LIFE CARE PLANNERS

Life Care Plans and their related economic evaluations are frequently used in cases involving catastrophic personal injury. The Life Care Plan itself is a detailed, comprehensive report involving a medical records review, an interview with the patient, and detailed communication with medical providers by the life care planner. The Life Care Plan is a tool used for estimating medical and non-medical needs of a person with a catastrophic injury/illness to ensure adequate funding will be available throughout the patient’s lifetime. The highlights of a Life Care Plan include assessment, diagnosis, outcome identification, planning, implementation, and evaluation. Life care plan cost depends on the amount of time required to thoroughly evaluate the injured parties likely future needs with a typical range of $3,000 to $10,000. Life care planner experience and location may affect the cost of the plan.

Medical Needs Assessment

Insurance companies sometimes choose a Medical Needs Assessment for setting reserves and taking a proactive approach to cost containment. A Medical Needs Assessment is based upon a medical records review and generally does not include an actual visit with the patient or detailed communication with medical providers. Attorneys typically prefer the more thorough and detailed Life Care Plan when litigating cases to ensure appropriate funding is available to meet their clients’ future life needs. Life Care Plans can be beneficial in mediation, hearings, and trials. Prior to case resolution/settlement, the Life Care Plan should be reviewed and possibly updated every six months due to potential medical changes.

Medicare Set-Asides

Medicare will no longer take the responsibility of paying workers’ compensation claims. It is imperative that one understands when and how the claims should be evaluated and what is acceptable to Medicare. The Medicare Set-Aside (MSA) is detail oriented and one must adhere to Medicare guidelines. The MSA Allocator must evaluate and understand the medical records to ascertain present and future medical needs. Codes must be matched and fee schedules utilized that are appropriate with the diagnosis. Centers for Medicare & Medicaid Services (CMS) warns that Medicare could seek up to double the correct amount if a MSA has been avoided or completed incorrectly. In addition, the injured worker may lose Medicare eligibility. Supported documentation and careful research must be completed during the MSA creation process.

Case Management

Case management services (medical & vocational) involve assisting an injured/ill person in their medical treatment/recovery and return to optimal functioning within the community. Medical case management services include an assessment of the injured/ill person’s medical and non-medical needs; identification of necessary medical resources, coordination/facilitation of appropriate medical and non-medical recommendations, and an evaluation of the person’s medical recovery progress.

Vocational case management services include an assessment of the injured/ill person’s employment/education history, identification of barriers (physical, mental, behavioral, environmental, etc.) preventing the person from returning to gainful employment, vocational testing to identify alternate employment opportunities, and assisting the person in returning to a productive lifestyle.

Case management services are beneficial for persons involved with a workers’ compensation claim, short-term & long-term disability claims, and personal injury/liability claims. Case management services provide cost containment services for the insurance carrier as well as a patient advocacy role to the injured/ill person.

Legal Nurse Consulting

Legal nurse consulting utilizes the experience and insight of RNs in identifying and resolving potential legal claims. Legal Nurse Consulting services are provided to plaintiff/defense attorneys and insurance carriers. These services may include:

• Obtain, organize, review & analyze medical records
• Compile medical records into timelines & chronological order
• Detect record inconsistencies & conflicting information in medical records
• Form comprehensive picture of medical treatment & patient’s recovery
• Assist client in understanding life-altering injuries & interpret medical records
• Educate client about potential medical complications
• Recommend appropriate medical resources to facilitate patient’s recovery