INEM · FOR INSURERS AND TPA
Medical opinions for insurers
Independent medical support for claims teams: life, health, accident and personal injury lines. Medical assessment for insurers based on records — with an agreed scope, report language and fee confirmed before commissioning.
HOW A REPORT IS PREPARED
From a question
to a reasoned report.
Keep scrolling — we show how an independent medical report is prepared.
Scope of the assignment
First we define the questions, the purpose of the report and the specialty required. The enquiry form contains no medical records.
Scope and fee are confirmed before commissioning.- 01
Assignment
We agree the questions, the purpose and the specialty.
- 02
Completeness of records
We check whether the records can answer the questions and identify gaps.
- 03
Specialist analysis
A physician of the appropriate specialty assesses the case material.
- 04
Quality check
We verify completeness, reasoning and consistency with the agreed scope.
- 05
Finished report
A signed report with reasoning and stated limitations.
One medical question. One reliable answer.
We support claims departments, underwriting and TPA teams in cases where the decision depends on a medical assessment. The report is based on records; if the file cannot answer the questions, we identify missing material or the need for an examination.
Personal injury claims
Assessment of the consequences of the event, causation and medical necessity of treatment — within the questions agreed for the case category.
Life insurance
Serious illness, work incapacity and accident consequences — records assessment according to the criteria supplied with the assignment.
Underwriting and risk assessment
Specialist interpretation of medical records before risk acceptance — supporting the terms decision, not a claims decision.
TPA and framework cooperation
Repeatable case categories, a uniform report structure and a single point of contact. Framework terms are described on the institutions page.
Example cases: question, scope, result
Personal injury after an accident
What are the documented consequences of the injury and their link to the event?
DOCUMENTS NEEDED
- Injury records
- Imaging results
- Policy terms and conditions
SCOPE OF ANALYSIS
Treatment chronology, description of consequences, prior conditions and the impairment criteria supplied with the assignment.
WHAT YOU RECEIVE
A signed report with references to the source records and stated limitations.
Questions about the scope of treatment
Were the services provided and their costs medically justified?
DOCUMENTS NEEDED
- Treatment history
- Schedule of services and costs
- Questions for the specialist
SCOPE OF ANALYSIS
Review of the indications, the services performed and the case material — without a predetermined outcome.
WHAT YOU RECEIVE
Conclusions confirming the necessity or identifying questions requiring clarification.
Synthetic examples — they do not depict real patients. The scope depends on the individual case.
What you receive
- A signed report answering the agreed questions
- A list of the records actually reviewed
- Reasoning for the conclusions and the report's limitations
- Identification of gaps in the records or the need for an examination
How cooperation works
- 1
Enquiry
You describe the type of cases and the expected scope — no medical records in the form.
- 2
Scope and fee
We agree the questions, specialties, report language, fee and timing — before commissioning.
- 3
Analysis and quality check
A specialist physician reviews the records; the report undergoes a completeness and reasoning check.
- 4
Finished report
You receive a signed report with reasoning, the list of records and stated limitations.
Related pages
Frequently asked questions
Does an INEM report replace the insurer's decision?
No. The report is purely medical — the insurer decides on benefits and policy terms.
Do you handle recurring case volumes?
Yes — question categories, report structure and framework terms are agreed individually. Details on the institutions page.
The report provides medical support for the process. The decision on benefits or insurance terms rests with the insurer.
Let us discuss your cases
The enquiry form requires no records or medical details. Scope, report language and fee are confirmed before commissioning.