Insurance Companies Software Utlized to Lower Settlements

Posted Friday, March 20, 2015 by Ed Harper

Recently, personal injury claims are being handled today much differently than they had been in the past. With the advent of Colossus, (created by Computer Sciences Corporation - CSC) and other claims handling software, are cost containment tools being utilized by numerous insurance companies to lower claim values. (A majority of this information was gleaned from an article written by Consumer Federation of America. http://www.consumerfed.org

This is how it works, generally:

The insurance company sets a benchmark - a consensus on the value of personal injury claims.

Insurance company then reviews their settlement numbers for claims.

Insurance company then sets a settlement range - fine tuning their system.

In this case, the CSC software Colossus, has 600 injury codes, and the software then sets a value - a $ amount for each severity point.

The particular region (State, County, City) does have an impact on claim value. This is factored in as well.

The diagnostic codes are used that were utilized by the physicians and health care providers. This are typically ICD-9 or ICD-10 codes. ICD stands for: The International Classification for Diseases.

The final prognosis, rendered by the physician or other health care provider is reviewed and ascertained. IF there is a need for future treatment, are there any ongoing complaints or have the complaints resolved? These questions help determine the range the computer program will provide to the adjuster.

Other important points include the following: Medications, diagnostic testing, hospitalization, admissions, physical therapy, restriction of movement, pain, and other factors as well.

the program will consider the special damages in the claim. These include the following: Medical bills; Lost wages; Future medical treatment needed; Future lost wages; out of pocket expenses.

Disfigurement or scarring.

Was there a permanent impairment rating.

Any aggravation of pre-existing conditions or injuries?

What was the length of treatment? Certainly the longer the care, the higher the value, or one would think.

Any gaps in treatment? A gap in care is always detrimental to a plaintiff’s claim. With these factors, a range is established. The adjuster, who formerly had a vast amount of freedom up to his or her authority, is giving a range to settle the claim. Usually within a range of 20% or so.

So, if you have any questions or concerns about your personal injury claim, and how it is being evaluated, don’t hesitate to give us a call at Harper Law PLLC.

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