How Are Future Medical Costs Calculated in a California Personal Injury Case?
By Andy Van Le
Quick Answer
Future medical costs in a California personal injury case may include the reasonable cost of medical care an injured person is reasonably certain to need because of their injuries.
Depending on the injury, future medical care could include additional surgeries, physical therapy, rehabilitation, prescription medications, specialist appointments, injections, medical equipment, in-home assistance, or other ongoing treatment.
Calculating these damages isn't simply a matter of guessing what medical care might be needed. Medical records, treating physicians, medical experts, anticipated treatment plans, the expected duration of care, and the reasonable cost of that treatment can all become important.
This is especially significant when someone has suffered a serious or permanent injury that may require care for years.
If you've suffered a serious injury because of someone else's negligence, you can learn more about how we help people understand their legal options after a serious injury.
What Are Future Medical Expenses?
Most people understand that medical bills can be part of a personal injury claim.
You may already have bills from:
- Ambulance transportation
- Emergency room treatment
- Hospitalization
- Diagnostic testing
- Surgery
- Doctor appointments
- Physical therapy
- Prescription medications
Those are generally past medical expenses because the treatment has already occurred.
Future medical expenses are different.
They involve medical care that hasn't happened yet but may reasonably be expected because of the injuries caused by the accident.
For someone who makes a full recovery within several weeks, future medical expenses may not be a major part of the case.
For someone facing permanent injuries, additional surgery, chronic pain, or years of rehabilitation, they can become extremely important.
Why Future Medical Costs Can Matter So Much
One of the dangers of evaluating an injury claim too early is that today's medical bills may represent only part of the financial impact.
Imagine someone suffers a serious knee injury in an accident.
They undergo initial treatment and physical therapy.
The medical bills currently total $30,000.
An insurance company might focus heavily on that number when discussing settlement.
But what if the treating physician believes the patient will likely require another surgery?
What if additional physical therapy will be necessary afterward?
What if the injury creates long-term mobility problems requiring periodic treatment?
Suddenly, the medical costs already incurred don't tell the whole story.
Once an injury case is fully and finally settled, an injured person generally cannot simply reopen that settlement later because their medical condition became more expensive than expected.
That's one reason understanding the likely course of future treatment can be important before resolving a serious injury claim.
What Types of Future Medical Care May Be Considered?
The answer depends entirely on the injury.
Potential future medical needs may include:
Additional Surgery
Some injuries require multiple procedures.
A person might undergo an initial surgery shortly after an accident but need another procedure months or years later.
Physical Therapy
Orthopedic and neurological injuries can require extended rehabilitation.
The duration and frequency of therapy can affect projected costs.
Pain Management
People living with chronic injuries may require ongoing treatment such as physician visits, medication management, injections, or other appropriate pain-management care.
Prescription Medication
Certain injuries may require medications for an extended period.
The projected duration and reasonable cost of those medications can become part of evaluating future care.
Specialist Appointments
An injured person may require ongoing treatment from specialists such as orthopedic surgeons, neurologists, pain-management physicians, or other medical professionals.
Medical Equipment
Depending on the injury, future needs could potentially include mobility aids, braces, wheelchairs, prosthetics, or other medical equipment.
In-Home Assistance
Catastrophic injuries can sometimes leave a person unable to perform activities they previously handled independently.
Future assistance or nursing care may therefore become an important consideration.
Rehabilitation
Serious injuries involving the brain, spinal cord, or major orthopedic damage may require substantial rehabilitation extending well beyond the initial hospitalization.
How Do You Prove Future Medical Expenses?
Future medical expenses need to be supported by evidence.
California's civil jury instructions address the reasonable cost of reasonably necessary medical care that an injured person is reasonably certain to need in the future.
In practice, that means a personal injury claim should not simply be based on speculation that additional treatment might someday be helpful.
Evidence may include:
- Medical records
- Diagnostic imaging
- Treating physician opinions
- Specialist evaluations
- Surgical recommendations
- Treatment plans
- Rehabilitation records
- Medical expert testimony
- Evidence concerning the reasonable cost of future care
The more serious and long-lasting the injury, the more important this documentation can become.
Why a Doctor's Opinion Can Be Important
A treating physician often has valuable information about the patient's prognosis.
For example, a doctor may be able to address:
- Whether the injury is permanent
- Whether additional surgery is anticipated
- How long physical therapy may continue
- Whether future injections may be required
- Whether the patient will need ongoing medication
- Whether symptoms are expected to improve
- Whether future complications are reasonably expected
- Whether the patient will have long-term physical limitations
This helps move the discussion away from speculation and toward medical evidence.
What Is a Life-Care Plan?
In cases involving catastrophic or permanent injuries, a life-care plan may sometimes be used to evaluate future needs.
A life-care plan is generally a detailed assessment of the medical care, services, equipment, and assistance a seriously injured person may require over time.
Depending on the circumstances, it might address:
- Medical appointments
- Surgery
- Rehabilitation
- Therapy
- Medication
- Medical equipment
- Home modifications
- Transportation needs
- Attendant care
- Other long-term medical needs
Life-care planning is more commonly associated with significant injuries where the cost of future care could be substantial.
Not every personal injury case requires one.
Permanent Injuries Can Change the Calculation
Future medical damages become particularly important when an injury is permanent.
Examples could include certain:
- Spinal cord injuries
- Traumatic brain injuries
- Severe orthopedic injuries
- Nerve injuries
- Amputations
- Chronic pain conditions
- Significant mobility impairments
A permanent injury may require treatment for years or potentially for the remainder of someone's life.
The calculation therefore needs to consider not just what treatment costs today, but how much care may reasonably be required over the expected period.
What About Future Surgeries?
A future surgery can represent a substantial expense.
But an insurance company may challenge whether the surgery will actually occur.
For example, the insurer might argue:
- The doctor merely mentioned surgery as a possibility.
- Conservative treatment could resolve the problem.
- The patient hasn't decided to undergo surgery.
- The surgery is unrelated to the accident.
- A preexisting condition caused the need for surgery.
This is why the medical evidence surrounding the recommendation matters.
The question isn't simply whether surgery is theoretically possible.
The strength of the claim may depend on evidence showing that the treatment is reasonably expected because of the accident-related injury.
How Do Preexisting Conditions Affect Future Medical Expenses?
Having a preexisting medical condition does not automatically mean a person cannot have a valid injury claim.
Accidents can aggravate or worsen existing conditions.
For example, someone may have had manageable back problems before a collision but experience substantially worse symptoms afterward.
The challenge may be separating:
What medical care would likely have been necessary anyway?
from:
What additional medical care became necessary because of the accident?
Medical records from before and after the injury can become especially important in these situations.
Can Future Rehabilitation Be Included?
Potentially, yes.
A serious injury can require a long recovery process.
Future rehabilitation may involve:
- Physical therapy
- Occupational therapy
- Speech therapy
- Cognitive rehabilitation
- Vocational rehabilitation
- Other medically necessary services
The type and duration of rehabilitation depend on the individual injury.
Again, the important issue is whether the future treatment is supported by the evidence rather than based purely on speculation.
What About Rising Healthcare Costs?
Future care may occur years from now.
That creates another issue: medical treatment doesn't necessarily cost the same in the future as it does today.
In significant cases involving years of anticipated care, experts may become involved in evaluating future costs.
Economic considerations can also arise because future economic damages may involve present-value calculations.
These issues can become complicated quickly, particularly when an injury will require lifelong care.
Why Settling Too Early Can Be a Problem
After an accident, an insurance company may make a settlement offer before the injured person fully understands the extent of the injury.
That can be tempting.
Medical bills may already be arriving.
You may be missing work.
Your family may be under financial pressure.
But resolving a serious injury claim before the medical picture is clear can create risk.
Suppose you accept a settlement and later learn that you need surgery.
Or your doctor determines that your injury is permanent.
Or months of additional rehabilitation become necessary.
A settlement that initially seemed reasonable may look very different once those future expenses become known.
I've discussed this issue further in Should You Accept the First Insurance Settlement Offer in California?.
How Future Medical Costs Affect the Value of a Personal Injury Case
There isn't a universal formula for determining what a personal injury case is worth.
Two people can suffer similar accidents but have very different damages.
Factors may include:
- Severity of the injury
- Medical treatment already received
- Future medical needs
- Whether the injury is permanent
- Lost income
- Reduced future earning capacity
- Pain and suffering
- Available insurance coverage
- Liability
- Comparative fault
- Other case-specific circumstances
Future medical expenses are therefore one component of the overall damages analysis.
For a broader discussion, see How Much Is My Personal Injury Case Worth in California?.
Medical Treatment Helps Document the Progression of an Injury
Consistent medical documentation can help show how an injury develops over time.
Records may document:
- Initial symptoms
- Diagnostic findings
- Treatment received
- Response to treatment
- Continuing limitations
- Future recommendations
- Prognosis
Gaps in treatment can sometimes create disputes.
An insurance company may argue that a long period without treatment means the injury improved or wasn't as serious as claimed.
There can be perfectly legitimate reasons for treatment gaps, but maintaining appropriate medical care and documentation can help establish the medical history of the injury.
You can read more in Do You Need Medical Treatment to Win a Personal Injury Case in California?.
Future Medical Expenses and Pain and Suffering Are Different
Future medical expenses are generally economic damages associated with anticipated medical care.
Pain and suffering is different.
It addresses noneconomic harm that may include physical pain, emotional distress, inconvenience, physical impairment, and loss of enjoyment of life, depending on the circumstances.
A serious permanent injury could potentially involve both.
For example, a person might require years of future medical treatment while also experiencing long-term physical limitations and pain.
I've explained this separately in What Is Pain and Suffering Worth in California Injury Cases?.
What Should You Keep After a Serious Injury?
Documentation can become extremely important when future damages are being evaluated.
Consider keeping:
- Medical records
- Medical bills
- Prescription information
- Doctor recommendations
- Therapy records
- Diagnostic imaging reports
- Work restriction documentation
- Receipts for injury-related expenses
- Insurance correspondence
You may also want to maintain a record of upcoming appointments and recommended future treatment.
The goal isn't to create damages that don't exist.
It's to accurately document the impact the injury has already had and the medical care that may reasonably be necessary going forward.
Why Future Medical Costs Shouldn't Be an Afterthought
When someone suffers a serious injury, the focus is understandably on what is happening today.
How am I going to pay this hospital bill?
When can I return to work?
When will the pain stop?
But a serious personal injury case may need to consider a different question:
What will this injury cost me in the future?
If future surgery, rehabilitation, medication, or long-term medical care is reasonably expected, those costs can be an important part of evaluating the full impact of the injury.
That's why I believe serious injury cases should be evaluated based on the complete medical picture—not simply the bills that have arrived so far.
Speak With a San Diego Personal Injury Lawyer
If you've suffered a serious injury because of someone else's negligence, understanding your future medical needs can be an important part of evaluating your claim.
At Accident Law Center, I help injured people throughout San Diego understand their legal rights and the damages that may be involved in their cases.
Learn more about how we help people understand their legal options after a serious injury.
Call (619) 525-0001 or contact our office for a free consultation.
Legal Disclaimer
This article is for informational purposes only and does not constitute legal advice. Reading this content does not create an attorney-client relationship with Andy Van Le & Associates, PC. Every case is different, and available damages depend on the facts, evidence, applicable law, and other circumstances. Contact an attorney directly for legal advice about your specific situation.
Frequently Asked Questions
Can you recover future medical expenses in a California personal injury case?
Potentially. California law allows recovery of qualifying future medical expenses when the evidence establishes the reasonable cost of reasonably necessary medical care the injured person is reasonably certain to need in the future.
What counts as future medical expenses?
Depending on the injury, future medical expenses may include surgery, physical therapy, rehabilitation, prescription medications, specialist care, medical equipment, pain management, or other reasonably necessary future treatment.
How are future medical costs proven?
Evidence may include medical records, physician recommendations, treatment plans, expert opinions, rehabilitation records, anticipated procedures, and evidence concerning the reasonable cost of future care.
Can future surgery be included in an injury claim?
A future surgery may potentially be considered when sufficient evidence supports that the procedure is reasonably certain to be necessary because of the injury. A merely speculative possibility of surgery is different from a medically supported expectation of future treatment.
What is a life-care plan in a personal injury case?
A life-care plan can be used in some serious injury cases to evaluate anticipated long-term medical care, rehabilitation, equipment, assistance, and other needs. They are generally more relevant in cases involving catastrophic or permanent injuries.
Can a preexisting condition affect future medical damages?
Yes. A preexisting condition can make the analysis more complicated, particularly when determining which future treatment relates to the accident and which treatment may have been necessary regardless of the accident.
Why can settling an injury claim too early be risky?
If the full extent of an injury and future medical needs are not yet known, an early settlement may not account for later surgery, rehabilitation, or other long-term treatment. This is one reason the medical prognosis can be important when evaluating a serious injury claim.
