MEDICAL RECORD REVIEW
A Medical Record Review is a forensic review of all of the submitted documents. A Medical Record Review is not interactive, like a Medical Case Analysis (see below). It is a one-time “snapshot” based upon the evidence in hand at the time of the assignment. The medical expert performing a Medical Record Review will write a report based upon the documents submitted for review.
A Peer Review is a review of medical records specifically to determine if a specific treatment procedure or diagnostic study was medically necessary as a result of the accident in question. It is not a full Medical Record Review of the entire case.
An Additional Review is a service we provide subsequent to the completion of any one of our other services. After receiving the opinion from one of our medical experts, if further documentation is received to the claim file (be it more treatment records, a rebuttal letter or any other document you feel may serve to alter our medical expert’s opinion) an Additional Review is the appropriate service. If you have new questions that were not posed at the time of the requested service, this would also be considered an Additional Review.
If any of the questions posed at the time of the requested service were not addressed or not clearly addressed in the medical report, TPN will have the medical expert prepare an addendum at no charge to our client.
MEDICAL CASE ANALYSIS
A Medical Case Analysis is a review of all of the submitted documents (medical records, films, photos, recorded statements, depositions, interrogatories, etc.) by one of our Medical Advisors to include a follow-up case discussion by telephone with our client and/or client counsel. A written report will be provided, if requested, after the case discussion. This service is interactive and may involve multiple telephone conversations between our Medical Advisor and our client/client counsel.
- To decide a course of action
- I.D. valuable missing medical records
- Provide insightful questions to be posed to Claimants and/or Treating Physicians
SECOND INJURY FUND REVIEW
A Second Injury Fund Review is completed specifically to analyze the medical component of the case to determine if there is sufficient medical evidence to support the case meeting the specific requirements of the State in which the work related injury occurred. As each State Fund has its own nuances, each case must be reviewed with those nuances in mind.
Why can’t I just use the treating doctor to answer the question about Second Injury Fund potential? Most treating physicians do not understand the Second Injury Fund, and too often many treating physicians are just too busy to take the time to learn this, as it applies to such a small percentage of their patients. What if the State I am handling a claim in requires that I try to get the treating doctor to agree before I seek an independent medical opinion? Our experience has taught us that, if the opinion of an experienced medical expert determines that the case meets the required criteria, a treating physician will agree with the medical expert’s opinion. As a result, we offer Second Injury Fund Review services in which our reviewing medical expert will contact the treating physician by telephone to discuss the case and why it has merit under the Second Injury Fund guidelines. We have had great success with this approach. If, for some reason, the treating doctor will not agree, in spite of the evidence as presented by our medical expert, our medical expert has already reviewed the case, you have fulfilled your responsibility to attempt to work with the treating physician and our medical expert will complete a medical report and/or form depending upon the State requirements.
PATTERN & PRACTICE ANALYSIS
A Pattern & Practice Analysis is a review of a volume of individual cases from one healthcare practice, with a comparison being made from patient to patient, looking for patterns that are not in keeping with accepted standard medical practices. A Pattern & Practice Analysis is utilized when there is suspicion of medical practices based upon financial gain and not on individual patient needs.
Still not sure what service is appropriate for your claim?
Feel free to contact TPN by phone (800) 777-6160, by email (use form below), or fax: Use form below and fax to (800) 999-6160.
Just send us a quick synopsis of the case and a member of our staff will contact you shortly.