Decades of care, priced today. The plan supplies the needs; the economics supply the growth, the horizon and the discounting. Both get cross-examined.
Start a conversation with Cournot, the Institute’s damages concierge, already scoped to future medical & life care. Pick a starting point, or describe the dispute directly.
Catastrophic injury produces a second projection alongside the earnings loss: the cost of the care the person will need for the rest of their life. The instrument is the life care plan, a structured inventory, prepared by a qualified planner, of the treatment, therapy, equipment, medication, home modification and attendant care the injury requires, each item with a frequency, a duration and a price. The economist's work begins where the plan ends: converting the inventory into a cost stream, growing each category at a defensible rate, running the stream over the right horizon, and discounting it to present value. Two features dominate the economics. Medical costs have historically grown faster than general prices, so the growth assumption compounds into enormous differences over a forty-year horizon, and the spread between medical inflation and the discount rate does more to determine the answer than most of the plan's line items. And the horizon itself, the person's life expectancy, may be contested where the injury affects it, which places a medical question underneath the largest single multiplier in the model. The attacks are as structured as the plan: items without a physician's foundation, prices from the wrong market, growth rates chosen for effect, attendant care hours that outrun the medical evidence. A plan built to survive those attacks looks different from one built to impress a mediator, and the difference is visible early.
The plan is medical. The stream is economic. The fights happen at the joints.
Every element of future care with frequency and duration, each tied to a medical foundation rather than to the planner’s habit.
What each item costs in the market where the person will actually obtain it. Charged rates, paid rates and geographic reality all contested.
Usually the largest category: hours per day, skill level required, agency against family-provided rates. Small changes here move the total substantially.
The rate care prices rise, historically above general inflation. Compounded over decades, the model’s most powerful assumption.
Life expectancy, normal or injury-adjusted. A medical question that multiplies everything downstream.
The discount machinery, with the net spread between growth and discount rate doing the quiet work.
How the Institute approaches a future care question.
In catastrophic cases, often larger than the earnings claim.
Over a forty-year horizon, a modest change in the gap between medical cost growth and the discount rate moves the present value more than most disputed line items in the plan. Any serious analysis states the spread, sources both halves of it, and shows the result across a range.
Foundation and restraint. A strong plan ties each significant element to a physician's recommendation or a documented treatment history, prices items in the market where the person will actually receive care, and distinguishes what the injury requires from what would merely be beneficial. Vulnerable plans show recognizable patterns: items no treating doctor endorsed, equipment replaced on schedules with no source, therapy frequencies that never taper when the medical records suggest they will, and attendant care hours beyond what the functional assessments support. Because the plan arrives as a list, it is attacked as a list, item by item, and each unsupported entry costs credibility that the supported entries then have to buy back.
Because there is no single price for an ordinary medical service. The same procedure carries a provider's billed charge, a negotiated insurer rate, and public program rates, and these can differ by multiples. Which of them represents the cost the plaintiff will actually bear involves both a factual question, how this person will obtain care, and legal questions about collateral sources and the treatment of insurance that vary by jurisdiction and belong to counsel. Geography adds another layer, since care costs differ by market. The defensible economic position is transparency: state which price benchmark is used and why it matches the person's actual circumstances, and show the sensitivity, rather than selecting the highest available number and hoping the foundation goes unexamined.
As medical testimony feeding an economic model, with the division of labor kept clean. Population tables supply the baseline expectancy; where the injury plausibly shortens life, physicians or specialists in the condition provide the adjusted expectancy, and the economist runs the cost stream over the medically supported horizon. The stakes cut in both directions, which surprises some counsel: a shorter horizon reduces future care costs but can also reduce the earnings claim, and the defense argument that shortens one stream shortens the other. What the economist must not do is source the horizon personally; an economic expert opining on survival is outside their discipline, and the challenge that follows is usually successful.
The award form is a legal and strategic question, but it has economic content worth understanding early. A lump sum settles the matter and transfers all future risk, of inflation, of investment returns, of living longer than the tables predicted, to the plaintiff, which is precisely what the discounting assumptions are silently allocating. Structured arrangements pay over time and can be costed against annuity markets, which occasionally provides a useful reality check: the market price of an annuity delivering the plan's stream is evidence about present value that does not depend on anyone's litigation assumptions. Where the case involves a structure, the economist's role is comparing like with like, because a periodic stream and a lump sum can only be compared through explicit discounting, and mixing the frames misleads.
Describe the injury and the care picture. The Institute will help you see where the plan and its economics will be attacked.