Our Medical Canvassing Experts Discuss Effective Techniques
In a perfect world, insurance companies would be able to trust workers who claim they suffered an injury or illness on the job. Unfortunately, some workers may attempt to use a company’s insurance provider to claim benefits for injuries or illnesses that did not occur.
Insurance fraud accounts for billions of dollars in lost revenue each year. Fortunately, insurance providers can use medical canvassing to prevent insurance fraud. Medical canvassing, also called a medical background check, is a complex set of investigatory techniques that insurance adjusters would have a difficult time carrying out on their own.
During the medical canvassing process, an investigator may comb through years of medical records from pharmacies and hospitals while also checking a claimant’s social media profiles. Below, the medical canvassing experts at Bosco Legal Services, Inc. discuss some of the tricks of the trade.
Checking Pharmacy Records
Pharmacy records can provide a lot of insight about a worker’s injury claim. During medical canvassing, an investigator can contact pharmacies to determine prior visits and information about prescriptions. For example, an investigator may be able to determine if the worker filled prescriptions for medications related to his or her alleged workplace injury. Pharmacy records may also uncover a pattern of drug-seeking behavior or treatment for undisclosed medical conditions.
Checking with a pharmacy can uncover additional important information during an investigation. Information from a pharmacy may show whether a worker left information off a workplace accident claim form, or gave misleading or false information when filing a claim.
Checking Hospital and Doctors’ Office Records
Medical records on file at a doctor’s office, hospital or urgent care clinic can uncover useful information about a claimant’s medical history. These records may show information about the claimant’s first appointment, prior appointments and appointments scheduled for the future.
Hospitals, urgent care clinics and doctors’ office records may be able to show whether the worker visited medical providers before an alleged workplace accident or illness occurred and whether the injury is similar. A history of similar insurance claims made in the past may be a red flag.
In some cases, a medical background investigator can use prior records to demonstrate a claimant failed to disclose a health condition that is relevant to the insurance claim. It may be possible to show the claimant is attempting to claim benefits for a preexisting condition.
Checking Social Media
Social media investigations can complement a medical background check. Claimants may post photos, videos or text messages that show they overstated the severity of a workplace injury or illness. Some posts may show the claimant never suffered an injury. If a claimant said he or she suffered a debilitating back injury, but then posts a photo of themselves rock climbing only a week later, it could be a sign of insurance fraud.
Bosco Legal Services, Inc. also performs social media investigation services. You can schedule a consultation with us to learn more about how medical background checks and social media investigations work together during the insurance claims process.
About Our Medical Background Investigation Services
Bosco Legal Services, Inc. has decades of experience helping insurance providers, businesses and law firms with medical background and social media investigations. Our services can help prevent insurance fraud from workers’ comp claims.
We provide investigation services in California and across the United States. For more information on how we can help defend against insurance fraud, we encourage you to contact us. Call us at (877) 353-8281 or use the confidential contact form on our site.