Fraud isn’t always obvious. It rarely shows up with flashing warning lights or neatly labeled red flags. More often, it hides in plain sight—buried in medical records, scattered across treatment timelines, or quietly living on social media.
For law firms and insurance carriers, the key isn’t assuming fraud. It’s knowing where to look, what to question, and how to connect the dots when something doesn’t quite add up.
Start With the Medical Records (But Look Beyond the Surface)
Medical records are often treated as a box to check: retrieve them, review them, move on. But when you slow down and analyze them strategically, they can tell a much richer story.
Some common inconsistencies worth paying attention to:
- Injury severity that escalates—or minimizes—over time with no clear clinical explanation
- Treatment gaps that don’t align with reported pain levels or functional limitations
- Diagnoses that change significantly from one provider to another
- Sudden treatment spikes shortly after a claim is filed
- Complaints that don’t match imaging or exam findings
None of these automatically mean fraud. But they do signal areas that deserve a closer look.
The Power of Medical Canvassing
This is where medical canvassing becomes a game-changer.
By canvassing beyond the records tied to the reported injury, you can uncover:
- Prior treatment for the same body part
- Pre-existing conditions that were never disclosed
- Overlapping treatment timelines
- Providers that appear repeatedly across unrelated claims
Medical canvassing helps answer critical questions like:
Is this injury truly new?
Has this claimant reported similar complaints before?
Does the treatment history match the narrative?
Often, the most important context isn’t in the records you received—it’s in the ones you didn’t know to request.
Social Media Canvassing: The Missing Layer
Medical records tell one version of the story. Social media often tells another.
Social media canvassing can uncover:
- Physical activities that contradict reported limitations
- Travel, hobbies, or work activities inconsistent with injury claims
- Timelines that don’t match treatment or recovery narratives
- Public posts, photos, videos, and digital behavior tied to prior incidents
- Patterns of suspicious or repeated claims activity
This isn’t about “gotcha” moments. It’s about context. Social and digital activity can validate—or challenge—the story being told in the claim file. And in many cases, these insights simply don’t exist in public records or incident reports.
Connecting the Dots Is Where Insight Lives
The real value comes when you bring everything together:
- Medical records
- Canvassed treatment history
- Social and digital activity
- Claim timelines
When those elements align, confidence in the claim increases. When they don’t, you gain clarity about where to investigate further, what questions to ask, and how to move forward strategically.
Smarter Review, Better Outcomes
Spotting inconsistencies isn’t about assuming the worst—it’s about being thorough, informed, and proactive. With the right approach to medical record analysis, combined with medical and social media canvassing, firms and carriers can:
- Identify red flags earlier
- Reduce unnecessary costs
- Strengthen defensible decisions
- Gain a clearer, more complete picture of each claim
Because the truth is rarely found in a single document, it’s revealed when you know how to read between the lines.
