Payment Exception (Leakage) Audit
For self-insureds or large deductible programs.
Payment exception (leakage) audits are contingency-fee reviews that examine the accuracy of claim file payments. Leakage occurs when the TPA overpays on claims (that money comes straight out of a self-insureds bank account) due to adjuster error.
Leakage can occur when the adjuster’s actions cause a claim or benefit payment that was not owed to the injured employee, incorrect medical bill payments to the medical providers, and vendor overpayments when unneeded outside parties are used “to adjust the claim;” such as overpayments to attorneys, rehabilitation nurses, and medical networks.
If you are involved in a lawsuit over unpaid premiums, or about to be, we can help you. We have provided expert witness testimony and assistance in dozens of cases around the country. We have answered the questions at depositions. We have testified in Federal Court. We can help you reduce legal costs.
We have successfully disputed NCCI inspections at Appeals Board Hearings which have led to revisions on Scopes and the Basic Manual. We have represented clients before Labor Departments over the inclusion of uninsured subs; and won.