Insurance Company Software

Insurance Company Software

A little over 15 years ago, your insurance claim would have been evaluated by an insurance adjuster without the involvement of any software or significant computerized information.  However, in the past 15 years, insurance companies have begun to implement computer software programs that play a large role in the claim evaluation process.  While insurance companies claim that the use of this software is mere to assist its adjusters in ensuring consistency with respect to claims payouts, there is a significant body of research indicating that in fact the insurance companies are utilizing this software to “lowball” its claimants in an attempt to settle claims for as little as possible.

The software that is most popular with insurance companies is a computer program called Colossus.  In theory, an insurance adjuster will input into Colossus various factors surrounding a given claim such as the velocity of impact, medical treatment, prognosis, etc.  However, the software also lends itself to manipulation by an individual insurance adjuster, or worse, the entire insurance company as a whole.

In fact, there are several methods by which insurance adjusters and insurance companies can utilize Colossus to manipulate the claims process and consistently low-ball claimants in both liability and UM/UIM claims.  These methods include:

1.  Reduce all economic claims by a predetermined percentage.  The Colossus software can be manipulated so that no matter what information is put in, whether it be a minor soft tissue case or a catastrophic traumatic brain injury case, the suggested payout may be reduced by a certain percentage as determined by the insurance company.

2.  The software can be set to ignore outlier claims where a jury handed down a multi-million dollar verdict for the same injury that is now being considered.  This will result in a claim payout average that is lower than what the true average would actually be.

3.  The software allows for adjusters with no formal medical education or training to second-guess medical professionals by altering significant details of medical reports and selecting injury codes that yield lower recommended settlement values.  For example, if an MRI is done that reaches certain conclusions, the adjuster may pick and choose which factors to input into Colossus and may choose not to include all of them, thus decreasing the value of the claim.

4.  The adjuster may fail to input into Colossus that future medical treatment has been recommended or may be recommended in the future.  The software may also prohibit adjusters from entering information about the likelihood of future medical visits and permanent impairment ratings, which also reduces settlement values.

5.  Colossus may require adjusters to run medical bills through a medical pre-pricing software program and then enter in the reduced bill amounts.  This is artificially decreasing the value of the claim because it has failed to take into consideration the actual value of the medical care that was provided to the claimant.

6.  The software encourages adjusters to determine that claimants are comparatively negligent, and are thus responsible for paying part of the costs of their treatment.  Adjusters are trained to attempt to cast at least some of the blame for an accident on the claimant.  This allows the adjuster to decrease by a certain percentage the amount of money that the claimant may actually be entitled to.  For example, if the adjuster can assign 10% of the blame for the accident to the claimant, the total value of that claim will then be reduced by 10%.

As you can see, although the insurance industry touts Colossus as a means by which to ensure consistency in claims evaluation and payouts, the software is actually widely being used to ensure that claims are settled for the absolute lowest number possible, essentially resulting in “low ball” offers on a regular basis.

So, what can be done?  The implementation of computerized claims processes has made it even more apparent as to why individuals injured in auto accidents and other types of accidents should seek out an experienced and knowledgeable attorney to guide them throughout the claims process.  An attorney will be able to spot a low ball Colossus generated offer and take appropriate action to make sure the Colossus evaluation is set aside and begin true negotiations.  Claimants should not wait until they are given a low ball Colossus offer before contacting an attorney.

The best option and the most likely scenario for maximizing the value of a claim are to retain an attorney before any negotiations with an insurance company begin in the first place.  This will allow the attorney to frame the matter in such a way as to increase the value of the payout from the very beginning.  Many insurance companies even have separate claims departments for “attorney represented claimants” versus “non-attorney represented claimants.”  Make sure that the insurance company knows that you are represented and will not be pushed under the rug as so many of the non-represented claimants are.  If you or a loved one have been injured in an accident, call the Charles E. Boyk Law Offices, LLC today at 419-241-1395 or 1-800-637-8170.  First consultations are always free and we only collect an attorney fee if you win your case.