When Should a Case Be Sent for a Peer Review?

Written By Erich Kelly

Not every disability claim needs a full peer review, but some indications suggest it's warranted:

  • Conflicting medical opinions

  • Vague or insufficient clinical documentation

  • Extended durations without re-evaluation

  • Complex or multi-system conditions

Knowing when to elevate a case to a peer reviewer ensures the right level of clinical scrutiny, especially in high-risk or borderline scenarios. Choosing the correct specialty and expertise of the peer reviewer is also essential in this process.

Erich Kelly http://www.mmroinc.com
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