As a professional, you work hard to provide the highest standard of care to your clients. Even so, you may still face insurance investigations, inquiries, or audits.
Standard Professional Liability Insurance policies typically do not cover the costs of an insurance audit, leaving professionals to handle them out of pocket without this protection.
Insurance audits check that billing and claims are submitted correctly. They can be stressful and time-consuming, but audit coverage ensures you have expert guidance throughout the process.
This coverage helps review audit requests, communicate with the insurer, and handle any disputes. It also helps cover the costs of defending your billing practices.
Steph, a professional, receives a notice that her billing practices are being audited after an insurance company flagged several claims. Concerned about potential legal costs and the impact on her business, she seeks assistance.
With Legal Expense for Insurance Audit coverage, her legal fees are covered and she is assigned a specialized lawyer who helps her prepare the necessary documentation and represents her throughout the audit.
The audit concludes without any issues, allowing Steph to continue her practice with confidence, knowing her legal rights were protected and her expenses were covered.
Find answers to common questions and get the information you need quickly.
Please note that answers may vary depending on your program or policy and are provided for general informational purposes only; they do not constitute legal, professional, or insurance advice.
Professionals experience insurance audits when the insurance company wants to ensure that the bills you submitted accurately reflect the services you actually provided.
The audit checks that you didn’t overcharge, bill for services that weren’t delivered, or make errors in coding or documentation. It’s essentially a verification process to make sure that claims payments are correct and compliant with policy rules.
The insurer needs to be notified of any claim as soon as possible after you are made aware of it. Prompt claims reporting is critical to the process of bringing claims to a successful resolution. Members aware of any actual or potential claim must report it immediately.
Please refrain from making any written or oral statements to the claimant unless the insurer or adjuster advises to do so. Please do not offer to compensate a client as such action could interfere legally with the management of a claim.
You can find claim reporting details on your certificate of insurance or policy documents.
