Providing Insight Into Medical Claims

Founded in 1991, The Physician Network, Inc. (TPN) started out as an independent medical                         

evaluations (IME) company simply coordinating examinations and general medical record review                   

services. Over time, we learned that the typical cookie­cutter approach to the IME and File                           

Review process was contributing to the IME/IMR report losing its value. In fact, the typical                           

IME/IMR report in many circles are no longer viewed as being “independent” and have been                           

reduced to serving only as a negotiation tool for settlement purposes instead of a valuable                           

claims decision making tool that it can and should be.

Meanwhile, the average dollar value of claim settlements – along with insurance fraud – has                           

continued to rise while insurance carriers face declining premium rates. This has created undue                         

pressure on claims staff to cut costs (including looking for even cheaper IME/IMR services,                         

which has only served to worsen the problem). As we began to recognize these developments,                           

we evolved into a medical consulting firm providing specific services designed to help our clients                           

meet these challenges (more complex cases, pressure on expenses, etc.).

In addition to the above challenges, one of the biggest issues we see facing the insurance                             

industry today is physicians rendering medical opinions about claims without enough knowledge                     

or understanding of the various types of insurance and the numerous state laws governing each                           

of them.

Too often, medical reports are written without a clear understanding of these issues, resulting in                           

inaccurate assessments causing unnecessary delays in claim processing, which frustrates                 

everyone involved and adds to the cost of administering a claim. TPN has shown that by simply                               

teaching a physician to use proper terminology for the specific claim type and state of loss can                               

make the difference between the acceptance and denial of a claim. This is why we match our                               

clients with physicians knowledgeable about both the claim type and the state of loss for each                             

case and then work with those medical experts to produce a clear, relevant, and substantiated                           

medical report.