Physician Peer Review
Physician Peer Review
Physician peer reviews provide an expert examination of clinical records to address questions and issues found within a claim file and provide the claims professional with the information needed to bring the claim to a conclusion.
During a peer review, our board-certified physicians utilize the standards of evidence-based medicine in completing their assessments, to include the parameters noted within the Official Disability Guidelines, the MDGuidelines, and the latest clinical citations to answer specific questions related to:
- Compensability
- Extent of injury
- Claimant treatment plans
- Expected duration of disability
- Utilization of care
Proffesional, Affordable, Efficient
C3 maintains compliance with your statute’s parameters to ensure the injured worker receives all appropriate care as quickly and efficiently as possible.
Peer reviews ensure that all pertinent clinical information and medical records are reviewed and considered to address the specific clinical questions presented, in support of the insurance carrier’s determination regarding medical necessity, compensability, extent of injury, and/or entitlement to benefits under the statute.
Workflow for New York Claims
Send files
Submit records and your questions through intake. Include claim number, date of injury, jurisdiction, and any dates we should plan around.
Record preparation
We confirm receipt, flag missing documentation, and organize diagnostics so the review starts clean.
Physician review
A board-certified physician conducts an evidence-based review matched to your intent.
Deliverable
You receive clear conclusions with citations, consistent formatting, and recommendations for next steps. If more records are needed, you get simple, actionable requests to keep timelines predictable.
Medical Opinions Supported with Science
Our physician reports, crafted to the latest evidence-based medicine standards, offer objective and independently verifiable medical evidence. This enables you to deliver the best possible care for compensable injuries sustained by injured employees. Our Peer Review services provide adjusters with detailed physician reports, complete with clinical citations, to help define compensable injuries and limit treatment to related sequela.
Streamline Claims Management with Objective Medical Evidence
Our physician reports, crafted to the latest evidence-based medicine standards, offer objective and independently verifiable medical evidence. Our Peer Review services provide adjusters with detailed reports, complete with clinical citations, to:
- Define compensable injuries
- Limit treatment to related sequela
- Inform parties of accepted injuries and disputed diagnoses
- Gain guidance on extent of injury and expected length of disability
- Make informed decisions on ability to return to work issues
- Limit exposure for lifetime medical benefits
Workflow for New York Claims
Send files
Submit records and your questions through intake. Include claim number, date of injury, jurisdiction, and any dates we should plan around.
Record preparation
We confirm receipt, flag missing documentation, and organize diagnostics so the review starts clean.
Physician review
A board-certified physician conducts an evidence-based review matched to your intent.
Deliverable
You receive clear conclusions with citations, consistent formatting, and recommendations for next steps. If more records are needed, you get simple, actionable requests to keep timelines predictable.
Meet Evidence-Based Medicine Standards and Improve Claim Outcomes
Our reports meet the evidence-based medicine standards adopted by the Texas Department of Insurance and the Division of Workers Compensation and are suitable for inclusion in medical records and Claim File Analysis to be reviewed by Designated Doctors. These reports also serve as a means of adding clinical citations founded on evidence-based medicine into the record for a Contested Case Hearing (CCH) in support of the Carrier’s position.