Maximizing Injury Claim Settlement Valuation

 

Consumer Federation of America Released it's Report on Insurer's Utilization of Insurance Claims Evaluation Softwares

Former Industry Executive Details Claims’ Tactics That Shortchange Consumers Newly Released Court Documents Reveal Huge and Questionable Insurer Claims’ “Savings”

The Report from the Consumer Federation Of America, reveals that Colossus software marketing representatives talk about the real reason insurers are willing to invest millions of dollars into software licenses, installations, employee training and maintenance for these products. Insurers can use the programs to save millions of dollars by making “lowball” claims’ offers on a broad scale that are less than what injured consumers should receive under the terms of their insurance policies

“This report is a wake-up call for consumers and regulators who are not aware of the many ways that computer claims’ software can be manipulated to produce unjustifiably low injury payments to consumers and tens of millions of dollars in illegitimate ‘savings’ for insurers,” said Mark Romano, CFA’s Claims Project Director. Romano was the “subject matter expert” on the Colossus injury claims’ evaluation system at Allstate and Encompass insurance companies for almost ten years. Colossus, which is the dominant claims’ system in the marketplace, is sold by Computer Sciences Corporation (CSC).

“When CSC and its competitors talk publicly about computer-based claims’ systems, they stress that the programs allow insurers to more consistently evaluate bodily injury claims,” said Romano. “Consistency is a legitimate goal, but these companies tell a different story behind closed doors. Software marketing representatives acknowledge that the real reason insurance companies are willing to invest millions in these systems is that they can dial down claims’ payments to thousands of consumers at a time, regardless of whether these payouts are fair.” The report, “Low Ball: An Insider’s Look at How Insurers Can Manipulate Computerized Systems to Broadly Underpay Injury Claims”, details the history of the use of Colossus and similar software products by insurance companies. It provides considerable information about how these programs are set up, “tuned” to reach particular claims’ payment monetary goals and adjusted over time. The report also identifies specific techniques that insurers can use to directly and indirectly produce “lowball” claims:

• Directly reduce payments by a predetermined amount across-the-board, without determining whether this will lead to unjustifiably low payments for individual claims.
   
• Selectively remove higher-cost claims from data used to determine the acceptable range of payments for particular injuries. This has the effect of lowering payments for all claims of this type.
   
• Require insurance adjusters without medical training or credentials to second-guess medical professionals by altering injury determinations, thus dictating lower payments for certain injuries.
   
• Encourage adjusters to downplay or even ignore the likelihood that injured consumers will need future medical treatment or will be permanently impaired, thus lowering payouts.
   
• Encourage adjusters to determine that drivers are partly at-fault for the auto accident that injured them, even when they may not be.

“Many of the concerns about Colossus and similar programs have focused on the potential for insurers to manipulate these systems directly in order to reduce claims’ payouts,” said Romano. “But insurers can also use many techniques to unjustifiably lower payments in a more subtle manner, by putting biased or incomplete information into the system.” The report includes excerpts from recently released court records in a major class action lawsuit, Hensley v. Computer Sciences Corporation, that reveal disturbing information about how Colossus and similar products are marketed to and used by insurance companies:

• Insurers could adjust Colossus to produce virtually any claims’ payment reduction they wanted, whether or not it was justified. One CSC executive told the court that Colossus could be “tuned” to potentially achieve a particular level of savings, such as 15 percent, for all claims.
   
• CSC claimed insurers could produce huge reductions in claims’ payouts, which insurers achieved in many cases. A CSC executive told the court that Colossus achieved savings of around 19 percent on overall claims payouts for some its insurer clients. Meanwhile, CSC’s competitors, like the Insurance Services Office (ISO) claimed that they could maintain even higher savings over time.
   
• CSC misled regulators about the purpose of Colossus, claiming that main function of the product was to achieve consistent payouts rather than enormous claims’ “savings,” which might be illegitimate.

“These documents show that most of the nation’s top insurers used the Colossus system in ways that put millions of American consumers at risk of not getting the claims payments that they paid for with their premiums,” said J. Robert Hunter, CFA’s Director of Insurance and former Federal Insurance Administrator and Texas Insurance Commissioner. “The documents also reveal, unfortunately, that top executives at these companies violated their obligation to deliver fair claims’ payments to their own policyholders on a huge scale, in order to increase profits.” The report offers a number of recommendations to state insurance regulators to better protect consumers from insurers that manipulate Colossus and similar systems to unjustifiably reduce claims’ payouts:

1. Regulate all companies that sell claims’ adjustment software products, such as CSC. Currently, neither the states nor the National Association of Insurance Commissioners (NAIC) does this for all vendors of these products.
    
2. Examine and monitor the use of computerized claims’ assessment systems by major insurers. The NAIC should thoroughly investigate methods that all large insurers can or do use to directly or indirectly reduce claims’ payouts in an illegitimate manner. (The NAIC and state-based regulators signed an agreement with Allstate in 2010 that required the company to make a few small changes in how it used Colossus.)
    
3. Require insurers to notify consumers in writing that a computerized claims’ assessment was used to process their claim and to provide a copy of the report generated by the system. This will help injured consumers to determine if they received a fair payment.

“The NAIC examination of computer adjustment systems was incomplete and flawed,” said Hunter. “They only investigated how a single company, Allstate, which used only one of these systems, Colossus. And their agreement with the company did little to change how Allstate adjusted Colossus to make claims’ payments or to protect consumers from potential abuses.”

Can A Person Be Injured In A Low Speed Collission - Even If There Is No Damage To The Vehicles?

Absolutely YES!!

Do Not be Misled or Intimidated As Insurers Would Want. 

CNN RESEARCH FINDS: Theme of [insurance company strategy] is; 

• Deny
• Delay
• Defend  

"Auto insurers play hardball in minor-crash claims":  State Farm, Allstate, employ consultant's strategy, which CNN research finds the Theme of Strategy is; "deny, delay, defend".

Former employee says companies convince juries that claims are fraudulent. 

ATLANTA, Georgia (CNN) -- If you are injured in a minor car crash, chances are good that you will be in the fight of your life to get the insurance company to pay all the medical costs you incur -- even if the accident was no fault of your own.

That's what CNN discovered in an 18-month investigation into minor-impact soft-tissue injury crashes around the country. Those are accidents in which there is little damage to the vehicle and the injuries to people are not easy to see by the naked eye or conventional medical tools like X-rays.

Find this article at:

http://www.cnn.com/2007/US/02/09/Insurance_hardball/index.html

 

 

Don't be a victim of both an auto accident AND the insurance companies. The insurance companies have changed the way they value claims. Changes occur so rapidly that even your doctor or lawyer may not have all the latest information to help you in your accident claim. We've created questions for you to ask both your doctor and lawyer to determine if they are trained in the practice and policies of the insuarnce companies. We also direct them to national symposiums where thye can get all the latest up to date information to help you. It takes committment and dedication and these highly trained medical and legal professionals are prepared to assist you. You can find knowledgeable doctors and lawyers in the directory on this site. These doctors and lawyers are known to be trained on the Collosus System. You can ask them a series of questions to interview them regards their knowledge. See 17 questions to ask in the section entitled 3 KEY ELEMENTS.

Insurance Company Advantages;

3 Key Elements to know about insurance settlements of claims and how to combat them.

Insurance Advantage #1:

There are 35 Different Claims Evaluation Software Types Being Used To Evaluate Claims.

• Your Combat Advantage:
  Use Decision Points.

Insurance Advantage #2:

There are 45 Treatment Acceptance & Payment Software Types Being Used To Evaluate Treatment and doctors fees.

• Your Combat Advantage:
  Use Value Drivers

Insurance Advantage #3:

They use Claims, Practice & Procedure Software to evaluate claims.

• Your Combat Advantage:
  Use 9 Point Medical Validating Letter And 19 Liability Drivers 

BEWARE
Insurance companies make broad scale low ball injury payouts to their insured that is less what they deserve under their policy!

According to a report by The Consumer Federation Of America, the payment of bodily injury claims covered by automobile insurance has evolved from a system based primarily upon the experience and knowledge of claims’ adjusters to a computer-based assessment that has the potential to be easily and broadly manipulated by insurers.

This technology has enabled many insurers to increase profits by reducing the amount paid to consumers who file bodily injury liability claims, including uninsured and underinsured motorist claims.

Insurers have also been able to hire less-experienced employees to handle these types of claims, since the computer programs conduct much of the decision-making. Few consumers, including physicians and attorneys have knowledge of these practices, while even less understand the significant impact that the practices can have on the injured.

The Accident Victims Advocate Forum exists to inform both the public and regulators about the complexity of this environment and the need to understand how these systems can be manipulated to the detriment of consumers. We will reveal and show how to avoid the 13 Unfair Claims Acts insurers use to shortchange consumers. The information on this site will change your awareness forever more.

THIS IS A CONSUMER AWARENESS FORUM WHICH REVEALS TACTICS AND STRATEGIES USED BY INSURANCE COMPANIES TO GIVE THEM AN ADVANTAGE AND LOWER THE INJURED’S YOUR SETTLEMENT VALUE... 

This Forum Will Show You Exactly What To do About It.

Even if you were legitimately, seriously hurt and it is objectified or even if you were rear ended at 50 miles an hour and have multiple levels of herniated discs and are really hurt, it has little to do with how you're going to be compensated UNLESS your doctor and attorney know and use the data that is contained within this web forum.

The intent is to educate and inform the injured party about they’re rights so they can Avoid Unfair, Unrealistically Low Settlement Offers.

NOTE: The information contained within this site is disturbing. The insurance companies don’t want you to know about it and many lawyers and doctors are unaware of it. The result is that unless you overcome these litigation obstacles and liability hurdles, you will receive a settlement offer that can be up to 80% less!

A Guide to Personal Injury Settlement Offers, Myths, Misconceptions and Secrets...This Site Has Been Created To Assist You To:

• AVOID GETTING OR ACCEPTING A LOW SETTLEMENT OFFER!
• LEARN HOW TO SELECT THOSE LAWYERS AND DOCTORS WHO HAVE THIS INFORMATION AND HOW TO LOCATE THEM!

There are 10,720 individual aspects of a claim that can be identified and communicated to the insurance industry during their process of evaluating claim values and settlements.

This information has remained unavailable to most attorneys and physicians until the creation of this website. Those who do not have and utilize this data, find themselves with offers that are either unfair or stalled, but certainly at the wrong end of a substantially lower case settlement valuation.

There are four (4) main ‘Drivers’ of an evaluation made by an insurance company to generate a claim determination. 

• Injuries. [Injuries are assessed by number and ”Injury Severity Type”].
• Impairment. [Classified by disability factors manifested by the impairment].
• DUD. [Referred to as “Duties under Duress” while interfering with occupational duties
• LOE. [Referred to as “Loss Of Enjoyment Of Life” while performing certain activities while in pain]. 

Pain & Suffering is a sub category and is a summation and composite of #1 and #2 above.  

The factors above are the specific definition of what most insurance companies can arrive at in determining the value of the claim.  

Insurance Companies NOW use 19 Value Drivers to determine settlement offers. Although they try to keep it secret, it is imperative that both the lawyer and doctor know about, use and represent the Value ‘Drivers’ in your case.

The omission of the correct terminology, format and sequence, broken down into Value Drivers and if these liability drivers are not addressed, there is up to a 20% reduction of settlement value.

In addition to the Value 'Drivers, it is recommended that an Independent Medical Validation is performed to assist in raising the settlement value. Make sure this is being done on your behalf.

The insurance company software programs determine the value of the settlement and if the ''Drivers' are not included in the representation, valuation is lost.

The accumulation of the specific data we discussed above, when presented to the insurance company in the correct terminology, format and sequence, translates into SEVERITY POINTS in the insurance industry software interpretation, which then translates into dollars based on each insurer’s rate or formula. 

Colossus is a software program used to guide settlement values for bodily injury claims after automobile accidents.

AllSTATE HAS AGREED TO PAY A TEN ($10,000,000.00) MILLION DOLLAR REGULATORY SETTLEMENT

New York State Insurance Superintendent James J. Wrynn announced.

NEWS RELEASE 10/18/2010 New York State Insurance Department…The agreement follows an 18-month targeted National Association of Insurance Commissioners (NAIC) multi-state market conduct examination of Allstate’s claims handling practices.

The NAIC examination, for which New York was one of the lead states, focused primarily on Allstate’s use of claims handling software, particularly the software program, Colossus.

The examination found inconsistencies in Allstate’s management and oversight of the Colossus software program. In particular, the examination found that Allstate had failed to modify or “tune” the software in a uniform and consistent manner across its claims handling regions.

Insurance Company Software Lowers Settlement Values…       

What you can do to offset unfair, unrealistic offers! 

With the exception of one company, all insurance companies have adopted computer software which they now rely upon to perform 2 functions;

• The first software function determines whether they are willing to accept and pay for the duration, type and frequency of medical treatments.
• The second software function adopted by the insurance industry actually inputs the results of the first software program and then evaluates the claim for settlement purposes.

The combined software evaluation then translates into settlement authority.

If the attorney or physician do not incorporate these factors, the ‘windows’ of the software do not open and you lose the compensation for these factors associated with these injuries and factors.

This process is so detailed & complex that the public must rely upon those doctors and attorneys that are educated in this environment. To do otherwise would give back large portions of the settlement to the insurance industry & leave large amounts of dollars that were already determined to be paid in the settlement.