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Analysis

Physician notes on medical records, IMEs, and the logic of defense reviewers

Practical reading for litigation teams. Written from the perspective of a physician with payer-side US claim review experience under InterQual and MCG, now applying that lens to plaintiff and defense work.

Compliance
May 20, 20267 min read
ERISA · Positioning

Why ERISA Fiduciary Defense Needs a UM Physician, Not a Compliance Attorney

The missing piece in ERISA benefits defense: a clinician who has actually applied the criteria under dispute. Why compliance attorneys and actuaries cannot answer the central clinical question.

ERISARead →
Compliance
May 13, 20268 min read
Denial Defensibility · ERISA

What Makes a Medical Necessity Denial Clinically Defensible — and What Doesn't

The four-dimension test a physician reviewer applies to every denial. Written from first-hand criteria application — the operational standard, not the legal standard.

Denial DefensibilityRead →
Compliance
May 6, 20269 min read
MHPAEA · Parity

What MHPAEA's Six NQTL Categories Mean in Actual UM Practice

Most MHPAEA writing is legal. This is operational — what each of the six NQTL categories looks like from inside the utilization review operation, and where the disparities actually emerge.

MHPAEARead →
Both sides
Jun 10, 20267 min read
Litigation Prep · Defense/Carrier

The Utilization Review Record: What Plaintiff's Counsel Will Subpoena and What It Needs to Show

Defense and carrier orientation. Written for in-house counsel and defense firms preparing for bad faith litigation.

Bad FaithRead →
Defense & Carriers
Jun 3, 20268 min read
Bad Faith Defense · Criteria

Criteria Application in Bad Faith Defense: What Makes a Denial Documentarily Defensible

Written from first-hand criteria application experience. For insurance defense counsel and carrier legal teams.

Bad Faith DefenseRead →
Defense & Carriers
May 27, 20269 min read
Daubert · Defense

When the Plaintiff's Expert Report Doesn't Survive Daubert: The Analytical Defects

The mirror image of the seven IME defects — applied to plaintiff expert reports. What defense counsel should look for before deposition.

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Defense & Carriers
May 20, 20267 min read
Reserve Analysis · TPA/Carrier

Reserve-Setting with Medical Evidence: The Documentation Standard for Defensible Reserve Decisions

What a physician-authored reserve analysis provides that a claims adjuster cannot. Why documented defensible reserves matter in bad faith exposure management.

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Defense & Carriers
May 13, 20268 min read
IME Quality · Defense

Before Your IME Goes Out: The Seven Defects That Create Cross-Examination Problems

The same seven-defect framework — but for defense counsel who commissioned the IME. What the plaintiff will attack, and how to address it before submission.

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Plaintiff & Claimant
May 6, 20268 min read
Causation · PI

Pre-existing Conditions in PI Cases: What the Defense Will Argue and How to Counter

Prior pathology is the single most common defense angle in soft-tissue and orthopedic PI cases. What the documentation has to show to reduce its impact — and the temporal markers that strengthen an aggravation theory.

Personal InjuryRead →
Both sides
Apr 29, 20267 min read
Service Boundaries

Physician Case Intelligence vs. Legal Nurse Consulting: Where the Lines Are

Two services that look adjacent on the surface and are structurally different in what they can defensibly assert. When each is the right answer, and how firms that use both organize the work.

MethodologyRead →
Plaintiff & Claimant
Apr 22, 20267 min read
Case Economics

Why Case Viability Screening Before You Retain an Expert Saves $5,000+

The economics of pre-expert screening when expert retainers start at $2,500 and run to $15,000+. What screening catches that the first expert call won't, and when screening is unnecessary.

Case EconomicsRead →
Both sides
Apr 15, 20268 min read
Causation

More Likely Than Not: What the Medical Evidence Actually Has to Show

The civil causation standard is conceptually simple and operationally subtle. What a physician reviewer looks for when asked whether the record supports the 51% threshold — and the four most common reasons records fall short.

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Plaintiff & Claimant
Apr 8, 20269 min read
IME Deconstruction

Seven Defects We Find in Almost Every Defense IME Report

Defense IMEs follow a recognizable internal logic with recognizable failure modes. The seven defects that appear in the majority of reports we read, with the deposition question each one supports.

IME DeconstructionRead →
Both sides
Apr 1, 202610 min read
Methodology · Founding Essay

What a Payer Reviewer Actually Looks For in a Medical Record

Most discussion of utilization review is written from the outside. This is written from first-hand application of the methodology. What the mental model actually is, why it produces the denials it produces, and what it means for litigation records that travel through similar reviewer logic.

Founding EssayRead →
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New analysis posts

New pieces are added as clinical and methodological questions arise from active engagements. Referenced in case letters when directly relevant to the matter.

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