Medical Cost Projection Services
A medical cost projection estimates the cost of an individual’s expected future medical treatment over a defined period. It is a shorter, faster, and lower cost alternative to a full life care plan, and it is often the right first step when a claim, case, or reserve decision needs a defensible number before anyone commits to a comprehensive plan.
Rehabilitation Care Coordination has prepared future medical cost analyses for attorneys, insurers, employers, and fiduciaries for more than thirty years. Our medical cost projections are prepared by the same certified life care planners who produce our full life care plans, using the same clinical review process and the same cost research standards.
What Is a Medical Cost Projection?
A medical cost projection, often shortened to MCP, is a written report that identifies the medical treatment an injured or ill individual is reasonably expected to need going forward and assigns a cost to each item over a stated period of time. The projection is grounded in the medical record, in the treating providers’ documented recommendations, and in current cost data for the geographic area where the care will actually be delivered.
A medical cost projection answers a narrower question than a life care plan. It focuses on the cost of medical treatment. It does not attempt to describe the full picture of a person’s long term functional, residential, and support needs.
Medical Cost Projection vs. Life Care Plan
Both documents project future care costs. They differ in scope, in the depth of assessment behind them, and in what they are built to withstand.
| Medical Cost Projection | Life Care Plan | |
|---|---|---|
| Scope | Medical treatment, medications, diagnostics, and directly related services | All future care needs, including attendant care, home modification, equipment, transportation, therapies, and support services |
| Time horizon | A defined period, often a set number of years | Typically the individual’s remaining life expectancy |
| Assessment basis | Medical records and documented provider recommendations | Records, provider recommendations, a clinical interview, and usually a home and life assessment |
| Typical use | Early case evaluation, reserve setting, mediation, settlement negotiation | Trial, structured settlement, trust funding, long term care planning |
| Testimony | Generally supports negotiation rather than trial testimony | Prepared to withstand deposition and cross examination |
| Relative cost and turnaround | Lower cost, shorter turnaround | Higher cost, longer turnaround |
Many matters begin with a medical cost projection and convert to a full life care plan when the case does not resolve. RCC structures its projections so that the underlying records review and cost research carry forward, which reduces duplicated work and cost if a full plan later becomes necessary.
When a Medical Cost Projection Is the Right Tool
- Early case evaluation, before liability and damages positions have hardened
- Setting or adjusting claim reserves on an open file
- Preparing for mediation or a settlement conference
- Evaluating a demand package or testing an opposing expert’s damages figure
- Budgeting for a client whose treatment is ongoing but whose long term needs are not yet clear
- Matters where the projected treatment period is finite rather than lifelong
When a Full Life Care Plan Is the Better Choice
- Catastrophic injury with permanent functional loss, including spinal cord injury, traumatic brain injury, amputation, and severe burn injury
- Cases proceeding to trial where a damages expert will testify
- Funding a special needs trust or structuring a settlement
- Matters involving attendant care, home modification, or long term equipment replacement schedules
- Pediatric cases where the care horizon extends across decades and developmental stages
If you are not certain which document your matter calls for, RCC will review the file and tell you. We would rather scope the work correctly than sell a report that does not fit the case.
What an RCC Medical Cost Projection Includes
- Review of medical records, imaging reports, operative notes, and provider documentation
- Identification of recommended and reasonably anticipated future treatment
- Frequency, duration, and replacement schedules for every projected item
- Current geographic cost research tied to the market where care will be delivered
- Itemized cost tables with annual and cumulative totals
- A written narrative explaining the clinical basis for each projected item
- Clear notation of any item that is clinically indicated but not yet confirmed by a treating provider
How We Build a Medical Cost Projection
- Records review. We read the full medical record rather than a summary, including provider notes, imaging, therapy records, and prior authorizations.
- Treatment identification. We separate treatment that has been affirmatively recommended by a provider from treatment that is clinically anticipated based on the diagnosis and course of recovery. The report distinguishes between the two.
- Frequency and duration analysis. Each item receives a frequency, a duration, and where applicable a replacement interval, so that the totals can be traced line by line.
- Cost research. We research current costs in the geographic market where the individual receives care. Regional differences in provider rates, facility charges, and equipment pricing are material and we do not apply national averages in place of local data.
- Report assembly. Costs are presented in itemized tables with a supporting narrative, so that any single figure can be tied back to a specific clinical rationale.
- Internal review. A second certified life care planner reviews the projection before it is released.
Who Uses Our Medical Cost Projections
Plaintiff Attorneys
A projection gives you a supportable damages figure early, before the expense of a full life care plan, and gives you something concrete to bring to mediation.
Defense Counsel and Insurers
A projection provides an independent read on future medical exposure, useful for reserve accuracy and for evaluating a plaintiff demand that may be built on national averages rather than local cost data.
Employers and Third Party Administrators
On workers’ compensation matters, a projection helps quantify anticipated future treatment on a claim that is stabilizing but not closed.
Fiduciaries, Trustees, and Conservators
A projection supports budgeting decisions for a beneficiary whose medical needs are ongoing and whose funds must be allocated across a defined period.
Frequently Asked Questions
Q
What is the difference between a medical cost projection and a life care plan?
A
A medical cost projection covers expected medical treatment costs over a defined period. A life care plan covers all future care needs across the individual’s remaining life expectancy, including attendant care, home modification, equipment, and support services. A projection is faster and less expensive. A life care plan is more comprehensive and is built to withstand deposition and cross examination.
Q
Who prepares RCC’s medical cost projections?
A
Our projections are prepared by certified life care planners with clinical nursing backgrounds, the same professionals who prepare our full life care plans. Every projection receives a second internal review before release.
Q
Can a medical cost projection be converted into a full life care plan later?
A
Yes. We structure projections so that the records review and cost research carry forward. If a matter does not resolve and a full life care plan becomes necessary, the earlier work reduces both the cost and the turnaround time of the plan.
Q
Is a medical cost projection admissible at trial?
A
A medical cost projection is most often used in negotiation, reserve setting, and mediation rather than as trial evidence. Admissibility depends on the jurisdiction, the scope of the report, and how it was prepared. When a matter is likely to be tried, we generally recommend a full life care plan instead.
Q
What records do you need to get started?
A
At minimum we need the medical records covering the injury or illness and the course of treatment to date, including provider notes, imaging reports, and any documented recommendations for future care. We will tell you if anything material is missing before we begin.
Q
Do you prepare medical cost projections outside California?
A
Yes. RCC works on matters nationwide. Because regional cost variation is significant, we research costs in the market where the individual actually receives care rather than applying a single national figure.
Request a Medical Cost Projection
Send us the file and we will tell you whether a medical cost projection or a full life care plan fits the matter. Call 1 (619) 299-9922 or use the contact form to start the conversation.
Call us at (619) 299-9922, email info@rehabcarecoord.com, or use the contact form to request a case consultation.
