When a major injury or illness strikes, insurance companies quickly ask for justifications before paying out large claims. This is why a Life Care Plan is so often used in negotiating settlements.
Typical Insurance Process
First, the insurer asks for all relevant medical records. Then they may request a Life Care Planning report, often with cost details going far into the future.
“Without a detailed **Life Care Plan**, insurance adjusters may underestimate what care will actually cost over a lifetime.”
Insurers review these plans closely, looking for:
- Procedures or equipment they might deem “unnecessary”
- Reasonable timelines for recovery and therapy
- Costs above average for the patient’s location
Where Do Disagreements Arise?
Large claims often turn on whether a recommended therapy can be delayed, or a piece of equipment is “essential.” Sometimes the insurer’s own Medical Expert Witness will review the plan and challenge certain costs.
“Arguments about necessity, frequency, and local standards are common. The more detailed a **Life Care Plan**, the stronger your negotiating position.”
Practical Tips for Families and Attorneys
- Make sure every item and cost is supported by a doctor’s note or published standard
- Request written explanations for any items the insurer refuses
- Get a second opinion if the insurer cuts out core needs
Sample Negotiation Points
| Requested Item | Plan’s Estimate | Insurance Offer |
|---|---|---|
| Home nurse visit, weekly | $8,000/yr | $5,000/yr (with limit) |
| Custom wheelchair | $7,500 | $5,000 (no repairs covered) |
| OT for one year | $2,400 | Full coverage |
Finishing Thoughts
A strong Life Care Plan gives families leverage when dealing with insurance. The process can be lengthy and even frustrating, but thorough documentation and expert support remain the best path to fair settlement.
