A personal injury settlement can include the cost of prosthetics and assistive devices when an injury caused by someone else makes that equipment necessary. These expenses are economic damages, the category that covers measurable financial losses such as medical bills. A claim can account for the initial device and reasonably expected future costs, including fittings, repairs, replacements, and training. Related home or vehicle modifications may also be included. The equipment must address the injury, its cost must be reasonable, and future expenses must have sufficient supporting evidence. State law, available insurance coverage, and responsibility for the accident can affect the amount recovered.
Assistive devices often bring expenses that continue long after the first purchase. Prosthetic sockets may need refitting as a residual limb changes, and wheelchairs may need new batteries, repairs, or replacement parts. A settlement that accounts only for the first device can leave significant future needs unaddressed.
Medical documentation and realistic cost projections help establish those needs. A personal injury lawyer can help gather that evidence and evaluate how insurance payments or reimbursement obligations may affect the settlement.
Key Takeaways: Can a Personal Injury Settlement Include the Cost of Prosthetics and Assistive Devices?
- A claim can include the reasonable cost of prosthetics and assistive devices needed because of the injury.
- Future replacements, repairs, fittings, and related supplies may be included when supported by evidence.
- Training, therapy, and necessary home or vehicle modifications can also be part of the claim.
- Insurance payments may affect recoverable damages, and some payers have rights to reimbursement from a settlement.
- Settling before long-term device needs are understood can leave future expenses out of the agreement.
Which Prosthetics and Assistive Devices Can Be Included?
If an injury makes a device reasonably necessary, its reasonable cost can generally be included in the claim. A prescription or specialist’s recommendation helps establish that need, but the type of equipment and its price may still be disputed.
Devices that may be included are:
- Artificial limbs, including myoelectric arms and microprocessor-controlled knees when the evidence supports that level of technology
- Mobility equipment, such as manual and power wheelchairs, walkers, and custom orthotics
- Sensory devices, including hearing aids, cochlear implants, and vision aids when the injury caused the need for them
- Communication devices, such as speech-generating equipment for someone whose injury affects their ability to communicate
- In-home medical equipment, including patient lifts, hospital beds, and pressure-relief mattresses
The question often comes down to which device reasonably meets your needs. For example, an insurer may dispute a microprocessor-controlled knee recommended by your specialist and argue that a less expensive model is sufficient. Medical records explaining your mobility, work responsibilities, safety needs, and daily activities can help support the recommendation.
Keep receipts and records for equipment, fittings, repairs, and related expenses. These records help document what you have already spent and give experts a starting point for estimating future costs.
How Do You Prove Future Replacement and Maintenance Costs?
Future expenses can make up a substantial part of a claim involving long-term equipment needs. The evidence should explain what you are likely to need, how often you will need it, and what it is expected to cost.
A prosthetic limb’s replacement schedule depends on factors such as the device, activity level, growth, and changes in the residual limb. Wheelchair needs can also change as a person’s condition or mobility changes. There is no single replacement schedule that fits everyone.
Courts generally require more than a possibility that an expense might arise. The precise standard varies by state, but future medical costs typically must be reasonably probable or reasonably certain.
Evidence supporting those costs may include:
- Medical opinions explaining the injury, expected recovery, and ongoing equipment needs
- Prosthetist or equipment specialist assessments describing anticipated adjustments, maintenance, and replacements
- Cost estimates for recommended devices, components, supplies, and services
- Evidence about how long the equipment will be needed, including life expectancy when lifetime care is anticipated
A permanent injury claim may require expert testimony to explain your future equipment needs and what they are likely to cost. A general estimate without supporting medical recommendations may be difficult to prove.
Can Training, Repairs, and Home Modifications Be Recovered?
A claim can include reasonable injury-related expenses needed to use and maintain an assistive device safely.
Someone learning to walk with a prosthetic limb may need physical therapy. A person using a power wheelchair may need occupational therapy or other training to navigate daily activities. These services can be included when they are reasonably necessary because of the injury.
Ongoing expenses may include socket adjustments, replacement liners, wheelchair batteries, and repairs. Necessary supplies for home medical equipment may also be included.
Home and vehicle modifications can be part of the claim when they address limitations caused by the injury. Examples include:
- Installing a wheelchair ramp
- Widening doorways
- Making a bathroom accessible
- Adding vehicle hand controls
- Installing a wheelchair lift
Each proposed expense should have a clear connection to the injury and a reasonable cost estimate. For larger modifications, medical recommendations and an accessibility assessment can help explain why the work is needed.
How Does a Life-Care Plan Account for Long-Term Device Needs?
A life-care plan organizes expected future care and equipment costs. It may list replacement devices, therapy, maintenance, supplies, and accessibility modifications, along with their anticipated frequency and cost.
Several professionals may contribute:
- Medical specialists and prosthetists explain which devices and services are appropriate.
- Life care planners organize supported recommendations into a detailed estimate of future needs.
- Forensic economists help calculate future costs, including expected price increases and any present-value adjustments required by the law that applies to the case.
A present-value adjustment accounts for receiving money now to cover expenses that will arise later. The rules governing that calculation vary by state and type of claim.
Economists may also assess future lost earnings if the injury affects the ability to work. Those losses are separate from equipment costs, although both may be part of the same claim.
A well-supported life-care plan gives the insurer specific expenses and medical recommendations to evaluate. It does not guarantee agreement on every item. If the case goes to trial, qualified experts may use the plan to explain future needs, subject to the court’s evidence rules.
Why Does Settlement Timing Matter?
Long-term device needs may be unclear during the early stages of recovery. After an amputation, for example, the residual limb may continue to change while rehabilitation helps establish the person’s mobility and equipment needs.
Settling before those needs are reasonably understood can leave important costs out. A settlement release generally ends the claims it covers, even if future care turns out to be more expensive than expected.
That does not mean you should wait to take legal action. Filing deadlines still apply, and they vary by state and the circumstances of the claim. A lawsuit may need to be filed while treatment and future-care evaluations are ongoing.
When choosing a personal injury lawyer, experience evaluating long-term medical needs can be particularly relevant to a claim involving permanent equipment use.
Frequently Asked Questions About Prosthetics and Assistive Devices
Can a claim include upgraded devices needed later?
A claim may include a different or more advanced device when the evidence supports a reasonably expected future need. For example, a specialist may anticipate a change in equipment as rehabilitation progresses, or a growing child may need repeated fittings and larger devices.
The recommendation should explain why the future device is appropriate and when it will likely be needed. A preference for newer technology, without evidence supporting its necessity, may not be enough.
What happens if insurance pays part of the device cost?
The effect depends on state law and the type of coverage. Some states allow courts to reduce certain damages when another source has paid, or will pay, the same expense. These are often called collateral-source rules.
For example, New Jersey generally requires deductions for certain duplicate benefits, subject to exceptions. New York also allows reductions for qualifying benefits that replace the same economic losses, with exceptions and adjustments for coverage costs.
These court-award rules can influence settlement negotiations, but they do not mean every settlement receives an automatic insurance deduction.
Reimbursement is a separate issue. Medicare or another payer with an enforceable reimbursement right may seek payment from the settlement. If Medicare made conditional payments for injury-related care, those payments generally must be addressed when the case settles. The final repayment amount may be reduced under applicable rules.
These issues should be evaluated before accepting an offer so you understand how they may affect the money available for future equipment and care.
Does Medicare cover prosthetic devices?
Original Medicare Part B covers certain prosthetic devices when its coverage requirements are met. For covered devices, you generally pay 20% of the Medicare-approved amount after meeting the Part B deductible.
An order from a health care provider does not automatically establish coverage for every device or model. Supplier requirements and other coverage conditions also apply. Some surgically implanted devices may fall under Part A, depending on where the procedure takes place.
Medicare coverage does not automatically prevent a personal injury claim for device costs. However, Medicare’s payment rules and any reimbursement obligations need to be considered when evaluating the claim.
Will my share of fault affect compensation for assistive devices?
Your share of fault can affect the overall claim, including compensation for equipment costs. Many states reduce damages according to your percentage of responsibility. Some also bar recovery when your fault reaches a specified threshold.
A few jurisdictions follow contributory negligence, which can bar recovery in a negligence claim when your own negligence contributed to the injury. The rules and exceptions depend on the jurisdiction and type of case.
Understanding how negligence laws affect your personal injury claim helps explain how responsibility for the accident may affect settlement negotiations.
Get Legal Help with Brandon J. Broderick, Attorney at Law
A serious injury can bring equipment and care expenses that continue for years. Evaluating a settlement means looking beyond the first device to the fittings, maintenance, replacements, and support you are reasonably expected to need.
At Brandon J. Broderick, Attorney at Law, our team can help document those expenses, work with appropriate specialists, and evaluate how future needs should be addressed in your claim. We offer a free consultation, and our team is available 24/7.