What occurs during a claim's "peer review" process?

During a claim's "peer review" process, medical records are evaluated by independent experts. This assessment is crucial to provide an unbiased opinion regarding the medical necessity and appropriateness of the treatment the injured worker is receiving or has received. The independent reviewers, often comprised of specialists in relevant medical fields, analyze the medical documentation to determine whether the treatment aligns with established medical standards and guidelines.

This evaluation helps in making informed decisions regarding the claim, ensuring that the worker's treatment is both necessary and effective in relation to their injury. The peer review process serves to uphold the integrity of the workers' compensation system by preventing unnecessary or inappropriate medical treatments and associated costs. It establishes a more objective viewpoint, contributing to better outcomes for both the claimant and the employers involved.