What is Medical Canvassing: Canvass Investigations
What is a Medical Canvass Report?
A medical canvass report is an investigative document prepared by a medical canvassing company (usually private investigators) to uncover a claimant's complete medical history and identify relevant providers and facilities where the claimant received care. The report provides the critical “where” and “when”, highlighting medical providers that adjusters need to target with medical authorization releases. The findings help insurers accurately assess claims, identify potential fraud, and uncover crucial information intentionally omitted by claimants with preexisting injuries. A medical canvass is critical in providing a 360-degree view of a claimant's medical past.
Medical Canvassing for Claims Adjusters: An Expert’s Guide
Uncovering Hidden Injuries and Medical Treatment with a Medical Canvass Report
Introduction
It started as a routine bodily injury claim. A car accident victim seeking compensation for neck and back injuries from the at-fault driver's insurance company. Textbook, open-and-shut case. But when the adjuster began reviewing medical records, red flags emerged. The claims adjuster ordered a medical canvass report from a private investigator and it turns out the claimant had failed to disclose a recent spinal injury and painkiller prescriptions—critical medical treatment that predated the supposed auto accident. Confronted with the investigation's findings and potential insurance fraud charges, the claimant withdrew the claim. Case closed without an unnecessary six-figure payout.
The success was no fluke. Skilled claims professionals know the power of a meticulous medical canvass and pharmacy canvass to combat inflated, unreported treatment, or downright fraudulent injury claims. Uncovering a claimant's full history of medical treatment prior to the date of injury frequently contradicts the story they peddle to maximize financial recovery. The detailed intelligence gathered through medical canvassing provides an informational advantage to insurance carriers while revealing true claim value. As one fraud director put it, "A thorough canvass report is the strongest weapon in our arsenal for combatting any type of questionable or excessive injury claim." Use medical canvassing wisely and claims insurers once dreaded can transform into frauds defeated.
Insurance claims adjusters rely on medical canvass reports to identify undisclosed medical treatment and prior injuries that may indicate fraudulent claims activity. A detailed medical canvass provides a comprehensive overview of a claimant's medical history, revealing key information about prior medical treatment that is often intentionally concealed.
This powerful investigative tool helps claims professionals accurately assess the value of bodily injury claims and detect fraudulent patterns. By uncovering a claimant's full treatment history including the dates of treatment, adjusters can confront suspicious claims armed with thorough documentation. A proper medical canvass by an experienced private investigation firm delivers tangible results and cost savings for insurance companies.
Medical Canvassing Companies
Often times private investigator who is willing to do some meticulous digging will uncover the truth - the claimant had a pre-existing back condition and had filed previous injury claims without disclosing them. The key is finding medical canvassing companies (a private investigation agency) with experience, and the fortitude to go the extra mile to complete meticulous searches with the best results for a medical canvass search.
For claims adjusters and private investigators alike, medical canvassing is a potent secret weapon against inflated or downright fraudulent workers' compensation or personal injury claims. By comprehensively reconstructing a claimant's full treatment history, skilled medical canvassers uncover critical evidence that contradicts false narratives. Whether it's prior accidents, undisclosed conditions, or suspicious treatment patterns, the revelations of a proper medical canvass can debunk even seemingly airtight claims. That's why PIs conducting insurance investigations prioritize this powerful tool. Get medical canvassing right, and potentially massive liability payouts transform into frauds defeated.
Conducting a Thorough Medical Canvass
A meticulous medical canvass examines a wide range of sources to piece together a complete timeline of a claimant's medical treatment and reported injuries. The medical canvassing process typically includes:
Most medical facilities and medical providers keep records in decentralized proprietary systems. PIs typically have to conduct targeted searches and make direct requests to individual hospitals, clinics, etc. piece by piece.
There are regulations like HIPAA that limit access to medical treatment records for PIs. They usually need claimant consent or court subpoenas to get voluntary cooperation from providers.
Conducting geo-targeted searches within a defined radius around a claimant's home and work addresses to identify medical facilities they may have visited. The geo-targeted area search can expand based on address history.
Directly contacting any medical facilities identified through databases or geo-targeting to request treatment records. This may involve clinics, doctor's offices, physical therapy providers, pain management centers, and more. Persistent private investigators utilize multiple contact methods to obtain information.
To get prescription records, PIs typically need to make requests to individual pharmacies and healthcare providers. A signed HIPAA release from the subject is usually required to get voluntary cooperation. Court orders can also compel disclosure.
Obtaining workers' compensation claim records if relevant, along with any accident or injury reports connected to the claimant.
Leveraging advanced tools and proprietary resources only accessible to specialized canvassing professionals. This includes customized databases and established provider relationships.
The most thorough canvassing utilizes all these strategies in a methodical process refined over years of insurance investigations. Comprehensive canvassing leaves no stone unturned.
Key Point Of Consideration for medical records canvassing:
A common misperception is that the medical canvass report itself contains a claimant's full treatment history and medical records. In reality, the insurance claims canvassing is the first investigative step to identify relevant providers and facilities where the claimant received care.
The canvass medical records report provides the critical “where” and “when”, highlighting medical providers that adjusters need to target with medical authorization releases for the claimant's signature. Only with an executed release in hand can adjusters then request the comprehensive medical documentation from start to finish of the treatment timeline.
Think of the initial canvass report as the provider roadmap. The report guides adjusters to the appropriate providers and dates of service so detailed medical records can be comprehensively obtained directly from the source. The full claimant medical history then crystalizes through provider disclosures, enabled by the intelligent targeting of the canvass.
Lines of Insurance That May Want to Consider Ordering a Medical Canvass Report
Medical canvass reports can provide invaluable insights for several lines of insurance during claims investigations and litigation. Here are some top insurance types that often utilize medical canvassing services:
Auto Insurance/Auto Bodily Injury - Medical records canvassing is critical for investigating personal injury claims stemming from auto accidents. Uncovering prior injuries, pre-existing conditions, and treatment gaps helps accurately assess claims and identify fraud.
Homeowners Insurance - Homeowners carriers routinely order canvasses for slip-and-fall and liability injury claims on residential properties. Full medical histories are compared against details of the claimed accident.
Workers' Compensation Claims - Work comp insurers need to investigate occupational injury claims. Canvassers uncover prior workplace injuries, health conditions, and activities that may impact causation assessments.
Disability Insurance - Pre-existing conditions and earnings activities may be revealed during disability claim canvassing. This protects against fraudulent or exaggerated claims.
Life Insurance - Canvassing deceased policyholders helps identify undisclosed health conditions during contestability investigations prior to death claim payouts.
Any insurance product vulnerable to questionable or inflated personal injury claims can benefit from professional medical canvassing during litigation or suspicious claims. The records uncovered help insurers measure true liability.
Key Data in the Medical Canvassing Report
The final medical canvass report delivers actionable intelligence for claims analysis. Key details include:
Date of service, providers, and locations of previously undisclosed medical treatment. This covers treatment predating the accident claim date of loss being investigated.
Complete address history spanning 5-10 years to accurately match treatment locations to where the claimant lived at the time.
Specific injury and accident information revealed through treatment documentation.
Identification of potential fraud indicators: a long history of treatment, gaps in care, visits to multiple providers, unclear injury circumstances, and inconsistencies in the claimant's story.
A detailed summary analysis highlighting red flag findings from the records obtained. This focuses the adjuster on the most pertinent undisclosed treatment and discrepancies uncovered during canvassing.
For complex claims, the medical canvass report creates an informational advantage for the insurance carrier over uncooperative claimants concealing their full medical history.
Benefits of a Medical Canvass Report
A properly executed medical canvass delivers invaluable benefits:
Identifying undisclosed injuries and prior treatment related to the claimed injury. This allows for accurate liability assessment.
Checking the veracity of claimants' statements by comparing medical records to their account of alleged injuries and treatment.
Supporting fraud investigations by uncovering duplicitous patterns and suspicious gaps in care.
Providing documentation to confront dubious or inflated claims. Recorded evidence carries more weight than verbal assertions.
Supplying adjuster's detailed intelligence to reduce litigation risks. Attorneys leverage canvass findings.
Detecting fraud early to avoid unnecessary settlements. This generates significant cost savings.
Deterring future fraud attempts by revealing the canvassing capabilities insurers wield.
Assessing the full scope of injuries and treatment to establish equitable claim values. Settlements align with complete medical histories.
These tangible benefits make medical canvassing a key piece of any fraud investigation or suspicious injury claim. The claimant's medical treatment history directs better claims decisions.
Choosing an Experienced Medical Canvassing Company
Conducting a meticulous, multi-sourced medical canvass requires specialized expertise and access. Claims professionals should seek out reputable vendors with proven success canvassing for insurers. Warning signs include vague methodologies, limited data sources, or cookie-cutter reports.
Instead, look for these indicators of an experienced medical canvassing provider:
Deep knowledge of how to obtain information from any U.S. medical facility, including customized contact protocols. Local investigators understand the records systems in their region.
Direct access to specialized databases and sources aggregated from past insurance industry work. Look for proprietary canvassing tools.
Advanced capabilities to conduct geo-targeted canvassing around any U.S. address. Search radius and scope should be customizable to targeted geographical areas.
HIPAA-compliant to legally obtain information - Medical Canvassing HIPAA is necessary for a proper medical canvass.
Rapid turnaround times using an efficient methodology perfected over years.
Custom reporting aligned to the needs of claims examiners. Reports should integrate seamlessly into workflows.
Here are some of the key types of medical treatment providers and facilities that would typically be searched in a comprehensive medical canvass:
Hospitals - Both inpatient and outpatient hospital treatment records need to be checked. This includes visits to emergency rooms, surgeries, imaging, and specialist consultations.
Primary Care Doctors - Family medicine, general practice, and internal medicine providers who served as the claimant's main physicians.
Specialists - Orthopedists, neurologists, physiotherapists, chiropractors, pain management clinics, and other specialists relevant to the claimed injuries.
Urgent Care Clinics - Urgent Care Facilities are walk-in clinics used for immediate outpatient care. Often not disclosed by claimants.
Imaging Centers - X-ray, MRI, CT scan facilities that could have records of diagnostic imaging related to claimed injuries.
Ambulatory Surgery Centers - Same-day outpatient surgical facilities.
Physical Therapy Clinics - PT is common treatment for musculoskeletal injuries.
Pain Clinics - Especially important for chronic pain and prescription medication records.
Pharmacies - Prescription records from retailers and mail order services can identify medications, prescribing doctors, and diagnoses.
Workers Comp Records - If relevant, obtain the claimant's complete workers' comp medical information.
The goal is to pursue every possible treatment avenue related to the claimed injuries, utilizing public sources, proprietary searches, and persistence to get the complete record.
Reputable medical canvassing companies welcome client inquiries into their process, data sources, and security protocols. Hiring an experienced partner delivers the detailed intelligence claims professionals need to dissect suspicious injury claims and curtail fraud.
The final report of a medical canvass contains a summary of key findings, including dates and locations of undisclosed medical treatment identified through the canvassing process.
It does not contain the full medical records from each provider. It instead serves as a roadmap to guide requests for complete records.
The final, comprehensive medical records are obtained directly from the treatment providers identified in the canvass report, with signed authorizations from a HIPAA authorization form.
The full medical records provide much more detail than the canvass report summary, including provider notes, test results, prescribed medications, and specified medical treatment information.
The canvass report guides the collection of the full records, but it only contains high-level findings, not complete documentation.
Adjusters use the detailed intelligence from the full medical records obtained to make claims determinations. The canvass report alone provides direction, not definitive documentation.
So in essence, the canvass report maps out undisclosed treatment sites and dates to target, while the resulting complete medical records deliver the nitty-gritty detail needed for claims analysis and confrontation of discrepancies. The two documents work in tandem, with the canvass report directing the acquisition of the comprehensive records.
Case Study 1:
Our investigators were hired by a home insurance provider to canvass the medical history of John S., who had filed a substantial slip-and-fall claim. He reported no relevant prior injuries. Our in-depth canvass uncovered three recent urgent clinic visits for chronic back pain just months before the home accident. We also obtained pharmacy records showing Mr. S was prescribed strong opiate painkillers.
This prior undisclosed treatment contradicted his claim of no related medical conditions. Confronted with the canvass findings, Mr. S withdrew his claim citing a pre-existing back problem. Our client avoided an unnecessary $100,000+ payout.
Case Study 2:
A national auto insurance carrier enlisted our services to canvass Anna T. after she filed a bodily injury liability claim seeking $1 million+ in damages. Our geo-targeted canvassing discovered Ms. T had undergone extensive spinal surgery just weeks before her reported auto accident. None of this treatment was disclosed.
Ms. T's legal team withdrew her grossly inflated claim once confronted with detailed medical records contradicting her reported injury timeline and history. This saved our client significant litigation expenses and payout costs.
Conclusion
For claims adjusters and private investigators, medical canvass reports provide a potent weapon to combat fraudulent injury claims plaguing the insurance industry. Done right, medical canvassing supplies undisputed evidence to refute dubious claims activity, assess true liability, steer settlement discussions, and generally deter fraud in future cases.
An experienced, technologically empowered canvassing company with specialized insurance expertise can transform the claims review process. Their ability to comprehensively reconstruct a claimant's medical history - no matter how hard one tries to conceal it - delivers peace of mind and cost savings claim after claim. Medical canvassing is mission critical.
Having conducted insurance claim investigations since 2003, Salt Lake Investigations is a trusted, reputable private investigative agency equipped to handle even the most complex medical canvassing assignments. Our team of dedicated investigators has the experience and determination to leave no stone unturned when reconstructing a claimant’s full medical history. We utilize cutting-edge investigative databases, leverage our established industry relationships, and exhaust all possible avenues to identify undisclosed medical providers and records. At Salt Lake Investigations, we remain relentless in pursuit of the truth, no matter how difficult records may be to uncover. Our customized, meticulous canvassing methodologies deliver actionable intelligence to defeat inflated or fraudulent injury claims.
Check out our other articles:
Uncovering Insurance Fraud: How Private Investigators Help
How to choose the right private investigator for your needs
Investigative Techniques: Surveillance Tips for Private Investigators
