Reserve decisions in liability claims are fundamentally medical judgments expressed as dollar ranges. The clinical question — what does the medical record actually support in terms of injury severity, treatment necessity, and future medical exposure — determines the reserve range. But the documentation of that clinical judgment is often inadequate.
Claims adjusters set reserves based on experience, comparable case data, and their reading of the medical record. But a claims adjuster's reserve assessment is not a physician assessment. In bad faith litigation, the question of whether the reserve was adequate is often the question of whether the medical record was adequately evaluated. A physician-authored reserve analysis provides the documented clinical basis that a claims adjuster cannot produce — and that survives internal audit scrutiny.
What a physician-authored reserve analysis provides
The deliverable is not a medical opinion letter. It is a structured assessment of what the medical record supports and what it does not — expressed in terms that a reserve committee can act on. Injury causation strength: is the claimed mechanism supported by the documented record? Treatment necessity: which treatments meet the medical necessity threshold and which are exposed to challenge? Future medical exposure: what further treatment does the record support, and what range is clinically defensible?
Why the documentation standard matters
If the claim becomes a bad faith lawsuit, the plaintiff's attorney will subpoena the reserve file. A reserve supported by a physician-authored medical exposure assessment with documented clinical reasoning is significantly more defensible than a reserve supported only by adjuster notes and comparable case data. The documented standard is the defense.
Who commissions this
TPA claims directors, carrier medical directors, and VP-level claims operations executives — anyone responsible for reserve adequacy on high-exposure claims. The entry point is typically a single high-value claim where the reserve decision needs documented physician support. The recurring relationship develops from there.