Maryland Serious Injury Cases: Getting Paid for Long-Term Care

If you want help evaluating long-term care damages, insurance coverage, and lien exposure, contact our Maryland injury team.

What “Long-Term Care” Means in a Maryland Injury Claim

In a serious injury case, “long-term care” generally refers to future services and supports that are reasonably expected because of the injury. Depending on the person’s condition, that can include ongoing physician follow-ups, medications, physical/occupational therapy, durable medical equipment (wheelchairs, braces, hospital beds), home modifications (ramps, bathroom changes), transportation assistance, in-home nursing or attendant care, and, in some situations, assisted living or skilled nursing care.

In Maryland, these future needs are typically pursued as part of future medical and related expenses, and courts commonly require proof that the future expenses are reasonably probable rather than speculative. See, e.g., Hilleary v. Garber (Md. Ct. Spec. App. 1992) (discussing standards for recovery of future medical expenses).

Damages That May Support Long-Term Care Compensation

Every case is fact-specific, but long-term care compensation often connects to several damage categories:

• Future medical care and treatment: projected costs of medically necessary care over time, supported by medical testimony and records (see Hilleary v. Garber).
• Rehabilitation and therapy: PT/OT, cognitive therapy, vocational rehab, and similar services when supported by medical evidence.
• In-home assistance and attendant care: paid caregiving services, nursing, or support with activities of daily living.
• Home and vehicle modifications: reasonable modifications tied to medical limitations.
• Lost earning capacity: reduced ability to work in the future due to lasting impairment.
• Non-economic damages: pain, suffering, and loss of enjoyment of life. In Maryland, non-economic damages are subject to statutory caps that vary by claim type and filing date. See Md. Code, Cts. & Jud. Proc. § 11-108.

The value of long-term care is usually driven by medical documentation and credible projections, not just the diagnosis label.

Key Proof: Building a “Future Care” Record That Holds Up

Insurers commonly dispute future care needs by arguing the patient will improve, that recommended treatment is “elective,” or that cheaper alternatives exist. Long-term care claims are generally stronger when they include:

• Treating provider opinions on prognosis: clear notes explaining functional limitations, expected progression, and what ongoing care is medically necessary.
• Objective testing and functional assessments: imaging, neuropsychological testing, functional capacity evaluations, and therapy records that document limitations.
• Life care planning: a life care planner can translate medical recommendations into a detailed future-care roadmap with cost support.
• Economic analysis (as appropriate): an economist may help quantify future costs and earnings impacts in a way that aligns with accepted damages methodology.
• Real-world documentation: caregiver logs, home-care invoices, prescriptions, DME quotes, and contractor estimates for modifications.

When future needs are documented early and consistently, it is harder for an insurer to characterize long-term care requests as speculative (see Hilleary v. Garber).

Life Care Plans: What They Are and Why They Matter

A life care plan is a structured evaluation of anticipated future medical and support needs after a serious injury. It often covers treatment frequency, equipment replacement schedules, attendant care hours, therapy durations, and expected costs over time.

In settlement negotiations, a well-supported life care plan can:

• Anchor discussions around concrete medical recommendations rather than broad estimates.
• Reduce guesswork in future-cost calculations.
• Help evaluate settlement options for whether the proposed recovery is realistically aligned with projected needs.

Even when a formal plan is not used, itemizing the care needs and pricing them with supporting documentation can materially improve a demand package.

Insurance Limits and “Where the Money Comes From”

Long-term care needs can exceed the at-fault party’s available insurance. Understanding the funding landscape early can affect strategy and recovery:

• Liability insurance limits: the at-fault driver’s or property owner’s policy may cap what is available.
• Multiple potential defendants: depending on the facts, additional parties may exist (employers, contractors, product manufacturers, premises owners, maintenance companies).
• Umbrella/excess coverage: some defendants have additional layers of coverage.
• Uninsured/underinsured motorist (UM/UIM) coverage: in vehicle cases, your own policy may provide additional recovery, subject to the policy and Maryland’s UM/UIM framework. See Md. Code, Ins. § 19-509.

A case can be well-documented and still constrained by coverage. Early investigation is often important to identify viable sources of recovery.

Medical Bills, Health Insurance, and Liens: Protecting Net Recovery

Serious injury settlements often involve reimbursement claims by health insurers or benefit programs. These claims can affect how much a client actually takes home.

Issues that commonly arise include:

• Private insurance reimbursement/subrogation: terms vary by plan and can affect negotiation posture.
• Medicare Secondary Payer rules: Medicare may seek reimbursement for conditional payments related to the injury. See 42 U.S.C. § 1395y(b) and the CMS Medicare Secondary Payer overview.
• Medicaid recovery limits: federal law and case law restrict recovery in certain contexts, and compliance is fact-specific. See Arkansas Dep’t of Health & Human Servs. v. Ahlborn (U.S. 2006) and Wos v. E.M.A. (U.S. 2013).
• Resolution timing: lien/reimbursement resolution can affect when a case can be finalized and how settlement funds are disbursed.

Because reimbursement claims can significantly change the real-world value of a settlement, they should be identified and addressed early, ideally before mediation or final negotiations.

Structured Settlements and Special Needs Planning (When Appropriate)

When long-term care is a primary concern, how money is paid can matter as much as how much is paid.

• Structured settlements: part of the recovery may be paid over time. Depending on the structure, portions of personal physical-injury recoveries and certain structured arrangements may receive favorable tax treatment under federal law. See 26 U.S.C. § 104(a)(2) and 26 U.S.C. § 130.
• Benefits-sensitive planning: if a person receives (or may need) means-tested benefits, certain planning tools may help preserve eligibility while allowing funds to be used for supplemental needs. This is highly individualized and should be coordinated with qualified benefits counsel/financial professionals.

These options are not right for everyone and require careful review of the person’s medical outlook, household needs, and benefit status.

Common Mistakes That Undercut Long-Term Care Value

Long-term care damages can be discounted when:

• Treatment gaps create doubt about seriousness or ongoing need.
• Future care is asserted without medical support or clear projections (see Hilleary v. Garber).
• The claim focuses only on past bills and ignores lifetime costs.
• The case overlooks caregiver time and home-modification needs.
• Liens and reimbursement claims are not accounted for in net-settlement planning (see 42 U.S.C. § 1395y(b) and Ahlborn).

FAQ

How do Maryland courts treat future medical and long-term care expenses?

Future care is commonly pursued as future medical and related expenses and generally must be supported with competent evidence that the need and cost are reasonably probable, not speculative. See Hilleary v. Garber.

Can my recovery be limited even if my future care needs are real?

Yes. Available insurance coverage (and whether other responsible parties or UM/UIM coverage apply) can cap practical recovery even when damages are well-supported. See Md. Code, Ins. § 19-509.

Do Medicare or Medicaid have to be repaid from a settlement?

Often, yes. Medicare reimbursement may apply under the Medicare Secondary Payer framework. Medicaid recovery is also possible but subject to important limits and allocation rules. See 42 U.S.C. § 1395y(b), Ahlborn, and Wos.

Are structured settlements required in long-term care cases?

No. They are an option that may help match funds to future needs in certain situations, but whether they make sense depends on the person’s medical outlook, household finances, and benefits considerations. See 26 U.S.C. § 104(a)(2) and 26 U.S.C. § 130.

What to Do If You Are Facing a Lifetime of Care Needs

Consider these steps:

• Get consistent medical follow-up and keep copies of records.
• Save receipts and invoices for equipment, transportation, home care, and modifications.
• Track symptoms and functional limitations over time.
• Ask treating providers for clear written opinions on prognosis and future care needs.
• Consult counsel early to identify coverage, preserve evidence, and plan for liens and long-term cost projections.

Ready to talk? Contact us to discuss long-term care damages, coverage, and lien issues in a Maryland serious injury case.