reasonably necessary medical care that is reasonably certain to be required in the future. The amount cannot be based entirely on speculation or on treatment that is merely possible.
This does not mean every appointment must already be scheduled. Future healthcare is inherently predictive. The evidence must nevertheless establish a reasonable medical basis for believing the care will be needed.
Supporting evidence may include:
- Treating physicians’ opinions
- Surgical recommendations
- Rehabilitation assessments
- Current medical literature
- The patient’s prognosis
- The expected progression of the condition
- Complication risks
- Prior treatment response
- A professionally prepared life-care plan
The more substantial the projected cost, the more important it becomes to explain why the care is necessary, how often it will occur and how long it is expected to continue.
What Is a Life-Care Plan?
A life-care plan is a comprehensive document that identifies the current and future services, equipment and support a person is expected to need because of a catastrophic injury or chronic disability.
Professional life-care planning standards describe the process as an individualized assessment built from medical records, clinical information, research, consultations and the person’s unique circumstances. The plan generally outlines recommended items and services, their expected frequency and their associated costs.
A life-care plan is not merely a list of expensive possibilities. It should connect each recommendation to the injured person’s diagnosis, prognosis, functional limitations and medical evidence.
A comprehensive plan may include:
- The person’s medical history
- Diagnoses and accident-related impairments
- Current treatment
- Functional abilities and limitations
- Expected future complications
- Recommended medical services
- Therapy requirements
- Equipment and supply needs
- Personal-care requirements
- Environmental modifications
- Frequency and duration of each item
- Local or regional cost research
- Equipment replacement schedules
- The anticipated period over which each cost will occur
The plan may cover the injured person’s remaining estimated lifespan, although not every service will necessarily continue for life. Some needs may be temporary, while others may increase as the individual ages.
Who Prepares a Life-Care Plan?
Life-care plans may be prepared by qualified nurses, physicians, rehabilitation professionals or other practitioners with appropriate training and experience.
The planner typically does not work in isolation. Depending on the case, the process may involve consultations with:
- Treating physicians
- Surgeons
- Neurologists
- Physiatrists
- Physical therapists
- Occupational therapists
- Speech-language pathologists
- Neuropsychologists
- Mental health professionals
- Prosthetists
- Rehabilitation engineers
- Case managers
- Home-modification specialists
- Vocational experts
- Economists
Each professional may address a different part of the injured person’s future.
A surgeon may explain whether another procedure is likely. An occupational therapist may assess the equipment needed for bathing or dressing. A rehabilitation engineer may evaluate wheelchair access. An economist may calculate how inflation and investment assumptions affect the amount needed today to pay future costs.
How Is the Injured Person Evaluated?
The life-care planning process generally begins with a detailed review of the individual’s medical condition and daily needs.
The planner may examine:
- Emergency and hospital records
- Operative reports
- Imaging studies
- Rehabilitation notes
- Medication histories
- Prior medical records
- Physicians’ recommendations
- Functional assessments
- Employment information
- Home environment
- Family support
- Existing equipment
The planner may also interview the injured person and family members. In some cases, an in-person assessment helps the planner understand how the injury affects mobility, communication, self-care, cognition and safety.
The goal is to develop an individualized plan. Two people with the same diagnosis may have very different needs because of their age, injury severity, occupation, home environment, family support and medical complications.
How Are Future Surgeries Calculated?
Some catastrophic injuries require more than one operation. Other patients may need revision procedures years after the original surgery.
Future surgical expenses may involve:
- Spinal procedures
- Orthopedic reconstruction
- Joint replacement
- Revision of surgical hardware
- Neurosurgery
- Skin-graft procedures
- Plastic or reconstructive surgery
- Amputation revision
- Implant or pump replacement
- Treatment of foreseeable complications
Estimating the cost requires more than listing the surgeon’s fee.
A projection may include:
- Preoperative testing
- Surgeon and assistant fees
- Anesthesia
- Hospital or surgical-facility charges
- Imaging
- Medical devices or implants
- Postoperative physician visits
- Medication
- Rehabilitation
- Home assistance during recovery
- Transportation to appointments
- Potential replacement or revision procedures
Medical testimony is often essential. An insurance company may argue that a proposed operation is only one possible treatment option or that the claimant may never choose to undergo it.
A supporting physician can explain whether the procedure is reasonably probable, what medical developments would trigger it and when it is likely to become necessary.
Rehabilitation and Therapy Costs
Rehabilitation is often central to recovery after a traumatic brain injury, spinal cord injury, amputation, severe burn or major orthopedic trauma.
Future rehabilitation may include:
- Physical therapy
- Occupational therapy
- Speech and language therapy
- Cognitive rehabilitation
- Vocational rehabilitation
- Psychological counseling
- Behavioral therapy
- Recreational therapy
- Driver rehabilitation
- Aquatic therapy
The calculation should address the type of therapy, the frequency of sessions and the expected duration.
For example, the plan may recommend intensive therapy several times a week during an initial period, followed by periodic sessions to maintain mobility or address complications. Some individuals may need additional courses of therapy after surgery, a change in function or replacement of a prosthetic device.
Maintenance therapy can be disputed by insurers that characterize it as unnecessary because it may not produce further improvement. Medical professionals may need to explain that ongoing treatment is intended to preserve function, prevent contractures, reduce pain or avoid secondary complications.
Prescription Medications and Medical Supplies
A serious injury may require medication for years or throughout the person’s life.
Potential medication expenses include drugs used to manage:
- Pain
- Muscle spasms
- Nerve symptoms
- Seizures
- Depression or anxiety
- Sleep difficulties
- Blood clots
- Bowel or bladder dysfunction
- Infection
- Skin breakdown
- Cognitive or behavioral symptoms
The analysis may consider:
- The current dosage
- Frequency of use
- Generic versus brand pricing
- Periodic monitoring
- Possible medication changes
- Infusion or injection costs
- Supplies needed to administer the medication
Future costs can also include recurring supplies such as catheters, wound-care products, braces, disposable gloves, feeding supplies or incontinence products.
Small recurring expenses can become substantial when projected over decades.
Assistive Devices and Medical Equipment
Assistive equipment can allow an injured person to move safely, communicate, work and participate in everyday life.
A life-care plan may include:
- Manual or power wheelchairs
- Wheelchair cushions
- Walkers or canes
- Prosthetic limbs
- Orthotic braces
- Hospital beds
- Patient lifts
- Shower and toileting equipment
- Communication devices
- Hearing or vision aids
- Environmental-control systems
- Functional electrical-stimulation equipment
- Portable ramps
- Backup equipment
Medical equipment does not last forever. A power wheelchair may need replacement, while batteries, cushions and other components may require more frequent service.
A reliable calculation should therefore address:
- Initial purchase price
- Maintenance
- Repairs
- Replacement frequency
- Training
- Accessories
- Backup devices
- Changes in the person’s size or condition
Counting only the first wheelchair or prosthetic device could substantially underestimate the lifetime expense.
Home Modifications
An injured person may be unable to return safely to a home that was designed for someone without mobility or cognitive limitations.
Potential home modifications include:
- Entrance ramps
- Widened doors and hallways
- Accessible bathrooms
- Roll-in showers
- Grab bars
- Lowered counters
- Wheelchair-accessible sinks
- Stair lifts
- Ceiling-mounted lifts
- Bedroom relocation
- Non-slip flooring
- Emergency alert systems
- Improved lighting
- Fencing or security features
- Backup power for medical equipment
In some situations, modifying the current property may not be practical. The plan may evaluate the added cost of obtaining an accessible residence or constructing a suitable living space.
The calculation should distinguish between the ordinary cost of housing and the additional expense made necessary by the injury.
Accessible Transportation
Transportation needs may also change after a catastrophic injury.
An individual who uses a wheelchair may require:
- A wheelchair-accessible van
- A ramp or lift
- Hand controls
- Modified seating
- Vehicle restraints
- Driver training
- Transportation services
- Periodic vehicle replacement
As with medical equipment, a vehicle modification is not necessarily a one-time expense. The plan may include replacement cycles, maintenance and the added cost associated with purchasing an appropriate vehicle.
Attendant Care and Personal Assistance
Attendant care can become one of the largest components of a catastrophic injury claim.
Some injured people need help with:
- Bathing
- Dressing
- Toileting
- Eating
- Medication management
- Transfers
- Mobility
- Transportation
- Household tasks
- Skin inspection
- Bowel or bladder programs
- Cognitive supervision
- Behavioral management
- Safety monitoring
The required level of care may range from a few hours each week to continuous 24-hour support.
The plan must consider:
- Number of hours needed
- Type of caregiver
- Required skill level
- Local hourly rates
- Overnight supervision
- Weekend and holiday rates
- Respite care
- Agency charges
- Changes as the injured person ages
Family members frequently provide extensive unpaid care after an accident. An insurer may argue that this assistance has no economic value because the family is not currently charging for it.
However, the need for care does not disappear merely because a spouse, parent or adult child has temporarily provided it. Family availability may change, caregivers may age, and the injured person may eventually require professional help.
California case authority recognizes that reasonably necessary home nursing and related care may be recoverable as medical expenses when properly supported.
Long-Term Complications Must Also Be Considered
Catastrophic injuries can create secondary medical problems that develop gradually.
Depending on the condition, foreseeable complications may include:
- Pressure injuries
- Recurrent infections
- Chronic pain
- Joint contractures
- Muscle atrophy
- Respiratory problems
- Falls
- Seizures
- Depression
- Blood clots
- Osteoporosis
- Overuse injuries
- Prosthetic complications
- Bowel or bladder problems
- Early joint deterioration
A life-care plan should not assume that the injured person’s current condition will remain unchanged. At the same time, it should not treat every theoretical complication as certain.
Medical professionals must assess which risks are sufficiently probable to include and what monitoring or preventive care is reasonably necessary.
How Are Prices Assigned to Future Services?
Once future needs are identified, the planner researches their current costs.
Possible sources include:
- Healthcare providers
- Hospital or facility charges
- Pharmacies
- Medical-equipment suppliers
- Home-care agencies
- Contractors
- Transportation vendors
- Published fee databases
- Regional market information
Costs should reflect the geographic area where the care is likely to be received. Medical and caregiving prices in San Diego may differ from costs in another part of California or the country.
The planner may calculate the current annual cost of recurring services and identify the anticipated year of major one-time expenses, such as surgeries, home renovations or equipment replacements.
The completed plan may show both annual costs and a lifetime undiscounted total.
How Is Life Expectancy Used?
Life expectancy affects how many years of care are included.
The analysis may begin with published life-expectancy data, but catastrophic injuries can sometimes shorten or otherwise affect expected lifespan. A medical expert may be needed to explain whether standard tables are appropriate for that particular person.
Relevant considerations may include:
- Age
- Sex
- Injury type
- Injury severity
- General health
- Medical complications
- Access to appropriate care
- Lifestyle and risk factors
- Scientific research regarding similar patients
Life expectancy should not be confused with work-life expectancy. One relates to how long medical care may be needed; the other concerns how long the person would likely have remained in the workforce.
How Does Medical Inflation Affect the Calculation?
Healthcare costs tend to change over time. A treatment that costs a certain amount today may cost substantially more when needed 10, 20 or 30 years from now.
For that reason, economists may apply inflation assumptions to different categories of future expenses. Medical services, medications, equipment, attendant care and construction do not necessarily increase at the same rate.
It is therefore more accurate to use category-specific, evidence-based projections than to apply one arbitrary percentage to every item.
The calculation may consider:
- Historical medical-cost trends
- General inflation
- Wage growth for caregivers
- Pharmaceutical pricing
- Equipment costs
- Construction-cost trends
- Regional economic data
These assumptions can have an enormous effect in a case involving a young person who will need care for many decades.
What Is Present Value?
A future expense is not always presented to a jury as a simple inflated lifetime total.
California jury instructions address reducing future economic damages to their present cash value. Present value represents the amount of money that, if prudently invested today, would be expected to cover the future expense when it arises.
A forensic economist may begin with the life-care plan and analyze:
- When each expense will occur
- Expected price inflation
- Appropriate growth rates
- Potential investment returns
- Discount rates
- The timing of recurring costs
- Life expectancy
The economist then calculates the amount needed in current dollars.
This process is more nuanced than simply multiplying the current annual care cost by the person’s remaining years. Professional commentary on catastrophic-injury calculations similarly emphasizes the use of inflation projections and present-value analysis.
A Simplified Example
Suppose a person will likely need a power wheelchair costing $25,000 today, with replacement every five years for 30 years.
A basic calculation might list six future chairs for a total of $150,000. That figure would still be incomplete because it may not account for:
- Medical-equipment inflation
- Different replacement dates
- Repairs and batteries
- Seating evaluations
- Accessories
- Backup mobility equipment
- Present-value adjustments
The same process must be repeated across hundreds of possible services and products.
That is why life-care plans in severe injury cases can become highly detailed.
How Insurance Companies May Challenge Future Medical Costs
An insurance carrier or defendant may dispute almost every part of the projection.
Common arguments include:
The Care Is Not Reasonably Certain
The defense may argue that a surgery, therapy or complication is only a possibility.
Medical testimony can explain why the item is reasonably probable based on the diagnosis, prognosis and treatment history.
The Cost Is Too High
An insurer may rely on lower rates from a different provider, geographic market or reimbursement system.
The parties may disagree about whether the calculation should reflect billed charges, negotiated rates, private-pay costs or another measure.
The Service Is Unnecessary
The defense may claim that less therapy, less expensive equipment or fewer hours of attendant care would be adequate.
Functional assessments and treating-provider opinions can help explain why the recommended level of support is medically appropriate.
Family Members Can Provide the Care
The insurer may assume that relatives will remain available indefinitely.
A life-care planner can address caregiver burnout, aging, employment obligations and the need for professional or respite care.
Health Insurance Will Pay
Future insurance benefits may be uncertain. Coverage, networks, deductibles, copayments and benefit rules can change over time.
The injured person’s future should not be planned around an unsupported assumption that a particular policy or public program will always cover every needed service.
The Injured Person Has a Shorter Life Expectancy
Defense experts may argue that fewer years of care should be included.
When life expectancy is disputed, both sides may present medical and statistical evidence.
Why Settling Too Early Can Be Dangerous
The full medical consequences of a catastrophic injury may not be clear immediately after an accident.
A person may still be undergoing rehabilitation. Doctors may not yet know whether another surgery will be required, whether the individual will regain independence or what permanent limitations will remain.
Accepting a settlement before those questions are adequately evaluated could leave important expenses unaccounted for.
After a settlement release is signed, the injured person generally cannot return years later and request more compensation because:
- A device needs replacement
- A family caregiver can no longer help
- Another surgery becomes necessary
- Medication costs increase
- The home requires additional modifications
- The person develops a foreseeable complication
Before resolving a catastrophic injury claim, the long-term medical picture should be developed as thoroughly as reasonably possible.
Future Medical Costs Are Only One Part of the Claim
A life-care plan focuses primarily on healthcare, equipment and related support. A catastrophic injury claim may involve other damages as well.
These can include:
- Past medical expenses
- Lost income
- Reduced earning capacity
- Pain and suffering
- Emotional distress
- Disability
- Disfigurement
- Loss of enjoyment of life
- Property damage
- Household-service losses
Vocational and economic experts may separately evaluate the injured person’s inability to return to the same work or earn the income they likely would have earned without the accident.
Care must be taken to avoid either omitting damages or counting the same expense twice.
Building a Claim That Reflects a Lifetime of Needs
Calculating future medical expenses requires much more than estimating the cost of the next doctor’s appointment.
A well-supported analysis may involve:
- Establishing the diagnosis and prognosis
- Identifying reasonably probable future care
- Determining how often each service will be needed
- Researching reasonable local costs
- Accounting for equipment replacement
- Evaluating life expectancy
- Projecting medical and service-cost inflation
- Reducing future damages to present value when required
- Explaining the conclusions through qualified expert testimony
The process should remain focused on the injured person – not simply on averages for a diagnosis.
Speak With a San Diego Catastrophic Injury Attorney
A catastrophic injury can create financial needs that extend for decades. Failing to account for future surgeries, rehabilitation, medications, equipment, home modifications and attendant care could place a tremendous burden on the injured person and their family.
The San Diego catastrophic injury lawyers at Pines Salomon Personal Injury Lawyers can investigate the accident, gather medical evidence and work with qualified experts to document the full scope of future care.
With more than 80 years of combined experience and over $100 million recovered for injured clients, Pines Salomon understands the importance of evaluating not only what an injury has already cost, but what it may continue to cost for the rest of a person’s life.
Contact Pines Salomon Personal Injury Lawyers for a free consultation to discuss a catastrophic injury claim and the compensation that may be available for future medical needs.
We proudly serve San Diego, San Diego County, and its surrounding areas:
Pines Salomon Injury Lawyers – San Diego Office
835 5th Avenue #302, San Diego, CA 92101
(858) 551-2090
Available 24/7
Pines Salomon Injury Lawyers – La Jolla Office
4660 La Jolla Village Dr. San Diego, CA 92122
(858) 585-9031
Available 24/7
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