A demand package is built to maximize a settlement. Reviewing it well is how insurers, TPAs, and self-insureds make sure the number reflects the medicine — not just the narrative.
When a bodily injury claim reaches the demand stage, the claimant's representative assembles a package: medical bills, treatment records, and a narrative arguing for a settlement amount. The package is persuasive by design. The job of a defense-side review is to test it against two independent standards — what was charged, and what was justified.
1. Start with the bills: was the charge correct?
The first pass is a certified medical bill audit. Every line is checked against jurisdiction-specific fee schedules and standard coding rules, looking for:
- Improper coding — upcoding or miscoded procedures that inflate the total.
- Unbundling — charging separately for services that should be billed together.
- Excessive or duplicate charges — amounts above the allowable schedule or billed more than once.
This step alone often removes a meaningful share of the demand. But it only answers whether the price was right — not whether the treatment belonged to the claim.
2. Add the clinical lens: was the treatment justified?
The second, decisive pass is a nurse clinical review. A certified nurse reads the records the way a court would and answers three questions:
- Causality & relatedness: Does this treatment actually stem from the claimed injury, or from a pre-existing or unrelated condition?
- Medical necessity: Was the care appropriate and supported by the clinical picture?
- Chronology: Does the treatment timeline line up with the mechanism and date of injury?
This is where the largest, most defensible adjustments usually come from. Unrelated treatment, once isolated and documented, is difficult to argue back into the demand.
3. Build a defensible position — not just a lower number
A lower counter-offer that can't be defended invites litigation. The goal of a strong review is a settlement position backed by evidence: cited clinical findings, a clear treatment calendar, and an audit trail showing how every adjustment was reached. That is what lets an adjuster hold the number under pressure.
4. Make it consistent
The risk in manual, ad-hoc review is inconsistency — strong on one file, thin on the next. Applying the same certified two-tier standard to every demand package is what turns occasional savings into a measurable program outcome, claim after claim.
The short version
Review the bills against the fee schedule. Review the treatment against the clinical evidence. Document both to a court-ready standard. Do it the same way every time. That's the framework DemandPro runs on every claim — consistent, certified, court-ready.