Comp Clues


Medical Record Search

By Karla Painter - Record Solutions, LLC
| Date: 10/01/2002

What is a Medical Record Search?  How will this search help the adjuster make a decision about questionable claims?

Most adjusters have experienced a claim that made them suspicious.  The claimant is not completely forthright when asked about medical history.  The claimant cannot remember names of past physicians or are evasive when asked direct question about medical history.  Without past medical records there is no way to prove or disprove pre-existing conditions.  Investigation can be expensive especially when all you have to go on is a gut feeling and the existence of Red Flags in regard to the claim.

A Medical Record Search could be the answer.  This investigative service will provide the adjuster with information that could be crucial to settling the claim quickly or directing the adjuster to investigate the claim in more detail. This one service can reveal providers who have seen the claimant in the past.  A list of providers never mentioned by the claimant is now available. These records may reveal medical conditions that affect the claim. It also sheds light on the integrity of the claimant.  Has this person withheld information that is pertinent to the case? This search may also reveal the claimant is being truthful allowing the adjuster to pay the claim in good faith

The adjuster simply provides name, date of birth, social security number, address of the claimant and a signed release if available.  A demographic search of hospitals, family physicians, orthopaedic physicians and chiropractors will reveal if the claimant has been seen.  Other areas of medicine can be researched as they apply to the claim.  The information obtained varies from provider to provider.  Some offices will give dates of service and why the person was seen.  Other providers will only acknowledge the patient has been seen. A report showing all providers contacted with their addresses and telephone numbers will be presented to the adjuster.

The adjusters who have been using this search have expressed the importance of the information provided to them. A Medical Record Search is a simple inexpensive way to reveal the integrity of a claimant.  Most importantly, a Medical Record Search will provide the adjuster with information to make an educated decision in regard to paying a claim or denying a claim.