Claims professionals know the challenges incomplete medical histories create. Whether evaluating a contestable life claim, a disability review, or a bodily injury liability case, missing treatment details complicate adjudication, inflate costs, and increase exposure.

Medical canvassing fills these gaps. By uncovering undisclosed treatment histories and providing actionable leads, it enables faster, more informed decisions.

Claims Bureau USA’s MedTrac® canvassing solution is trusted by life and health insurers as well as property and casualty carriers to improve outcomes and strengthen claims integrity.

What Medical Canvassing Reveals

Well-executed canvassing can reveal critical findings, including:

  • Treatment history that predates a reported loss.
  • Recurring injuries or ongoing conditions.
  • Medical visits unrelated to the claimed incident.
  • Undisclosed providers and facilities.
  • Patterns of potential drug-seeking behavior.
  • Discrepancies between reported and actual treatment.
  • Confirmed leads for precise record retrieval.

These insights provide claims professionals with data they can rely on to direct investigations and strengthen adjudication.

The Intersection of Medical Canvassing & HIPAA Compliance

Medical canvassing is the structured process of contacting healthcare providers within a defined geographic area to determine whether a claimant has received treatment. The outreach confirms the existence and timing of visits without requesting protected health details.

Utilizing Medical Canvassing Services Across Coverage Lines

Life & Health Insurance

In this sector, canvassing is particularly useful in:

Pre-Ex Reviews

Identifying prior treatment that materially impacts group coverage decisions.

Contestability Investigations

Leveraging the two-year look-back to uncover misrepresentation that may void or alter an individual policy.

Disability and Long-Term Care

Validating ongoing treatment for disabling conditions.

Casualty / Liability Insurance

For casualty carriers and defense teams, canvassing strengthens claim validation and fraud detection in:

Bodily Injury Liability

Determining whether alleged injuries predate the incident.

Auto & Premises Liability

Verifying treatment tied to accidents or slip-and-fall events.

Workers’ Compensation

Uncovering unrelated or exaggerated injuries.

Litigation Support

Supplying verifiable evidence for negotiations or court defense.

Canvassing often proceeds without an authorization, giving SIUs and claims teams rapid, reliable intelligence.

Why Claims Bureau for Medical Canvassing?

Claims Bureau has elevated canvassing with its proprietary MedTrac® platform, which integrates automation, machine learning, and trained investigator outreach.

 

Core Elements Include:

  • Demographic Validation: Pre-checks confirm claimant information.
  • Smart Provider Targeting: Software filters facilities by type and geography, eliminating duplicates.
  • Expert Outreach: Investigators use tested scripts to maximize accuracy.
  • Quality Control: Analyst follow-ups resolve inconclusive responses.
  • Actionable Reporting: Provider details, treatment dates, and instructions for facilitating record retrieval for fast analysis.

Most of our canvass reports are completed within three to five business days, a decisive advantage over the 30–45 days often required for record requests. That speed helps carriers meet statutory deadlines and avoid interest penalties.

Contact Us Today to Learn More

Medical canvassing is no longer optional. It is a critical tool for managing risk and ensuring claims integrity. For life and health carriers, it supports contestability reviews and validates disability claims. For casualty insurers, it exposes misrepresentation and supports liability defense.

With its MedTrac® platform, Claims Bureau USA delivers canvassing that is fast, precise, and actionable. Our services help claims teams make better-informed decisions, reduce fraud exposure, and protect their bottom line.

If you would like to learn more about Claims Bureau and how we can utilize our nearly 70 years of knowledge and experience in your claims operations, contact us today!