Written and reviewed by Josh Kohanim, Esq., California Bar No. 328609 · Reviewed
In this guide
Paralyzed, paraplegic, and quadriplegic are the plain words for this injury, and each level of injury changes what has to be arranged before discharge, what the record has to show, and what the claim has to fund. How a spinal cord injury claim is built is on our Los Angeles spinal cord injury lawyer page, and the care is priced on lifetime cost of care.
What paralysis means at each cord level
Paralysis is the loss of voluntary muscle function. It is not one condition, and the exam that classifies it works from the top down, level by level, testing a specific movement at each one. The StatPearls chapter on cervical injury, published by the National Library of Medicine and updated June 2, 2025, sets out which movement belongs to which cervical level. That mapping is why two people who both use a power chair can need entirely different care.
| Neurological level | Motor function at that level | What the plan usually has to carry |
|---|---|---|
| C1 to C4 | Diaphragm control runs on the phrenic nerve, C3 to C5 | Ventilator or tracheostomy care, attendant coverage around the clock, a fully converted home |
| C5 | Shoulder abduction (raising the arm out to the side) | Power mobility, a transfer lift, attendant hours every day |
| C6 | Elbow flexion and wrist extension (bending the elbow, lifting the wrist back) | Adapted equipment, attendant hours for part of the day, a modified bathroom |
| C7 | Elbow extension and wrist flexion (straightening the elbow, bending the wrist down) | Independent transfers for many people, a manual chair, equipment on a replacement cycle |
| C8 | Finger flexion (bending the fingers) | Grip returns, and the plan shifts toward shoulders, skin, and bladder care |
| T1 and below | Arms and hands unaffected | A manual chair, home access, a bowel and bladder program, and the conditions that follow |
The respiratory line matters more than any other. StatPearls states that injury at or above the level of C5 may impair diaphragmatic function through the phrenic nerve at C3 to C5, requiring long-term mechanical ventilation or tracheostomy care. A ventilator changes everything downstream of it: the attendant has to be trained, the power supply has to be backed up, and the person cannot be left alone. Insurance adjusters who price attendant care at an aide's hourly rate are pricing the wrong job.
What separates paraplegia from tetraplegia
Hands are the dividing line. Someone with paraplegia can push a chair, cook, drive with hand controls, dress, and manage a catheter without another person in the room, and the cost of the injury sits in equipment, access, and the medical conditions that follow. Someone with tetraplegia needs another person's hands for some part of every day, and paid hours are the largest recurring expense in the file. The same crash produces both, depending on where in the neck the force landed.
That difference has to reach the record in specific terms. Hours per day of help and who provides them. Whether transfers need one person or two. Whether a caregiver has to be awake at night. Whether the person can be alone in the house at all. Those answers come from an occupational therapy evaluation and a nursing assessment, and they are what a life care planner prices.
Work and income after the injury
The national numbers answer the return to work question plainly. The 2026 SCI Data Sheet from the National Spinal Cord Injury Statistical Center tracks employment for people injured since 2015 out to forty years.
| Time since injury | Employed |
|---|---|
| At injury | 64.5% |
| Year 1 | 17.8% |
| Year 10 | 26.4% |
| Year 20 | 29.1% |
| Year 30 | 31.2% |
| Year 40 | 27.6% |
Read the at-injury and year one figures together. Two thirds of this population was working the day of the injury and fewer than one in five is working a year later, and the recovery over the following decades never reaches half the starting rate. A defense argument that the injured person could go back to work in some capacity is arguing against thirty years of national data. The same data is why lost earning capacity is calculated across a career rather than across a recovery period.
Why the claim names a life expectancy
Every future cost in a paralysis claim is multiplied by how long the care will be needed, so the parties end up arguing about years. The statistical center publishes life expectancy by age at injury and severity. The figures below are the ones for people who have survived at least one year after the injury, which is the group most claims concern. AIS D, the mildest graded injury, means most muscles below the injury can still move against gravity.
| Age at injury | No spinal cord injury | High tetraplegia C1 to C4 | Paraplegia | Motor functional AIS D |
|---|---|---|---|---|
| 20 | 59.2 | 32.0 | 43.8 | 51.4 |
| 40 | 40.7 | 20.8 | 29.1 | 34.5 |
| 60 | 23.4 | 12.2 | 16.1 | 19.3 |
The same document notes that life expectancies during the first year after injury have risen steadily since the 1970s. Expectancies after that first year have not changed since the early 1980s and remain substantially below those of the general population. Medicine has improved at keeping people alive through the acute phase. It has not closed the gap that comes after.
Whether recovery from paralysis is possible
Sometimes, and partly. The 2026 data sheet reports that less than 1% of people experienced complete neurological recovery by the time of hospital discharge. Function does return for many people during rehabilitation, particularly with incomplete injuries, and that is a different question covered on incomplete spinal cord injury claims. Nobody can say at week three what week fifty-two will look like.
For the claim, that uncertainty cuts one way: settling before the neurological picture stabilizes hands the insurer the benefit of every unknown. A claim resolved on an early prognosis cannot be reopened when the prognosis turns out to be wrong.
When the level is not decisive
Ventilator dependence outweighs the level. The national tables carry ventilator dependent as its own row, and the expectancy numbers in it are far below every level-based category. A ventilator dependent claim is a different case from a C4 claim without one, even though both are high tetraplegia.
An incomplete injury high in the neck can cost more than a complete one lower down. Partial function that still needs supervision, plus spasticity, meaning involuntary muscle tightness, plus neuropathic pain from the damaged nerves, can require more paid hours than a stable complete paraplegia. The category is a label; the plan is the evidence.
Aging changes the plan. Shoulders that took thirty years of manual transfers stop tolerating them, and the person who was independent at 30 needs equipment and hours at 55. A plan that prices today's function and stops is a plan that runs out.
Some paralysis claims are not spinal cord claims at all. Nerve root injuries, brachial plexus injuries, meaning damage to the nerve bundle in the shoulder, and brain injuries can produce paralysis with an intact cord. Those follow different medicine and different proof, and a brain injury claim runs through our Los Angeles brain injury attorney page.
What the record has to show
Paralysis is described by a level and a grade, and both belong in the medical record in those exact terms, because every later number is built on them. Get the neurological level documented, get an occupational therapy assessment of what the person can and cannot do alone, and get the attendant hours written down by someone qualified to write them. Then the claim can be about what the life needs.