Medical Review (MDR) & Peer Review
Claims-focused medical reviews from our occupational health physicians for organisations without a chief medical officer, alongside a peer review service that helps case managers challenge medico-legal reports.
What it is
A medical review (MDR) gives organisations access to chief medical officer (CMO) expertise without employing one. It is conducted by a Form Health occupational health physician and covers the medical aspects of a claim, so that everything is thoroughly reviewed and accurately assessed before a decision is made.
The physician evaluates medical records, diagnostic tests and treatment plans, and identifies any inconsistencies or anomalies that could affect the legitimacy of a claim. They work closely with claims assessors, providing the medical insight needed to reach informed decisions and fair, justified outcomes for policyholders.
Peer review is a related service for case managers who need to challenge the content of a submitted medico-legal report. Reviews are compiled by experts skilled in interpreting medical evidence, giving a cost-effective way to test a report without instructing additional clinical experts.
Who it is for
The medical review service is for insurers and other organisations handling claims that do not have a chief medical officer, or cannot call on one when they need to. It gives claims assessors direct access to an occupational health physician's judgement on the medical evidence in front of them.
Peer review is for case managers who receive medico-legal reports and want them properly tested. It suits situations where a report looks weak, inconsistent or incomplete, and where instructing another clinical expert would add cost and delay.
What is involved
For a medical review, one of our occupational health physicians examines the medical aspects of the claim, including medical records, diagnostic tests and treatment plans. They flag any inconsistencies or anomalies and share their findings with your claims assessors so decisions rest on sound medical evidence.
For a peer review, an expert in interpreting medical evidence reviews the submitted medico-legal report and prepares three documents: a set of questions for the report author, a suggested letter of concerns for the opposing representatives, and a complete summary of the case for the case manager. The wording can be used verbatim or adapted to fit your approach.
Where a case needs more, we also provide a forensic review of medical records (FRMR) summarising relevant entries, gaps and contradictions, second opinion reports and desktop reviews offering alternative clinical opinions or challenging existing methodologies, and support with medico-legal reports and joint opinions, including shaping instructions and questions and identifying and instructing the right expert for the case.
For a medical or peer review, please send the relevant medical records and reports.
What the referrer receives
From a medical review, you receive a written report: a physician's assessment of the medical evidence behind the claim, with any inconsistencies or anomalies clearly identified. Your assessors get the medical insight they need to evaluate the claim accurately and reach a fair outcome.
From a peer review, you receive the three working documents: questions for the report author, a draft letter of concerns and a full case summary. Used consistently, peer reviews also sharpen case managers' skills in interpreting reports and, over time, drive up the quality of the reports you receive.
Questions referrers ask
What does a peer review include?
Every peer review includes three documents: a set of questions for the report author, a suggested letter of concerns for the opposing representatives, and a complete summary of the case for the case manager. You can use the wording as written or adapt it to suit the case.
Do we need to instruct another clinical expert to challenge a report?
Usually not. Peer reviews are compiled by experts skilled in interpreting medical evidence, which makes them a cost-effective way to challenge a medico-legal report without the expense of involving additional clinical experts.
Who carries out the medical review?
A Form Health occupational health physician. The service is designed for organisations that do not have, or cannot use, a chief medical officer, and provides the same function: a thorough, accurate review of the medical aspects of a claim.
What happens after you refer
Steps
- 1
Refer
- 2
Logged
- 3
Individual contacted
- 4
Assessment
- 5
Report to your inbox
- 1
Refer
- 2
Logged
- 3
Individual contacted
- 4
Assessment
- 5
Report to your inbox
Assessment client? See how vocational rehabilitation completes the claim.
An objective evaluation tells you where things stand. Our rehabilitation and case management take it from there, through to a sustained return to work.
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Whether it is one referral or a programme of work, start with a conversation.