Accidental Death
Accidental Death Insurance provides benefits when one dies of an unexpected event, and not the direct result of a medical condition that caused the death. TPN provides the forensic analysis of a patient’s medical history to arrive at an accurate cause of death and provide evidence-based reports with reviews by medical and investigative experts to help our clients make a determination of appropriate benefits to resolve their challenging claims.
TPN has more than 30 years of experience analyzing complex accidental death claims. Working with our team assures our clients get an accurate analysis and well-supported medical opinions that can support negotiations and equitably resolve accidental death claims.
TPN’s claim review process starts with a complimentary consultation of the case to understand the issues and our client’s expected outcomes, enabling us to recommend a road map of actions to settle the claim as efficiently and effectively as possible. TPN provides forensic services to ensure a complete review and analysis of the claim, including:
- Claim file audit, including a document discovery and analysis
- Review of the claim by TPN’s qualified medical and investigative experts from their extensive national network
- Medical exams by local physicians or mental health professionals that spend the time to understand the file and conduct a proper exam
TPN delivers an evidence-based report with opinions and recommendations substantiated by experts and authorities in their field to help our clients make informed decisions on claim resolution while lowering further or inflated indemnity payments.
Should the case go to trial, TPN will ensure the physicians and mental health professionals that conduct the claim review can also be available to the defense team as credible trial witnesses, as well as helping to prepare the treating physician for providing testimony that aligns with the claim and can produce positive trial outcomes.
Client Success
Challenge
A leading insurer had a challenging Accidental Death claim involving a retired Neurosurgeon in her mid-seventies. According to the medical reports, the patient had fallen out of her wheelchair while at home, suffering a subdural hematoma that led to her death. The claimant’s family filed an Accidental Death claim, seeking benefits for her death.
Solution
TPN conducted a claim audit and discovered key medical reports were missing from the PCP. TPN helped the client obtain these medical reports containing the patient’s medical history. rom TPN’s in-depth document analysis of the complete file, TPN found the patient was previously diagnosed with severe dementia. She had fallen numerous times and was deemed unfit to be in the wheelchair unless she was restrained properly to avoid further falls. TPN had a medical expert review the claim to determine if her death qualified as an “accident”.
Results
TPN provided a medical report with evidence of prior fractures to the forearms and other injuries from previous falls, as well as the PCP orders for restraints while in the wheelchair. The patient was not restrained in the wheelchair at the time of her death, and the fall led to a hematoma and ultimately her death. TPN’s expert determined the claimant’s death was a direct result of her known medical condition and not from an unexpected event. The patient’s death could have been avoided if she had been properly restrained in the wheelchair. Our client was able to use our evidence-based report and opinions from our qualified medical expert to resolve the claim quickly and equitably while greatly reducing liability costs for the insurer.
If you have complicated accidental death claims that continue to escalate in costs and time to resolve, TPN can provide a COMPLIMENTARY assessment of your claim and consultation to discuss how TPN can help you resolve them faster and equitably, while reducing further indemnity liabilities.