On August 19, 2022, a federal judge in the Eastern District of Missouri ruled on a motion to exclude a nurse's life care plan. A doctor sued over an amputation argued that no physician had reviewed the plan. The Court wrote that he had invited it "to arrogate to doctors the exclusive domain over expertise in such matters as, among other things, the costs of medical equipment, home modifications, and transportation." Its answer was brief: "The Court declines the invitation."
A life care plan, in that Court's words, is "an assessment of a person's future medical needs (and associated costs)." The planner lists the care an injured person will need, states how often and for how long, and prices each item. The plan then goes to the judge or jury as evidence of damages. In one case below, future medical expenses made up $1,100,000 of a $1,632,192.24 verdict.
This article reviews five rulings from federal and state courts in Missouri, Florida, Texas, and Louisiana. In each, a life care planner's testimony was admitted over a challenge, credited by the Court, or upheld on appeal.
Where Life Care Planning Appears in Litigation
The five cases began with a postal truck's left turn in Houston, a knee replacement in 2019, a dump truck at a red light, a storage container lowered onto a driveway, and a cement truck on Veterans Memorial Boulevard. One was a bench trial under the Federal Tort Claims Act. One was a medical malpractice suit. The rest were personal injury claims arising from a delivery and two truck collisions.
The planner's assignment was the same in each. He or she had to say what care the injury required, how often, for how many years, and at what price. Liability belonged to other witnesses. The life care planner spoke to damages.
Two of the five planners were physicians. In the Texas case, a neurologist prepared the plan and also gave a medical opinion on one of the Plaintiff's conditions. In the Florida case, a physiatrist was retained to address both the cause of the injuries and the cost of future care. The other three planners built their plans on the recommendations of treating physicians. In one Louisiana case, a forensic economist then calculated the present value of the plan.
The challenges fell into a few groups. One Defendant argued that a planner who is not a medical doctor cannot testify without a physician's review. Another raised the opposite complaint, that a physician planner went beyond what the treating doctors had recommended. Defendants attacked single items as speculative. They objected to costs based on charged amounts. They objected to late disclosure and to figures updated shortly before trial.
After verdict, Defendants argued that the award was excessive, or that no testimony reduced future costs to present value.
Jenkins v. North County General Surgery
U.S. District Court for the Eastern District of Missouri, Eastern Division. Case No. 4:20-cv-01415-SRC. Decided August 19, 2022.
Wendy Jenkins had a knee replacement in 2019. She developed an infection and, after several follow-up procedures, lost her leg. She and her husband, Richard, sued a number of doctors and entities. They alleged that negligence caused or contributed to the loss. The other Defendants settled. The claims against Dr. Floro and his practice, North County General Surgery, remained after the Court denied his summary judgment motion.
Plaintiffs retained a registered nurse to prepare a life care plan for Ms. Jenkins. The order stated that she had been a Registered Nurse since 1979 and a Certified Nurse Life Care Planner since 1999. She estimated that she had reviewed "closer to a thousand" cases in more than twenty years of life care planning.
Her plan addressed the needs that followed an above-the-knee amputation. It covered physician care, medication, procedures, prosthetics, and modifications to the home and to transportation. She based it on a video nursing assessment, a review of the medical records, and collaboration with treating physicians. Each item carried a low and a high estimate. The lifetime total ran from $2,252,651.58 to $3,375,311.48.
Dr. Floro moved to exclude the plan under Rule 702. He argued that Plaintiffs' expert was not a medical doctor and that no physician had reviewed and approved her plan. He also argued that her costs rested on charged amounts, contrary to a Missouri statute on recoverable medical costs.
The Court denied the motion. It noted that Rule 702 covers "other specialized knowledge" as well as scientific knowledge. Dr. Floro identified no specific part of the plan that a physician's assessment did not support. The Court wrote: "Dr. Floro does not provide, nor can the Court identify, any authority supporting the arrogation of life-care-plan expertise to medical doctors, and the Court rejects it."
The ruling set a boundary. Because Plaintiffs' expert was not a physician, she could not assess medical needs "from the standpoint of a physician." Her nursing diagnoses were not medical diagnoses. Within that boundary, the Court found her qualified and her method reliable. She had reasonably relied on medical records, consultations with treating physicians, and a meeting with the Jenkinses. On the statute, the Court followed a Missouri Court of Appeals decision that limited the provision to amounts already charged or paid.
The order cleared the plan for use at trial on damages. Disputes over single items, including a spinal cord stimulator whose cost she had described as undetermined, were left for cross-examination.
Stroup v. PODS Enterprises, LLC
U.S. District Court for the Middle District of Florida, Tampa Division. Case No. 8:25-CV-00492-JLB-SPF. Decided October 7, 2026.
Jane Stroup alleged that a PODS storage container was delivered to her home on July 15, 2023. According to her complaint, the driver lowered the front of the container while she was removing an item from it. The container allegedly crushed her left foot against the ground. She sued PODS Enterprises, LLC for her alleged injuries and emotional distress.
Plaintiff retained a physician to testify about the cause of her injuries and the future needs and costs of her medical care. The order described him as a triple board-certified, fellowship-trained interventional physiatrist who served as chief of physiatry at a hospital spine center. He had training in foot and ankle trauma, crush injuries, and complex regional pain syndrome. He obtained certification as a life care planner in 2021. He devoted 80% of his time to clinical practice.
Before giving his opinions, he reviewed Plaintiff's medical records, analyzed the opinions of her treating physicians, and examined her over Zoom. His plan adopted many of the treating physicians' recommendations, including continued pain management consultations, a consultation with a psychiatrist, and a left lumbar sympathetic block. It also included physical therapy, which he said had been recommended to her before. Another item was an ambulatory service every two to three years for a fall, which he tied to her history of falling since the accident.
Defendant moved to exclude the testimony. It argued that Plaintiff's expert lacked sufficient facts and a reliable method because his opinions did not mirror those of the treating physicians. It called some of his projected costs speculative. It also suggested that a virtual examination undercut his analysis.
"Plaintiff has the better argument," the Court wrote. It described the record review, the analysis of treating opinions, and the examination as "sound methodology." The Court then turned Defendant's argument around. An expert who only repeated the treating providers' recommendations could be unreliable, because he must base his findings on independent judgment.
The order stated the rule this way: "while the recommendation of a treating physician is relevant, a life care plan that contains recommendations that a treating physician did not make is not the dispositive, bright-line rule that Defendant wishes it to be."
On costs, the Court held that the chance a Plaintiff will decline a treatment is "an inherent vulnerability in every life care plan." Defendant could raise it on cross-examination. The Court denied the motion without prejudice, and the testimony on future needs and costs remained available for trial.
Musgrave v. United States
U.S. District Court for the Southern District of Texas, Houston Division. Civil Action No. 4:23-CV-04168. Signed September 14, 2026.
Rebecca Musgrave, a retired teacher, was driving her adult son to an appointment in Houston on March 2, 2022. A United States Postal Service truck turned left across oncoming traffic, and her Toyota Highlander struck its passenger side. She was 65. Her injuries included a traumatic brain injury with a subdural hematoma, a shattered right tibia, fractures in her left hand, and a rib fracture. She sued the United States under the Federal Tort Claims Act. A three-day bench trial began on May 11, 2026.
Plaintiff's expert was a neurologist and life care planner. He put her remaining life expectancy at about eighteen years as of 2024. His plan priced future outpatient care, therapeutic services, medication, diagnostic testing, equipment, and supplies at $319,241.13 in current dollars.
The plan accounted for her health before the crash. Ms. Musgrave had numerous preexisting conditions, among them diabetes, arthritis, lower back pain, and migraine headaches. Plaintiff's expert assigned zero dollars to future treatment of her lower back pain, because she would have needed it without the accident. He did the same for future costs tied to her knee surgery. He capped household help at three to five years.
The United States tested the testimony on several fronts. It objected that his testimony on past medical expenses went beyond his report, and it had earlier moved to strike his affidavit on treatment costs. The Court denied the motion and overruled the objection. It agreed that the affidavit should have been disclosed earlier, but found the lapse "substantially justified or harmless." More than six months had passed between production of the affidavit and trial.
A neurosurgeon who testified at trial disputed two medications in the plan, a cholinesterase inhibitor and an NMDA antagonist. The Court observed that he was not a neurologist and had no experience providing long-term care for patients with traumatic brain injuries. It credited Plaintiff's expert, whose testimony it called "detailed and informed by his expertise as a neurologist."
The Court found the plan and its cost estimate "reasonable in all respects." It assigned 80% of the responsibility for the crash to the postal driver and 20% to Ms. Musgrave. It then awarded $255,392.90 for future medical expenses, which it described as 80% of the $319,241.13 estimated in the plan. The government's Medicare argument failed. It had cited no caselaw and offered no evidence of which costs Medicare would cover.
Ms. Musgrave's total recovery was $647,016.14. The future medical award was the plan's own figure, reduced for comparative fault and nothing else.
Jackson v. Underwriters at Lloyd's of London
Court of Appeal of Louisiana, Fifth Circuit. No. 21-CA-15. Decided September 29, 2021.
A Mack dump truck struck the rear of Dianne Jackson's Nissan Altima at about 6:00 a.m. on January 20, 2017, on La. Highway 44 in St. John the Baptist Parish. Defendants admitted that the truck driver was the sole cause. The trial, held August 26 to 29, 2019, turned on damages.
Ms. Jackson's pain management physician recommended recurring cervical injections and radiofrequency ablations. Her neurosurgeon recommended a two-level cervical fusion and testified that she would more likely than not need a second surgery.
Plaintiff's expert was accepted in life care planning and vocational rehabilitation. He met with Ms. Jackson, reviewed her medical records, spoke with both treating physicians, and read their depositions. He then researched costs to obtain a range from the least to the most expensive. A forensic economist calculated the present value of the plan at $1,192,483 on the low end and $2,370,534 on the high end.
Defendants' expert in the same fields offered a far smaller plan. Relying on a neurosurgeon who examined Ms. Jackson for the defense, she priced future care at $116,490.11 to $116,742.32.
The jury awarded $1,100,000 in future medical expenses. The trial court denied Defendants' motion for judgment notwithstanding the verdict or a new trial.
On appeal, Defendants called the award grossly excessive. They attacked the two neck surgeries, the injections and ablations, and the cost of Duexis, an anti-inflammatory medication. They argued that Plaintiff's expert, who was not a medical doctor, had to guess at medical recommendations for some procedures. They asked the Court to cut the award to no more than $263,016.44.
The Court affirmed. The award was $92,483 below the most conservative figure in Plaintiff's plan. The jury had not been asked to award future medical expenses by category, and the Court found that the evidence supported "multiple combinations of future treatment." It checked the Duexis arithmetic and found the costs properly calculated. It held that the neurosurgeon's testimony supported the second surgery.
Of Plaintiff's expert, the Court wrote that he "testified at length about his proposed life care plan and gave adequate reasons for the necessity and cost of its elements." The jury had two life care plans before it and chose the one prepared by Plaintiff's experts.
Savoie v. Landrieu Concrete and Cement Industries, LLC
Court of Appeal of Louisiana, Fourth Circuit. No. 2025-CA-0837, consolidated with No. 2025-CA-0838. Decided August 31, 2026.
Sherry Savoie was in the westbound turning lane of Veterans Memorial Boulevard on October 24, 2018, attempting a left turn onto Fleur de Lis Drive. A cement truck in the lane to her right also attempted a left turn and struck her 2005 Lexus. She suffered injuries to her lumbar and cervical spine, right shoulder, and chest. After an eight-day trial, a jury found the driver and his employer negligent and awarded $1,819,600. Defendants appealed only the damages.
The dispute over the life care planner arose from timing. Shortly before trial, Defendants received notice that Ms. Savoie's treating physician was recommending new surgeries, including a lumbar disc fusion. The recommendation followed an MRI in April 2025 and an examination on May 8, 2025. Both came after the cutoff for expert reports and the discovery deadline. Defendants called this a "trial by ambush." They argued that the new recommendations had caused Plaintiff's expert to "abandon" his earlier analysis and raise his cost estimate.
The trial court excluded the MRI report and the physician's written report of the May visit. It allowed the physician to testify about the visit and his recommendations. It also allowed Plaintiff's expert to give new calculations from the witness stand, based on those recommendations.
The Court of Appeal found no abuse of discretion. Ms. Savoie had been treated for more than six years, with therapy, injections, a discectomy on June 11, 2020, and continuous pain medication. As early as June 2021, her physician believed she would require a lumbar fusion. The Court wrote that hers "was a fluid, evolving situation and not such that it could have been cut off or suspended due to a trial setting."
It added: "While discovery cutoffs and trial scheduling deadlines are important, they must be balanced against a litigant's right to present their entire medical picture to the trier of fact."
Defendants also argued that Ms. Savoie had not proved future medical expenses, because no economic testimony reduced them to present value. The trial court had told Defendants to raise the point in cross-examining the life care planner. The record showed that he testified to the total cost of the surgeries and related treatment. Defense counsel did not examine those costs in detail. Counsel asked him only whether the costs would be zero if he adopted the defense medical expert's view that surgery was not required. The Court found no merit in the argument and affirmed the evidentiary rulings and the award.
What the Rulings Have in Common
None of the five courts required the life care planner to be a physician. The Missouri court admitted a nurse with a planning certification dating to 1999. The Louisiana Fifth Circuit upheld an award built on the plan of an expert in life care planning and vocational rehabilitation. Where the planner was a physician, the specialty mattered. The Texas court credited a neurologist over a neurosurgeon on brain injury medication, noting that the neurosurgeon had no experience providing long-term care for such patients.
Three rulings describe how the plan was prepared, and the steps match. The planner reviewed the medical records, met or examined the Plaintiff, and took account of the treating physicians' recommendations. Contact with the Plaintiff took the form of a video assessment in Missouri, a Zoom examination in Florida, and a meeting in Jackson. On price, the Missouri planner used local service providers, internet research, and published databases of charge data.
On fit, the plans stayed with the injury in suit. The Texas planner removed back and knee costs that the Plaintiff would have incurred anyway. The Florida planner linked an ambulatory service to falls that followed the accident. In both Louisiana cases, the surgeries in the plan rested on a treating physician's testimony, and the planner supplied the cost.
The courts also marked limits. The Missouri court said a nurse planner cannot assess medical needs from a physician's standpoint. The Florida court let a physician planner go beyond the treating doctors, but only after finding a factual and analytical foundation in his report.
These five rulings were selected because the testimony held up. They are not a measure of how often it does.
Practical Points for Attorneys
Dr. Floro's motion in Jenkins pointed to no part of the plan that lacked a physician's support, and the Court said so more than once. It told him he could cross-examine on any portion he had evidence against. The motion in Stroup did name items. The Court found the recommendations behind them supported by a reliable method.
For the party offering the plan, these records show a visible chain from physician to planner to price. In Jackson and Savoie, treating physicians testified to the need for surgery, and the planner priced what they described. In Musgrave, the plan already left out costs the Plaintiff would have incurred without the crash. The Court then rejected the government's argument that her ongoing conditions came from her preexisting health.
Disclosure appears in two of the rulings. The Musgrave Court agreed that a cost affidavit should have been produced earlier, and found any prejudice cured by the six months and more that passed before trial. In Savoie, the update came after the deadlines. The trial court kept out the written reports and allowed the testimony. Both results turned on the particular record.
For the opposing party, Savoie and Jackson are worth reading together. In Savoie, the trial court directed Defendants to raise present value on cross-examination, and defense counsel did not examine the costs in detail. In Jackson, the jury was not asked to divide future medical expenses by category. The appellate Court could not tell which items the jury accepted, and it affirmed because several combinations supported the total.
Two planners gave low and high estimates. In Jackson, the award came in below the low figure. These are observations drawn from five records, not legal advice.
From Plan to Award
Three of the five rulings state the plan's total. The figures ran from $319,241.13 in Musgrave to a high estimate of $3,375,311.48 in Jenkins. In Musgrave, the Court awarded the plan's figure less comparative fault. In Jackson, the jury awarded $1,100,000 against a low estimate of $1,192,483, and the award stood on appeal.
The orders in Jenkins and Stroup came before trial. In both, the planner's figures still had to face cross-examination before a jury.
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