In today’s claims environment, one of the greatest risks isn’t always what’s visible on the file — it’s what’s missing.
Incomplete treatment histories remain one of the most common and costly challenges across workers’ compensation, liability, and SIU investigations. When medical care goes undiscovered, claims teams are left navigating uncertainty, delays, and increased exposure — often without realizing it until much later in the claim lifecycle.
And by then, the impact can be significant.
The Real-World Impact of Missing Treatment
When a claim’s treatment history is incomplete, the ripple effects are felt across every stage of claim handling.
Missing or undisclosed providers can result in:
- Delayed or incorrect claim decisions
- Inaccurate medical timelines
- Unexpected late-stage treatment discoveries
- Increased litigation exposure
- Settlement values based on incomplete facts
- Frustration for adjusters, SIU teams, and defense counsel
These gaps don’t just slow claims down — they introduce uncertainty into causation, compensability, and exposure evaluation.
In an industry where timing and accuracy matter, incomplete information creates unnecessary risk.
Why Treatment History Is Often Incomplete
Most claims professionals do everything right — they ask the injured worker for prior treatment, collect intake documentation, and review available records.
Yet gaps still occur.
Common reasons include:
• Self-reported history limitations
Injured workers may forget prior visits, confuse provider names, or unintentionally omit treatment from years earlier.
• Care across multiple locations
Treatment may have occurred out of state, near former residences, or outside the employer’s primary network.
• Urgent care and ER visits
Short visits, especially years prior, are often overlooked or not remembered.
• Provider name changes and acquisitions
Facilities merge, rebrand, or operate under multiple names, making identification difficult.
• Lack of centralized medical data
Without a unified system, treatment information lives in silos across thousands of facilities nationwide.
In short — asking the claimant isn’t enough.
Why “We Asked the Claimant” Isn’t a Reliable Strategy
Relying solely on self-reported medical history places the burden of accuracy on memory — often years after treatment occurred.
This creates blind spots that may not surface until:
- A deposition
- A medical review
- A late subpoena
- An independent medical exam
- Or settlement negotiations
When new treatment appears late in the process, claims teams are forced into reactive mode — adjusting strategy under pressure.
That’s not ideal for outcomes, timelines, or costs.
How Proactive Medical Canvassing Changes the Equation
Medical canvassing fills the gap between assumption and verification.
Rather than requesting medical records, medical canvassing focuses on confirming treatment history directly with healthcare facilities, including:
- Dates of service
- Provider names
- Type of treatment
- Confirmation of no treatment when applicable
This process allows claims professionals to:
✔ Identify previously unknown providers
✔ Validate treatment timelines
✔ Confirm or rule out pre-existing conditions
✔ Reduce late-stage medical surprises
✔ Support defensible claim decisions early
It’s not about collecting volumes of records — it’s about clarity.
The Value of Early Visibility
When treatment history is verified early in the claim, teams gain:
- Greater confidence in compensability decisions
- More accurate reserves
- Stronger litigation positioning
- Faster claim resolution
- Fewer downstream disruptions
Early visibility transforms uncertainty into informed strategy.
Because in today’s complex claims environment, what you don’t know can hurt the most.
Final Thoughts
Incomplete treatment histories don’t occur due to lack of effort — they occur because today’s healthcare system is fragmented, decentralized, and difficult to navigate.
That reality makes proactive medical canvassing not a luxury — but a necessity.
When claims teams move beyond assumptions and into verification, they gain control of the file earlier, reduce exposure, and create better outcomes for all stakeholders involved.
Want to learn more about how medical canvassing can help uncover missing treatment early in the claim lifecycle?
Connect with Nate Hessel, President of CDI Canvassing, or visit www.cdicanvassing.com to learn more.