Medical Cost Projections: Our Alternative to the Guessing Game

When an employee is injured, the primary focus should be on their recovery—but for employers and insurers, there’s also the reality of planning for the medical costs that will follow.

Medical cost projections estimate the financial impact of an employee’s injuries and future medical expenses, often in the context of legal or insurance claims for both workers’ compensation and liability.

These projections are crucial for adjusters in their claims management, litigation and settlement negotiations. Yet if you’ve ever submitted a request for one, you know it can take months to get a response—well past the date the treatments were rendered.

As you can imagine (or have already experienced), this delay makes it extremely difficult for adjusters to get what they need in time to accurately set their reserves.

But you’re an employer, not an adjuster—why does getting a timely projection matter to you?

It matters because not having solid projections now means your company may be in for big budget surprises down the road.

How Medical Cost Projection Works

Medical cost projection is the process of reviewing medical records and other relevant data to estimate future costs of services an injured or ill person is likely to need.

These cost projection reports typically focus on:

• Current medical expenses (hospital bills, medications, therapies)
• Future medical needs (surgeries, rehabilitation, equipment)
• Cost savings opportunities
• Rehabilitation and long-term care costs

Why You Would Need It

If one of your employees is in the early stages of a legal or insurance case involving injury-related medical expenses, you want to have a documented set of expense projections for them ASAP. This helps insurance adjusters and attorneys fully understand the financial scope of damages, rather than litigating or settling for an amount not reflective of actual cost to your employee and insurer.

When You Would Need It

If you have an employee dealing with personal injury, workers’ compensation or medical malpractice cases where long-term care may be needed, you’ll want a cost projection. Ideally, you will get one early in the case development process to establish a baseline for future medical needs. You can also request one during settlement negotiations, when preparing a demand package, or collecting evidence to present at trial.

How Our Team Helps

Instead of just waiting for answers or relying on an industry benchmark pricing chart, our Medical Cost Projection team takes a proactive approach to creating reliable estimates by assessing each medical claim on a case-by-case, start-to- “finish” basis.

Since each case is assigned to a specialist that has a medical background on the particular injury or condition, we are typically able to turn around projections within 14 days.

Certified Medical Cost Projection Specialists (CMCPS)

This group of specialists looks at an individual’s past and current treatment needs by reviewing medical records (typically within the past two years), then builds an estimate of related future expenses like office visits, medications, therapy, etc. to get a clearer picture of overall cost. To be certified as CMCPS requires successful completion of a 45-hour training program.

Certified Life Care Planners (CLCP)

This group of specialists can pick up where a medical cost projection leaves off if the individual has stabilized but will need long-term care. They look at costs for chronic health conditions or catastrophic injuries and options for Life Care Plans. To be certified as a CLCP requires successful completion of a 120-hour training program.

If you work with medical claims for workers’ comp or liability and are interested in getting a better handle on your costs in advance, get in touch with us.