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CONTESTABLE CLAIM RECORD REVIEW

What the application said, what the record shows, and what the manual would have done.

Contestable claim record review reconstructs a life claim as a counterfactual: run the true medical record back through the underwriting manual in force at issue and see what class it would have produced. Three hundred to fifteen hundred pages, read for the one undisclosed encounter, every line page-cited.

Click any row → the source page it cites
Application vs. record · Case #IME-4812 reconciled
Adams, Timothy · contestable claim file
342 pp / 2 packets received logged
11 duplicate pages removed free
p.140 — wrong patient quarantined
Pages 342 Documents 27 Cited 100%

The manual is the test. The court keeps the score.

We do not build for a case type until we can name the standard that defines a correct output and the person who grades the file against it. In contestable life claims both are unusually well specified, and the specification is written down.

That is what makes the work reviewable. The counterfactual has one right method, the record either contains the encounter or it does not, and the citation either resolves to a page or it fails.

The rulebook and the referee
The rulebook
  • The incontestability clause — a statutory two-year contestable period in every state, running from policy issue
  • State materiality standards, which differ: some jurisdictions, Missouri and Kansas among them, require intent to deceive
  • The carrier's own underwriting manual at time of issue. The test is literally this: run the true record through the manual in force and see what class it would have produced
  • Together these make the correct output well specified: a dated, sourced comparison of application answers against the record, scoped to the contestable window
The referee
  • The courts. Rescission is challenged whenever it is economically worthwhile, and judges issue written opinions on materiality
  • The ACLI publishes the scoreboard: in 2024, $269M in new claims and $528M in other claims were in dispute
  • $183M was paid on new disputed claims that year
  • Inside the carrier, the claims analyst, the medical director, and coverage counsel each grade the file before it moves
Roughly $450 per investigation in retrieval and analyst time, before outside coverage counsel Flat 10¢/page here, duplicates free
File profile · Case #IME-4812 cited 100%
Typical volume300–1,500 pp · about 900 at the midpointrange
This packet342 pp / 2 packets · 11 deduplicatedlogged
Source productionsAPS, pharmacy history, claim filemerged
LegibilityFaxed scans, handwritten intake sheetsdegraded
Co-mingled pagesp.140 belongs to another patientquarantined
Every page read · cited 100% · no materiality calls
What the file actually looks like

Nine hundred pages, and one of them decides it.

A contestable file arrives as several productions at once: the attending physician statements, the pharmacy history, the hospital chart, and whatever the beneficiary's counsel has sent across. Three hundred pages at the low end, fifteen hundred at the high end, around nine hundred in the middle.

They are hard to read for ordinary reasons. Faxed and re-faxed scans, handwritten intake sheets, the same discharge summary appearing in three productions, and pages from a different patient co-mingled into the middle of a packet. The decisive item is usually one visit note or one prescription line, sitting somewhere in the lookback window.

~48,000
Contestable death claims a year. An estimate: roughly 19 million policies sit inside the two-year window, at select mortality near 0.25%.
12–17k
Of those, the number that draw a full investigation each year, at roughly $450 apiece in retrieval and analyst time.
What we'd build with you

One real file first, then the build.

Contestable review is a co-build, not a shrink-wrapped product. Your lookback questions, your application form, and your manual's classes are yours; the reading, sorting, and citing is ours. We start by proving the read on a file you already know the answer to.

Throughout, the boundary holds. We surface and cite what is in the record. Your analyst, your medical director, and your counsel decide what it means, whether it was material, and whether the claim is contested or paid.

01

Send one real file

A closed contestable claim, as you already have it, in whatever format the productions arrived in. In the demo case that is 342 pages across 2 packets, with a wrong-patient page quarantined before the read starts.

02

We return the read, page-cited

Every encounter, diagnosis, prescription, and referral inside the lookback window, lined up against the application's answers, with the negative findings called out rather than left as silence. You check it against what you already concluded.

03

We scope the build

Your application form, your lookback questions, and your manual's class definitions become the output template. If the case type is not buildable to your standard, we say so instead of shipping something that reads well and grades badly.

04

You run it

Your team works the queue. Every access is logged, every line resolves to a source page, and the materiality and rescission decisions stay exactly where they were before: with your people.

Why Medrecords AI

The rules the platform never breaks.

Medrecords AI EVERY LINE CITED
CASE #IME-4812 · ADAMS, T.342 pp
2/14 — ER visit, right knee p.4
4/18 — arthroscopic surgery p.61
p.140 — wrong patient quarantined
Medrecords AI
Read every page · cite every line

HIPAA, under a signed BAA

Every file is handled under our Business Associate Agreement, from the first byte.

Never trains a model

Your records are never used to train any AI model — ours or anyone else's.

Every line cited

If we can't cite it, we don't say it. Every sentence links to its source page.

Deleted after delivery

Files are deleted 30 days after delivery, with a full audit log of every access.

Powered by the platform

Four capabilities behind every contestable read.

The contestable claim review is one deliverable of the same platform that reads, sorts, and cites the whole record.

Medical Chronology

The treatment timeline builds itself and lines up against the issue date and the date of death, so the contestable window is visible at a glance.

IN ACTION · 342 pp / 2 packets → one dated timeline

Negative Findings Detection

A documented absence is evidence too. Explicit negatives are surfaced and cited instead of being left as a silent gap in the file.

IN ACTION · absence documented → absence cited

Patient History Extraction

Prior conditions, prescriptions, referrals, and social history pulled out of the productions and lined up against the application's answers.

IN ACTION · history extracted → application compared

Missing Records Identification

Referrals with no follow-up note, date ranges with no chart, providers named but never produced. The gaps are listed so you can go get them.

IN ACTION · 27 documents → the gaps between them named
FAQ

Contestable claim record review, answered.

When an insured dies inside the policy's contestable period, the carrier may examine whether the application matched the medical record. A contestable claim record review organizes that comparison: what the application disclosed, what the treatment history shows, and where the two diverge, each point cited to the page it came from. Whether to contest, rescind, or pay the claim stays a carrier decision, made by its claims, medical, and legal teams.

No. Materiality is a legal question and the standard varies by state; some jurisdictions, Missouri and Kansas among them, require intent to deceive. We surface and cite the undisclosed encounters, diagnoses, and prescriptions in the record so your analyst, medical director, and coverage counsel can apply the standard themselves. We do not grade materiality, score the claim, or recommend an outcome.

Encounters, diagnoses, prescriptions, referrals, and test results that fall inside the application's lookback window, plus the negative findings that confirm an absence rather than leave a silent gap. On a file of three hundred to fifteen hundred pages the decisive item is often a single visit note or one pharmacy line, so every page is read and every finding is cited to its source.

Every state sets a statutory two-year contestable period running from issue, after which the policy generally cannot be contested for misrepresentation. That window decides which dates matter, so the chronology is built against the issue date and the date of death and everything falling inside it is flagged and page-cited. Applying the clause to the claim is your counsel's call, not ours.

No. Medrecords AI does not retrieve records from providers or facilities. You bring the attending physician statements, pharmacy histories, and claim-file productions you already have, and review starts in minutes from upload. Retrieval vendors take days; you can keep yours and still cut the read to minutes.

Send one closed contestable file.

No obligation. If the case type is buildable we'll scope it; if it isn't, we'll say so.