Projections

A Medical Cost Projection (MCP) is an impartial and scientific forecast of reasonable and likely future medical costs for an individual claim. An MCP involves an analysis of physician recommendations, current treatment regimen, and evidence-based guidelines. Projections are typically used for setting case reserves, negotiating a settlement, or comparing exposures (i.e., conservative care vs surgery). Costs are calculated using either a workers’ compensation fee schedule, or usual and customary pricing (using geographic adjustment factors for the latter). The cost figures are based on the use of today’s dollars.

A Medical Cost Projection limits future care to the specific incident, accident, procedure or surgery the physician has recommended, but has not yet occurred. It differs from a life care plan because there is no personal interaction with the patient or family, or face-to-face communication with treating physicians. Past complications, current needs, co-morbidities, etc., are considered when estimating the cost of future care. It is advised that the treating physician review and approve the care recommended in the patient’s Medical Cost Projection.

Some attorneys prefer life expectancies based upon the (2010) Annuity Mortality Table for 1949, Ultimate Georgia Code Title 24– Appendix Title 24 Appx.r.3. My personal preference is to use figures based upon the most recent release of the CDC National Vital Statistics. This is the source used for life care plans and Medicare Set-Aside negotiations.

In cases of workers compensation, any time-based limitation on future care (such as Georgia’s 400 week cap on medical care) is considered in pricing.

Cost Projections are always subject to change should new information be provided at a later date, and if the patient’s condition changes, an updated Medical Cost Projection should be requested.