Claim Analysis Group, LLC

Terms of Service

Effective Date: November 29, 2025
Last Updated: July 11, 2026

Welcome to Claim Analysis Group, LLC ("Claim Analysis Group," "CAG," "we," "our," or "us"). These Terms of Service ("Terms") govern your access to our website and your use of our investigative analysis and consulting services (the "Services").

By accessing our website, requesting Services, submitting claim materials, or otherwise engaging Claim Analysis Group, you ("Client," "you," or "your") acknowledge that you have read, understood, and agree to be bound by these Terms.

If you are accepting these Terms on behalf of an insurance carrier, third-party administrator (TPA), managing general agent (MGA), self-insured organization, law firm, or other legal entity, you represent that you have the authority to bind that entity to these Terms.

1. Scope of Services

Claim Analysis Group provides independent, human-led investigative claim analysis designed to assist insurance organizations in evaluating complex or questionable claim files.

Our services may include, but are not limited to:

Fraud Indicator Reviews
Travel Claim Reviews
Verification Insight Reviews
Claim Defensibility Reviews
Metadata analysis
Open-source intelligence (OSINT) research
Structured documentation review
Independent investigative consulting

All services are advisory in nature and are intended to supplement, not replace, the Client's existing claims handling process.

2. Operational Boundaries

To avoid misunderstanding regarding our role, Claim Analysis Group operates under the following service limitations.

No Claims Adjusting

Claim Analysis Group is not a claims adjusting company.

We do not:

adjust insurance claims;
determine coverage;
authorize or deny benefits;
negotiate settlements;
establish claim reserves;
communicate claim decisions to insureds or claimants; or
exercise authority on behalf of an insurance carrier.

All claim decisions remain solely the responsibility of the Client.

No Legal Services

Claim Analysis Group is not a law firm. Nothing contained within our reports, communications, or recommendations constitutes legal advice, legal representation, or creates an attorney-client relationship. Clients should consult qualified legal counsel regarding claim denials, litigation strategy, regulatory matters, or legal interpretations.

No Direct System Access

Our operational model is intentionally external.

Unless specifically agreed otherwise in writing, Claim Analysis Group does not request or require direct access to:

claims management systems;
policy administration systems;
underwriting platforms;
internal databases; or
carrier networks.

Services are performed using documentation voluntarily provided by the Client through secure transmission methods.

Investigative Scope

Unless specifically agreed in writing, our Services do not include:

surveillance;
claimant interviews;
witness interviews;
provider interviews;
examinations under oath;
independent medical examinations;
field investigations;
claim adjusting activities;
legal representation; or
any activity requiring professional licensure outside our stated scope of services.

Our investigative work relies upon:

Client-provided documentation;
lawful open-source intelligence;
publicly available records;
metadata analysis;
structured analytical review; and
independent investigative reasoning.

3. Client Responsibilities

The Client agrees to:

provide complete and accurate claim documentation;
provide materials in a readable format;
ensure submitted information may legally be shared with Claim Analysis Group;
comply with all applicable privacy, confidentiality, and regulatory requirements;
remove information the Client is not authorized to disclose;
notify us of material updates affecting an active review whenever reasonably possible.

The accuracy and completeness of our work necessarily depend upon the information available during the review.

4. Confidentiality and Data Security

Both parties agree to maintain the confidentiality of all non-public information exchanged during the engagement. Claim Analysis Group maintains reasonable administrative, technical, and operational safeguards designed to protect confidential claim information while it remains within our possession.

Access to submitted materials is limited to individuals with a legitimate business need associated with the engagement.

Limited Retention

Our operating model utilizes limited document retention. Unless otherwise required by law, contract, litigation hold, or written agreement, submitted case materials are securely removed from our active systems following completion of the engagement within our normal operational retention period.

Clients remain responsible for maintaining their own permanent claim files.

5. Electronic Communications

The Client acknowledges that communications and document transmission may occur electronically through email, encrypted upload portals, or other mutually approved methods.

While Claim Analysis Group employs commercially reasonable safeguards to protect transmitted information, no method of electronic communication or storage can be guaranteed to be completely secure.

6. Fees and Payment

Services are billed according to:

published flat-rate pricing;
an executed Master Services Agreement;
an approved Statement of Work;
written proposal; or
another mutually agreed pricing arrangement.

Invoices are generally issued upon completion of the engagement unless otherwise agreed.

Payment is due within thirty (30) calendar days of the invoice date unless different payment terms are established in writing.

Claim Analysis Group reserves the right to suspend future work on accounts with materially overdue balances. The Client is responsible for all applicable taxes unless a valid exemption certificate is provided.

7. Intellectual Property

Claim Analysis Group retains exclusive ownership of all proprietary:

methodologies;
investigative techniques;
analytical frameworks;
templates;
software tools;
website content;
branding;
graphics;
training materials; and
internal processes.

Upon payment in full, the Client receives ownership of the final customized analysis report prepared specifically for that engagement.

Ownership of the report does not transfer ownership of Claim Analysis Group's proprietary methodologies, intellectual property, analytical processes, or investigative techniques.

The Client may use delivered reports internally for legitimate claims handling, litigation support, regulatory compliance, or related business purposes.

8. Reliance on Reports

Our reports are prepared solely for the Client that retained Claim Analysis Group.

No third party may rely upon, reproduce, distribute, or use our reports without our prior written consent unless required by law or legal process.

9. Professional Judgment

Our reports represent objective analytical opinions based upon the information available at the time of review.

Additional documentation, testimony, investigative findings, litigation discovery, or subsequently obtained evidence may materially affect our conclusions.

Claim Analysis Group does not guarantee:

detection of every fraud indicator;
confirmation of fraud;
claim denial;
litigation success;
regulatory outcomes; or
recovery of losses.

Our Services assist informed decision-making but do not replace the Client's independent judgment.

10. Disclaimer of Warranties

The Services are provided on an "as-is" and "as-available" basis.

To the fullest extent permitted by applicable law, Claim Analysis Group disclaims all warranties, whether express or implied, including any implied warranties of merchantability, fitness for a particular purpose, accuracy, completeness, non-infringement, or uninterrupted availability.

11. Limitation of Liability

To the fullest extent permitted by law, Claim Analysis Group shall not be liable for any indirect, incidental, consequential, special, exemplary, or punitive damages, including but not limited to:

lost profits;
lost business opportunities;
regulatory penalties;
bad faith claims;
reputational harm;
business interruption; or
attorney's fees arising from the Client's independent claims decisions.

Our maximum aggregate liability arising from any engagement shall not exceed the total fees paid to Claim Analysis Group for the specific engagement giving rise to the claim.

12. Indemnification

The Client agrees to defend, indemnify, and hold harmless Claim Analysis Group, its officers, members, employees, contractors, and affiliates from claims, liabilities, damages, or expenses arising from:

inaccurate information supplied by the Client;
unauthorized disclosure of information;
the Client's independent claims decisions;
misuse of our reports; or
violations of applicable law by the Client.

This provision does not apply to losses resulting solely from Claim Analysis Group's gross negligence, willful misconduct, or where prohibited by applicable law.

13. Force Majeure

Claim Analysis Group shall not be liable for delays or inability to perform resulting from circumstances beyond our reasonable control, including natural disasters, acts of government, cyber incidents, internet outages, utility failures, labor disputes, civil unrest, epidemics, pandemics, or other force majeure events.

Performance shall resume as soon as reasonably practicable.

14. Termination

Either party may terminate an engagement at any time upon written notice.

Termination does not relieve the Client of responsibility for payment of Services already performed.

Upon termination, Claim Analysis Group will securely dispose of Client materials in accordance with its retention policy unless otherwise required by law or written agreement.

Sections relating to confidentiality, payment obligations, intellectual property, limitation of liability, indemnification, dispute resolution, and governing law shall survive termination.

15. Governing Law and Venue

These Terms shall be governed by and construed in accordance with the laws of the State of Texas, without regard to conflict of law principles.

Any legal action arising from these Terms shall be brought exclusively in the state or federal courts located within the State of Texas, and each party consents to the jurisdiction of those courts.

16. Changes to These Terms

Claim Analysis Group may revise these Terms from time to time.

Updated versions will be posted on our website with a revised "Last Updated" date.

Continued use of our Services after revised Terms become effective constitutes acceptance of the updated Terms.

17. Entire Agreement

These Terms, together with any executed Master Services Agreement, Statement of Work, proposal, confidentiality agreement, or other written agreement between the parties, constitute the entire agreement concerning the Services.

If a conflict exists between these Terms and a separately executed written agreement, the separately executed agreement shall control.