When Two Records Walk into a Claim … Are They One or Two?

Let’s say you’re reviewing a claim file. You see a medical record. Then, a few pages later, you see it again. Same doctor, same date, same content. But wait, this second one has a fax stamp in the corner. Or maybe a scribbled set of initials. Or a different date in the footer. Is that a duplicate?

Your gut might say yes. Your system might say no.

Welcome to the strange world of Workers' Comp duplicity, a world where two records can be 99.9% identical and still be treated as unique by the very software designed to detect sameness.

What Most People Don't Know About Duplicates

We tend to think of duplicates as obvious. Copy and paste. Carbon copies. But in the land of medical records, things get trickier.

Did you know that only 38% of duplicates in Workers' Comp are exact matches? The other 62% are "soft duplicates" or "near duplicates".  Records that look the same to the human eye but fly under the radar of most TPA and Carrier systems because of minor formatting or metadata differences.

Some of the most common disguises include:

• Fax headers
• Page numbers that shift
• Highlighting or handwriting
• Updated logos
• Minor changes to margins, headers, or timestamps

To a human reviewer, these differences are irrelevant. To most legacy systems, they’re enough to confuse or miss entirely.

Why This Matters

Every time a duplicate sneaks into a claim file, it costs time. Adjusters scroll, reread, and second-guess. Defense attorneys over-prepare. Bill reviewers re-review. And in MLPRR-reimbursed cases, Carriers can end up footing a much larger bill than necessary.

In one real California case, duplicate medical records caused a $58,000 MLPRR overcharge for a well known TPA who claims to have a “duplicate removal system” in place. No one caught it until after reimbursement.

It's not just an efficiency problem. It's a clarity problem. It's a cost problem. It's a "why is this case so hard to close" problem.

And the worst part? Most teams don’t even know it’s happening.

The Philosophical Side of the Problem

This isn't just a technical issue. It's an identity crisis.

In Workers' Comp, there's no need to include duplicates. The reason Carriers and TPAs discontentedly spend such a significant amount of the case on redundant records is because their current systems aren't removing them efficiently.

Most systems default to pixel-by-pixel comparisons or simple hash-matching. Which means that one extra date stamp on a medical note can mean the difference between a clean file and a bloated one.  

Judges at the DWC have taken notice. They’re looking for Carriers, TPAs and law firms that proactively address this wasteful spending. The problem has become so central to efficiency and fairness that former Judge Nikki Mehrpoo joined Effingo Technology, a company that efficiently removes this exact dilemma at its root, and more moderators are following suit.

It's time we evolve our understanding of what counts as a duplicate. And more importantly, it’s time we stop letting outdated tools decide for us.

So What’s the Fix?

There is one tool out there that has studied the problem deeply, not just what duplicates are, but what duplicity looks like in the real world. It doesn’t just match PDFs. It evaluates semantic meaning, formatting shifts, and intent. It understands that sameness in Workers' Comp is a spectrum. Effingo Tech has solved this duplicity variation problem and addresses the inherently compute-intensive challenge of document comparison, where each page must be compared against all others.  For context, a 1,000-page document demands a staggering 499,500 comparisons to identify all forms of variation across text and images.

This tool finds all of the 62% that get missed. It can restore clarity to chaotic files. It can save hours of adjuster time, weeks of attorney time and eliminate unnecessary review work.

And yes, it exists.

More About Effingo

Effingo Tech is the only platform that guarantees less than 1% duplicity in any record set. It’s trusted by law firms, insurance carriers, and defense teams who are tired of second-guessing their data.  Endorsed by former DWC Judge and trusted by experts. 

To learn more, visit www.effingotech.com or email info@effingotech.com.

One record or seven? With Effingo, you’ll always know the answer.

Share This Article: