The Challenge
A major U.S. automotive insurance company was faced with a potential class action involving claims of underpayment for billed amounts. The plaintiffs alleged that the underpayment affected a large number of providers who were owed reimbursement under the terms of the contract and state law. A Data Insights and Forensics team member was engaged to serve as the expert for analyzing billing and payment data along with assessing the functionality of the defendant’s system and billing processes.
Kroll's Solution
The expert analyzed hundreds of thousands of records related to payments and billing to assess the veracity of the claims and perform tests of commonality and typicality. The analysis consisted of numerous regression-based analyses to identify whether the relevant proposed class members’ records shared those attributes. In addition, the system and business processes were assessed in conjunction with the data analysis results. Data from hundreds of pro forma reports was extracted from the PDF format into a unified database environment for analysis..
The Impact
Kroll’s expert submitted a rebuttal report that identified the challenges related to performing a substantive analysis of claims without performing additional manual claim file review.
