5 Tips for Writing Strong Peer Review Questions

When you’re managing a Workers’ Comp claim and things start getting complex, a peer review, Designated Doctor (DD), and Required Medical Exam (RMEs) are usually among the first suggestions. But these tools are only as effective as the questions you ask.

Poorly written questions waste time, create confusion and come back with vague or unusable answers.

Well-structured questions cut through the noise. They clearly identify clinical concerns and reference objective findings (such as imaging results, functional capacity evaluations, or medication history), and directly address the core issues of medical necessity, causation, and return-to-work timelines.

• Medical necessity: Is the proposed treatment consistent with evidence-based guidelines, and is it supported by current clinical findings?
• Causation: Are the symptoms and diagnoses directly related to the reported injury or exacerbated by a pre-existing condition?
• Return-to-work: What are the patient’s current functional limitations, and are they expected to improve with continued treatment or modified duties

Clinically informed questions not only guide the physician’s focus but also strengthen the integrity of the Utilization Review process, improving outcomes for both the injured worker and the claims professional. In this blog, we’ll break down how to ask smarter, clearer peer review questions and when to consider bringing in a DD or RME.

Peer Review vs. Designated Doctor vs. Post DD RME

Here’s a quick refresher on the roles of all these tools. Click here for a deep dive into peer reviews.

Peer Review

A Peer Review can be used if you’re questioning whether treatment is related to the injury or if it’s medically necessary. It assesses clinical review of treatment, typically without a physical exam, by a licensed provider. Used to determine:

• Medical necessity of ongoing treatment
• Appropriateness of specific procedures
• Compliance with treatment guidelines

Designated Doctor (DD)

DD exams are used when there’s a dispute between providers, or you need an official opinion that carries legal weight. This process requires a neutral physician assigned by the state (like the Texas DWC) to resolve disputes about:

• Maximum Medical Improvement (MMI)
• Impairment Rating (IR)
• Extent of injury
• Return-to-work capacity

Required Medical Exam (RME)

An RME is a carrier-requested exam, allowed only in certain situations, often after a DD opinion is issued. It’s used if you disagree with the DD’s conclusions and need a second opinion for potential litigation or dispute resolution

How to Write Great Peer Review Questions

Similar to writing an IME report and questions, peer review questions are part art, part science. And some tips will help you get it right:

1. Be Specific and Objective

Avoid vague language like “Is this appropriate?” Instead, call out the treatment, body part, date range, and link it to the injury.

Good Example:

• “Based on the submitted records, is the proposed lumbar MRI medically necessary to treat the compensable lumbar strain from the 5/3/24 injury?”

Bad Example:

• “Is the MRI necessary?”

Pro tip: Don’t assume the reviewer knows the full context—spell out the details.

2. Tie It to the Compensable Injury

Ask whether the treatment relates to the accepted diagnosis, not any condition the claimant may have.

Example:

• “Is the ongoing physical therapy medically necessary for the compensable left shoulder sprain only?”

3. Use Time Frames or Episode Markers

Set boundaries so the reviewer knows exactly what to focus on.

Example:

“Is physical therapy 3x/week for 6 weeks appropriate given the current clinical findings and functional status?”

4. Avoid Compound Questions

Don’t stack multiple questions into one sentence. Split them up.

Better Format:

• “Is the current prescription for hydrocodone medically necessary for pain related to the compensable injury?”
• “Is long-term opioid use supported by current clinical documentation?”

5. Ask for Rationale

Always include a prompt for explanation.

 Add-on Prompt:

“Please provide evidence-based rationale and reference to relevant guidelines or standards of care.”

Sample Peer Review Question Templates

Here are some ready-to-use formats you can plug in and personalize to your case:
• “Is the requested [treatment/test] medically necessary for the compensable [body part/diagnosis]?”
• “Does the documentation support continued [treatment method] beyond [X date]?”
• “Is the treatment plan consistent with [Official Disability Guidelines/MTUS/other]?”
• “Based on your review, does the patient meet clinical criteria for [procedure or medication]?”

When Should I Use a Peer Review vs. Designated Doctor vs. RME?

Here are some questions you can ask yourself when trying to determine if you need a peer review, DD, or RME:

• You’re questioning the necessity of ongoing treatment peer review
• There’s a disagreement about MMI/IR or return to work DD Exam
• You need to challenge or clarify a DD’s opinion Post-DD RME
• You suspect the treatment is not related to the compensable injury peer review or DD
• You’re preparing for litigation or dispute DD → RME (if needed)

Writing strong peer review questions is one of the most underrated skills in claims management. It speeds up resolution and ensures the injured worker gets the right care.

Need help with complex cases or peer reviews? Our team at Pathos knows how to ask the right questions and cut through the noise.

Check out our sources:

1. Texas Department of Insurance, Division of Workers’ Compensation. Request for Required Medical Examination (DWC Form-022). 27 Apr. 2023, https://www.tdi.texas.gov/forms/dwc/dwc022rme.pdf. Accessed 15 May 2025.
2. Texas Department of Insurance, Division of Workers’ Compensation. Designated Doctor Training and Testing. https://www.tdi.texas.gov/wc/dd/training.html. Accessed 15 May 2025.