What is a Workers Compensation Peer Review?

What is a Workers Compensation Peer Review?

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If you are hurt on the job, and your case is accepted by your self-insured employer, or your employer’s workers’ compensation carrier, your company has to pay your medicals bills, time out of work, and possibly compensation for a permanent injury.  Your company or their workers’ compensation insurance carrier gets to direct what physicians treat you for your on the job injury.  But, incredibly, the workers’ compensation insurance company, or your employer will often go looking for a medical opinion that contradicts the physician they initially picked to treat you in the first place!

How Peer Reviews Impact Your Workers’ Compensation Case

Called utilization, or peer review, if your workers’ compensation approved physician says you need surgery, or some other medical care that the workers’ compensation insurance company doesn’t want to be responsible for, your medical records get sent by the workers’ compensation insurance company to yet another workers’ compensation hired physician.  This process can also be described as if you don’t get what you pay for – try, try again!

Peer review physicians are doctors who have never examined you, or asked you any questions about your on the job injury, but what they do have is a contract with the workers’ compensation insurance company that pays them by the review.   These physicians are often retired, do not have an active medical practice anymore, and some make their only money from doing these workers’ compensation insurance company medical reviews.  You can probably guess how their medical reports, and recommendations usually go.  It is only human nature that if someone is paying you to do something, you are going to do your best to make sure that they get what they want, so you can keep getting more of the money they are paying you.  It is no different with peer, or utilization reviews.  Generally, the workers’ compensation insurance companies get what they pay for, and that is where you need an attorney that will fight for your rights, and in particular for the necessary medical treatment the original physician that workers’ compensation sent you to, says you need!

Workers’ compensation claims are frustrating enough without jumping through hoops regarding your medical treatment.  You don’t have to do so.  Get someone on your side!  You need someone to look out for you, so call Tippens & Zurosky, so we can be your voice, answer all of your questions, and file your claim!  Tippens & Zurosky has knowledgeable, experienced attorneys certified in North Carolina and South Carolina, who can fight for your rights during this often long and difficult workers’ compensation process.  Call us toll-free at 877-872-3580, or at 704-343-0018, for a free consultation.  Let us help you!