Is Medical Canvassing Legal?
By Carla Rodriguez | Jan. 16, 2025 | 4 min. read
What You Will Find Below:
- Is Medical Canvassing Legal?
- Medical Canvassing vs. Other Services
- When to Use Medical Canvassing?
You’re an insurance adjuster or risk manager trying to assess the validity of a claimant’s medical history. You need reliable, actionable information to make informed decisions – you need Medical Canvassing. It’s like detective work for healthcare, where trained professionals reach out to various medical facilities to determine if a claimant has sought treatment elsewhere that wasn’t disclosed.
This process helps adjusters uncover potential inconsistencies, such as undisclosed pre-existing conditions or simultaneous treatments.
Is Medical Canvassing Legal?
Let’s answer the questions you are here for—yes, medical canvassing is legal, provided it follows established laws and regulations. The key lies in maintaining compliance with privacy laws like the Health Insurance Portability and Accountability Act (HIPAA).
Why? Medical canvassers don’t request or access protected health information (PHI). Instead, they simply verify whether an individual sought treatment at a particular facility. As long as the process remains non-invasive, it’s perfectly above board.
Medical Canvassing: An Indispensable Tool
Uncover Hidden Information
Some claimants might omit certain details about their medical history—intentionally or not. Medical canvassing sheds light on these gaps, ensuring you have the full picture. For example, a claimant reports a back injury from a workplace accident. Through medical canvassing, you discover they’ve been receiving chiropractic care for years prior to the incident. This insight can significantly impact the claim’s outcome.
Reduce Fraud
Fraudulent claims can cost insurers millions annually. Medical canvassing acts as a fraud-fighting superhero, identifying red flags early.
If a claimant files for a disability claim, citing severe mobility issues. Medical canvassing reveals they’ve recently visited a sports therapy clinic—not for treatment but for performance coaching. Case closed.
Enhances Negotiation Power
Armed with accurate, verifiable information, you’re better positioned to negotiate settlements or dispute claims. It’s like walking into a poker game knowing everyone’s hand.
Streamlined Discovery
Canvassing reduces the need for multiple subpoenas by pinpointing relevant facilities with confirmed records.
Comprehensive Evaluations
By identifying pre-DoL (Date of Loss) treatments and comorbidities, canvassing provides a complete view of the claimant’s medical history, improving claim accuracy.
Provider Types
Common providers include hospitals, urgent care centers, pharmacies, and health clinics. Specialty providers, such as diagnostic imaging centers and chiropractors, can offer additional insights. Some facilities may require a medical release to confirm treatment dates.
HIPAA Considerations
While a medical release is typically unnecessary, maintaining compliance with privacy regulations is critical. De-identification of sensitive information ensures adherence to HIPAA standards.
Medical Canvassing Vs. Other Services
Surveillance, Social Media, or IME’s?
Medical canvassing, surveillance, social media checks, and independent medical exams (IMEs) are all investigative tools used in claims management, each serving distinct purposes.
Medical canvassing focuses on verifying undisclosed or omitted medical treatment by reaching out to healthcare providers within a claimant’s geographic area. It offers quick turnaround times (1–5 business days) and operates within HIPAA guidelines without requiring a signed medical release.
Surveillance, on the other hand, monitors a claimant’s physical activities and behavior in real-time, often taking longer and involving higher costs. Social media checks analyze publicly available online activity to uncover inconsistencies in the claimant’s lifestyle or statements, offering a relatively fast and cost-effective approach.
IMEs involve comprehensive medical examinations conducted by licensed physicians to evaluate the claimant’s condition, but they are time-intensive and expensive, requiring scheduling and claimant cooperation.
Medical canvassing stands out for its ability to uncover medical history quickly and cost-effectively, making it particularly useful early in the claims process or pre-deposition. While surveillance and social media checks provide insight into physical activity and lifestyle patterns, and IMEs deliver formal medical evaluations, medical canvassing uniquely targets treatment history, offering critical insights that can complement other investigative tools.
When to use Medical Canvassing?
Ideal scenarios for canvassing include:
- Contradictory or suspicious claims.
- Claimant’s reluctance to disclose medical history.
- Evidence or suspicion of prior treatment.
- Injuries with degenerative or unwitnessed characteristics.
Medical Canvassing is Legal
In conclusion, Medical Canvassing is a powerful, cost-effective tool that enhances the accuracy and efficiency of claims management. By uncovering undisclosed or omitted medical treatments, it helps adjusters and risk managers make informed decisions, reduce fraud, and strengthen negotiations. Its quick turnaround, legal compliance, and ability to provide critical insights into a claimant’s medical history make it a valuable asset in the investigative toolkit. Whether you’re dealing with contradictory claims or uncovering hidden treatments, medical canvassing offers a reliable, non-invasive approach to ensure the full picture is revealed, ultimately leading to better outcomes for all parties involved.