Corporates, Insurers& TPA
Medical claims and compensation decisions are only as good as the clinical record underneath them. We provide the technical audit that tells a claims team whether the documents support the amount being sought or already paid.
- Category
- 04
- Named Services
- 2
- Deliverable
- Written Advisory Note
- Enquiry
- Scope-first
Where leakage anddispute begin
Claim files routinely carry a diagnosis that the treatment record does not support, a disability rating without measurement, or an injury history inconsistent with the alleged event.
Files reach us at every stage — before a complaint is drafted, after an allegation is made, and after an order requires technical response.
- 01Medical documents submitted without supporting investigation
- 02Disability or loss-of-function claims unsupported by examination
- 03Injury mechanics inconsistent with the reported incident
- 04Workmen compensation assessments not clinically verified
The file, testedagainst itself.
Analysis is documentary and, where required, clinical. Nothing is concluded from the narrative alone; each finding is traced to a record, a measurement or an examination.
- Diagnosis versus submitted investigation
- Treatment necessity and reasonable-cost benchmarking
- Disability percentage and functional-loss verification
- Incident narrative versus injury pattern
- Record authenticity and timeline testing
Four movements,in a fixed order.
- A
Claim file review
Every submitted medical document is read against the claim's stated facts and dates.
- B
Technical opinion
A written clinical opinion on what the file supports, and where it does not.
- C
Dispute support
Reasoned rebuttal material for repudiation, arbitration, consumer or ombudsman proceedings.
- Health and motor insurers
- Third Party Administrators
- Corporate HR, EHS and insurance cells
- Loss assessors and claim review teams
01Insurance Claim Fraud Audits
Clinical and documentary audit of submitted claims to identify unsupported diagnosis, inflated treatment or fabricated injury.
02Workmen Compensation Verification
Verification of injury causation, disability degree and functional limitation for employer compensation decisions.