Life Care Plans &
Medical Necessity


Personal injury and malpractice cases increasingly feature damages in the form of expected future care, life care plans, (“LCPs”) and related forms of future losses (for example, earnings or hedonic damages). There are five main limitations to the typical LCP: (1) dollar amounts reflect expected charges, not reasonable value; (2) some services may not be medically necessary and would benefit from an independent review of necessity; (3) some non-medical services, like attendant care, may be incorrectly valued; (4) estimates of life expectancy (“LE”) may be incorrect or may fail to account for preexisting conditions known to decrease LE; and (5) inflation and net present value (“NPV”) may not be properly accounted for. Avalon has a team who can provide insights on all these tasks, determining reasonable value and medical necessity. Our clinical team can also develop LCPs that take into consideration reasonable value and medical necessity.

Types Of Engagements

  • Reasonable value of life care plans in personal injury cases
  • Calculation of future Medicare, Medicaid, workers’ compensation, and Personal Injury Protection (PIP) payments
  • Development of life care plans in a personal injury cases
  • Assessment of medical necessity in life care plans
  • Calculation of life expectancy based on pre-existing comorbid conditions
  • Cost parameter estimates for future care in cost impact, budget impact, and cost-effectiveness models

Reasonable Value of Medical Charges

Key Staff

  • John Schneider, PhD
  • Cara Scheibling, MBA
  • Anna Whelan, BA
  • Laura Bellmont, MPAS

Related Markets & Industries

  • Insurance & third-party payers
  • Attorneys & law firms
  • Medical services
  • Hospitals & health systems
  • Utilities
  • Construction
  • Transportation