Welcome to the first installment of our workers’ compensation series. Navigating the workers’ compensation process requires knowledge of a range of state-specific regulations and the medical conditions prevalent in workers’ compensation claims. As an independent medical review company, we provide peer review of WC claims to ensure workers receive appropriate and medically-necessary care that enables their return to work.

What is an independent medical review company?

Independent medical review companies are also referred to as peer review companies or independent review organizations (IROs). An IRO is a company that conducts objective medical assessments separate from insurance companies. Typically, individuals request an independent medical review when they have exhausted the appeal process through their benefit provider. URAC accredited companies in peer review demonstrate they uphold industry standards that ensure chart reviews are unbiased and use evidence-based medical guidelines.

What kind of services does an IRO offer?

IROs offer a variety of services for workers’ compensation claims, for both individuals and employers. MLS Group of Companies LLC (MLS) is equipped to provide services including:

  • Peer reviews
  • Independent medical exams (IME)
  • Functional capacity evaluations (FCE)
  • Impairment ratings

MLS works with a national network of trained and licensed physicians to assist in the management of workers' compensation claims for insurance carriers, employers and third-party administrators.

What challenges do workers’ compensation claims bring?

Many of the questions and challenges that payers and providers have with workers’ compensation claims are similar. These include:

  1.  The rising cost of healthcare and medication
  2.  Employees’ health and lifestyle factors, including obesity, diabetes, joint pain and other conditions
  3.  The rising opioid crisis
  4.  Mental health and the prevalence of post-traumatic stress disorder on workers in police, fire and other first responders
  5.  Increased complexity of claims
  6.  Regulatory and legislative changes on a local, state and national level
  7.  Distracted drivers
  8.  Data breaches
  9.  Cumulative trauma, or injuries arising from things like overuse
  10.  Claim cases that go to court

At MLS, we pride ourselves on our experience and expertise handling complicated cases and will help our clients navigate any challenges that may arise. We involve medical staff, administrators and peer reviewers with the appropriate skills to help you manage any and all claims.

How is using an IRO beneficial for the employee and employer?

When an employee is injured on the job, the process of initiating a workers’ compensation claim can be confusing and frustrating. While the employee wants to ensure that their medical expenses are covered, an employer wants to ensure that the medical treatment that is proposed or has occurred is medically necessary and compliant with any and all regulations or laws.

Physician reviewers contracted by an IRO provide unbiased and evidence-based reviews. These independent medical reviews streamline the entire review process, from physician matching with an appropriate reviewer to submitting a clinically accurate rationale in the final report. At MLS, workers’ compensation claims are reviewed with care, expertise, and a dedication to ensuring patients are given the treatment they need to return to work.
The Role of Independent Medical Review Companies in Workers’ Compensation