Written and reviewed by Josh Kohanim, Esq., California Bar No. 328609 · Reviewed
In this guide
When a family is deciding whether a case is being built properly, or has been told that future care "cannot be proved," the plan is where the answer sits. This guide prices no individual case. The overview sits on our Los Angeles catastrophic injury lawyer page.
Who writes a life care plan
A life care planner is usually a rehabilitation nurse, a physician, or a rehabilitation counselor certified in life care planning. The work is a records review, interviews with the treating physicians and the family, usually a home visit, and pricing at rates the person would be charged in this region.
The planner does not decide what care is needed. The treating physicians do, and the plan documents their recommendations, converts them into items and intervals, and prices them. A plan whose author invented the medical content will be excluded by the court or destroyed on cross-examination, and it is worse than no plan at all.
What is inside the plan
| Category | Typical contents | How the cost is built |
|---|---|---|
| Physician and therapy | Follow-up visits, physical and occupational therapy, psychological care | Visits per year times regional charge |
| Surgery and procedures | Revision surgery, hardware removal, implanted device replacement | Cost per event times expected number of events |
| Medication | Pain management, antispasmodics, antibiotics, supplies | Annual cost, adjusted for the years it continues |
| Durable equipment | Wheelchairs, prosthetics, lifts, beds, orthotics | Unit cost times replacements across life expectancy |
| Attendant care | Personal care, nursing, supervision hours | Hourly rate times hours per day, by level of care |
| Home, vehicle, transport | Ramps, bathroom modification, hand controls, accessible vehicle | One-time cost plus a replacement cycle for vehicles |
The replacement interval is the part people underestimate. A wheelchair, a prosthesis, or an accessible van has a service life, and a plan that buys each item once understates the case by decades of purchases. A plan that replaces everything annually invites the attack it will get.
What the plan has to prove
California asks the jury for "the reasonable cost of reasonably necessary medical care that [the plaintiff] is reasonably certain to need in the future." That language is CACI No. 3903A, one of California's standard jury instructions, and the courts have approved it: Markow v. Rosner (2016) 3 Cal.App.5th 1027, 1050, quotes the instruction, and Cuevas v. Contra Costa County (2017) 11 Cal.App.5th 163, 183, holds that it is an accurate statement of the law.
Reasonable certainty is a real filter. A treating surgeon who says a hip will need revision is evidence. A planner who adds a service nobody has recommended is not. The same section of Cuevas, at page 180, adds a point plaintiffs sometimes miss: the collateral source rule, which limits what a jury hears about other sources paying your bills, "is not violated when a defendant is allowed to offer evidence of the market value of future medical benefits." Both sides may argue what the future costs.
What the total is worth today
Present cash value is defined for the jury in CACI No. 3904A as "the amount of money that, if reasonably invested today, will provide [the plaintiff] with the amount of [their] future damages." A person who needs $100,000 of care in year twenty does not receive $100,000 today, because the award can be invested in the meantime. The discount rate decides how much less, and small differences in that rate move seven-figure numbers.
The burdens are assigned by case law. In Lewis v. Ukran (2019) 36 Cal.App.5th 886, 896, the court held that a defendant seeking a reduction to present value "has the burden of presenting expert evidence of an appropriate present value calculation, including the appropriate discount rate." At page 889 the same opinion places the mirror burden on the plaintiff for inflation, and states that the jury or judge should do neither adjustment without that evidence or an agreement between the parties.
CACI No. 3904B gives juries worksheets and tables when the parties agree to use them. Table A handles a repeating annual amount, such as attendant care, and Table B handles items that occur in specific years, such as future surgeries. The instruction's own worked example shows the mechanics: at fifteen years and an interest rate of 10 percent, the Table A present value factor is 7.61, and the Table B factor for year fifteen is 0.239.
| Damages item | Reduced to present value? | Authority |
|---|---|---|
| Future medical care | Yes, on proof of a discount rate | CACI 3904A; Lewis v. Ukran (2019) |
| Future lost earnings and earning capacity | Yes, same proof | CACI 3904A |
| Future household services | Yes, as economic damage | CACI 3903E and 3904A |
| Future pain, suffering, disfigurement | No | CACI 3905A; Salgado v. County of Los Angeles (1998) |
| Past medical expenses | No, already incurred | CACI 3903A |
Everything in the plan runs across a life expectancy, which is itself evidence. CACI No. 3932 tells the jury to decide how long the person will probably live using published figures, and its Directions for Use recommend the life tables in Vital Statistics of the United States, published by the National Center for Health Statistics. The instruction then tells jurors the published number is not conclusive, and that they should also consider the person's health, habits, activities, lifestyle, and occupation.
How the defense attacks the plan
- No treating physician recommended it. The strongest attack, and the easiest to avoid, is on items that exist only in the planner's report.
- The pricing is not what anyone pays. Expect market-rate evidence in response to pricing based on billed charges, which Cuevas expressly permits.
- The replacement intervals are too short. Manufacturer service life and the person's actual usage history answer this.
- The same care appears twice. Attendant care and skilled nursing hours often overlap, and a duplicated hour discredits the whole document.
- The life expectancy is wrong. A defense expert reduces it; CACI No. 3932 lets the jury weigh the person's own health and habits either way.
- The plan was written too early. A plan built before maximum medical improvement, the point where the condition has stabilized, guesses at the medicine, and the guess is what gets cross-examined.
What a published cost table is not
The National Spinal Cord Injury Statistical Center's 2026 SCI Data Sheet is the closest thing to public pricing for one catastrophic injury type, and our catastrophic injury page reproduces its cost table. Its methodology is what makes it usable and what limits it.
- The demographic data covers 38,647 people with traumatic spinal cord injury, collected through August 2025 at 31 federally funded Model Systems centers.
- Costs are expressed in 2025 dollars, and the lifetime columns are discounted at 2 percent.
- The center labels the table "historical lifetime costs," and its stated data source is the Economic Impact of SCI study published in Topics in Spinal Cord Injury Rehabilitation, Volume 16, Number 4, in 2011.
- Indirect losses, meaning wages, fringe benefits, and productivity, are excluded and averaged $97,787 per year in 2025 dollars.
- The same document reports that about 29 percent of people with spinal cord injury are re-hospitalized at least once in a given year, with an average stay of about 18 days.
The table is an average of a national cohort, built on cost research that is more than a decade old and inflated to current dollars. That is useful for scale and useless for valuation. A jury is asked about one person's care, not a cohort's, which is why the plan for an individual is priced locally, tied to that person's physicians, and defended item by item. The figures themselves are in the 2026 data sheet, and our spinal cord injury page covers what they mean for that injury.
When the plan is the wrong tool
- The injury is expected to resolve. A plan for a healing fracture adds cost to a case without adding value, and the defense will use it to argue the whole claim is inflated.
- The medicine has not settled. Before maximum medical improvement, the future cannot be priced yet, which is a reason to wait rather than guess.
- Nobody can pay it. When available coverage is far below the plan, the plan still matters for negotiation, but the strategy shifts to finding policies and reducing liens. See what happens when the insurance is not enough.
- The person is on public benefits. Medi-Cal and Medicare interests change how the future medical portion of a settlement is structured, and that has to be handled before money moves.
What this means for your case
Future medical care is provable in California, and the instruction that governs it is short enough to read in a minute. What decides the number is whether the plan follows the treating physicians, whether the prices are real, and whether an economist has done the present-value work the defense will otherwise do alone. Ask whoever is handling the case when the plan will be prepared and who is writing it.
Injury-specific versions appear in our guides to amputation and limb loss and severe burn injuries, where the intervals and surgical futures look very different.