Payers Turn to Physician Reviews to Resolve Complex Claims

As many as a quarter of serious workers’ comp claims — those with more than 30 days of lost time — involve a misdiagnosis or inappropriate treatment, according to a report by Best Doctors, a company that provides “second opinions” on injured workers’ treatment. And for the claims in the top 5% in terms of expense, Best Doctors estimated an error rate of 50%. “Many of these will be failed back surgeries and a host of chronic pain conditions with an overdependence on opiates,” the report said. “These clinical failures take a toll on the...