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What Is a Peer Review in Workers’ Compensation?

The Law Office of Robert E. Wood  Nov. 10, 2023

If you're a worker who has recently suffered an injury, chances are you've heard of peer reviews in workers' compensation. But what exactly do they entail? What is the purpose of a peer review and why should injured workers take advantage of them? 

At The Law Office of Robert E. Wood, we're here to help you navigate the ins and outs of workers’ compensation. The peer review process can play an instrumental role in ensuring that, as an injured employee, you receive appropriate care and treatment.  

Looking for legal assistance? If you're in the San Francisco Bay Area, contact our firm in Oakdale, California, to schedule a free consultation with our workers' comp attorney. We're ready to help you understand your legal options and secure the benefits you deserve.  

What Is a Workers' Compensation Peer Review?

A workers' compensation peer review is a comprehensive evaluation carried out by medical professionals. Its objective? To determine whether the right care is being provided or recommended to an injured employee.  

This process requires an unbiased, expert medical opinion that aids all stakeholders in a workers' compensation claim to make informed decisions. The peer review process scrutinizes the services rendered based on current jurisdictional requirements and evidence-based medical guidelines. It's a thorough check ensuring that the treatment being given is in line with the most up-to-date and effective medical practices. 

Benefits of a Peer Review

There are significant benefits tied to a peer review in a workers' compensation case. The following covers a few highlights: 

  • Workers' comp peer reviews are designed to ensure that injured employees receive appropriate treatment. This is crucial as it directly impacts the recovery time. With the right treatment plan, injured employees can recover faster and return to work as soon as possible. It's not just about getting back to work, but returning with the confidence that you've had the best care possible. 

  • A peer review provides an objective, medical opinion from an expert. This impartial evaluation is typically indisputable and serves as a key piece of evidence in a worker's compensation claim. It helps all stakeholders, including your legal representatives, make informed decisions about your case. It's basically like having a top-notch medical consultant on your team. 

  • Lastly, let's talk costs. Medical treatments can be expensive, and unfortunately, not all are effective. A peer review helps identify ineffective or unnecessary treatments, which in turn reduces the overall costs of claims. This process helps to keep things fair, ensuring the focus remains on the most effective treatments for your recovery. 

In essence, a peer review acts as a safeguard in the workers' compensation system. It can be an essential tool in connecting you with the right care, by facilitating informed decision-making and helping manage costs. As your dedicated legal team, we'll do everything we can to make sure this process works to your advantage, advocating for your rights every step of the way. 

The Workers' Comp Peer Review Process

Now that we have a grasp of the importance of a workers' compensation peer review, let's explore the process itself. Understanding how this evaluation unfolds can help you know what to expect, how to prepare, and how the results can shape your workers' compensation claim. The workers' comp peer review process typically follows these steps: 

  1. Initiation of the Peer Review: When a workers' compensation claim is filed, it may be subject to a peer review. This is typically initiated by the insurer or the employer.  

  1. Selection of the Peer Reviewer: A qualified medical professional who understands evidence-based guidelines and matches the specialty of the treating physician is selected to conduct the peer review.  

  1. Review of the Treatment Plan: The peer reviewer then thoroughly examines the proposed treatment plan. They assess the patient's condition, the diagnosis, and the suggested treatments. The reviewer will strongly consider treatment standards during this process. 

  1. Discussion of Irregularities: If the peer reviewer identifies any deviations from standard protocols in the treatment plan, they may engage in a discussion with the treating physician. This dialogue allows for clarification and reassessment of the proposed treatments. 

  1. Completion of the Peer Review Report: After the review is complete, the peer reviewer compiles their findings into a detailed report. This report includes an objective, impartial evaluation of the treatment plan and its appropriateness for the injured worker. 

  1. Delivery of the Peer Review Decision: The peer review report is then delivered to all relevant parties. This includes the injured worker, the employer, the insurer, and the treating physician. Timely delivery of this decision can lead to a quicker recovery for the worker and faster closure of the claim. 

  1. Appeal or Acceptance: Depending on the findings of the peer review, the treatment plan may be accepted as is, modified, or denied. If the plan is denied or altered, there are avenues for appeal, which we at The Law Office of Robert E. Wood can help you navigate. 

How an Attorney Can Help

Suffering an injury while on the job can be a physically and emotionally challenging experience. In addition to dealing with the pain and recovery process, workers often face the daunting task of navigating through complex legal procedures to receive the compensation they deserve.  

The workers' compensation system can get especially complicated when it comes to the peer review process. That's why it's in your best interest to work with an attorney. As an experienced workers' compensation lawyer, our attorney offers invaluable assistance in understanding and advocating for your rights. We have extensive knowledge of California workers' comp laws and can guide you through the entire process.  

Learn About Your Rights and Options

Understanding the concept of a workers' compensation peer review, its benefits, and the role of an attorney can make navigating the complexities of the system more manageable. Remember, protecting your rights as an injured worker is our top priority here at The Law Office of Robert E. Wood

Our attorney handles a wide range of workers' compensation cases, including back injuries, repetitive stress injuries, head injuries, and more. We understand the unique challenges associated with each type of injury and are well-equipped to provide guidance tailored to your specific needs. 

Contact our office in Oakland, California, today to get started with a free case consultation. We serve residents throughout the San Francisco Bay Area, and we're ready to help you find your best path forward.