Peer Review (Insurance)

A Second Set of Eyes for the Carrier

A peer review is an evaluation performed by a second professional, typically another adjuster, a forensic engineer, or a subject matter specialist, at the carrier's request to verify or challenge the findings of the original claim assessment. Carriers use peer reviews as a quality control and cost control measure. When an estimate seems high, when the cause of loss is disputed, or when a supplement pushes the claim above certain thresholds, the carrier may order a peer review before approving payment.

For contractors, a peer review means your scope and documentation are being examined by someone whose job is to find problems with it.

Types of Peer Reviews

Peer reviews range from a desk-based review of the estimate and photos to a full field re-inspection by a specialist. A desk peer review is faster and less invasive. The reviewer examines the existing documentation and provides an opinion on the scope and pricing. A field peer review involves a new inspection, often by an engineer, who physically examines the property and may reach different conclusions about the cause of loss, extent of damage, or repair methodology.

Engineering peer reviews carry more weight with the carrier because they involve a licensed professional providing a technical opinion. They are also more expensive for the carrier, so they are typically reserved for high-value or disputed claims.

Responding to a Peer Review

When a peer review reduces or denies items in your scope, do not accept the findings without scrutiny. Request the full peer review report, including the reviewer's credentials, methodology, and specific findings. Compare their conclusions to your documentation. If the peer reviewer did not visit the property, that is a valid point of challenge. If their findings contradict manufacturer specifications or building codes, cite those standards in your response. A peer review is an opinion, and opinions can be countered with better evidence.