Bundled Investigations: Smarter Claims Strategy

When managing a complex claim, the pressure is real: rising medical bills, ambiguous treatment narratives, and the hunt for evidence that holds up under scrutiny. For adjusters, the question is always: How do I get clarity quickly while minimizing exposure?

One increasingly effective strategy is the bundled investigative approach. It combines Independent Medical Exams (IMEs), Utilization Review (UR), Bill Review, and Surveillance into a single, coordinated workflow.

Why Bundling Works

In many cases, each of these services is ordered separately and handled by different vendors or departments. That fragmentation can lead to delays, miscommunication, and even conflicting results.

By coordinating these services within one investigation strategy, adjusters gain:

• Stronger evidence alignment: Medical findings can be directly cross-referenced with surveillance or billing data.
• Faster turnaround times: Fewer handoffs and better scheduling coordination shorten the claim lifecycle.
• Reduced costs: Duplicate or excessive treatment charges are identified earlier, minimizing medical leakage.
• Improved claim defensibility: When documentation supports every decision, settlements are cleaner and less likely to be disputed.

Still, the real impact shows up in the numbers. Research consistently finds that fragmentation leads to measurable leakage. In bill review alone, insurers saw 8–18% of bills with invalid authorizations when the process wasn’t integrated with UR to confirm medical necessity (DataCare). This is a clear source of avoidable spend.

When IMEs, utilization review, bill review, and surveillance are coordinated as part of a unified investigative plan, adjusters gain a full, defensible picture of the claim rather than just fragments of it. One integrated bill-review model, for instance, reported average savings of 14.2% per claim compared to separate reviews (Sedgwick).

Case Study

Consider a claim involving a relatively minor motor vehicle accident. The claimant, a 34-year-old male, reported ongoing pain and received years of chiropractic and pain management treatment totaling more than $150,000 in billed charges.

When the adjuster coordinated a multi-pronged review, combining an IME, UR, bill review, and surveillance, the story changed dramatically:

• The IME found no objective injury or neurological impairment.
• The UR determined that much of the treatment was unreasonable under ODG guidelines.
• The bill review flagged more than $140,000 in inflated or unsupported charges.
• The surveillance captured the claimant performing physically demanding tasks, contradicting his reported limitations.

By aligning the timing and communication across all services, the adjuster quickly built a comprehensive, defensible case that led to an early settlement and substantial cost savings.

The data and real-world results point to the same conclusion: coordination drives clarity.
When investigative services work together, rather than in silos, adjusters uncover inconsistencies faster, contain costs earlier, and make defensible decisions backed by clear, corroborated evidence.

Bundled investigations are efficient and effective. For adjusters under pressure to close files quickly and defensibly, that integration can make all the difference.

Ready to reduce claim costs and streamline investigations? Partner with Ethos for a smarter, integrated approach. 

Check out our sources:

DataCare. Integrating Bill Review and Utilization Review for Better Outcomes. DataCare, 2023, www.datacare.com. 

Ethos Risk Services. Case Study: Bundled Services. Better Outcomes. Ethos Risk Services, Oct. 2025.

Sedgwick. Bill Review Case Study: Integrated Medical Management Reduces Costs and Improves Efficiency. Sedgwick, 2024, www.sedgwick.com/case-study-bill-review.