What is Medical Canvassing? (and Why You Need It)

What is Medical Canvassing?

Canvassing is a meticulous, comprehensive research process that’s designed to uncover a claimant’s pre-existing injuries, illnesses, claims, and unreported treatments. It is an all-inclusive search of general or primary care facilities to specialized providers like chiropractors or pharmacies. These searches can incorporate prior addresses if the claimant has moved around. generally performed by phone, where trained investigators uncover treatment history through geographic targeting relative to the claimant’s location.

This is especially important when plaintiffs are pursuing compensation for injuries as they may deliberately withhold information about their current or past medical history. This way you get a bigger picture of where and when the medical history of your claimant was conducted.

Medical Canvassing is good practice if your claim is experiencing the following symptoms:

• Suspicious or contradictory circumstances.
• Injury that does not align with details of the loss, or simply inconsistent facts.
• Lack of witnesses
• History of claims
• Visits to multiple doctors far from claimants residence.
• Monday Morning injuries

It requires a trained and knowledgeable medical canvasser to investigate a specified geographic area and determine what facilities the person who filed the claim was treated in and if so, during what time period.

Why do you need Medical Canvassing?

Unfortunately, not all claims are legitimate. There are instances where pre-existing conditions are filed as workers’ compensation claims – this is where a good canvasser can uncover crucial pieces of information.

For example:

If your claim deals with someone complaining of neck pain after a work accident in 2023 you might benefit from also knowing that he has been seeing a neck and shoulder chiropractor since before COVID happened.

How they do it:

1. Medical canvassers are simply looking for a yes or no answer from the provider on whether the patient has received treatment at that office. Which requires no need for patient authorization.
2. Beware – canvassers are trained, quality agents with extensive, annual HIPAA privacy training and will not accept PHI (protected health information) from a provider.
3. These individuals are equipped to handle delicate conversations and know the importance of establishing trust early with the providers they inquire. They will act with full transparency and make sure the provider knows not to share any sensitive information.

Pro Tip: An experienced, well-trained canvasser will not accept protected health information (PHI) under HIPAA laws as it makes both parties liable

Conclusion

Due to the essential information that is collected during a medical canvass – the validity of the claim can be quickly assessed. The faster the treatment information is obtained the faster you have actionable intelligence to make claim decisions. If there is fraud afoot, a canvass will help shine the light on it. Better decisions based on facts, closes claims sooner and saves your company money.