Insurance Carriers and Third-Party Administrators

Insurance Carriers and Third-Party Administrators

Leading insurance providers, reinsurers, and third-party administrators, including Liberty Mutual, Farmers, Swiss Re, Disability RMS, Allstate, Acadia Insurance, CCMSI, The Lawson Group, and many other providers rely on TPN to provide forensics on their challenging medical claims. TPN understands insurers obligation is to ensure their customers receive the medical treatment needed to reach MMI or return to work. Yet insurers have claims that remain unresolved for months and years and cost well above tolerable limits.

The head of claims management and complex claims departments have told us they struggle with many claims that are complex due to the complicated injuries involved or lack of internal resources or expertise to resolve them. Costs escalate, including fees spent for inadequate reviews or exams and medical payments for treatments that may not be causally related. Whether it is a worker’s comp, automobile, general liability, disability, medical malpractice or other claim, TPN partners with our clients to effectively resolve the claims while limiting or reducing exposure.

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Our clients trust in our forensic process, customized for every claim, to uncover issues and missing documents and determine a path forward. From our file audit and document discovery service, TPN ensures the file is complete and fully prepared to provide to the best medical and investigative experts in their network to determine the diagnosis, causation, and necessary and reasonable treatment needed. Insurers know they will receive a thorough medical report with expert recommendations and evidence, so they can make confident decisions and substantiate negotiations to settle claims.

When claims are represented by plaintiff attorneys, costs can quickly escalate and continue to accumulate, and months or years go by without resolution. Insurers need a way to substantiate negotiations or support their defense team should the claim go to trial. TPN’s experts provide evidence-based medical reports with expert opinions that can help insurers equitably settle their toughest claims. Should the case go to trial, our experts are prepared to back up their reports to help defense teams defend the recommendations for settlement.

TPN also supports special investigative units (SIU) to resolve claims that have been flagged by insurers as needing further investigation. SIU departments lack the staff resources and expertise to conduct a thorough analysis of the entire claim file, especially since many can include hundreds or thousands of pages of documents and medical reports to review.

TPN’s forensic process is comprehensive, providing file audits to determine if all pertinent documentation is included. Our team also conducts a document analysis to answer critical questions and determine the level of effort and experts needed to uncover the truth. TPN matches their qualified experts to the claim to conduct an in-depth review or exam to find evidence of medical injuries that are not related to the claim, uncover the causally related facts, determine if physicians are billing for the appropriate treatment, determine the best and fastest medical treatment path to MMI and more. TPN’s reports can help SIU teams to uncover evidence to use in justifying closing the claim or recover payments from illegitimate claims.

Try our COMPLIMENTARY Consultation to see how TPN can help settle even your most difficult claims.