Automobile Accidents
More than six million automobile accidents happen every year in the U.S. resulting in medical related injuries and deaths. Forensic review and analysis are critical for claims that involve complex injuries to determine if an underlying medical condition could have caused the accident or there were pre-existing conditions not caused by or impacted by the accident. Our attention to detail, many years of experience, and extensive network of experts versed in auto accident injuries can help our clients resolve claims and ensure indemnity payments are for causally related injuries only.
TPN has years of experience assisting our clients with automobile accidents involving:
- Single vehicles
- Multiple vehicles
- Pedestrian
Some of the questions TPN can help to answer through our in-depth audit and analysis, as well as expert reviews and exams include:
- Was the injured party under the influence of any substances?
- Does the mechanism of injury match the diagnosis?
- Are there any co-morbidities that should be considered in the medical analysis?
- Are we too eager to accept the notion that the patient complained of symptoms after the accident, therefore the accident must have caused the source of these complaints?
- And many other critical questions to uncover the facts
Too often, insurers wait too long and claim costs escalate without a clear path to resolution. TPN can provide a complimentary consultation on the automobile claim to discuss the challenges and goals with the client to understand why the claim cannot be resolved internally or by IMEs or other service providers. From that initial consult, TPN can determine if they can help and the forensic services recommended to help settle the claim and avoid further cost escalation for non-causal related injuries or unnecessary treatments.
Client Success
Challenge
A leading insurer had a lingering severe neck injury auto claim with escalating medical costs. They questioned evidence that the neck injury was linked to the accident but did not have the medical evidence to prove otherwise. The insurer did not have a complete picture of the claimant’s medical history to determine if there were pre-existing conditions.
Solution
TPN conducted a claim audit and discovered key medical reports were missing. TPN helped the client obtain the missing medical reports demonstrating the patient’s prior medical history, and from the analysis of the complete documentation, TPN found the claimant’s condition did not match the causally related injuries reported due to the accident. TPN used a local spine surgeon from their extensive Network of Experts to evaluate the claim and provide their expert opinion regarding causation of the alleged injuries and conditions that existed before the accident.
Results
TPN provided a medical report with defensible evidence of prior conditions, backing up our client to negotiate that the treatments requested were not aligned with the alleged accident injuries. The client was able to confidently resolve the claim, saving tens of thousands of dollars in costs they otherwise would have continued to pay the insured.