Claim File Audit

Claim File Audit

File Audit

There are many questions that need to be answered and analysis conducted to effectively resolve claims:

  • Does the claim require a review by a medical or investigative expert? If so, what disciplines / specialty areas are needed?
  • Is a medical exam of the claimant needed?
  • Do you have all the documents and information needed to properly evaluate the file to uncover causally related facts?
  • What are the issues preventing the claim from being settled?
  • Are there missing documents or reports that could be relevant to the case?

These are just a few of the questions TPN answers as part of our forensic claim file audit process. Through document discovery and analysis of the entire claim file, we can better advise our clients on the course of action and the types of experts needed to resolve their claims.

TPN ensures the claim file is fully prepared and complete before our clients invest in expert reviews and exams. The full file is provided to our experts so they are fully informed about the case and have everything they need to make a diagnosis and determine causally related injuries and treatments.

If clients already have an understanding of their claim and know what experts are needed, we will present the prepared file to the physicians and other experts TPN assigns to the claim so they have all the relevant information.

On a recent long-term disability claim, TPN discovered the claimant had a long history of substance abuse from analyzing hundreds of pages of claim file documents. Our mental health expert was able to diagnose the claimant’s current medical issues were a direct cause from illegal substances used by the insured. Our client could use TPN’s medical report to substantiate negotiations so our corporate client did not have to cover unsubstantiated long-term benefits.

Document Recovery

We understand our clients are overwhelmed with the number of cases they must close every month. TPN can assist our clients with document recovery services if requested to quickly obtain critical missing medical reports, police reports, and other documentation that can provide evidence on the claimant’s medical history, prior or post injuries, and other information used by our team and experts to get to the truth.

TPN received a worker’s comp claim and conducted our forensic file audit, discovering key medical reports missing. TPN recovered the reports for our client and provided the full claim file to our medical expert. By providing a complete file and preparing our expert on the nuances of the claim, our physician was able to conclude a different diagnosis than what was claimed, helping our client resolve the claim quickly and reduce their cost exposure by tens of thousands of dollars.

TPN’s complimentary initial consultation is focused on determining the best path to resolution for your claim. Experience for yourself how our forensic process differs from other service providers and the savings we can provide by handling your most challenging claims right the first time.

Already know the services and medical experts needed to resolve your claim? Refer a new claim today to see how TPN can minimize risks and exposure.