Texas Bar Journal • February 2026

Life Care Planners in Personal Injury Litigation

Some challenges and solutions.

Written by Travis Livermore

nurse and elder patient

Plaintiffs in personal injury cases often use life care planners as experts because a good life care plan can significantly increase the value of verdicts. A plaintiff who brings suit following a trucking accident or slip-and-fall may receive treatment from a general practitioner, an orthopedic surgeon, a neurologist, and a neuropsychologist. Each of these providers may render general recommendations for future care. A good life care planner converts these general recommendations into specific treatment, diagnostic care, and services to be administered throughout a plaintiff ’s life. The life care planner either assigns a cost to recommended items, or the plaintiff separately retains a cost expert.

For defense practitioners, the trip from generic recommendations about future care in a plaintiff ’s medical records to the specific recommendations for future treatment found in a life care plan may be a psychedelic journey without scientific explanation, as well as one that dramatically changes the estimated value of the case from what the defense attorney previously provided to her client or the client’s carrier. The life care plan may force defendants to spend more on experts to counter opinions on reasonableness and cost of future care, as well as make them more likely to settle at greater amounts to avoid a higher adverse verdict.

Life care planners come from various backgrounds, but they are often physicians, and specifically physiatrists.
Registered nurses, often with separate certificates as planners, are also used.

This article briefly discusses the use of nurses as life care planners and issues related to physician planners who make recommendations beyond their practice area. The article will benefit attorneys that represent plaintiffs or defendants in personal injury litigation.

SUBSTANTIVE QUALIFICATIONS AND WORKAROUNDS
Apart from specific procedures, recommendations for a plaintiff ’s future medical care are often vague. For example, a physician might write that “the patient will in all likelihood continue to experience symptoms and require future treatment;” or “the patient may require future treatments including therapy and interventional procedures.” On the other hand, life care plans involve specific care, such as steroid injections or radiofrequency ablation at specific frequencies.

Texas Rules of Evidence Rule 702 provides:

“If scientific, technical, or other specialized knowledge will assist the trier of fact to understand the evidence or to determine a fact in issue, a witness qualified as an expert by knowledge, skill, experience, training or education, may testify thereto . . .”1

The party offering expert testimony bears the burden to prove the witness is qualified.2 The trial court has broad discretion with respect to qualifications of an expert.3

Under Texas law, the term “professional nursing . . . does not include acts of medical diagnosis or the prescription of therapeutic or corrective measures,”4 and nurses are prohibited from engaging in such activities.5 Therefore, to the extent a life care plan prepared by a nurse recommends specific treatments or frequencies that do not match the recommendations of a plaintiff ’s treating physicians, nurse practitioners, or physician experts, the nurse should generally not be qualified as an expert.

In Brazos Contractors Dev, Inc. v. Jefferson,6 the plaintiff, who was employed by a subcontractor, sued the general contractor for injuries sustained when he was struck by a steel cross brace.7 The plaintiff presented testimony from a nurse and certified life care planner. Defense counsel elicited testimony from the nurse and life care planner that she (1) was not qualified to testify regarding medical necessity and (2) was not testifying to medical necessity with respect to services in the life care plan.

Nonetheless, she testified regarding future care and estimated future expenses of $1,213,659 for a 10-year period. The jury awarded $500,000 of the recommended $1.2 million.

On appeal, the court determined that, while the nurse’s testimony “alone [did] not show a reasonable probability that the . . . future expenses [would] be incurred,” specific components of the plan were supported by other expert testimony. The court noted the testimony of:

  • An oral surgeon, that the plaintiff would need surgery at a cost of $123,169;

  • A neurologist, that the plaintiff would require assistance for the rest of his life and recommended the plaintiff reside in assisted living;

  • A neuropsychologist, who recommended assisted living based on the plaintiff ’s “significant” deficits in executive functioning and memory; and

  • A kidney specialist, that the plaintiff ’s life expectancy was 6.4 years.

The court upheld the jury’s award. In doing so, the court did not note any conference involving the life care planner and the plaintiff ’s other medical experts. The supporting testimony of other, qualified experts was enough to affirm the award.

While the plaintiff in Brazos had a team of physician experts whose opinions supported that of the nurse planner, other plaintiffs may not have such a team. In such circumstances, testimony by a nurse life care planner that specifies future treatment not specified by treating physicians or qualified medical experts should be excluded. Nonetheless, a workaround may simply be for the nurse to converse with the plaintiff ’s treating physicians. One could argue that such a step would not be sufficient for a jury to make an award based on specific treatment recommendations by the nurse planner. However, at some point, even a physician life care planner would be unqualified to recommend specific treatment without consulting another physician if the life care planner’s specialty is different from the area of treatment.8 For example, a physiatrist may not be qualified to render a psychiatric diagnosis, yet she may prepare a life care plan that involves specific recommendations in response to the diagnosis based on conversations with a psychiatrist or psychiatric expert.

SUBSTANTIVE QUALIFICATIONS AND WORKAROUNDS FOR REASONABLENESS OF COST
In Texas, a plaintiff may only recover for reasonable charges in connection with medical care.9 Importantly, physicians are not always qualified to testify as to the reasonableness of charges for care. In one case, the court determined that a chiropractor was not qualified to opine on whether charges for treatment other than chiropractic care were reasonable and customary.10 In another case, the court concluded that an orthopedic surgeon was not qualified to render opinions on the reasonableness of charges by a chiropractor.11 The surgeon’s “status as a licensed physician did not automatically qualify him as an expert on every medical question.”12

The Supreme Court of Texas has indicated that a physician may not be qualified, even within his own practice area, to opine on whether charges for treatment are reasonable and customary, given the complexity of modern healthcare pricing.13 On the other hand, “insurance agents are generally well-suited” to determine reasonableness of cost. Additionally, nurses are often qualified to render such an opinion if they are sufficiently familiar with medical billing and coding.14

Because a physician may not be qualified to give an opinion on reasonableness of charges, and because life care plans involve anticipated, future charges for care, a registered nurse who is trained in billing and coding, and who confers with treating physicians, may be a better choice as a planner than would be a physician who is not as familiar with billing and coding. Additionally, a jury may view a nurse as more relatable.

In conclusion, life care planners can add significant value to a plaintiff ’s personal injury case and present challenges to the defense. Considerations in selection of a life care planner include the life care planner’s training in the medical field and in cost and billing, along with the relatability of the life care planner to a jury.

Notes

  1. See Broders v. Heise, 924 S.W.2d 148, 151–52 (Tex. 1996), citing Tex. Rules of Evidence Rule 702.

  2. Id., citing Goode, et al., Guide to the Texas Rules of Evidence: Civil and Criminal, § 702.3 n.1 (Texas Practice 1988); see also Matson v. State, 819 S.W.2d 839, 851 (Tex. Crim. App. 1991).

  3. Id., citing Cf. E.I. du Pont de Nemours and Co. v. Robinson, 923 S.W.2d 549, 558 Tex. 1995); seealsoGinsbergv.TheFifthCourtofAppeals,686 S.W.2d 105, 108 (Tex. 1985).

  4. Tex. Occ. Code Ann. § 301.002 (West).

  5. Esquivel v. El Paso Healthcare Sys., Ltd., 225 S.W.3d 83, 90 (Tex. App. 2005).

  6. Brazos Contractors Dev., Inc. v. Jefferson, 596 S.W.3d 291 (Tex. App. 2019).

  7. Id.

  8. Supra note 1 (“. . . given the increasingly specialized and technical nature of medicine, there is no validity, if there ever was, to the notion that every licensed medical doctor should be automatically qualified to testify as an expert on every medical question . . . ”).

  9. In re K&L Auto Crushers, LLC, 627 S.W.3d 239, 249–50 (Tex. 2021).

  10. Hong v. Bennett, 209 S.W.3d 795 (Tex. App. 2006).

  11. Turner v. Peril, 50 S.W.3d 742, 747 (Tex. App. 2001).

  12. Id.

  13. Gunn v. McCoy, 554 S.W.3d 645, 673 (Tex. 2018) (“Thus, it is not uncommon or surprising that a given medical provider may have no basis for knowing what is a ‘reasonable’ fee for a specific service.”).

  14. See In re Baker, No. 02-23-00133-CV, 2023 WL 3879669, at *4 (Tex. App. June 8, 2023).

Justice Evan A. YoungTRAVIS LIVERMORE is a senior associate attorney of Marshall Presley & Pipal. He practices throughout Texas in all areas of construction law, including defects and injury litigation, pay and contractual disputes, contract drafting and negotiation, and OSHA citation contests.