Insurance fraud is a major problem for insurers. Insurers should protect themselves from potential losses by investigating claims as thoroughly as possible. On the other hand, many deserving claimants have their requests for benefits denied. Both the attorney representing the claimant and the insurance company must have a comprehensive understanding of the claimant’s medical history. This will help him or her know how to proceed with the claim. This information is not always known by both parties either because the claimant does not remember important details, or has not been truthful with their attorney about their medical history.
In both of these situations, a medical canvass investigator can help. He or she can conduct an investigation to find information about the claimant’s medical history. Below, we define the term medical canvassing. We also discuss the situations that would make medical canvassing necessary.
What Is Medical Canvassing?
Essentially, medical canvassing is an investigation to verify a claimant’s medical history. The primary goal is to determine which medical treatment a claimant received before and after an injury or illness. This investigation can help the insurance company decide how to process a claim. It can also help the claimant’s attorney decide how to handle the claims process.
Medical Insurance Claims Investigations
As mentioned above, insurers lose billions of dollars to insurance fraud each year. For example, many employees have injuries that occur outside of their scope of employment. Yet, they may choose to file a claim for benefits with their employer’s insurer.
In this situation, an insurance adjuster should contact a medical canvass investigator. He or she can conduct a medical background investigation. An investigation will determine whether an employee received treatment for injuries suffered outside the scope of his or her employment.
Other reasons for insurers to contact a medical canvass investigator include:
- To determine if an employee receives the same prescription from multiple providers
- To discover if an employee left out important information on his or her claimant form
- To find out what medical treatment the employee has received prior to the accident date
Medical Records Retrieval Services
Besides helping insurers, a medical background investigator can provide assistance to a claimant’s attorney. For example, a claimant may have forgotten every instance where he or she received medical treatment. A medical canvass investigator can help the claimant’s attorney find any undisclosed medical records. The results of medical canvassing may uncover additional information that bolsters the claimant’s case.
It is important to obtain copies of the claimant’s medical records. These records are an important piece of a claimant’s case. A medical canvass investigator can help a claimant’s attorney obtain the records he or she needs by preparing and serving the required subpoenas and/or authorizations.
At Bosco Legal Services, Inc. we provide medical records retrieval services for both insurers and claimants’ attorneys. A medical background investigation will ensure that your client’s medical records are accurate.
Contact Us for Medical Background Investigation Services
Insurance fraud is prevalent. An insurer can help prevent fraud by having a medical canvass investigator look into insurance claims. Medical background investigations can also help attorneys representing employees looking to recover benefits for their injuries. An investigation may reveal information that supports a claimant’s initial filing.
Are you in need of a medical background investigation? If so, then Bosco Legal Services, Inc. can help. Contact us today at (877) 353-8281 for an initial consultation. You can also send us a message online. We have several offices across Southern California, including Rancho Cucamonga, Palm Springs, Irvine and San Bernardino.