Medical Cost Projection applied to workers' compensation litigation: methodology, deliverables, and case-specific considerations.
Plans address the injury-related care the treating physician projects: physician follow-up, medications, injections, future surgery, therapy, durable medical equipment and replacement, diagnostic testing, and, in catastrophic work injury, attendant care and home modification. Because state fee schedules govern payment, the plan typically prices items under the applicable schedule and, where useful, at usual and customary rates for comparison.
A written expert report, supporting data appendices, and, when retained, deposition and trial testimony.
The clinical methodology is the same, but pricing follows the state fee schedule, the scope is limited to injury-related care the carrier is responsible for, and the plan is often prepared with settlement and Medicare Set-Aside requirements in mind.
When a settlement closes future medical benefits and the claimant is a Medicare beneficiary or has a reasonable expectation of enrollment. The allocation projects Medicare-covered, injury-related care and is prepared from the same records and physician projections as the life care plan.
The plan documents the treating physician's recommendations and their clinical basis, which counsel can use in disputes over the reasonableness and necessity of future treatment under the state's procedures.
Under the applicable fee schedule for the carrier's obligation, with market rates shown where the claimant may need to purchase care outside the system after settlement.
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