Medical and Investigative Expert Reviews & Exams
Whether we conduct a claim file audit to ensure critical reports and information are included, or our customers have all the pertinent documentation and a fully prepared claim file, TPN can provide the appropriate and qualified experts to conduct reviews and exams as needed. With more than 20,000 physicians, mental health, and investigative professionals across the United States in our Network of Experts, TPN can support all types of claims and the most complex and multiple injuries involved in a case.
Our experts are fully vetted by TPN and offer exceptional claim review and exam skills, expertise in their respective fields, and are well prepared by our team on the nuances of the claim and legal / policy aspects. TPN ensures the assigned experts spend the appropriate amount of time to conduct an in-depth analysis of each claim and all supporting documentation to provide our clients with unbiased and evidence-based recommendations and opinions in their reports.
TPN received a complicated general liability claim from a third-party administrator that had remained unresolved for more than two years. The case involved a business professional that had been hit by a piece of equipment that fell from the scaffolding of a building. The claim had already been reviewed by the administrator’s internal R.N.; however, the opinion did not provide enough evidence to substantiate a resolution. TPN analyzed the claim file and determined that a medical expert in head trauma was needed to conduct a thorough review. They were able to determine that the injuries claimed could not have been caused by the equipment, enabling our client to finally come to an equitable settlement and reduce future exposure.
Too often, IME medical evaluators take the claimant at their word and they do not have all the documentation to provide any evidence on the contrary to what the claimant or their attorney has claimed for injuries. We understand that physicians want the best for their patients, however, there is a balance between getting proper medical treatment for accident injuries or sickness and covering expensive medical treatments that may or may not have occurred due to the accident. TPN’s experts can uncover and separate out truth from fiction and provide the diagnosis, causally related injuries, and reasonable and necessary medical treatment recommendations to help our clients negotiate equitable resolutions while reducing cost exposure.
Should the claim require our medical and mental health experts to examine the claimant or investigative professional to dig deeper into a case, TPN will assign qualified experts that can thoroughly examine the patient.
Before our experts are engaged, TPN prepares a brief with all pertinent data on the case background so the experts are well informed on the claim. Once the review or exam is completed, our experts prepare a medical report that is well supported with credible evidence and consistent with the specific issues surrounding the case and worded appropriately to be complaint with the claim type and the regulations of the state of loss. The advantage of this focus on details, enables us to identify pre-existing medical conditions, pre- or post-accident injuries, names of medical providers involved that were not previously known to the client, and other critical factors that can impact the claim. TPN’s experts can drastically reduce the client’s overall and future claim exposure by using our experienced experts to produce a medical report backed by evidence.
TPN recommended bringing in one of their spine surgeon experts to review an insurer’s worker’s comp claim to determine if the claimant’s injury was related to the slip & fall accident. Our medical expert conducted a thorough review of the claim documentation and medical reports to conclude a different scenario.
TPN’s spine surgeon was able to diagnose that the spine injury had occurred two years prior to the accident. Our expert’s unbiased medical report gave our client the confidence to negotiate a settlement so the claimant could receive some medical treatment for the accident injury, while saving the reinsurer hundreds of thousands of dollars in potential medical costs for spine surgery.
Refer your difficult claims to TPN to ensure you get the best medical and investigative experts that can produce unbiased reports that can substantiate resolution negotiations or testify.