A 28-year-old with traumatic brain injury: - Past medical: $250,000 (acute care, rehabilitation, initial treatment) - Future medical: $4,500,000 (lifetime attendant care, ongoing therapy, medications, equipment, periodic medical evaluation) In catastrophic cases, future medicals can represent 70-80% of total damages. Getting this calculation right matters enormously. The three components of future medical damages Calculating future medical expenses requires answering three questions: What care will you need? How much will that care cost? What's the present value of those future costs? Each component requires its own expertise and evidence. Component 1: What care will you need? This is the medical question. Your treating physicians and retained medical experts project the specific care you'll need based on: The nature and severity of your injuries Your medical history and overall health Current medical standards of care Your age and life expectancy Anticipated complications or deterioration Maintenance therapy needs The projected care might include: Ongoing medical treatment: - Periodic physician visits (specialists, primary care) - Imaging studies (X- rays, MRIs, CTs) - Lab work and monitoring - Medications (acute, maintenance, pain management) Surgical procedures: - Additional surgeries needed in the future - Hardware removal procedures - Revision surgeries - Complications that require surgery Rehabilitation: - Physical therapy (ongoing or periodic) - Occupational therapy - Speech therapy (for brain injuries) - Cognitive rehabilitation Equipment and supplies: - Mobility aids (wheelchairs, walkers, braces) - Prosthetics - Adaptive equipment for home/vehicle - Replacement of equipment over time 1. 2. 3. - - - - - - Home modifications: - Wheelchair ramps and lifts - Bathroom modifications - Vehicle modifications Attendant care: - Home health aides - Skilled nursing care - 24-hour care for severe disabilities - Assistance with daily living activities Mental health care: - Psychiatric treatment - Psychological counseling - Medication management Component 2: How much will that care cost? Once the needed care is identified, the cost projection considers: Current cost of each treatment, procedure, or service in your geographic area Inflation adjustment for future years Quality of care expected (private vs. public insurance equivalents) Equipment replacement cycles Variation in care providers and prices Medical economists or life care planners typically build detailed schedules showing each cost item year by year over the plaintiff's projected lifespan. Component 3: Present value calculation Future costs need to be converted to present-day dollars. This is because: A jury awards a lump sum today That lump sum, invested, will grow to cover future costs The future costs are reduced to "present value" reflecting investment growth The present value calculation requires: Discount rate: The rate at which future dollars are reduced to present value. Often based on US Treasury yields or low-risk investment returns Inflation rate: Particularly for medical care, which historically inflates faster than general inflation "Net discount rate": The difference between expected investment returns and expected medical inflation Different experts use different rates, leading to wildly different present value calculations. A 4% net discount rate vs. a 1% net discount rate can change the bottom-line figure by 30% or more on long-term projections. Who participates in the calculation Building a credible future medical expenses claim requires multiple experts. - - - - - - - - - - - ## Treating physicians
The doctors who actually treated you provide the foundation: Their medical records document your injuries and treatment They can testify about the nature and permanence of your injuries They can project anticipated future treatment based on their direct knowledge Their opinions carry significant weight because they've actually examined you Treating physicians are sometimes reluctant to project future care extensively because they're focused on current treatment rather than legal proceedings. Retained medical experts For serious cases, attorneys often retain additional medical experts who specialize in particular injury types: Neurosurgeons for spinal injuries Neurologists or neuropsychologists for brain injuries Orthopedic surgeons for fracture and joint injuries Physiatrists (rehabilitation medicine) for functional outcomes Pain management specialists for chronic pain cases These experts review your medical records, sometimes examine you, and provide opinions specifically directed at projecting future needs. Life care planners For catastrophic cases, life care planners create comprehensive documents detailing every aspect of future care needs. A life care plan typically includes: Periodic physician visits Therapy schedules Medications Equipment and supplies with replacement schedules Home modifications Attendant care needs Transportation needs Emergency or backup care provisions - - - - - - - - - - - - - - - - - Life care plans can run hundreds of pages with extreme detail. They're particularly important in catastrophic injury cases. Economic experts Economists or vocational rehabilitation experts handle the financial calculations: Translate medical needs into specific dollar amounts Apply inflation projections Calculate present values Account for life expectancy Vocational experts When future medical needs affect employment, vocational experts may also weigh in on loss of earning capacity (a separate damage category, though related). What insurance companies argue Defense strategies for reducing future medical expense claims include: "The plaintiff won't actually need that much care" Defense medical experts often produce more conservative projections of future care needs. They argue that: The plaintiff has reached maximum medical improvement and won't need additional surgery Conservative treatment (no surgery, lower-cost medications) is sufficient Care will be needed less frequently than the plaintiff's experts project Plaintiff's pre-existing conditions account for some of the care needed "The cost projections are inflated" Even accepting the same care needs, defense economists often use: Lower regional cost averages Public insurance reimbursement rates (Medicare, Medicaid) rather than private market rates Different inflation assumptions Different discount rates These adjustments can reduce the bottom-line number by 30-50%. - - - - - - - - - - - - ## "The plaintiff's life expectancy is shorter"
For long-term care cases, the projected duration of care matters enormously. Defendants may argue: The plaintiff's injuries shorten life expectancy Pre-existing conditions affect life expectancy Lifestyle factors (smoking, obesity, etc.) reduce expected lifespan A 5-year reduction in projected lifespan in a catastrophic case can reduce damages by hundreds of thousands of dollars. "Future medical care should be provided through insurance" Some defenses argue that: The plaintiff has health insurance that will cover future care Therefore the damages should be limited to what insurance won't cover Or the plaintiff has lifetime access to subsidized care through other programs Arizona's collateral source rule generally prevents this argument, but defense attorneys still raise it. "The plaintiff isn't following medical advice" If the plaintiff isn't doing prescribed exercises, taking medications as directed, or following lifestyle modifications, the defense argues that future damages should be reduced because the plaintiff's own conduct affects future needs. How comparative fault affects future medicals Arizona's pure comparative fault rule (A.R.S. § 12-2505) applies to all damage categories including future medical expenses. If the jury finds the plaintiff: - 0% at fault: full future medical damages awarded - 30% at fault: damages reduced by 30% - 70% at fault: damages reduced by 70% - 99% at fault: damages reduced by 99% (but still recoverable) The percentage applies to the gross damage award. A $1,000,000 future medical claim with 25% plaintiff fault becomes $750,000. Special considerations for specific injury types Different injuries have different future medical expense patterns. - - - - - - ## Spinal cord injuries
Often the highest future medical expense cases. Lifetime care can exceed $10 million for severe cases involving: Quadriplegia or paraplegia requiring 24/7 care Ongoing pulmonary care Pressure sore prevention Recurrent UTIs and infections Equipment replacement Adaptive technology Traumatic brain injury Highly variable depending on severity: Mild TBI: $50,000-$300,000 (ongoing therapy, monitoring, occasional medication) Moderate TBI: $500,000-$2,000,000 (significant rehabilitation, possible permanent care needs) Severe TBI: $2,000,000-$10,000,000+ (lifetime attendant care, ongoing medical needs, equipment) Severe orthopedic injuries Future expenses often include: Anticipated joint replacement surgeries (typically every 15-20 years) Hardware removal procedures Ongoing pain management Physical therapy maintenance Activity-limiting effects on cardiovascular health Chronic pain conditions Often the most contested future medical claims because: Objective documentation is harder Pain management costs accumulate over decades Defense argues plaintiff should be on different (cheaper) treatments - - - - - - - - - - - - - - - - - ## Amputations
Future medical expenses include: Prosthetic replacement (typically every 3-5 years) Ongoing physical therapy Skin care and complications Psychological support Adaptive equipment The 2-year statute of limitations affects future medicals Arizona's 2-year statute of limitations doesn't extend just because future medical needs may continue indefinitely. You must file your case within 2 years of injury, then prove future medical damages within that case. Once the case is filed (or even after settlement), you generally cannot return to court for additional future medical expenses that turn out to be greater than projected. This makes accurate initial projection critical. Real-world example calculations To make this concrete, here are two simplified examples. Example 1: Moderate orthopedic injury 35-year-old plaintiff with permanent back injury from car accident: Past medical: $75,000 Future medical (projected): - Periodic physician visits ($300 × 4/year × 40 years): $48,000 - Ongoing physical therapy ($150 × 24/year × 10 years): $36,000 - Pain medication ($200/month × 40 years): $96,000 - Future surgery (probable, year 10): $80,000 - Hardware revision (year 25): $50,000 - Total nominal future cost: $310,000 - Present value (4% net discount): ~$170,000 Total medical claim: $245,000 Example 2: Catastrophic brain injury 28-year-old plaintiff with severe TBI: Past medical: $400,000 Future medical (projected): - 24/7 attendant care ($150,000/year × 50 years): $7,500,000 - Periodic physician/specialist visits: $200,000 - Therapy maintenance: $600,000 - Medications: $400,000 - Equipment and supplies: $300,000 - Home modifications (lifetime): $250,000 - Total nominal future cost: $9,250,000 - Present value (4% net discount): ~$4,800,000 - - - - - ## Total medical claim: $5,200,000
Frequently asked questions Can I include future medical care that's only possible, not certain? Generally only care that's "more likely than not" needed. Speculative care doesn't qualify. The standard is reasonable medical probability. What if my future medical needs are higher than projected? You generally can't return to court for more. This is why initial projections must include reasonable margins for uncertainty. Some catastrophic injury settlements use structured settlements with periodic payments that can flex based on actual needs. Are future medical damages taxable? Generally no. Damages for physical injury (including future medical) are federally tax-exempt under IRC Section 104(a)(2). What if I have insurance that will pay for future care? Arizona's collateral source rule generally allows recovery of full future medical damages regardless of insurance. The defense can't reduce your award based on insurance you have or may have. How long does it take to develop future medical projections? For serious cases, expect 3-6 months of expert work to build comprehensive life care plans and economic projections. Catastrophic cases can take longer. Do I have to pay for the experts up front? Most personal injury attorneys advance these costs as case expenses, reimbursed from the eventual settlement. What if the defense doctor disagrees with my doctor? This is normal. Both sides typically have medical experts. The jury (or arbitrator) weighs the conflicting testimony based on each expert's credibility and the underlying records. This article is for general informational purposes only and does not constitute legal advice. To discuss your specific situation, contact Saguaro Injury Law at (623) 887-2002 for a free consultation or take our free case review. Hablamos español. Past results do not guarantee future outcomes.
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*Disclaimer: This article is for general informational purposes only and is not legal advice. Reading it does not create an attorney-client relationship. For advice on your specific situation, please contact a licensed Arizona attorney. Past results do not guarantee future outcomes.*