In the insurance and litigation context, peer review involves a physician evaluating medical records to opine on causation, treatment necessity, and appropriateness without a physical examination.
It is distinct from hospital peer review addressing practitioner competence.
Alternative Names:
Medical Peer Review, Records Review
Why it Matters?
Records-only review is substantially cheaper than an examination and is used to screen claims and support treatment denials. Its limitation is the absence of examination, which plaintiff counsel emphasize at trial and which restricts the opinions the reviewer can credibly offer. For causation and treatment necessity questions answerable from documentation it is adequate; for functional capacity and current condition it generally is not.
Frequently Confused with
Related terms
Frequently asked questions
How does peer review differ from an IME?
When is records-only review adequate?
