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Medical Review

Medical Review Officer

In personal injury, workers’ compensation and medical malpractice cases, the need for an impartial opinion is crucial to both the injured party and the insurer. This is where medical reviewers are needed to provide their unbiased opinions regarding the medical care that is being given or has been given to the patient.

Benefits of an Unbiased Opinion

An unbiased opinion can benefit not only the insurer but also the injured party. A second set of eyes can make sure that appropriate care is being provided to the patient to avoid prolonging an injury that could, in turn, result in increased costs to both the insurer and their client in the form of higher premiums. But most importantly, a medical review helps weed out fraudulent claims and eliminates over-utilization. An independent medical reviewer’s unbiased opinion assists in determining what a fair claims settlement should be for all parties involved on both sides of a personal injury, workers’ compensation or medical malpractice case.

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Medical Review

Medical legal cases often require medical review and unbiased opinions from a doctor who is not associated with an insurer, injured party or negligent party. A second opinion can weed out fraudulent claims, spot treatment errors and helps ensures that an injured party receives the care that they need to recover from his or her injury as quickly as possible.

Prevents Cutting Corners in Patient Care

Insurance companies are not in the business to lose money. Their goal is to make money for their shareholders. When managing the care of claimants in workers’ compensation or other personal injury cases, there always exists the possibility that corners could be cut in patient care. Insurance doctors may avoid recommending expensive diagnostic tests or treatments that patients need. This could be to keep expenses down for the insurer or ensure that they will continue to receive referrals from the insurer.

This practice hurts not only the injured party, but also the employer or negligent party. Improper or unneeded treatment can prolong the time out of work and extend the length of time that the injured party is under medical care. With workers’ compensation cases, the employer is also entitled to request an independent medical examination (IME) if he or she has concerns regarding extensive medical treatment, including surgery or other long-term treatment.

When a Second Opinion is Needed

A medical review and unbiased opinion from a second physician is advisable and/or required in legal cases that involve claims for:

  • Workers’ compensation
  • Insurance claims for accidental injuries (e.g. motor vehicle, slip and fall, falling objects)
  • Medical malpractice
  • Medical negligence
  • Wrongful death

Article by AllRevedUp Internet Solutions powered by WSI.

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