The case audit reads every document on file — QME reports, PTP notes, UR decisions, defense correspondence — and cross-references what it finds against the Application for Adjudication.
What it catches
- Body part mismatches — the QME is treating the right shoulder but it is not in the Application. That is $30K-$50K in PD value at risk.
- Expired deadlines — a UR denial from 35 days ago with no IMR appeal filed
- Unpaid TD — client off work per the PTP but no TD payments in the ledger. LC 4650(d) self-increase + LC 5814 penalty exposure.
- Defense mistakes — late UR (voidable per Dubon), wrong MTUS guideline, defense advocacy before QME
One firm found $47,000 in missed penalties and a $50,000 settlement gap in its first week of audits.