Workers' compensation life care planning engagements focus on the injury-related care the treating physician projects, priced under the governing state fee schedule, and on the Medicare set-aside allocation that often accompanies settlement. The plan separates injury-related care from treatment for unrelated conditions so the carrier's exposure is stated accurately.
Checklist
Identify the jurisdiction's fee schedule and the accepted body parts or conditions
Obtain the treating physician's records, restrictions, and projected future treatment
Confirm Medicare status and whether a set-aside allocation is part of the engagement
Provide independent and agreed medical examination reports
Confirm whether the carrier or counsel wants usual and customary pricing shown for comparison
Questions to ask the expert
Do you price under this state's fee schedule, and how do you document the source?
How do you handle disputed or denied body parts?
Can you prepare the Medicare set-aside allocation from the same clinical foundation?
Timeline
30-45 days for most workers' compensation plans; add time if a set-aside allocation is prepared together with the plan.
Required documents
Claim file and accepted-condition determinations
Treating physician records, restrictions, and treatment plan
Independent or agreed medical examination reports
Pharmacy history and equipment records
Common pitfalls
Ignoring the fee schedule and pricing at usual and customary rates
Including care for conditions the carrier has not accepted without flagging it
Discovering Medicare status late and having to rework the settlement figures
How does a workers' compensation plan differ from a civil litigation plan?
The clinical method is the same. The difference is pricing under the state fee schedule, the limit to accepted injury-related care, and the need to reconcile the plan with a Medicare set-aside allocation at settlement.
Ready to Get Started on workers' compensation cases?
Contact our team to discuss how KW Life Care Planning can support your case with certified life care planning expertise. Request a Consultation or call (201) 343-0700.