Spinal cord injury or paralysis: what a claim must cover for the rest of your life

What is a spinal cord injury, and what are the signs?

This page explains claims and is not medical advice. If a spinal injury is possible after a crash or fall, call 911. NINDS says emergency crews will place a rigid collar around the neck and carefully place the person on a backboard.

NINDS says the damage can cause temporary or permanent changes in feeling, movement, strength and body functions below the point of injury. Symptoms can include numbness or tingling in the hands and feet, loss of bladder and bowel control, weakness, and trouble walking or breathing.

Paralysis can come on immediately or develop over time from bleeding and swelling. Motor vehicle accidents and serious falls are the most common causes in the U.S.

Complete or incomplete: why does the word matter for a claim?

An incomplete injury means the spinal cord is still able to send some messages to or from the brain. A complete injury means there is no nerve communication below the injury site. The level also matters: the higher on the spine, the more of the body is affected.

Those two facts shape nearly every number in the claim, from care needs to work ability. Doctors can now predict the likely long-term outcome with reasonable accuracy, which is what makes a future care estimate possible.

The medical picture also explains costs other pages leave out. About one-third of people with these injuries need temporary or permanent help breathing. Autonomic dysreflexia is a life-threatening reflex action that needs fast care. About 29 percent of people with these injuries are re-hospitalized in any given year.

What do doctors document in a spinal cord injury claim?

What can a spinal cord injury claim cover?

Beyond medical bills, a claim can include future care, lost earnings, lost earning capacity, home and vehicle changes, attendant care, pain, loss of enjoyment of life, and a spouse's loss of companionship in some states. The two parts that move the numbers most are the life care plan and the earning capacity report.

A life care plan is a written, priced list of everything a person is likely to need for the rest of their life. A nurse or rehab specialist usually prepares it with the treating doctors.

These national estimates show why the plan matters. They are costs of care and living, not settlement amounts, and they vary greatly by person. They do not include lost wages.

Lost earning capacity is the gap between what you could have earned and what you can earn now. It is not only your last paycheck. A vocational expert looks at your work history and limits, and an economist puts it into today's dollars.

National data puts indirect costs such as lost wages at an average of $97,787 per year. Only about 18 percent of people are employed a year after injury, so work is a large part of these claims.

Who pays when costs are this high?

The hard truth is that insurance limits often cap what can be collected. Many drivers carry small policies. So a thorough search matters from the start.

Plan for what comes out of a recovery. Medicare's conditional payments must be repaid when a person receives a settlement. Ask early about Social Security disability, Medicaid rules and a possible special needs trust, because a lump sum can change eligibility. These are questions for a lawyer and a benefits specialist together.

How do insurers dispute spinal cord injury claims?

• Prior conditions. They point to arthritis or narrowing of the spine and say the crash only made a small change.
• Delayed symptoms. They say weakness that appeared later came from something else, though NINDS says damage can develop over time.
• Gaps in care. Any long break in rehab is treated as a sign you improved.
• The life care plan. They hire their own planner to remove items or lower the hours of help.
• Work ability. They claim you can do a desk job and that the gap in pay is small.
• Life expectancy. A shorter projected life lowers future care numbers, and this is a difficult but real part of these cases.
• Fault. They argue you were not wearing a belt or were partly to blame.

How long does a spinal cord injury claim take?

Longer than most, often years when a lawsuit is filed. No agency publishes an average. Doctors need time to see how much function returns, and a plan cannot be priced until then. Your deadline does not wait for that, so a lawyer often files suit while treatment continues.

1. Treat and stabilize. A lawyer can send preservation letters during this time.
2. Investigate fault and find every insurance policy.
3. Build the numbers: life care plan, earning capacity, economist.
4. Demand, then lawsuit if needed. Exchange of records and depositions follow.
5. Mediation or trial. A structured settlement can pay over time.

What is different in Arizona and Texas?

Arizona's rule that each defendant pays only its share matters a great deal in a catastrophic case. If a jury puts part of the fault on someone with no insurance, that part may go unpaid.

Mistakes that hurt spinal cord injury claims

• Accepting the policy limits without looking for other insurance.
• Signing a release before anyone has priced future care.
• Failing to plan for Medicare, Medicaid or liens.
• Missing a government notice because the family was focused on the hospital.
• Letting the car or other evidence disappear in the first weeks.

Questions