Life Care Plans and Independent Medical Reviews

Life Care Plans specify the medical conditions and ongoing medical requirements of catastrophically and/or chronically ill or injured individuals, and quantify the cost of supplying them with requisite, medically-related goods and services over a specified probable duration of care.

Often used for litigation purposes, a patient-specific Life Care Plan specifies qualitative and quantitative medical and quality-of-life needs for chronically ill, injured, and disabled individuals to ensure they are able to adequately plan for the future. While Life Care Plans are highly individualized, they generally include, but aren’t limited to:

  • Thorough Case Overview
  • Chronological Review of Records to Date
  • Interview & Physical Examination
  • Summary of Diagnoses
  • Glossary and Description of Pertinent Injuries & Illnesses
  • Specific Medical Requirements for Treatment
  • Projection of Future Care Costs

There are two types of Life Care Plans based on an individual’s ability to perform activities of daily life (ADL.)

Catastrophic Life Care Plans outline treatment costs and needs of people living with permanent physical or mental impairment or chronic illness who have lost the ability to fully perform ADL.

Non-Catastrophic Life Care Plans outline treatment costs and needs of people living with permanent, chronic illness or physical impairment who retain the ability to perform some or all ADL, but do so with noted difficulty and loss of quality of life.

Common life care plan areas include:

Independent Medical Evaluations (IME’s)

An Independent Medical Evaluation involves a physician, psychologist or other healthcare professional who has generally not previously been involved in an individual’s care, who conducts an unbiased examination to assess the cause, extent, and medical treatment of an injury/illness, often when liability is at issue. The IME is important in determining the degree of impairment and adequately plan for future cost of care. Dr. Weiss has over 20 years experience providing care and rendering opinions with impairment ratings and IME’s. He has also served as Designated Doctor for the state of Texas for over 20 years.

Expert Witness Services

An expert witness is someone, who by virtue of education, training, skill or experience,is believed to possess expertise and specialized knowledge in a particular subject that is materially beyond that of the average person.

Life Care Planning is a tool that, when performed by a physician, requires specialized training and experience before it can be expertly applied. The certification of Life Care Planning is not mandatory when performing LCPs, but it certainly helps to get that extra training when doing Life Care Plans.

If the life care planner provides opinions outside of the scope of expertise, regardless of whether or not he/she is a physician, his/her testimony runs the risk of being successfully challenged via Daubert or Kumho, precedent-setting cases regarding the admissibility of witness testimony. The trier of fact can disqualify the expert’s testimony based on the lack of the specialized knowledge that the life care planner requires.

It is important to seek a Life Care Planning Professional with the proper certifications. My expert testimony includes:

  • Independent Medical Examinations (IMEs)
  • Depositions
  • Life Care Plans authored by a Certified Life Care Planner

Cost Analysis

Life Care Plans use Usual, Customary, & Reasonable (UCR) rates in determining the cost of recommended services. I look at multiple fields of medical services when I look at the cost analysis. Depending on the injured patient’s conditions, I can investigate the costs of neurosurgery, orthopedics, pain medicine, primary care, neurology, internal medicine, physical therapy, imaging studies, home health aides, medications, etc.

What’s the advantage of having a physician certified life care planner?

Because issues related to long term healthcare needs can be complicated and vast, it is ideal for a Life Care Plan to include physician input. Utilizing a life care planner that is a physician means the same individual creating the Life Care Plan report can also perform the following necessary steps to compile it:

  • Independent medical exam
  • Comprehensive medical assessment
  • Medical record review including EMG and nerve conduction study analysis, CT scan and MRI assessments
  • Expert witness testimony
  • Expert opinion on causality within a reasonable degree of medical probability
  • Expert opinion regarding liability issues
  • Expert opinion as to the presence or absence of permanent injury
  • Impairment rating using the AMA guidelines
  • MMI determination (for workers comp cases)
  • Treatment recommendations for current and future pain management requirements (spinal cord stimulator implant, pain pump, lumbar or cervical facet blocks, lumbar or cervical epidural steroid injections, RF ablations, stellate ganglion blocks, trigger point injections, joint injections, among others)
  • Thorough home evaluation
  • Quality-of-life needs assessment

Other services provided by Dr Weiss:

Medical cost projections, home evaluation, medical assessment, Independent Medical Exam, expert witness work, medical record review, EMG and nerve conduction study analysis, CT scan and MRI assessments, MMI determination, make treatment recommendations, render an opinion regarding liability issues, render an opinion of the presence or absence of a permanent injury, future need of pain management techniques, such as: spinal cord stimulator implant, pain pump, lumbar or cervical facet blocks, lumbar or cervical epidural steroid injections, radiofrequency ablations, stellate ganglion blocks, trigger point injections, joint injections, etc.

Biographical information:

  • 35 years experience as an expert treating multiple traumatic disabilities and spine care.
  • Board Certified by American Academy of Physical Medicine and Rehabilitation
  • Experienced in pain procedures, spinal procedures, spinal surgeries, and EMGs.
  • Trained at one of the top programs , New York University, Rusk Institute of Rehabilitation
  • Experienced as Assistant Professor of Rehabilitation Medicine at top programs: Mount Sinai and Baylor College of Medicine.
  • CARF surveyor of rehabilitation hospitals,clinics and pain programs. Evaluator of the quality of the program.
  • Peer reviewer for general and outpatient neurological and orthopedic conditions for insurance companies.
  • Designated Doctor for state of Texas and 20 plus years experience using standardized ODG guidelines.
  • Certified Life Care planner
  • Educational Experience includes hosting and producing TV,radio and Internet shows for over 20 years on medical topics.
  • Experience medical director of rehabilitation program
  • Experienced medical consultant for multiple TBI programs.