Reserves rarely break in one moment. They drift. The claim starts out as a simple strain/sprain but severity creeps in with complicating factors such as comorbid conditions or surgery and suddenly you are under reserved.
A medical cost projection gives you a grounded forecast of future needs so you can set reserves with confidence and steer the file with fewer surprises.
What a medical cost projection does for an adjuster
Medical cost projections are designed to support accurate reserve setting. They address future needs for a defined segment of time or lifetime expectancy.
This is what it can include:
- Future medical
- Pharmacy
- Durable equipment and supplies
- Home care
- Home modifications
- Transportation
Typical outputs include:
- Medical record review and summary
- Comprehensive report
- Narrative
- Cost analysis worksheet
When to order one
Use a medical cost projection when you feel any of this:
- “Treatment keeps changing and I cannot pin down what the next year looks like.”
- “Pharmacy is climbing and I need a clean forecast.”
- “I need reserves that match reality, not hope.”
- “Negotiation is coming and I want numbers I can stand behind.”
The sharp line: medical cost projection vs Medicare Set-Aside
These can look similar because both project future treatment. The difference is the job they are built to do.
- Medical cost projection: reserve setting and strategy, broad future needs across key categories.
- Medicare Set-Aside: protects Medicare’s interests when settling future medical and includes only Medicare-covered services and medications.
How to use the projection to drive action
Do not file it away. Use it to:
- Reset reserves to a realistic forecast
- Identify cost drivers early, before they harden into permanent exposure
- Walk into a negotiation with a clear, defensible story
If your reserves feel fragile, stop the drift now. Get a medical cost projection and anchor the file to a forecast you can defend.