Catastrophic Injury Claims and the Life Care Plan

By Hank FasthoffSeptember 14, 2026

A brain injury, spinal cord injury, amputation, or severe burn can require years of treatment, assistance, and changes to daily life. A life care plan identifies anticipated care and its cost, helping the injured person and the lawyers evaluate future medical expenses. The claim also requires evidence of legal responsibility and support for each requested category of damages.

The Damages Texas Recognizes

Texas personal injury damages include medical expenses, lost earnings, and lost earning capacity, along with physical pain, mental anguish, disfigurement, and physical impairment. Each requested category requires supporting evidence, and categories can overlap. In Golden Eagle Archery, Inc. v. Jackson, 116 S.W.3d 757 (Tex. 2003), the Supreme Court of Texas explained that loss of enjoyment of life can be considered within physical impairment. The court also described an appropriate instruction requiring substantial impairment beyond pain, suffering, mental anguish, lost wages, or diminished earning capacity, while prohibiting compensation twice for the same loss.

An injured person’s account of daily limitations, observations from family and coworkers, employment records, and medical evidence serve different purposes. Someone who returns to paid employment may experience substantial limitations in caring for children, maintaining a home, or participating in former activities. Evidence must identify those limitations and distinguish them from losses included in other damages categories.

Past Medical Expenses

Under Texas Civil Practice and Remedies Code § 41.0105, medical expense recovery is limited to amounts paid or incurred. In Haygood v. Garza de Escabedo, the Supreme Court of Texas limited recovery and trial evidence to expenses the provider had a legal right to receive. An unpaid amount can qualify if it is legally owed. Charges the provider has written off and cannot collect are excluded, and the recoverable expenses must be reasonable, necessary, and attributable to the injury at issue.

Section 18.001 permits affidavits supporting the reasonableness and necessity of charges, with an itemized statement of services. The ordinary service deadline is the earliest of 90 days after the defendant answers or the offering party’s expert designation deadline under a court order or the civil rules. Different provisions address providers who begin treatment after the answer and continuing services. The parties may alter deadlines by agreement, or the court may grant permission to alter them.

An affidavit supplies evidence of reasonable charges and necessary services; causation requires separate support. In In re Allstate Indemnity Co., the Supreme Court of Texas held that an uncontroverted affidavit does not conclusively establish those expenses or prevent the defendant from challenging them through evidence or argument. The affidavit procedure can reduce the need for live testimony, but the claimant must account for objections, counteraffidavits, and the evidence connecting treatment to the event.

What a Life Care Plan Establishes

A life care plan contains an itemized projection of anticipated treatment, equipment, assistance, and related expenses over a supported period. Depending on the injury, it may address physician visits, therapy, medication, surgery, mobility equipment, personal assistance, home modifications, and replacement schedules. The International Academy of Life Care Planners describes a process based on assessment, data analysis, and research. Preparing the plan commonly involves reviewing records, assessing the person’s needs, and consulting medical professionals. The planner’s qualifications and supporting medical evidence must fit the opinions offered.

Future medical expenses require evidence that the care will probably be needed and that its projected cost is reasonable. In Gunn v. McCoy, the Supreme Court of Texas discussed competing plans for home care and residential care and recognized the uncertainty inherent in predicting future expenses. A plan needs support for the type of care, frequency, duration, cost, and life expectancy assumptions used in the calculation.

The evidence required depends on the claimed loss. In National Freight, Inc. v. Snyder, the Eastland Court of Appeals explained that future medical costs can be supported by the nature of the injury, prior care, and the person’s condition at trial, without an absolute requirement of expert testimony on those costs. Complex projections of decades of medical care commonly call for qualified experts. The need for those experts follows from the medical and financial questions their testimony must answer.

An economist can calculate the present value of projected expenses, meaning the amount needed today to fund anticipated future costs, using stated assumptions about inflation and investment returns. Lost earning capacity requires a separate assessment of the person’s ability to earn income, considering education, employment history, medical restrictions, and vocational evidence about available work. The calculations should disclose their assumptions so that the parties can evaluate how different care needs or employment prospects affect the result.

Documenting the Injury’s Effects

Brain injury assessment can include testing of memory, attention, learning, and problem solving, together with clinical examinations and reports about daily functioning. The Centers for Disease Control and Prevention explains that neuropsychological or neurocognitive tests can help identify effects of a mild traumatic brain injury, while a CT scan is used for different questions, such as possible bleeding. Clinicians must interpret the findings in context. A test result alone doesn’t establish every claimed limitation, its cause, or its expected duration.

For any severe injury, the evidence should describe the assistance the person needs and how often it is required. Records of transfers, bathing, dressing, medication management, supervision, and equipment use can help evaluate proposed care. A plan should also distinguish medical recommendations from assumptions about care that family members will provide and identify the basis for each projected expense.

Caps on Recovery

Ordinary negligence claims against private drivers and carriers generally have no statutory cap on compensatory damages. The applicable claim and defendant can change that result. For example, § 101.023 limits government liability under the Texas Tort Claims Act. A severe injury doesn’t remove an applicable statutory limit.

Health care liability claims have separate noneconomic damages limits under § 74.301. The cap is $250,000 per claimant collectively against physicians and other health care providers that are not health care institutions. Each health care institution has a $250,000 cap per claimant, with a $500,000 aggregate cap across multiple institutions. These limits concern noneconomic damages; other provisions can affect particular claims and judgments.

Exemplary damages punish qualifying misconduct, such as gross negligence, under Chapter 41. The claimant must satisfy the clear and convincing standard, meaning evidence sufficient to produce a firm belief or conviction about the allegations. In a jury trial, the jury must agree unanimously on exemplary liability and amount.

Under § 41.008, the ordinary cap is the greater of $200,000 or twice economic damages plus the lesser of the noneconomic damages award or $750,000. Specified statutory exceptions require their conditions to be established. The severity of an injury alone doesn’t establish entitlement to exemplary damages.

Interest and Filing Deadlines

Texas Finance Code §§ 304.102, 304.103, and 304.104 govern prejudgment interest in personal injury cases. Subject to applicable exceptions, simple interest begins on the earlier of the 180th day after the defendant receives written notice of the claim or the filing date and ends the day before judgment. The rate equals the applicable postjudgment rate. Under § 304.1045, future damages receive no prejudgment interest, and qualifying settlement offers can limit accrual under § 304.105.

Under § 16.003, an ordinary personal injury lawsuit must be filed within two years after the claim accrues, which ordinarily occurs on the collision date for injuries sustained in a vehicle collision. Statutory exceptions require examining the claim and claimant. Health care liability claims have separate limitation rules under § 74.251, and government claims may require notice under § 101.101. Treatment and settlement negotiations must be managed alongside the applicable deadlines.

Responsibility for the injury also affects recovery. For claims governed by Chapter 33, a claimant whose responsibility exceeds 50% is barred from recovering damages under § 33.001. Responsibility above zero and up to 50% reduces recovery proportionately under § 33.012. Evidence of substantial care needs must therefore be considered alongside the evidence of how the injury occurred.

Evaluating a Settlement Offer

An offer made while treatment is developing requires an assessment of known needs, uncertain prognosis, available insurance, other collectible assets, and the risks of litigation. Additional medical evidence can support a larger damages claim, but it can also show improvement or undermine an earlier projection. The timing of a decision depends on those facts and any deadlines attached to the offer.

A valid release can resolve claims for future consequences that the parties agreed to include. In Williams v. Glash, the Supreme Court of Texas recognized that a personal injury release can be challenged on grounds such as fraud or mutual mistake, while emphasizing the narrow circumstances in which mutual mistake permits avoiding a settlement. You should understand the claims being released and the unresolved medical questions before accepting an offer.

Planning for Payments and Benefits

A settlement can combine money available immediately with payments scheduled for future dates. An annuity, an insurance contract providing payments under agreed terms, can fund part of that arrangement. The payment schedule, access to funds for unexpected expenses, inflation assumptions, and the insurer’s financial condition require evaluation. The Texas Department of Insurance’s annuity guidance describes payment options and the importance of reviewing the issuing insurer.

Medicare payment obligations require separate attention from eligibility for benefits. Medicare eligibility generally depends on age, disability, or qualifying medical conditions and related statutory requirements. Medicare’s secondary payer rules govern when another insurer must pay and when Medicare can recover conditional payments. Future treatment must be considered under the rules applicable to the settlement; CMS’s published workers’ compensation set aside program concerns workers’ compensation cases. Those program procedures cannot be assumed to govern every liability settlement.

Medicaid and Supplemental Security Income can involve income and resource limits. A properly established special needs trust may preserve eligibility while allowing funds to be used for the beneficiary, subject to the particular program’s rules. For example, 42 U.S.C. § 1396p(d)(4)(A) addresses qualifying trusts funded with a disabled person’s assets before age 65 and requires repayment to the state from funds left at death, up to the Medicaid assistance paid on the person’s behalf. The Social Security Administration also explains that trust distributions can affect benefits. The trust’s terms and administration require attention before settlement funds are paid.

What the Net Recovery Includes

Hospitals, health plans, Medicare, and Medicaid may assert payment or reimbursement claims, each subject to its governing law and requirements. A Texas hospital lien requires analysis under Property Code Chapter 55; Medicare and Texas Medicaid have separate recovery procedures. The lawyers handling the settlement should identify enforceable claims, available reductions, disputed amounts, and any funds that must be reserved.

Before settlement, you should receive an explanation of the proposed fees, case expenses, repayment claims, annuity funding, trust funding, and amount available for immediate use. The accounting should distinguish confirmed amounts from estimates or unresolved claims. Comparing that allocation with anticipated care costs helps you assess what the proposed recovery can fund.