Our peer review service offers clients a 2 to 1 return on investment.
What is the peer review service?
Our peer review service is a system for bringing clarity to potentially confusing or esoteric medical reports. Authoritative and evidence-based, it enables claims handlers to fully understand the medical aspects of a claim.
Why use peer review?
Medical reports can be inconsistent or incomplete, common inaccuracies generally falling into one or more of these areas:
- events are not recorded as claimed
- symptoms are not recorded in the medical notes
- treatment has not been sought
- inconsistencies and proportionalities are not spotted
- a lack of rigour exists
- the report is incomplete or selective
A comprehensive and systematic review of medical reports by one of our specialist doctors can identify potential issues and provide you with the medical insight required to constructively question them.
When should peer review be used?
Claims handlers are faced with a bewildering array of medical reports and other subsidiary evidence when claims are submitted. Our peer review service can be deployed to assist claims handlers to quality-control these reports; and to validate, adjust or reject claims. Peer reviews are particularly invaluable when any of the below elements figure in a claim:
- unusual or long prognosis
- unusual injury
- unresolved contradictions and disproportions
- insubstantial report
- pre/post-existing conditions or events
- disproportionate incapacity
- lack of documentary evidence
- fraud indicators
How does the service work?
You send us the medical report and subsidiary evidence from the claimant’s representative. In ten days or less from receiving an instruction, one of our specialist doctors will have reviewed the evidence and our peer review team will provide the following information electronically:
- a summary letter to the claims handler which highlights areas for further investigation in the specialist’s report, together with a clear explanation of any weak or unsupported arguments, diagnoses and prognoses
- a list of key questions that the handler can submit to the claimant’s specialist or doctor to either seek further clarification
- a draft letter, where appropriate, to third parties highlighting issues and concerns
What are the benefits?
Our peer reviews provide an improved quality of investigation which better prepares claims handlers for negotiation, allowing them to question medical experts on their own ground.
- ensuring earlier, more reasonable settlement of valid claims, which better reflect the injury;
- reducing associated disbursements (for example through demonstrating where further medical investigations would be unnecessary); and
- the possible repudiation of invalid claims
On average our peer reviews result in a 2 to 1 return on investment.
Why use MDG for peer review?
Our peer review service has been running since 2004 and we currently review around 100 cases each week. Our industry knowledge and specialist experience means we can be trusted to provide you with the negotiating power you want within the timeframe you need. We are the only outsourced full peer review process provider to the claims market.
As part of our peer review service we provide regular, complimentary in-house training to claims managers on how the peer review service works and how to identify appropriate cases for referral.
For further information, please contact our National Account Manager, Suzanne Wilkinson at firstname.lastname@example.org