Clinical Claim Consulting & Medical Records Review
A clinical second look at claims that have stalled.
Overview
What clinical claim consulting covers
Some claims drift — treatment continues without clear progress, records are hard to interpret, or the path to closure isn't obvious. A focused clinical review can bring the picture into focus.
We review medical records and treatment history, identify gaps or inconsistencies, and deliver plain-language findings with practical next steps your claims team can act on.
What's included
- Medical records review and treatment timeline summaries
- Assessment of treatment against the documented injury and accepted guidelines
- Identification of gaps, duplications, or inconsistencies in care
- Recommendations on next steps, independent evaluations, or case management
- Plain-language explanations of diagnoses and procedures
- Consultation calls with adjusters and claims leadership
Outcomes
What it means for your claims.
- 01
Clarity on complex files
Turn a stack of medical records into a clear summary and actionable plan.
- 02
Better decisions
Clinically grounded recommendations support reserving, authorization, and settlement discussions.
- 03
Claims that move
Identify what's holding a claim open — and what it will take to resolve it.
When to consider clinical claim consulting
Not sure it's the right fit? Tell us about the claim and we'll recommend the right level of involvement.
- Long-tail claims without clear progress
- Files with extensive or conflicting medical records
- Claims approaching settlement or closure decisions
- Teams that need clinical expertise on demand
FAQ
Clinical Claim Consulting questions
What does a clinical claim consultant do?
A clinical claim consultant applies medical knowledge to an insurance claim — reviewing records, explaining diagnoses and treatment, flagging gaps or inconsistencies, and recommending practical next steps so claims professionals can make well-informed decisions.
Related services
- Field Case ManagementA clinical professional attends medical appointments in person, clarifies treatment and work status, and reports back to your claims team.
- Catastrophic Case ManagementSpecialized management of severe, life-altering injuries — coordinating complex care from the hospital through rehabilitation and home.
- Return-to-Work CoordinationClear restrictions, realistic goals, and employer coordination for a safe and timely return to work.
Contact
Request clinical claim consulting
Tell us about the claim and we'll respond promptly to discuss next steps and assign the right case manager.
For a new referral, it helps to include:
- Claim number and line of coverage
- Injured person's name and date of injury
- Service requested and claim location
- Adjuster contact information