Getting Claimants Back to Work: Benefits of Outsourcing Workers’ Comp Peer Review

MLS Group of Companies, LLC (MLS) has a wealth of experience in providing workers’ compensation medical reviews. We employ a nationwide network of licensed, Board-certified physicians who review and assess the clinical aspects of workers’ compensation claims. As part of the workers’ comp claims process, we facilitate independent medical examinations and work with insurance carriers, third-party administrators and employers to produce a report that adheres to high standards.

Regulatory and Medical Expertise

MLS is a URAC-accredited, national provider of independent medical reviews, including workers’ compensation (WC) claims. We work with clients across the United States and boast a nationwide network of physician specialists and sub-specialists that objectively perform examinations and help determine an unbiased opinion for WC claims.

Additionally, MLS employs a full-time medical director to ensure all examinations and claims are handled appropriately, and that they are compliant and adhere to local, state and federal regulations.

Nurse-Driven Quality Assurance 

Physician reviewers carry expertise in a variety of medical specialties, from orthopedics to PM&Rs. After WC claims are submitted, our nurse-driven quality assurance model ensures that all independent medical examinations and peer reviews are accurate, objective and comprehensive. MLS reviewers understand that when it comes to your health, time is of the essence; that is why we pride ourselves on quick turnaround times.

Individualized Approach 

Each WC claim is unique and must be treated so by an independent review organization (IRO). Because of this, MLS offers clients a customizable template that enables them to apply the appropriate processes, questions and guidelines to each review. Ensuring that each patient receives an unbiased, expert review is of tantamount importance — something we understand and are committed to providing.

Streamlining the Workers' Comp Process

Typically, the WC process looks something like this:

1. After an employee is injured on the job, they notify their employer and file a WC claim. Their employer then submits paperwork to file an insurance claim to receive WC benefits.
2. Once the employee has filled out all of the appropriate paperwork, the employer submits the claim to the WC insurance carrier which includes a medical report from the injured worker’s treating provider.
3. The insurer either approves or denies the WC claim. If the insurance company denies the claim, the employee has a chance to appeal the decision.

But where does an independent review organization come in? An IRO conducts independent medical examinations and peer reviews of a claimant’s case. An IRO can help make the WC process more efficient, reduce overtreatment and ensure legal compliance.

The laws for requesting independent medical reviews vary by state, but MLS employs a network of physician reviewers across the United States who are experts in local, state and federal laws surrounding WC claims.

Getting Employees Back to Work

Companies and WC organizations are taking the initiative to not only streamline the WC process, but also to prevent further workplace injuries with extra safety training and additional protocols. It’s also important for companies to inform an injured employee of their rights in the WC claim process and their right to an appeal. Whether the insurer approves or denies a claim, the most important part of the WC process is to ensure employees receive necessary treatment so they can return to work.