The opinion
In the United States Court of Federal Claims
OFFICE OF SPECIAL MASTERS
No. 13-190V
(Filed: May 30, 2014)
* * * * * * * * * * * * * * *
TORY MOODY and SARAH MOODY, * UNPUBLISHED
Parents of minor child, VEM, * Special Master Dorsey
*
Petitioners, *
*
v. *
* Decision on Proffer; Damages;
SECRETARY OF HEALTH * Measles, Mumps, Rubella
AND HUMAN SERVICES, * (MMR) vaccine; Varicella vaccine;
* Table Encephalopathy.
Respondent. *
*
* * * * * * * * * * * * * * *
David Porter Murphy, Greenfield, IN, for petitioners.
Heather Lynn Pearlman, United States Department of Justice, Washington, DC, for respondent.
DECISION AWARDING DAMAGES1
On March 12, 2012, Tory Moody and Sarah Moody (“petitioners”) filed a petition on
behalf of a minor, VEM, pursuant to the National Vaccine Injury Compensation Program.2 42
U.S.C. §§ 300aa-1 to -34 (2006). The petition alleges that VEM received a measles, mumps,
rubella (“MMR”) and varicella vaccines on April 1, 2010, and suffered “febrile status epilepticus
after immunizations with subsequent decline, and now with intractable epilepsy which was
caused-in-fact by the MMR and Varicella vaccinations . . . .” Petition at 2, 5.
1
Because this decision contains a reasoned explanation for the undersigned’s action in this case,
the undersigned intends to post this ruling on the website of the United States Court of Federal
Claims, in accordance with the E-Government Act of 2002, Pub. L. No. 107-347, § 205, 116
Stat. 2899, 2913 (codified as amended at 44 U.S.C. § 3501 note (2006)). As provided by
Vaccine Rule 18(b), each party has 14 days within which to request redaction “of any
information furnished by that party: (1) that is a trade secret or commercial or financial in
substance and is privileged or confidential; or (2) that includes medical files or similar files, the
disclosure of which would constitute a clearly unwarranted invasion of privacy.” Vaccine Rule
18(b).
2
The National Vaccine Injury Compensation Program is set forth in Part 2 of the National
Childhood Vaccine Injury Act of 1986, Pub. L. No. 99-660, 100 Stat. 3755, codified as amended,
42 U.S.C. §§ 300aa-1 to -34 (2006) (Vaccine Act or the Act). All citations in this decision to
individual sections of the Vaccine Act are to 42 U.S.C.A. § 300aa.
Respondent has conceded that petitioners have satisfied all legal prerequisites for
compensation under the Vaccine Act and recommends that compensation be awarded to
petitioners. Respondent’s Report at 2, 4-5, filed June 11, 2013.
Informed by respondent’s concession that an award of damages is appropriate, the
undersigned finds that petitioners are entitled to compensation under the Vaccine Act.
On May 29, 2014, respondent filed a Proffer on Award of Compensation (“Proffer”). In
the Proffer, respondent represented that petitioners agree with the proffered award. Based on the
record as a whole, the undersigned finds that petitioners are entitled to an award as stated in the
Proffer.
Pursuant to the terms stated in the attached Proffer, the undersigned awards petitioners:
A. A lump sum payment of $864,746.00, in the form of a check payable to
petitioners, as guardians/conservators of VEM’s estate, for the benefit of
VEM. No payments shall be made until petitioners provide the Secretary with
documentation establishing the appointment of petitioners as the
guardians/conservators of VEM’s estate. If petitioners are not authorized by a
court of competent jurisdiction to serve as guardians/conservators of the estate of
VEM, any such payment shall be made to the party or parties appointed by a court
of competent jurisdiction to serve as guardian(s)/conservator(s) of the estate of
VEM upon submission of written documentation of such appointment to the
Secretary.
B. A lump sum payment of $3,747.89, representing compensation for past
unreimbursable expenses, payable to Tory Moody and Sarah Moody,
petitioners.
C. A lump sum payment of $800,033.55, representing the trust seed which consists
of the present year cost of five years of VEM’s non-medical life care items
($547,877.82) for the years 2048 through 2052 plus Year One life care expenses
($252,155.73), payable to PEOPLESBANK, a Codorus Valley Company of
York, Pennsylvania, to establish an irrevocable reversionary trust for the benefit
of VEM, by and among the United States, as Grantor, and PEOPLESBANK, a
Codorus Valley Company of York, Pennsylvania, as Trustee and petitioners,
as Guardians/Conservators.
D. A lump sum payment of $108,846.13, representing compensation for satisfaction
of the State of Indiana Medicaid lien, payable jointly to petitioners as
guardians/conservators of the Estate of VEM and Indiana Medicaid:
2
Indiana Medicaid
HP Enterprise Services
Attn: TPL Casualty Dept.
P.O. Box 7262
Indianapolis, IN 46207
Petitioners agree to endorse this payment to Indiana Medicaid.
E. An amount sufficient to purchase an annuity contract, subject to the conditions
described in the Proffer and the attachments to that Proffer.
Proffer ¶ II.
In the absence of a motion for review filed pursuant to RCFC Appendix B, the clerk of
the court SHALL ENTER JUDGMENT herewith.3
IT IS SO ORDERED.
s/ Nora Beth Dorsey
Nora Beth Dorsey
Special Master
3
Pursuant to Vaccine Rule 11(a), entry of judgment is expedited by the parties’ joint filing of
notice renouncing the right to seek review.
IN THE UNITED STATES COURT OF FEDERAL CLAIMS
OFFICE OF SPECIAL MASTERS
TORY MOODY and SARAH MOODY,
Parents of minor child, VEM,
Petitioners,
No. 13-190V
v. Special Master Dorsey
ECF
SECRETARY OF HEALTH AND
HUMAN SERVICES,
Respondent.
RESPONDENT’S PROFFER ON AWARD OF COMPENSATION
I. Items of Compensation
A. Life Care Items
The parties engaged life care planners to provide an estimation of VEM’s future vaccine-
injury related needs, and the parties’ planners came to a joint consensus regarding appropriate
items of care. All items of compensation identified in the joint life care plan, filed on May 22,
2014 as Respondent’s Exhibit A, are supported by the evidence, and are illustrated by the chart
entitled Items of Compensation for VEM, attached hereto as Tab A. 1 Respondent proffers that
VEM should be awarded all items of compensation set forth in the joint life care plan and
illustrated by the chart attached at Tab A. Petitioners agree.
1
The chart at Tab A illustrates the annual benefits provided by the life care plan. The annual benefit years run from
the date of judgment up to the first anniversary of the date of judgment, and every year thereafter up to the
anniversary of the date of judgment.
1
B. Lost Future Earnings
The parties agree that based upon the evidence, VEM will never be gainfully employed.
Therefore, respondent proffers that VEM should be awarded full lost future earnings as provided
under the Vaccine Act, 42 U.S.C. § 300aa-15(a)(3)(B). Respondent proffers that the appropriate
award for VEM’s lost future earnings is $614,746.00 at net present value. Petitioners agree.
C. Pain and Suffering
Respondent proffers that VEM should be awarded $250,000.00 in actual and projected
pain and suffering. This amount reflects that the award for projected pain and suffering has been
reduced to net present value. See 42 U.S.C. § 300aa-15(a)(4). Petitioners agree.
D. Past Unreimbursable Expenses
Evidence supplied by petitioner documents their expenditure of past unreimbursable
expenses related to VEM’s vaccine-related injury. Respondent proffers that petitioners should
be awarded past unreimbursable expenses in the amount of $3,747.89. Petitioners agree.
E. Medicaid Lien
Respondent proffers that VEM’s should be awarded funds to satisfy the State of Indiana
Medicaid lien in the amount of $108,846.13, which represents full satisfaction of any right of
subrogation, assignment, claim, lien, or cause of action the State of Indiana may have against any
individual as a result of any Medicaid payments the State of Indiana has made to or on behalf of
VEM from the date of her eligibility for benefits through the date of judgment in this case as a
result of her vaccine-related injury suffered on or about April 1, 2010, under Title XIX of the
Social Security Act.
2
F. Attorneys’ Fees and Costs
This proffer does not address final attorneys’ fees and costs. Petitioners are entitled to
reasonable final attorneys’ fees and costs, to be determined at a later date upon petitioners filing
substantiating documentation.
II. Form of the Award
The parties recommend that the compensation provided to VEM should be made through
a combination of lump sum payments and future annuity payments as described below, and
request that the Special Master’s decision and the Court’s judgment award the following: 2
A. A lump sum payment of $864,746.00, representing compensation for lost future
earnings ($614,746.00) and pain and suffering ($250,000.00), in the form of a check payable to
petitioners, as guardians/conservators of VEM’s estate, for the benefit of VEM. No payments
shall be made until petitioners provide the Secretary with documentation establishing the
appointment of petitioners as the guardians/conservators of VEM’s estate. If petitioners are not
authorized by a court of competent jurisdiction to serve as guardians/conservators of the estate of
VEM, any such payment shall be made to the party or parties appointed by a court of competent
jurisdiction to serve as guardian(s)/conservator(s) of the estate of VEM upon submission of
written documentation of such appointment to the Secretary;
B. A lump sum payment of $3,747.89, representing compensation for past
unreimbursable expenses, payable to Tory Moody and Sarah Moody, petitioners;
C. A lump sum payment of $800,033.55, representing the trust seed which consists of
the present year cost of five years of VEM’s non-medical life care items ($547,877.82) for the
years 2048 through 2052 plus Year One life care expenses ($252,155.73), payable to
2
Should VEM die prior to the entry of judgment, the parties reserve the right to move the Court for appropriate
relief. In particular, respondent would oppose any award for future medical expenses, future lost earnings, and
future pain and suffering.
3
PEOPLESBANK, a Codorus Valley Company of York, Pennsylvania, to establish an irrevocable
reversionary trust for the benefit of VEM, by and among the United States, as Grantor, and
PEOPLESBANK, a Codorus Valley Company of York, Pennsylvania, as Trustee and petitioners,
as Guardians/Conservators.
D. A lump sum payment of $108,846.13, representing compensation for satisfaction of
the State of Indiana Medicaid lien, payable jointly to petitioners as guardians/conservators of the
Estate of VEM and Indiana Medicaid:
Indiana Medicaid
HP Enterprise Services
Attn: TPL Casualty Dept.
P.O. Box 7262
Indianapolis, IN 46207
Petitioners agree to endorse this payment to Indiana Medicaid.
E. An amount sufficient to purchase an annuity contract, 3 subject to the conditions
described below, that will provide payments for the life care items contained in the life care plan,
as illustrated by the chart at Tab A attached hereto, paid to the life insurance company 4 from
which the annuity will be purchased. Compensation for Year Two (beginning on the first
anniversary of the date of judgment) and all subsequent years shall be provided through
3
To satisfy the conditions set forth herein, in respondent’s discretion, respondent may purchase one or more
annuity contracts from one or more life insurance companies.
4
The Life Insurance Company must have a minimum of $250,000,000 capital and surplus, exclusive of any
mandatory security valuation reserve. The Life Insurance Company must have one of the following ratings from
two of the following rating organizations:
a. A.M. Best Company: A++, A+, A+g, A+p, A+r, or A+s;
b. Moody's Investor Service Claims Paying Rating: Aa3, Aa2, Aa1, or Aaa;
c. Standard and Poor's Corporation Insurer Claims-Paying Ability Rating: AA-, AA, AA+, or
AAA;
d. Fitch Credit Rating Company, Insurance Company Claims Paying Ability Rating: AA-, AA,
AA+, or AAA.
4
respondent's purchase of an annuity, which annuity shall make payments directly to
PEOPLESBANK a Codorus Valley Company of York, Pennsylvania, as trustees for VEM’s
Vaccine Trust, only so long as VEM is alive at the time a particular payment is due. At the
Secretary’s sole discretion, the periodic payments may be provided to the Trust in monthly,
quarterly, annual or other installments. The “annual amounts” set forth in the chart at Tab A
describe only the total yearly sum to be paid to the guardian/conservator and do not require that
the payment be made in one annual installment.
1. Growth Rate
Respondent proffers that a four percent (4%) growth rate should be applied to all non-
medical life care items, and a five percent (5%) growth rate should be applied to all medical life
care items. Thus, the benefits illustrated in the chart at Tab A that are to be paid through annuity
payments should grow as follows: four percent (4%) compounded annually from the date of
judgment for non-medical items, and five percent (5%) compounded annually from the date of
judgment for medical items.
2. Life-contingent annuity
Petitioners will continue to receive the annuity payments from the Life Insurance
Company only so long as VEM is alive at the time that a particular payment is due. Written
notice shall be provided to the Secretary of Health and Human Services and the Life Insurance
Company within twenty (20) days of VEM’s death.
3. Guardianship Issues
No payments shall be made until petitioners provide respondent with documentation
establishing that they have been appointed as the guardians/conservators of VEM’s estate. If
petitioners are not authorized by a court of competent jurisdiction to serve as
5
guardians/conservators of the estate of VEM, any such payment shall be made to the party or
parties appointed by a court of competent jurisdiction to serve as guardian(s)/conservator(s) of
the estate of VEM upon submission of written documentation of such appointment to the
Secretary.
III. Summary of Recommended Payments Following Judgment
A. Lump Sum paid to petitioners as guardians/conservators of
VEM’s estate: $864,746.00
B. Lump sum paid to petitioners: $ 3,747.89
C. PeoplesBank a Codorus Valley Company of York, Pennsylvania,
for the benefit of VEM Vaccine Trust $800,033.55
D. Reimbursement for Medicaid lien: $108,846.13
E. An amount sufficient to purchase the annuity contract described
above in section II. E.
F. Reasonable final attorneys’ fees and litigation costs: TBD
Respectfully submitted,
STUART F. DELERY
Assistant Attorney General
RUPA BHATTACHARYYA
Director
Torts Branch, Civil Division
VINCENT J. MATANOSKI
Deputy Director
Torts Branch, Civil Division
ALTHEA W. DAVIS
Senior Trial Counsel
Torts Branch, Civil Division
6
s/ HEATHER L. PEARLMAN
HEATHER L. PEARLMAN
Senior Trial Attorney
Torts Branch, Civil Division
U.S. Department of Justice
P.O. Box 146
Benjamin Franklin Station
Washington, D.C. 20044-0146
Tel: (202) 353-2699
DATED: May 29, 2014
7
ITEMS OF COMPENSATION
V. E. M.
CL. CT. NO. 13-0190V
GROWTH PAID IN CASH
NO. ITEM RATE 2014 2015 2016 2017 2018 2019 2020 2021
MEDICAL INSURANCE
ANTHEM ESSENTIAL DIRECT ACCESS / ANTHEM BLUE CROSS BLUE SHIELD
1 PREMIUM, DEDUCTIBLE AND MAXIMUM OUT OF POCKET 5% 10,802.80 10,802.80 10,802.80 10,802.80 10,802.80 10,802.80 10,802.80 10,802.80
2 ANTHEM BLUE CROSS BLUE SHIELD PRESCRIPTION DRUGS (included in above costs) 5% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
3 MEDICARE PART A 5% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
4 MEDICARE PART B PREMIUM & DEDUCTIBLE 5% 1,405.80 1,405.80 1,405.80 1,405.80 1,405.80 1,405.80 1,405.80 1,405.80
5 MEDIGAP - MEDICARE ADVANTAGE PLAN / BLUE MEDICARE ACCESS VALUE (UNDER 65) 5%
6 BLUE MEDICARE ACCESS VALUE - DRUG COVERAGE 5%
7 MEDICARE SUPPLEMENT ( AGE 65 AND OVER) 5%
8 MEDICARE DRUG PLAN SUPPLEMENT (Premium & Medication Costs) 5%
ROUTINE MEDICAL CARE - (With Insurance Offsets)
9 NEUROLOGIST 5% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
10 PRIMARY CARE PHYSICIAN 5% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
11 PHYSICAL MEDICINE AND REHABILITATION 5% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
EMERGENCY MEDICAL CARE/AGGRESSIVE TREATMENT (With Insurance Offsets)
12 INSERTION OF VNS - HOSPITAL CHARGES 5% 0.00
13 INSERTION OF VNS - PROVIDER FEES 5% 0.00
14 REPLACEMENT OF VNS GENERATOR - HOSPITAL CHARGES 5% 0.00
15 REPLACEMENT OF VNS LEADS 5% 0.00
16 KETOGENIC DIET DIETICIAN 4% 658.35 59.85 59.85 59.85
17 DIGITAL SCALE FOR KETOGENIC DIET 4% 123.50
DIAGNOSTIC TESTING (With Insurance Offsets)
18 HIP X-RAYS 5% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
19 SPINE SERIES X-RAYS 5% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
20 LIPID PANEL 5% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
21 BANZEL LEVEL 5% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
22 PHENOBARBITAL LEVEL 5% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
23 METABOLIC PANEL 5% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
24 LAB DRAW 5% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
NOTE: Items replaced every "X" years (e.g., 3 yrs., 5 yrs, etc.) are paid to last valid replacement date during years indicated in the life care plan.
AEC Financial, Inc. Page 1 of 32 Revised - May 21, 2014
ITEMS OF COMPENSATION
V. E. M.
CL. CT. NO. 13-0190V
GROWTH PAID IN CASH
NO. ITEM RATE 2014 2015 2016 2017 2018 2019 2020 2021
MEDICATIONS (With Insurance Offsets)
25 LEVOCARNITIN 5% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
26 ONFI (CLOBAZAM) 5% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
27 CETIRIZINE 5% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
28 DIAZEPAM 5% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
29 BANZEL 5% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
30 PHENOBARB ELIXIR 5% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
OVER THE COUNTER MEDICATIONS
31 POLYETHYLINE GLYCOL POWDER 4% 107.34 107.34 107.34 107.34 107.34 107.34 107.34 107.34
32 CO-ENZYME Q 4% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
NUTRITION AND FEEDING (With Insurance Offsets)
33 ELECARE JUNIOR VANILLA 4% 29,592.00 29,592.00 29,592.00 29,592.00 29,592.00 29,592.00 29,592.00 29,592.00
34 JOEY FEEDING BAG 4% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
35 MicKEY BUTTON 4% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
36 MicKEY RIGHT ANGLE V PORT 4% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
THERAPEUTIC MODALITIES (With Insurance Offsets)
37 SPEECH/ OCCUPATIONAL / PHYSICAL THERAPY 4% 50,758.16 50,758.16 50,758.16 0.00 0.00 0.00 0.00 0.00
38 PHYSICAL, OCCUPATIONAL OR SPEECH THERAPY 4% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
39 ANNUAL PT or OT RE-EVALUATION 5%
40 SPEECH THERAPY RE-EVALUATION 5% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
41 MUSIC THERAPY 4% 4,000.00 4,000.00 4,000.00 4,000.00 2,200.00 2,200.00 2,200.00 2,200.00
42 CAMP 4% 467.33 467.33 467.33 467.33 467.33 467.33
43 NURSE CASE MANAGER 4% 2,400.00 2,400.00 2,400.00 2,400.00 2,400.00 2,400.00 2,400.00 2,400.00
EDUCATIONAL / VOCATIONAL
44 PARAPROFESSIONAL ASSISTANCE 4% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
45 PSYCHOLOGICAL TESTING AND EDUCATIONAL ASSESSMENT 4% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
46 VOCATIONAL / AVOCATIONAL EVALUATION 4% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
NOTE: Items replaced every "X" years (e.g., 3 yrs., 5 yrs, etc.) are paid to last valid replacement date during years indicated in the life care plan.
AEC Financial, Inc. Page 2 of 32 Revised - May 21, 2014
ITEMS OF COMPENSATION
V. E. M.
CL. CT. NO. 13-0190V
GROWTH PAID IN CASH
NO. ITEM RATE 2014 2015 2016 2017 2018 2019 2020 2021
ARCHITECTURAL MODIFICATIONS
47 MODIFICATION OF BATHROOM 4% 11,606.00
48 RAMPS FOR ENTRANCE AND EXIT TO HOME 4% 5,415.00
49 WIDEN 5 DOORWAYS 4% 2,875.00
50 SURE HANDS LIFT - CEILING MOUNTED LIFT SYSTEM 4% 11,000.00
51 REPLACEMENT SLINGS / BODY SUPPORTS FOR LIFT SYSTEM (Covered by Ins.) 4% 0.00
EQUIPMENT (With Insurance Offsets)
52 TILT N SPACE CUSTOM MANUAL WHEELCHAIR 4% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
53 WHEELCHAIR MAINTENANCE AND REPAIR (Includes tires/wheels) 4% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
54 ACTIVITY CHAIR 4% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
55 SLEEPSAFE BED MATTRESS AND PADDING 4% 6.00 2,400.00 480.00 480.00 480.00
56 ADAPTED TRICYCLE 4% 1,939.33
57 JOGGING STROLLER / WHEELCHAIR 4% 1,087.07 217.41 217.41 217.41 217.41 217.41 217.41 217.41
58 ADAPTIVE TOYS / THERAPEUTIC TOYS 4% 250.00 50.00 50.00 50.00 50.00 50.00 50.00 50.00
59 KANGAROO FEEDING PUMP 4% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
60 WATERPIK CLASSIC WATER FLOSSER 4% 49.33 16.44 16.44 16.44 16.44 16.44 16.44 16.44
61 SEIZURE MONITOR 4% 330.00
62 SIMPLE ENVIRONMENTAL CONTROL UNIT 4% 120.00 24.00 24.00 24.00 24.00 24.00 24.00 24.00
63 ADAPTIVE EQUIPMENT FOR EATING 4% 158.00
64 ADAPTIVE EQUIPMENT FOR EATING - REPLACEMENTS 4% 125.00 125.00 125.00 125.00 125.00 125.00 125.00
65 ADAPTIVE EQUIPMENT FOR EATING - REPLACEMENTS 4% 33.00 11.00 11.00 11.00 11.00
66 STANDER 4% 2,315.00
67 COMMODE CHAIR / ROLLING SHOWER CHAIR 4% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
68 PEANUT EXERCISE BALLS, 2 SIZES 4% 99.00 33.00 33.00 33.00 33.00 33.00 33.00 33.00
69 ANTI-BURST ROUND EXERCISE BALL 4% 24.99 8.33 8.33 8.33 8.33 8.33 8.33 8.33
70 THERAPY ROLL 4% 345.00 69.00 69.00 69.00 69.00 69.00 69.00 69.00
71 CHEWY TUBE 4% 30.00 30.00
72 SPECIAL NEEDS SWING WITH HARNESS 4% 554.90
ORTHOTICS AND PROSTHETICS (With Insurance Offsets)
73 BILATERAL HINGED AFOS 4% 0.00
NOTE: Items replaced every "X" years (e.g., 3 yrs., 5 yrs, etc.) are paid to last valid replacement date during years indicated in the life care plan.
AEC Financial, Inc. Page 3 of 32 Revised - May 21, 2014
ITEMS OF COMPENSATION
V. E. M.
CL. CT. NO. 13-0190V
GROWTH PAID IN CASH
NO. ITEM RATE 2014 2015 2016 2017 2018 2019 2020 2021
SUPPLIES
74 DIAPERS 4% 1,200.85 1,200.85 1,200.85 1,200.85
75 ADULT SIZE MEDIUM INCONTINENCE BRIEFS 4% 1,642.50 1,642.50 1,642.50 1,642.50
76 BED LINERS 4% 120.45 120.45 120.45 120.45 120.45 120.45 120.45 120.45
77 DISPOSABLE GLOVES 4% 94.90 94.90 94.90 94.90 94.90 94.90 94.90 94.90
78 HAND SANITIZER 4% 92.16 92.16 92.16 92.16 92.16 92.16 92.16 92.16
79 WIPES 4% 102.20
80 BARRIER CREAM 4% 25.56 25.56 25.56 25.56 25.56 25.56 25.56 25.56
81 DRY DISPOSABLE WASHCLOTHS 4% 306.60 306.60 306.60 306.60 306.60 306.60 306.60
82 MEDICAL ID BRACELET, SHOE TAG OR NECKLACE 4% 35.00 11.67 11.67 11.67 11.67 11.67 11.67 11.67
83 CONTOURED VINYL MATTRESS PROTECTOR 4% 116.00 116.00 116.00 116.00 116.00 116.00 116.00 116.00
TRANSPORTATION
84 PRIMARY CARE PHYSICIAN 4% 36.00 36.00 36.00 36.00 36.00 36.00 36.00 36.00
85 PHYSICAL MEDICINE AND REHABILITATION PHYSICIAN 4% 36.96 36.96 36.96 36.96 36.96 36.96 36.96 36.96
86 NEUROLOGIST 4% 123.84 123.84 123.84 123.84 123.84 123.84 123.84 123.84
87 NEUROSURGEON AT IU - RILEY 4% 72.00 10.29 1.47 0.21 0.03 0.00 0.00 0.00
88 IU CHILDREN'S THERAPY CENTER - REHAB FOR THERAPIES 4% 1,290.24 1,290.24 1,290.24 322.56 322.56 322.56 322.56 322.56
89 NATIONALSEATING AND REHAB FOR WC/SEATING EVALUATION 4%
90 MODIFICATIONS FOR VAN 4% 27,000.00 2,700.00 2,700.00 2,700.00 2,700.00 2,700.00 2,700.00 2,700.00
HOME CARE AND FACILITY CARE
91 HOME HEALTH AIDE - WEEKDAY CARE 4% 28,461.00 28,461.00 28,461.00 28,461.00 28,461.00 28,461.00 28,461.00 28,461.00
92 HOME HEALTH AIDE - WEEKDAY CARE DURING SCHOOL BREAKS 4% 21,465.00 21,465.00 21,465.00 21,465.00 21,465.00 21,465.00 21,465.00 21,465.00
93 RN - WEEKDAY CARE DURING SCHOOL BREAKS 5% 10,935.00 10,935.00 10,935.00 10,935.00 10,935.00 10,935.00 10,935.00 10,935.00
94 HOME HEALTH AIDE - WEEKEND RESPITE CARE 4% 13,992.00 13,992.00 13,992.00 13,992.00 13,992.00 13,992.00 13,992.00 13,992.00
95 RN - WEEKEND RESPITE CARE 5% 8,910.00 8,910.00 8,910.00 8,910.00 8,910.00 8,910.00 8,910.00 8,910.00
96 GROUP HOME OR LONG TERM CARE FACILITY FOR YOUNGER ADULTS 4%
97 SKILLED NURSING FACILITY 5%
-------------------
SUBTOTAL - 1ST YEAR EXPENSES 252,155.73
98 PAST UNREIMBURSED EXPENSES 3,747.89
99 PAIN AND SUFFERING 250,000.00
100 LOST WAGES 614,746.00
101 STATE OF INDIANA MEDICAID LIEN 108,846.13
102 TRUST SEED: PEOPLES BANK, A CODORUS VALLEY CO. OF YORK,PA. 547,877.82
-------------------- ----------------- ----------------- ----------------- ----------------- ----------------- ----------------- -----------------
TOTAL: 1,777,373.57 189,627.65 190,056.16 138,368.06 139,321.68 137,401.65 137,401.65 137,401.65
NOTE: Items replaced every "X" years (e.g., 3 yrs., 5 yrs, etc.) are paid to last valid replacement date during years indicated in the life care plan.
AEC Financial, Inc. Page 4 of 32 Revised - May 21, 2014
ITEMS OF COMPENSATION
V. E. M.
CL. CT. NO. 13-0190V
GROWTH
NO. ITEM RATE 2022 2023 2024 2025 2026 2027 2028 2029
MEDICAL INSURANCE
ANTHEM ESSENTIAL DIRECT ACCESS / ANTHEM BLUE CROSS BLUE SHIELD
1 PREMIUM, DEDUCTIBLE AND MAXIMUM OUT OF POCKET 5% 10,802.80 10,802.80 10,802.80 10,802.80 10,802.80 10,802.80 10,802.80 10,802.80
2 ANTHEM BLUE CROSS BLUE SHIELD PRESCRIPTION DRUGS (included in above costs) 5% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
3 MEDICARE PART A 5% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
4 MEDICARE PART B PREMIUM & DEDUCTIBLE 5% 1,405.80 1,405.80 1,405.80 1,405.80 1,405.80 1,405.80 1,405.80 1,405.80
5 MEDIGAP - MEDICARE ADVANTAGE PLAN / BLUE MEDICARE ACCESS VALUE (UNDER 65) 5%
6 BLUE MEDICARE ACCESS VALUE - DRUG COVERAGE 5%
7 MEDICARE SUPPLEMENT ( AGE 65 AND OVER) 5%
8 MEDICARE DRUG PLAN SUPPLEMENT (Premium & Medication Costs) 5%
ROUTINE MEDICAL CARE - (With Insurance Offsets)
9 NEUROLOGIST 5% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
10 PRIMARY CARE PHYSICIAN 5% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
11 PHYSICAL MEDICINE AND REHABILITATION 5% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
EMERGENCY MEDICAL CARE/AGGRESSIVE TREATMENT (With Insurance Offsets)
12 INSERTION OF VNS - HOSPITAL CHARGES 5%
13 INSERTION OF VNS - PROVIDER FEES 5%
14 REPLACEMENT OF VNS GENERATOR - HOSPITAL CHARGES 5%
15 REPLACEMENT OF VNS LEADS 5%
16 KETOGENIC DIET DIETICIAN 4%
17 DIGITAL SCALE FOR KETOGENIC DIET 4%
DIAGNOSTIC TESTING (With Insurance Offsets)
18 HIP X-RAYS 5% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
19 SPINE SERIES X-RAYS 5% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
20 LIPID PANEL 5% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
21 BANZEL LEVEL 5% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
22 PHENOBARBITAL LEVEL 5% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
23 METABOLIC PANEL 5% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
24 LAB DRAW 5% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
NOTE: Items replaced every "X" years (e.g., 3 yrs., 5 yrs, etc.) are paid to last valid replacement date during years indicated in the life care plan.
AEC Financial, Inc. Page 5 of 32 Revised - May 21, 2014
ITEMS OF COMPENSATION
V. E. M.
CL. CT. NO. 13-0190V
GROWTH
NO. ITEM RATE 2022 2023 2024 2025 2026 2027 2028 2029
MEDICATIONS (With Insurance Offsets)
25 LEVOCARNITIN 5% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
26 ONFI (CLOBAZAM) 5% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
27 CETIRIZINE 5% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
28 DIAZEPAM 5% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
29 BANZEL 5% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
30 PHENOBARB ELIXIR 5% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
OVER THE COUNTER MEDICATIONS
31 POLYETHYLINE GLYCOL POWDER 4% 107.34 107.34 107.34 107.34 107.34 107.34 107.34 107.34
32 CO-ENZYME Q 4% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
NUTRITION AND FEEDING (With Insurance Offsets)
33 ELECARE JUNIOR VANILLA 4% 29,592.00 29,592.00 29,592.00 29,592.00 29,592.00 29,592.00 29,592.00 29,592.00
34 JOEY FEEDING BAG 4% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
35 MicKEY BUTTON 4% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
36 MicKEY RIGHT ANGLE V PORT 4% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
THERAPEUTIC MODALITIES (With Insurance Offsets)
37 SPEECH/ OCCUPATIONAL / PHYSICAL THERAPY 4% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
38 PHYSICAL, OCCUPATIONAL OR SPEECH THERAPY 4% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
39 ANNUAL PT or OT RE-EVALUATION 5%
40 SPEECH THERAPY RE-EVALUATION 5% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
41 MUSIC THERAPY 4% 2,200.00 2,200.00
42 CAMP 4% 467.33 467.33 467.33 467.33 467.33 467.33 467.33 467.33
43 NURSE CASE MANAGER 4% 2,400.00 2,400.00 2,400.00 2,400.00 2,400.00 2,400.00 2,400.00 2,400.00
EDUCATIONAL / VOCATIONAL
44 PARAPROFESSIONAL ASSISTANCE 4% 0.00 0.00 0.00 0.00 0.00
45 PSYCHOLOGICAL TESTING AND EDUCATIONAL ASSESSMENT 4% 0.00 0.00 0.00 0.00 0.00
46 VOCATIONAL / AVOCATIONAL EVALUATION 4% 0.00 0.00 0.00 0.00 0.00
NOTE: Items replaced every "X" years (e.g., 3 yrs., 5 yrs, etc.) are paid to last valid replacement date during years indicated in the life care plan.
AEC Financial, Inc. Page 6 of 32 Revised - May 21, 2014
ITEMS OF COMPENSATION
V. E. M.
CL. CT. NO. 13-0190V
GROWTH
NO. ITEM RATE 2022 2023 2024 2025 2026 2027 2028 2029
ARCHITECTURAL MODIFICATIONS
47 MODIFICATION OF BATHROOM 4%
48 RAMPS FOR ENTRANCE AND EXIT TO HOME 4% 5,415.00
49 WIDEN 5 DOORWAYS 4%
50 SURE HANDS LIFT - CEILING MOUNTED LIFT SYSTEM 4%
51 REPLACEMENT SLINGS / BODY SUPPORTS FOR LIFT SYSTEM (Covered by Ins.) 4%
EQUIPMENT (With Insurance Offsets)
52 TILT N SPACE CUSTOM MANUAL WHEELCHAIR 4% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
53 WHEELCHAIR MAINTENANCE AND REPAIR (Includes tires/wheels) 4% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
54 ACTIVITY CHAIR 4% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
55 SLEEPSAFE BED MATTRESS AND PADDING 4% 480.00 480.00 480.00 480.00 480.00 480.00 480.00
56 ADAPTED TRICYCLE 4% 2,684.33
57 JOGGING STROLLER / WHEELCHAIR 4% 217.41 217.41 217.41 217.41 217.41 217.41 217.41 217.41
58 ADAPTIVE TOYS / THERAPEUTIC TOYS 4% 50.00 50.00 50.00 50.00 50.00 50.00 50.00 50.00
59 KANGAROO FEEDING PUMP 4% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
60 WATERPIK CLASSIC WATER FLOSSER 4% 16.44 16.44 16.44 16.44 16.44 16.44 16.44 16.44
61 SEIZURE MONITOR 4%
62 SIMPLE ENVIRONMENTAL CONTROL UNIT 4% 24.00 24.00 24.00 24.00 24.00 24.00 24.00 24.00
63 ADAPTIVE EQUIPMENT FOR EATING 4%
64 ADAPTIVE EQUIPMENT FOR EATING - REPLACEMENTS 4% 125.00 125.00 125.00 125.00 125.00 125.00 125.00 125.00
65 ADAPTIVE EQUIPMENT FOR EATING - REPLACEMENTS 4% 11.00 11.00 11.00 11.00 11.00 11.00 11.00 11.00
66 STANDER 4% 2,652.00 5,716.00
67 COMMODE CHAIR / ROLLING SHOWER CHAIR 4% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
68 PEANUT EXERCISE BALLS, 2 SIZES 4% 33.00 33.00 33.00 33.00 33.00 33.00 33.00 33.00
69 ANTI-BURST ROUND EXERCISE BALL 4% 8.33 8.33 8.33 8.33 8.33 8.33 8.33 8.33
70 THERAPY ROLL 4% 69.00 69.00 69.00 69.00 69.00 69.00 69.00 69.00
71 CHEWY TUBE 4%
72 SPECIAL NEEDS SWING WITH HARNESS 4% 299.95
ORTHOTICS AND PROSTHETICS (With Insurance Offsets)
73 BILATERAL HINGED AFOS 4%
NOTE: Items replaced every "X" years (e.g., 3 yrs., 5 yrs, etc.) are paid to last valid replacement date during years indicated in the life care plan.
AEC Financial, Inc. Page 7 of 32 Revised - May 21, 2014
ITEMS OF COMPENSATION
V. E. M.
CL. CT. NO. 13-0190V
GROWTH
NO. ITEM RATE 2022 2023 2024 2025 2026 2027 2028 2029
SUPPLIES
74 DIAPERS 4%
75 ADULT SIZE MEDIUM INCONTINENCE BRIEFS 4% 1,642.50 1,642.50 1,642.50 1,642.50 1,642.50 1,642.50 1,642.50 1,642.50
76 BED LINERS 4% 120.45 120.45 120.45 120.45 120.45 120.45 120.45 120.45
77 DISPOSABLE GLOVES 4% 94.90 94.90 94.90 94.90 94.90 94.90 94.90 94.90
78 HAND SANITIZER 4% 92.16 92.16 92.16 92.16 92.16 92.16 92.16 92.16
79 WIPES 4%
80 BARRIER CREAM 4% 25.56 25.56 25.56 25.56 25.56 25.56 25.56 25.56
81 DRY DISPOSABLE WASHCLOTHS 4% 306.60 306.60 306.60 306.60 306.60 306.60 306.60 306.60
82 MEDICAL ID BRACELET, SHOE TAG OR NECKLACE 4% 11.67 11.67 11.67 11.67 11.67 11.67 11.67 11.67
83 CONTOURED VINYL MATTRESS PROTECTOR 4% 116.00 116.00 116.00 116.00 116.00 116.00 116.00 116.00
TRANSPORTATION
84 PRIMARY CARE PHYSICIAN 4% 36.00 36.00 36.00 36.00 36.00 36.00 36.00 36.00
85 PHYSICAL MEDICINE AND REHABILITATION PHYSICIAN 4% 36.96 36.96 36.96 36.96 36.96 36.96 36.96 36.96
86 NEUROLOGIST 4% 123.84 123.84 123.84 123.84 123.84 123.84 123.84 103.20
87 NEUROSURGEON AT IU - RILEY 4% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
88 IU CHILDREN'S THERAPY CENTER - REHAB FOR THERAPIES 4% 322.56 322.56 322.56 322.56 322.56 322.56 322.56 322.56
89 NATIONALSEATING AND REHAB FOR WC/SEATING EVALUATION 4%
90 MODIFICATIONS FOR VAN 4% 2,700.00 2,700.00 2,700.00 2,700.00 2,700.00 2,700.00 2,700.00 2,700.00
HOME CARE AND FACILITY CARE
91 HOME HEALTH AIDE - WEEKDAY CARE 4% 28,461.00 28,461.00 28,461.00 28,461.00 28,461.00 28,461.00 28,461.00 28,461.00
92 HOME HEALTH AIDE - WEEKDAY CARE DURING SCHOOL BREAKS 4% 21,465.00 21,465.00 21,465.00 21,465.00 21,465.00 21,465.00 21,465.00 21,465.00
93 RN - WEEKDAY CARE DURING SCHOOL BREAKS 5% 10,935.00 10,935.00 10,935.00 10,935.00 10,935.00 10,935.00 10,935.00 10,935.00
94 HOME HEALTH AIDE - WEEKEND RESPITE CARE 4% 13,992.00 13,992.00 13,992.00 13,992.00 13,992.00 13,992.00 13,992.00 13,992.00
95 RN - WEEKEND RESPITE CARE 5% 8,910.00 8,910.00 8,910.00 8,910.00 8,910.00 8,910.00 8,910.00 8,910.00
96 GROUP HOME OR LONG TERM CARE FACILITY FOR YOUNGER ADULTS 4%
97 SKILLED NURSING FACILITY 5%
SUBTOTAL - 1ST YEAR EXPENSES
98 PAST UNREIMBURSED EXPENSES
99 PAIN AND SUFFERING
100 LOST WAGES
101 STATE OF INDIANA MEDICAID LIEN
102 TRUST SEED: PEOPLES BANK, A CODORUS VALLEY CO. OF YORK,PA.
----------------- ----------------- ----------------- ----------------- ----------------- ----------------- ----------------- -----------------
TOTAL: 140,053.65 137,401.65 143,300.98 135,201.65 135,201.65 135,501.60 135,201.65 140,417.01
NOTE: Items replaced every "X" years (e.g., 3 yrs., 5 yrs, etc.) are paid to last valid replacement date during years indicated in the life care plan.
AEC Financial, Inc. Page 8 of 32 Revised - May 21, 2014
ITEMS OF COMPENSATION
V. E. M.
CL. CT. NO. 13-0190V
RESIDENTIAL
CARE
GROWTH BEGINS
NO. ITEM RATE 2030 2031 2032 2033 2034 2035 2036 2037
MEDICAL INSURANCE
ANTHEM ESSENTIAL DIRECT ACCESS / ANTHEM BLUE CROSS BLUE SHIELD
1 PREMIUM, DEDUCTIBLE AND MAXIMUM OUT OF POCKET 5% 10,802.80 10,802.80 10,802.80 10,802.80 10,802.80 10,802.80 10,802.80 10,802.80
2 ANTHEM BLUE CROSS BLUE SHIELD PRESCRIPTION DRUGS (included in above costs) 5% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
3 MEDICARE PART A 5% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
4 MEDICARE PART B PREMIUM & DEDUCTIBLE 5% 1,405.80 1,405.80 1,405.80 1,405.80 1,405.80 1,405.80 1,405.80 1,405.80
5 MEDIGAP - MEDICARE ADVANTAGE PLAN / BLUE MEDICARE ACCESS VALUE (UNDER 65) 5%
6 BLUE MEDICARE ACCESS VALUE - DRUG COVERAGE 5%
7 MEDICARE SUPPLEMENT ( AGE 65 AND OVER) 5%
8 MEDICARE DRUG PLAN SUPPLEMENT (Premium & Medication Costs) 5%
ROUTINE MEDICAL CARE - (With Insurance Offsets)
9 NEUROLOGIST 5% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
10 PRIMARY CARE PHYSICIAN 5% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
11 PHYSICAL MEDICINE AND REHABILITATION 5% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
EMERGENCY MEDICAL CARE/AGGRESSIVE TREATMENT (With Insurance Offsets)
12 INSERTION OF VNS - HOSPITAL CHARGES 5%
13 INSERTION OF VNS - PROVIDER FEES 5%
14 REPLACEMENT OF VNS GENERATOR - HOSPITAL CHARGES 5%
15 REPLACEMENT OF VNS LEADS 5%
16 KETOGENIC DIET DIETICIAN 4%
17 DIGITAL SCALE FOR KETOGENIC DIET 4%
DIAGNOSTIC TESTING (With Insurance Offsets)
18 HIP X-RAYS 5% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
19 SPINE SERIES X-RAYS 5% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
20 LIPID PANEL 5% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
21 BANZEL LEVEL 5% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
22 PHENOBARBITAL LEVEL 5% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
23 METABOLIC PANEL 5% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
24 LAB DRAW 5% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
NOTE: Items replaced every "X" years (e.g., 3 yrs., 5 yrs, etc.) are paid to last valid replacement date during years indicated in the life care plan.
AEC Financial, Inc. Page 9 of 32 Revised - May 21, 2014
ITEMS OF COMPENSATION
V. E. M.
CL. CT. NO. 13-0190V
RESIDENTIAL
CARE
GROWTH BEGINS
NO. ITEM RATE 2030 2031 2032 2033 2034 2035 2036 2037
MEDICATIONS (With Insurance Offsets)
25 LEVOCARNITIN 5% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
26 ONFI (CLOBAZAM) 5% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
27 CETIRIZINE 5% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
28 DIAZEPAM 5% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
29 BANZEL 5% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
30 PHENOBARB ELIXIR 5% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
OVER THE COUNTER MEDICATIONS
31 POLYETHYLINE GLYCOL POWDER 4% 107.34 107.34 107.34 107.34 107.34 107.34 107.34 107.34
32 CO-ENZYME Q 4% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
NUTRITION AND FEEDING (With Insurance Offsets)
33 ELECARE JUNIOR VANILLA 4% 29,592.00 29,592.00 29,592.00 29,592.00 29,592.00 29,592.00 29,592.00 29,592.00
34 JOEY FEEDING BAG 4% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
35 MicKEY BUTTON 4% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
36 MicKEY RIGHT ANGLE V PORT 4% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
THERAPEUTIC MODALITIES (With Insurance Offsets)
37 SPEECH/ OCCUPATIONAL / PHYSICAL THERAPY 4% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
38 PHYSICAL, OCCUPATIONAL OR SPEECH THERAPY 4% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
39 ANNUAL PT or OT RE-EVALUATION 5%
40 SPEECH THERAPY RE-EVALUATION 5% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
41 MUSIC THERAPY 4%
42 CAMP 4%
43 NURSE CASE MANAGER 4% 2,400.00 2,400.00 2,400.00 2,400.00 2,400.00 2,400.00 2,400.00 2,400.00
EDUCATIONAL / VOCATIONAL
44 PARAPROFESSIONAL ASSISTANCE 4%
45 PSYCHOLOGICAL TESTING AND EDUCATIONAL ASSESSMENT 4%
46 VOCATIONAL / AVOCATIONAL EVALUATION 4%
NOTE: Items replaced every "X" years (e.g., 3 yrs., 5 yrs, etc.) are paid to last valid replacement date during years indicated in the life care plan.
AEC Financial, Inc. Page 10 of 32 Revised - May 21, 2014
ITEMS OF COMPENSATION
V. E. M.
CL. CT. NO. 13-0190V
RESIDENTIAL
CARE
GROWTH BEGINS
NO. ITEM RATE 2030 2031 2032 2033 2034 2035 2036 2037
ARCHITECTURAL MODIFICATIONS
47 MODIFICATION OF BATHROOM 4%
48 RAMPS FOR ENTRANCE AND EXIT TO HOME 4%
49 WIDEN 5 DOORWAYS 4%
50 SURE HANDS LIFT - CEILING MOUNTED LIFT SYSTEM 4%
51 REPLACEMENT SLINGS / BODY SUPPORTS FOR LIFT SYSTEM (Covered by Ins.) 4%
EQUIPMENT (With Insurance Offsets)
52 TILT N SPACE CUSTOM MANUAL WHEELCHAIR 4% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
53 WHEELCHAIR MAINTENANCE AND REPAIR (Includes tires/wheels) 4% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
54 ACTIVITY CHAIR 4% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
55 SLEEPSAFE BED MATTRESS AND PADDING 4%
56 ADAPTED TRICYCLE 4%
57 JOGGING STROLLER / WHEELCHAIR 4%
58 ADAPTIVE TOYS / THERAPEUTIC TOYS 4%
59 KANGAROO FEEDING PUMP 4% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
60 WATERPIK CLASSIC WATER FLOSSER 4% 16.44 16.44 16.44 16.44 16.44 16.44 16.44 16.44
61 SEIZURE MONITOR 4%
62 SIMPLE ENVIRONMENTAL CONTROL UNIT 4% 24.00 24.00 24.00 24.00 24.00 24.00 24.00 24.00
63 ADAPTIVE EQUIPMENT FOR EATING 4%
64 ADAPTIVE EQUIPMENT FOR EATING - REPLACEMENTS 4%
65 ADAPTIVE EQUIPMENT FOR EATING - REPLACEMENTS 4%
66 STANDER 4% 816.57 816.57 816.57 816.57 816.57 816.57 816.57 816.57
67 COMMODE CHAIR / ROLLING SHOWER CHAIR 4% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
68 PEANUT EXERCISE BALLS, 2 SIZES 4%
69 ANTI-BURST ROUND EXERCISE BALL 4%
70 THERAPY ROLL 4%
71 CHEWY TUBE 4%
72 SPECIAL NEEDS SWING WITH HARNESS 4%
ORTHOTICS AND PROSTHETICS (With Insurance Offsets)
73 BILATERAL HINGED AFOS 4%
NOTE: Items replaced every "X" years (e.g., 3 yrs., 5 yrs, etc.) are paid to last valid replacement date during years indicated in the life care plan.
AEC Financial, Inc. Page 11 of 32 Revised - May 21, 2014
ITEMS OF COMPENSATION
V. E. M.
CL. CT. NO. 13-0190V
RESIDENTIAL
CARE
GROWTH BEGINS
NO. ITEM RATE 2030 2031 2032 2033 2034 2035 2036 2037
SUPPLIES
74 DIAPERS 4%
75 ADULT SIZE MEDIUM INCONTINENCE BRIEFS 4% 1,642.50 1,642.50 1,642.50 1,642.50 1,642.50 1,642.50 1,642.50 1,642.50
76 BED LINERS 4%
77 DISPOSABLE GLOVES 4%
78 HAND SANITIZER 4%
79 WIPES 4%
80 BARRIER CREAM 4%
81 DRY DISPOSABLE WASHCLOTHS 4%
82 MEDICAL ID BRACELET, SHOE TAG OR NECKLACE 4% 11.67 11.67 11.67 11.67 11.67 11.67 11.67 11.67
83 CONTOURED VINYL MATTRESS PROTECTOR 4%
TRANSPORTATION
84 PRIMARY CARE PHYSICIAN 4% 36.00 36.00 36.00 36.00 36.00 36.00 36.00 36.00
85 PHYSICAL MEDICINE AND REHABILITATION PHYSICIAN 4% 36.96 36.96 36.96 36.96 36.96 36.96 36.96 36.96
86 NEUROLOGIST 4% 103.20 103.20 103.20 103.20 103.20 103.20 103.20 103.20
87 NEUROSURGEON AT IU - RILEY 4% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
88 IU CHILDREN'S THERAPY CENTER - REHAB FOR THERAPIES 4%
89 NATIONALSEATING AND REHAB FOR WC/SEATING EVALUATION 4% 34.08 6.82 6.82 6.82 6.82 6.82 6.82 6.82
90 MODIFICATIONS FOR VAN 4%
HOME CARE AND FACILITY CARE
91 HOME HEALTH AIDE - WEEKDAY CARE 4%
92 HOME HEALTH AIDE - WEEKDAY CARE DURING SCHOOL BREAKS 4%
93 RN - WEEKDAY CARE DURING SCHOOL BREAKS 5%
94 HOME HEALTH AIDE - WEEKEND RESPITE CARE 4%
95 RN - WEEKEND RESPITE CARE 5%
96 GROUP HOME OR LONG TERM CARE FACILITY FOR YOUNGER ADULTS 4% 74,825.00 74,825.00 74,825.00 74,825.00 74,825.00 74,825.00 74,825.00 74,825.00
97 SKILLED NURSING FACILITY 5%
SUBTOTAL - 1ST YEAR EXPENSES
98 PAST UNREIMBURSED EXPENSES
99 PAIN AND SUFFERING
100 LOST WAGES
101 STATE OF INDIANA MEDICAID LIEN
102 TRUST SEED: PEOPLES BANK, A CODORUS VALLEY CO. OF YORK,PA.
----------------- ----------------- ----------------- ----------------- ----------------- ----------------- ----------------- -----------------
TOTAL: 121,854.36 121,827.10 121,827.10 121,827.10 121,827.10 121,827.10 121,827.10 121,827.10
NOTE: Items replaced every "X" years (e.g., 3 yrs., 5 yrs, etc.) are paid to last valid replacement date during years indicated in the life care plan.
AEC Financial, Inc. Page 12 of 32 Revised - May 21, 2014
ITEMS OF COMPENSATION
V. E. M.
CL. CT. NO. 13-0190V
GROWTH
NO. ITEM RATE 2038 2039 2040 2041 2042 2043 2044 2045
MEDICAL INSURANCE
ANTHEM ESSENTIAL DIRECT ACCESS / ANTHEM BLUE CROSS BLUE SHIELD
1 PREMIUM, DEDUCTIBLE AND MAXIMUM OUT OF POCKET 5% 10,802.80 10,802.80 10,802.80 10,802.80 10,802.80 10,802.80 10,802.80 10,802.80
2 ANTHEM BLUE CROSS BLUE SHIELD PRESCRIPTION DRUGS (included in above costs) 5% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
3 MEDICARE PART A 5% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
4 MEDICARE PART B PREMIUM & DEDUCTIBLE 5% 1,405.80 1,405.80 1,405.80 1,405.80 1,405.80 1,405.80 1,405.80 1,405.80
5 MEDIGAP - MEDICARE ADVANTAGE PLAN / BLUE MEDICARE ACCESS VALUE (UNDER 65) 5%
6 BLUE MEDICARE ACCESS VALUE - DRUG COVERAGE 5%
7 MEDICARE SUPPLEMENT ( AGE 65 AND OVER) 5%
8 MEDICARE DRUG PLAN SUPPLEMENT (Premium & Medication Costs) 5%
ROUTINE MEDICAL CARE - (With Insurance Offsets)
9 NEUROLOGIST 5% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
10 PRIMARY CARE PHYSICIAN 5% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
11 PHYSICAL MEDICINE AND REHABILITATION 5% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
EMERGENCY MEDICAL CARE/AGGRESSIVE TREATMENT (With Insurance Offsets)
12 INSERTION OF VNS - HOSPITAL CHARGES 5%
13 INSERTION OF VNS - PROVIDER FEES 5%
14 REPLACEMENT OF VNS GENERATOR - HOSPITAL CHARGES 5%
15 REPLACEMENT OF VNS LEADS 5%
16 KETOGENIC DIET DIETICIAN 4%
17 DIGITAL SCALE FOR KETOGENIC DIET 4%
DIAGNOSTIC TESTING (With Insurance Offsets)
18 HIP X-RAYS 5% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
19 SPINE SERIES X-RAYS 5% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
20 LIPID PANEL 5% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
21 BANZEL LEVEL 5% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
22 PHENOBARBITAL LEVEL 5% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
23 METABOLIC PANEL 5% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
24 LAB DRAW 5% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
NOTE: Items replaced every "X" years (e.g., 3 yrs., 5 yrs, etc.) are paid to last valid replacement date during years indicated in the life care plan.
AEC Financial, Inc. Page 13 of 32 Revised - May 21, 2014
ITEMS OF COMPENSATION
V. E. M.
CL. CT. NO. 13-0190V
GROWTH
NO. ITEM RATE 2038 2039 2040 2041 2042 2043 2044 2045
MEDICATIONS (With Insurance Offsets)
25 LEVOCARNITIN 5% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
26 ONFI (CLOBAZAM) 5% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
27 CETIRIZINE 5% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
28 DIAZEPAM 5% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
29 BANZEL 5% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
30 PHENOBARB ELIXIR 5% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
OVER THE COUNTER MEDICATIONS
31 POLYETHYLINE GLYCOL POWDER 4% 107.34 107.34 107.34 107.34 107.34 107.34 107.34 107.34
32 CO-ENZYME Q 4% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
NUTRITION AND FEEDING (With Insurance Offsets)
33 ELECARE JUNIOR VANILLA 4% 29,592.00 29,592.00 29,592.00 29,592.00 29,592.00 29,592.00 29,592.00 29,592.00
34 JOEY FEEDING BAG 4% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
35 MicKEY BUTTON 4% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
36 MicKEY RIGHT ANGLE V PORT 4% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
THERAPEUTIC MODALITIES (With Insurance Offsets)
37 SPEECH/ OCCUPATIONAL / PHYSICAL THERAPY 4% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
38 PHYSICAL, OCCUPATIONAL OR SPEECH THERAPY 4% 0.00 0.00 0.00 0.00 0.00
39 ANNUAL PT or OT RE-EVALUATION 5%
40 SPEECH THERAPY RE-EVALUATION 5% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
41 MUSIC THERAPY 4%
42 CAMP 4%
43 NURSE CASE MANAGER 4% 2,400.00 2,400.00 2,400.00 2,400.00 2,400.00 2,400.00 2,400.00 2,400.00
EDUCATIONAL / VOCATIONAL
44 PARAPROFESSIONAL ASSISTANCE 4%
45 PSYCHOLOGICAL TESTING AND EDUCATIONAL ASSESSMENT 4%
46 VOCATIONAL / AVOCATIONAL EVALUATION 4%
NOTE: Items replaced every "X" years (e.g., 3 yrs., 5 yrs, etc.) are paid to last valid replacement date during years indicated in the life care plan.
AEC Financial, Inc. Page 14 of 32 Revised - May 21, 2014
ITEMS OF COMPENSATION
V. E. M.
CL. CT. NO. 13-0190V
GROWTH
NO. ITEM RATE 2038 2039 2040 2041 2042 2043 2044 2045
ARCHITECTURAL MODIFICATIONS
47 MODIFICATION OF BATHROOM 4%
48 RAMPS FOR ENTRANCE AND EXIT TO HOME 4%
49 WIDEN 5 DOORWAYS 4%
50 SURE HANDS LIFT - CEILING MOUNTED LIFT SYSTEM 4%
51 REPLACEMENT SLINGS / BODY SUPPORTS FOR LIFT SYSTEM (Covered by Ins.) 4%
EQUIPMENT (With Insurance Offsets)
52 TILT N SPACE CUSTOM MANUAL WHEELCHAIR 4% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
53 WHEELCHAIR MAINTENANCE AND REPAIR (Includes tires/wheels) 4% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
54 ACTIVITY CHAIR 4% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
55 SLEEPSAFE BED MATTRESS AND PADDING 4%
56 ADAPTED TRICYCLE 4%
57 JOGGING STROLLER / WHEELCHAIR 4%
58 ADAPTIVE TOYS / THERAPEUTIC TOYS 4%
59 KANGAROO FEEDING PUMP 4% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
60 WATERPIK CLASSIC WATER FLOSSER 4% 16.44 16.44 16.44 16.44 16.44 16.44 16.44 16.44
61 SEIZURE MONITOR 4%
62 SIMPLE ENVIRONMENTAL CONTROL UNIT 4% 24.00 24.00 24.00 24.00 24.00 24.00 24.00 24.00
63 ADAPTIVE EQUIPMENT FOR EATING 4%
64 ADAPTIVE EQUIPMENT FOR EATING - REPLACEMENTS 4%
65 ADAPTIVE EQUIPMENT FOR EATING - REPLACEMENTS 4%
66 STANDER 4% 816.57 816.57 816.57 816.57 816.57 816.57 816.57 816.57
67 COMMODE CHAIR / ROLLING SHOWER CHAIR 4% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
68 PEANUT EXERCISE BALLS, 2 SIZES 4%
69 ANTI-BURST ROUND EXERCISE BALL 4%
70 THERAPY ROLL 4%
71 CHEWY TUBE 4%
72 SPECIAL NEEDS SWING WITH HARNESS 4%
ORTHOTICS AND PROSTHETICS (With Insurance Offsets)
73 BILATERAL HINGED AFOS 4%
NOTE: Items replaced every "X" years (e.g., 3 yrs., 5 yrs, etc.) are paid to last valid replacement date during years indicated in the life care plan.
AEC Financial, Inc. Page 15 of 32 Revised - May 21, 2014
ITEMS OF COMPENSATION
V. E. M.
CL. CT. NO. 13-0190V
GROWTH
NO. ITEM RATE 2038 2039 2040 2041 2042 2043 2044 2045
SUPPLIES
74 DIAPERS 4%
75 ADULT SIZE MEDIUM INCONTINENCE BRIEFS 4% 1,642.50 1,642.50 1,642.50 1,642.50 1,642.50 1,642.50 1,642.50 1,642.50
76 BED LINERS 4%
77 DISPOSABLE GLOVES 4%
78 HAND SANITIZER 4%
79 WIPES 4%
80 BARRIER CREAM 4%
81 DRY DISPOSABLE WASHCLOTHS 4%
82 MEDICAL ID BRACELET, SHOE TAG OR NECKLACE 4% 11.67 11.67 11.67 11.67 11.67 11.67 11.67 11.67
83 CONTOURED VINYL MATTRESS PROTECTOR 4%
TRANSPORTATION
84 PRIMARY CARE PHYSICIAN 4% 36.00 36.00 36.00 36.00 36.00 36.00 36.00 36.00
85 PHYSICAL MEDICINE AND REHABILITATION PHYSICIAN 4% 36.96 36.96 36.96 36.96 36.96 36.96 36.96 36.96
86 NEUROLOGIST 4% 103.20 103.20 103.20 103.20 103.20 103.20 103.20 103.20
87 NEUROSURGEON AT IU - RILEY 4% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
88 IU CHILDREN'S THERAPY CENTER - REHAB FOR THERAPIES 4%
89 NATIONALSEATING AND REHAB FOR WC/SEATING EVALUATION 4% 6.82 6.82 6.82 6.82 6.82 6.82 6.82 6.82
90 MODIFICATIONS FOR VAN 4%
HOME CARE AND FACILITY CARE
91 HOME HEALTH AIDE - WEEKDAY CARE 4%
92 HOME HEALTH AIDE - WEEKDAY CARE DURING SCHOOL BREAKS 4%
93 RN - WEEKDAY CARE DURING SCHOOL BREAKS 5%
94 HOME HEALTH AIDE - WEEKEND RESPITE CARE 4%
95 RN - WEEKEND RESPITE CARE 5%
96 GROUP HOME OR LONG TERM CARE FACILITY FOR YOUNGER ADULTS 4% 74,825.00 74,825.00 74,825.00 74,825.00 74,825.00 74,825.00 74,825.00 74,825.00
97 SKILLED NURSING FACILITY 5%
SUBTOTAL - 1ST YEAR EXPENSES
98 PAST UNREIMBURSED EXPENSES
99 PAIN AND SUFFERING
100 LOST WAGES
101 STATE OF INDIANA MEDICAID LIEN
102 TRUST SEED: PEOPLES BANK, A CODORUS VALLEY CO. OF YORK,PA.
----------------- ----------------- ----------------- ----------------- ----------------- ----------------- ----------------- -----------------
TOTAL: 121,827.10 121,827.10 121,827.10 121,827.10 121,827.10 121,827.10 121,827.10 121,827.10
NOTE: Items replaced every "X" years (e.g., 3 yrs., 5 yrs, etc.) are paid to last valid replacement date during years indicated in the life care plan.
AEC Financial, Inc. Page 16 of 32 Revised - May 21, 2014
ITEMS OF COMPENSATION
V. E. M.
CL. CT. NO. 13-0190V
Medicare/
Medigap
GROWTH Coverage
NO. ITEM RATE 2046 2047 2048 2049 2050 2051 2052 2053
MEDICAL INSURANCE
ANTHEM ESSENTIAL DIRECT ACCESS / ANTHEM BLUE CROSS BLUE SHIELD
1 PREMIUM, DEDUCTIBLE AND MAXIMUM OUT OF POCKET 5% 10,802.80 10,802.80 10,802.80 10,802.80 10,802.80
2 ANTHEM BLUE CROSS BLUE SHIELD PRESCRIPTION DRUGS (included in above costs) 5% 0.00 0.00 0.00 0.00
3 MEDICARE PART A 5% 0.00 0.00 0.00 0.00 0.00
4 MEDICARE PART B PREMIUM & DEDUCTIBLE 5% 1,405.80 1,405.80 1,405.80 1,405.80 1,405.80
5 MEDIGAP - MEDICARE ADVANTAGE PLAN / BLUE MEDICARE ACCESS VALUE (UNDER 65) 5% 7,256.00 7,256.00 7,256.00
6 BLUE MEDICARE ACCESS VALUE - DRUG COVERAGE 5% 3,180.10 3,180.10 3,180.10
7 MEDICARE SUPPLEMENT ( AGE 65 AND OVER) 5%
8 MEDICARE DRUG PLAN SUPPLEMENT (Premium & Medication Costs) 5%
ROUTINE MEDICAL CARE - (With Insurance Offsets)
9 NEUROLOGIST 5% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
10 PRIMARY CARE PHYSICIAN 5% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
11 PHYSICAL MEDICINE AND REHABILITATION 5% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
EMERGENCY MEDICAL CARE/AGGRESSIVE TREATMENT (With Insurance Offsets)
12 INSERTION OF VNS - HOSPITAL CHARGES 5%
13 INSERTION OF VNS - PROVIDER FEES 5%
14 REPLACEMENT OF VNS GENERATOR - HOSPITAL CHARGES 5%
15 REPLACEMENT OF VNS LEADS 5%
16 KETOGENIC DIET DIETICIAN 4%
17 DIGITAL SCALE FOR KETOGENIC DIET 4%
DIAGNOSTIC TESTING (With Insurance Offsets)
18 HIP X-RAYS 5% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
19 SPINE SERIES X-RAYS 5% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
20 LIPID PANEL 5% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
21 BANZEL LEVEL 5% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
22 PHENOBARBITAL LEVEL 5% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
23 METABOLIC PANEL 5% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
24 LAB DRAW 5% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
NOTE: Items replaced every "X" years (e.g., 3 yrs., 5 yrs, etc.) are paid to last valid replacement date during years indicated in the life care plan.
AEC Financial, Inc. Page 17 of 32 Revised - May 21, 2014
ITEMS OF COMPENSATION
V. E. M.
CL. CT. NO. 13-0190V
Medicare/
Medigap
GROWTH Coverage
NO. ITEM RATE 2046 2047 2048 2049 2050 2051 2052 2053
MEDICATIONS (With Insurance Offsets)
25 LEVOCARNITIN 5% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
26 ONFI (CLOBAZAM) 5% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
27 CETIRIZINE 5% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
28 DIAZEPAM 5% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
29 BANZEL 5% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
30 PHENOBARB ELIXIR 5% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
OVER THE COUNTER MEDICATIONS
31 POLYETHYLINE GLYCOL POWDER 4% 107.34 107.34 0.00 0.00 0.00
32 CO-ENZYME Q 4% 0.00 0.00 0.00 0.00 0.00
NUTRITION AND FEEDING (With Insurance Offsets)
33 ELECARE JUNIOR VANILLA 4% 29,592.00 29,592.00 0.00 0.00 0.00 0.00 0.00 29,592.00
34 JOEY FEEDING BAG 4% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
35 MicKEY BUTTON 4% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
36 MicKEY RIGHT ANGLE V PORT 4% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
THERAPEUTIC MODALITIES (With Insurance Offsets)
37 SPEECH/ OCCUPATIONAL / PHYSICAL THERAPY 4% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
38 PHYSICAL, OCCUPATIONAL OR SPEECH THERAPY 4%
39 ANNUAL PT or OT RE-EVALUATION 5% 409.34 409.34 409.34
40 SPEECH THERAPY RE-EVALUATION 5% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
41 MUSIC THERAPY 4%
42 CAMP 4%
43 NURSE CASE MANAGER 4% 2,400.00 2,400.00 0.00 0.00 0.00 0.00 0.00 2,400.00
EDUCATIONAL / VOCATIONAL
44 PARAPROFESSIONAL ASSISTANCE 4%
45 PSYCHOLOGICAL TESTING AND EDUCATIONAL ASSESSMENT 4%
46 VOCATIONAL / AVOCATIONAL EVALUATION 4%
NOTE: Items replaced every "X" years (e.g., 3 yrs., 5 yrs, etc.) are paid to last valid replacement date during years indicated in the life care plan.
AEC Financial, Inc. Page 18 of 32 Revised - May 21, 2014
ITEMS OF COMPENSATION
V. E. M.
CL. CT. NO. 13-0190V
Medicare/
Medigap
GROWTH Coverage
NO. ITEM RATE 2046 2047 2048 2049 2050 2051 2052 2053
ARCHITECTURAL MODIFICATIONS
47 MODIFICATION OF BATHROOM 4%
48 RAMPS FOR ENTRANCE AND EXIT TO HOME 4%
49 WIDEN 5 DOORWAYS 4%
50 SURE HANDS LIFT - CEILING MOUNTED LIFT SYSTEM 4%
51 REPLACEMENT SLINGS / BODY SUPPORTS FOR LIFT SYSTEM (Covered by Ins.) 4%
EQUIPMENT (With Insurance Offsets)
52 TILT N SPACE CUSTOM MANUAL WHEELCHAIR 4% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
53 WHEELCHAIR MAINTENANCE AND REPAIR (Includes tires/wheels) 4% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
54 ACTIVITY CHAIR 4% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
55 SLEEPSAFE BED MATTRESS AND PADDING 4%
56 ADAPTED TRICYCLE 4%
57 JOGGING STROLLER / WHEELCHAIR 4%
58 ADAPTIVE TOYS / THERAPEUTIC TOYS 4%
59 KANGAROO FEEDING PUMP 4% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
60 WATERPIK CLASSIC WATER FLOSSER 4% 16.44 16.44 0.00 0.00 0.00 0.00 0.00 16.44
61 SEIZURE MONITOR 4%
62 SIMPLE ENVIRONMENTAL CONTROL UNIT 4% 24.00 24.00 0.00 0.00 0.00 0.00 0.00 24.00
63 ADAPTIVE EQUIPMENT FOR EATING 4%
64 ADAPTIVE EQUIPMENT FOR EATING - REPLACEMENTS 4%
65 ADAPTIVE EQUIPMENT FOR EATING - REPLACEMENTS 4%
66 STANDER 4% 816.57 816.57 0.00 0.00 0.00 0.00 0.00 816.57
67 COMMODE CHAIR / ROLLING SHOWER CHAIR 4% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
68 PEANUT EXERCISE BALLS, 2 SIZES 4%
69 ANTI-BURST ROUND EXERCISE BALL 4%
70 THERAPY ROLL 4%
71 CHEWY TUBE 4%
72 SPECIAL NEEDS SWING WITH HARNESS 4%
ORTHOTICS AND PROSTHETICS (With Insurance Offsets)
73 BILATERAL HINGED AFOS 4%
NOTE: Items replaced every "X" years (e.g., 3 yrs., 5 yrs, etc.) are paid to last valid replacement date during years indicated in the life care plan.
AEC Financial, Inc. Page 19 of 32 Revised - May 21, 2014
ITEMS OF COMPENSATION
V. E. M.
CL. CT. NO. 13-0190V
Medicare/
Medigap
GROWTH Coverage
NO. ITEM RATE 2046 2047 2048 2049 2050 2051 2052 2053
SUPPLIES
74 DIAPERS 4%
75 ADULT SIZE MEDIUM INCONTINENCE BRIEFS 4% 1,642.50 1,642.50 0.00 0.00 0.00 0.00 0.00 1,642.50
76 BED LINERS 4%
77 DISPOSABLE GLOVES 4%
78 HAND SANITIZER 4%
79 WIPES 4%
80 BARRIER CREAM 4%
81 DRY DISPOSABLE WASHCLOTHS 4%
82 MEDICAL ID BRACELET, SHOE TAG OR NECKLACE 4% 11.67 11.67 0.00 0.00 0.00 0.00 0.00 11.67
83 CONTOURED VINYL MATTRESS PROTECTOR 4%
TRANSPORTATION
84 PRIMARY CARE PHYSICIAN 4% 36.00 36.00 0.00 0.00 0.00 0.00 0.00 36.00
85 PHYSICAL MEDICINE AND REHABILITATION PHYSICIAN 4% 36.96 36.96 0.00 0.00 0.00 0.00 0.00 36.96
86 NEUROLOGIST 4% 103.20 103.20 0.00 0.00 0.00 0.00 0.00 103.20
87 NEUROSURGEON AT IU - RILEY 4% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
88 IU CHILDREN'S THERAPY CENTER - REHAB FOR THERAPIES 4%
89 NATIONALSEATING AND REHAB FOR WC/SEATING EVALUATION 4% 6.82 6.82 0.00 0.00 0.00 0.00 0.00 6.82
90 MODIFICATIONS FOR VAN 4%
HOME CARE AND FACILITY CARE
91 HOME HEALTH AIDE - WEEKDAY CARE 4%
92 HOME HEALTH AIDE - WEEKDAY CARE DURING SCHOOL BREAKS 4%
93 RN - WEEKDAY CARE DURING SCHOOL BREAKS 5%
94 HOME HEALTH AIDE - WEEKEND RESPITE CARE 4%
95 RN - WEEKEND RESPITE CARE 5%
96 GROUP HOME OR LONG TERM CARE FACILITY FOR YOUNGER ADULTS 4% 74,825.00 74,825.00 0.00 0.00 0.00 0.00 0.00 74,825.00
97 SKILLED NURSING FACILITY 5%
SUBTOTAL - 1ST YEAR EXPENSES
98 PAST UNREIMBURSED EXPENSES
99 PAIN AND SUFFERING
100 LOST WAGES
101 STATE OF INDIANA MEDICAID LIEN
102 TRUST SEED: PEOPLES BANK, A CODORUS VALLEY CO. OF YORK,PA.
----------------- ----------------- ----------------- ----------------- ----------------- ----------------- ----------------- -----------------
TOTAL: 121,827.10 121,827.10 12,208.60 12,208.60 12,208.60 10,845.44 10,845.44 120,356.60
NOTE: Items replaced every "X" years (e.g., 3 yrs., 5 yrs, etc.) are paid to last valid replacement date during years indicated in the life care plan.
AEC Financial, Inc. Page 20 of 32 Revised - May 21, 2014
ITEMS OF COMPENSATION
V. E. M.
CL. CT. NO. 13-0190V
GROWTH
NO. ITEM RATE 2054 2055 2056 2057 2058 2059 2060
MEDICAL INSURANCE
ANTHEM ESSENTIAL DIRECT ACCESS / ANTHEM BLUE CROSS BLUE SHIELD
1 PREMIUM, DEDUCTIBLE AND MAXIMUM OUT OF POCKET 5%
2 ANTHEM BLUE CROSS BLUE SHIELD PRESCRIPTION DRUGS (included in above costs) 5%
3 MEDICARE PART A 5%
4 MEDICARE PART B PREMIUM & DEDUCTIBLE 5%
5 MEDIGAP - MEDICARE ADVANTAGE PLAN / BLUE MEDICARE ACCESS VALUE (UNDER 65) 5% 7,256.00 7,256.00 7,256.00 7,256.00 7,256.00 7,256.00 7,256.00
6 BLUE MEDICARE ACCESS VALUE - DRUG COVERAGE 5% 3,180.10 3,180.10 3,180.10 3,180.10 3,180.10 3,180.10 3,180.10
7 MEDICARE SUPPLEMENT ( AGE 65 AND OVER) 5%
8 MEDICARE DRUG PLAN SUPPLEMENT (Premium & Medication Costs) 5%
ROUTINE MEDICAL CARE - (With Insurance Offsets)
9 NEUROLOGIST 5% 0.00 0.00 0.00 0.00 0.00 0.00 0.00
10 PRIMARY CARE PHYSICIAN 5% 0.00 0.00 0.00 0.00 0.00 0.00 0.00
11 PHYSICAL MEDICINE AND REHABILITATION 5% 0.00 0.00 0.00 0.00 0.00 0.00 0.00
EMERGENCY MEDICAL CARE/AGGRESSIVE TREATMENT (With Insurance Offsets)
12 INSERTION OF VNS - HOSPITAL CHARGES 5%
13 INSERTION OF VNS - PROVIDER FEES 5%
14 REPLACEMENT OF VNS GENERATOR - HOSPITAL CHARGES 5%
15 REPLACEMENT OF VNS LEADS 5%
16 KETOGENIC DIET DIETICIAN 4%
17 DIGITAL SCALE FOR KETOGENIC DIET 4%
DIAGNOSTIC TESTING (With Insurance Offsets)
18 HIP X-RAYS 5% 0.00 0.00 0.00 0.00 0.00 0.00 0.00
19 SPINE SERIES X-RAYS 5% 0.00 0.00 0.00 0.00 0.00 0.00 0.00
20 LIPID PANEL 5% 0.00 0.00 0.00 0.00 0.00 0.00 0.00
21 BANZEL LEVEL 5% 0.00 0.00 0.00 0.00 0.00 0.00 0.00
22 PHENOBARBITAL LEVEL 5% 0.00 0.00 0.00 0.00 0.00 0.00 0.00
23 METABOLIC PANEL 5% 0.00 0.00 0.00 0.00 0.00 0.00 0.00
24 LAB DRAW 5% 0.00 0.00 0.00 0.00 0.00 0.00 0.00
NOTE: Items replaced every "X" years (e.g., 3 yrs., 5 yrs, etc.) are paid to last valid replacement date during years indicated in the life care plan.
AEC Financial, Inc. Page 21 of 32 Revised - May 21, 2014
ITEMS OF COMPENSATION
V. E. M.
CL. CT. NO. 13-0190V
GROWTH
NO. ITEM RATE 2054 2055 2056 2057 2058 2059 2060
MEDICATIONS (With Insurance Offsets)
25 LEVOCARNITIN 5% 0.00 0.00 0.00 0.00 0.00 0.00 0.00
26 ONFI (CLOBAZAM) 5% 0.00 0.00 0.00 0.00 0.00 0.00 0.00
27 CETIRIZINE 5% 0.00 0.00 0.00 0.00 0.00 0.00 0.00
28 DIAZEPAM 5% 0.00 0.00 0.00 0.00 0.00 0.00 0.00
29 BANZEL 5% 0.00 0.00 0.00 0.00 0.00 0.00 0.00
30 PHENOBARB ELIXIR 5% 0.00 0.00 0.00 0.00 0.00 0.00 0.00
OVER THE COUNTER MEDICATIONS
31 POLYETHYLINE GLYCOL POWDER 4%
32 CO-ENZYME Q 4%
NUTRITION AND FEEDING (With Insurance Offsets)
33 ELECARE JUNIOR VANILLA 4% 29,592.00 29,592.00 29,592.00 29,592.00 29,592.00 29,592.00 29,592.00
34 JOEY FEEDING BAG 4% 0.00 0.00 0.00 0.00 0.00 0.00 0.00
35 MicKEY BUTTON 4% 0.00 0.00 0.00 0.00 0.00 0.00 0.00
36 MicKEY RIGHT ANGLE V PORT 4% 0.00 0.00 0.00 0.00 0.00 0.00 0.00
THERAPEUTIC MODALITIES (With Insurance Offsets)
37 SPEECH/ OCCUPATIONAL / PHYSICAL THERAPY 4% 0.00 0.00 0.00 0.00 0.00 0.00 0.00
38 PHYSICAL, OCCUPATIONAL OR SPEECH THERAPY 4%
39 ANNUAL PT or OT RE-EVALUATION 5% 409.34 409.34 409.34 409.34 409.34 409.34 409.34
40 SPEECH THERAPY RE-EVALUATION 5% 0.00 0.00 0.00 0.00 0.00 0.00 0.00
41 MUSIC THERAPY 4%
42 CAMP 4%
43 NURSE CASE MANAGER 4% 2,400.00 2,400.00 2,400.00 2,400.00 2,400.00 2,400.00 2,400.00
EDUCATIONAL / VOCATIONAL
44 PARAPROFESSIONAL ASSISTANCE 4%
45 PSYCHOLOGICAL TESTING AND EDUCATIONAL ASSESSMENT 4%
46 VOCATIONAL / AVOCATIONAL EVALUATION 4%
NOTE: Items replaced every "X" years (e.g., 3 yrs., 5 yrs, etc.) are paid to last valid replacement date during years indicated in the life care plan.
AEC Financial, Inc. Page 22 of 32 Revised - May 21, 2014
ITEMS OF COMPENSATION
V. E. M.
CL. CT. NO. 13-0190V
GROWTH
NO. ITEM RATE 2054 2055 2056 2057 2058 2059 2060
ARCHITECTURAL MODIFICATIONS
47 MODIFICATION OF BATHROOM 4%
48 RAMPS FOR ENTRANCE AND EXIT TO HOME 4%
49 WIDEN 5 DOORWAYS 4%
50 SURE HANDS LIFT - CEILING MOUNTED LIFT SYSTEM 4%
51 REPLACEMENT SLINGS / BODY SUPPORTS FOR LIFT SYSTEM (Covered by Ins.) 4%
EQUIPMENT (With Insurance Offsets)
52 TILT N SPACE CUSTOM MANUAL WHEELCHAIR 4% 0.00 0.00 0.00 0.00 0.00 0.00 0.00
53 WHEELCHAIR MAINTENANCE AND REPAIR (Includes tires/wheels) 4% 0.00 0.00 0.00 0.00 0.00 0.00 0.00
54 ACTIVITY CHAIR 4% 0.00 0.00 0.00 0.00 0.00 0.00 0.00
55 SLEEPSAFE BED MATTRESS AND PADDING 4%
56 ADAPTED TRICYCLE 4%
57 JOGGING STROLLER / WHEELCHAIR 4%
58 ADAPTIVE TOYS / THERAPEUTIC TOYS 4%
59 KANGAROO FEEDING PUMP 4% 0.00 0.00 0.00 0.00 0.00 0.00 0.00
60 WATERPIK CLASSIC WATER FLOSSER 4% 16.44 16.44 16.44 16.44 16.44 16.44 16.44
61 SEIZURE MONITOR 4%
62 SIMPLE ENVIRONMENTAL CONTROL UNIT 4% 24.00 24.00 24.00 24.00 24.00 24.00 24.00
63 ADAPTIVE EQUIPMENT FOR EATING 4%
64 ADAPTIVE EQUIPMENT FOR EATING - REPLACEMENTS 4%
65 ADAPTIVE EQUIPMENT FOR EATING - REPLACEMENTS 4%
66 STANDER 4% 816.57 816.57 816.57 816.57 816.57 816.57 816.57
67 COMMODE CHAIR / ROLLING SHOWER CHAIR 4% 0.00 0.00 0.00 0.00 0.00 0.00 0.00
68 PEANUT EXERCISE BALLS, 2 SIZES 4%
69 ANTI-BURST ROUND EXERCISE BALL 4%
70 THERAPY ROLL 4%
71 CHEWY TUBE 4%
72 SPECIAL NEEDS SWING WITH HARNESS 4%
ORTHOTICS AND PROSTHETICS (With Insurance Offsets)
73 BILATERAL HINGED AFOS 4%
NOTE: Items replaced every "X" years (e.g., 3 yrs., 5 yrs, etc.) are paid to last valid replacement date during years indicated in the life care plan.
AEC Financial, Inc. Page 23 of 32 Revised - May 21, 2014
ITEMS OF COMPENSATION
V. E. M.
CL. CT. NO. 13-0190V
GROWTH
NO. ITEM RATE 2054 2055 2056 2057 2058 2059 2060
SUPPLIES
74 DIAPERS 4%
75 ADULT SIZE MEDIUM INCONTINENCE BRIEFS 4% 1,642.50 1,642.50 1,642.50 1,642.50 1,642.50 1,642.50 1,642.50
76 BED LINERS 4%
77 DISPOSABLE GLOVES 4%
78 HAND SANITIZER 4%
79 WIPES 4%
80 BARRIER CREAM 4%
81 DRY DISPOSABLE WASHCLOTHS 4%
82 MEDICAL ID BRACELET, SHOE TAG OR NECKLACE 4% 11.67 11.67 11.67 11.67 11.67 11.67 11.67
83 CONTOURED VINYL MATTRESS PROTECTOR 4%
TRANSPORTATION
84 PRIMARY CARE PHYSICIAN 4% 36.00 36.00 36.00 36.00 36.00 36.00 36.00
85 PHYSICAL MEDICINE AND REHABILITATION PHYSICIAN 4% 36.96 36.96 36.96 36.96 36.96 36.96 36.96
86 NEUROLOGIST 4% 103.20 103.20 103.20 103.20 103.20 103.20 103.20
87 NEUROSURGEON AT IU - RILEY 4% 0.00 0.00 0.00 0.00 0.00 0.00 0.00
88 IU CHILDREN'S THERAPY CENTER - REHAB FOR THERAPIES 4%
89 NATIONALSEATING AND REHAB FOR WC/SEATING EVALUATION 4% 6.82 6.82 6.82 6.82 6.82 6.82 6.82
90 MODIFICATIONS FOR VAN 4%
HOME CARE AND FACILITY CARE
91 HOME HEALTH AIDE - WEEKDAY CARE 4%
92 HOME HEALTH AIDE - WEEKDAY CARE DURING SCHOOL BREAKS 4%
93 RN - WEEKDAY CARE DURING SCHOOL BREAKS 5%
94 HOME HEALTH AIDE - WEEKEND RESPITE CARE 4%
95 RN - WEEKEND RESPITE CARE 5%
96 GROUP HOME OR LONG TERM CARE FACILITY FOR YOUNGER ADULTS 4% 74,825.00 74,825.00 74,825.00 74,825.00 74,825.00 74,825.00 74,825.00
97 SKILLED NURSING FACILITY 5%
SUBTOTAL - 1ST YEAR EXPENSES
98 PAST UNREIMBURSED EXPENSES
99 PAIN AND SUFFERING
100 LOST WAGES
101 STATE OF INDIANA MEDICAID LIEN
102 TRUST SEED: PEOPLES BANK, A CODORUS VALLEY CO. OF YORK,PA.
----------------- ----------------- ----------------- ----------------- ----------------- ----------------- -----------------
TOTAL: 120,356.60 120,356.60 120,356.60 120,356.60 120,356.60 120,356.60 120,356.60
NOTE: Items replaced every "X" years (e.g., 3 yrs., 5 yrs, etc.) are paid to last valid replacement date during years indicated in the life care plan.
AEC Financial, Inc. Page 24 of 32 Revised - May 21, 2014
ITEMS OF COMPENSATION
V. E. M.
CL. CT. NO. 13-0190V
GROWTH
NO. ITEM RATE 2061 2062 2063 2064 2065 2066 2067
MEDICAL INSURANCE
ANTHEM ESSENTIAL DIRECT ACCESS / ANTHEM BLUE CROSS BLUE SHIELD
1 PREMIUM, DEDUCTIBLE AND MAXIMUM OUT OF POCKET 5%
2 ANTHEM BLUE CROSS BLUE SHIELD PRESCRIPTION DRUGS (included in above costs) 5%
3 MEDICARE PART A 5%
4 MEDICARE PART B PREMIUM & DEDUCTIBLE 5%
5 MEDIGAP - MEDICARE ADVANTAGE PLAN / BLUE MEDICARE ACCESS VALUE (UNDER 65) 5% 7,256.00 7,256.00 7,256.00 7,256.00 7,256.00 7,256.00 7,256.00
6 BLUE MEDICARE ACCESS VALUE - DRUG COVERAGE 5% 3,180.10 3,180.10 3,180.10 3,180.10 3,180.10 3,180.10 3,180.10
7 MEDICARE SUPPLEMENT ( AGE 65 AND OVER) 5%
8 MEDICARE DRUG PLAN SUPPLEMENT (Premium & Medication Costs) 5%
ROUTINE MEDICAL CARE - (With Insurance Offsets)
9 NEUROLOGIST 5% 0.00 0.00 0.00 0.00 0.00 0.00 0.00
10 PRIMARY CARE PHYSICIAN 5% 0.00 0.00 0.00 0.00 0.00 0.00 0.00
11 PHYSICAL MEDICINE AND REHABILITATION 5% 0.00 0.00 0.00 0.00 0.00 0.00 0.00
EMERGENCY MEDICAL CARE/AGGRESSIVE TREATMENT (With Insurance Offsets)
12 INSERTION OF VNS - HOSPITAL CHARGES 5%
13 INSERTION OF VNS - PROVIDER FEES 5%
14 REPLACEMENT OF VNS GENERATOR - HOSPITAL CHARGES 5%
15 REPLACEMENT OF VNS LEADS 5%
16 KETOGENIC DIET DIETICIAN 4%
17 DIGITAL SCALE FOR KETOGENIC DIET 4%
DIAGNOSTIC TESTING (With Insurance Offsets)
18 HIP X-RAYS 5% 0.00 0.00 0.00 0.00 0.00 0.00 0.00
19 SPINE SERIES X-RAYS 5% 0.00 0.00 0.00 0.00 0.00 0.00 0.00
20 LIPID PANEL 5% 0.00 0.00 0.00 0.00 0.00 0.00 0.00
21 BANZEL LEVEL 5% 0.00 0.00 0.00 0.00 0.00 0.00 0.00
22 PHENOBARBITAL LEVEL 5% 0.00 0.00 0.00 0.00 0.00 0.00 0.00
23 METABOLIC PANEL 5%
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