A blog post

Computer System Used To Underpay Injury Claims

By: Jeffrey Lapin

A new report issued by the Consumer Federation of America (“CFA”), Low Ball: An Insider’s Look at How Some Insurers Can Manipulate Computerized Systems to Broadly Underpay Injury Claims, details how major car insurance companies are using computers systems, primarily Colossus, to underpay injury claims. One of the authors of the Report, Mark Romano, the CFA’s Director of Insurance Claims Projects, was formerly Allstate’s “Colossus Subject Matter Expert,” the top expert for Allstate’s computerized claims system. Allstate, and other insurers using these types of systems to evaluate claims, use a variety of tactics to lower the amount of money offered to injured persons. This post will discuss Colossus, how it is manipulated to underpay injured people and what regulators can do to ensure fair settlement offers.

COLOSSUS

Colossus is the most widely used injury evaluation software program used by car insurers to evaluate personal injury claims. It is sold by Computer Sciences Corporation (“CSC”). CSC and other companies allege these computer-based claims’ systems help insurers achieve consistency in evaluating bodily injury claims. Insurers employing Colossus or similar systems also support their usage by indicating they help the company save money, which in turn, keeps premiums lower for their insureds. Allstate is the insurance company primarily identified with Colossus. However, a number of other insurance companies use it, either as a primary method to settle automobile accident claims or as guide. Some of these other insurance companies include: American National General Insurance Co., Pacific Property & Casualty Company, Infinity Assurance Insurance Co., Farm Bureau Mutual Insurance Co., 21st Century Insurance Company, Metlife Auto & Home Group, Metropolitan Casualty Insurance Co., St. Paul Fire & Casualty Insurance Co., St. Paul Fire and Marine Insurance Co. and Travelers Casualty & Surety Company.

According to the Report, Colossus is setup by first selecting experienced adjusters who evaluate hypothetical claims. The next step is sampling settled injury claims from all of over the country and comparing the actual paid claims to amounts Colossus recommends. Insurers have the ability to alter Colossus to produce a projected percentage of savings the insurer wants. Colossus contains approximately 600 injury codes that represent various types of injuries that can occur in a motor vehicle accident. Each injury code has a severity value attached to it. Colossus assigns a dollar amount to each severity point. Permanent physical impairments have separate values and dollar amounts. Colossus is configured for different regions because settlement value can differ by state, county or city. Colossus is later “re-tuned” by examining actual settlements and excludes settlements that exceed Colossus’ recommended settlement.These “re-tunings” occur at pre-determined intervals.

Insurance companies train their adjusters on using Colossus. Adjusters input data about injured persons, medical billing codes from the injured person’s medical billing statements and other information from medical records and other sources.. The adjuster’s selection of prognosis codes is very important as it can have a significant effect on the amount Colossus recommends as a maximum settlement amount.

UNFAIRLY MANIPULATING COLOSSUS

Insurers often use several methods to produce unjustifiable or “low ball” settlement offers to injured persons. The Report lists some of the methods used:

  • Reduce the tuning in all economic regions for all claims by a predetermined percentage.
  • Selectively remove or exclude higher-cost claims from the tuning sample, thus lowering the amount of the tuning recommendation.
  • Manipulate the trauma severity line in the tuning graph to obtain the desired tuning variables and future values.
  • Require adjusters with no formal medical education or credentials to second-guess medical professionals by altering significant details of medical reports and selecting injury codes that yield lower recommended settlement values.
  • Encourage adjusters to select final prognosis codes that lower the recommended settlement values.
  • Prohibit adjusters from entering information about the likelihood of future medical
  • visits and permanent impairment ratings, which reduces settlement values.
  • Require adjusters to run medical bills through a medical re-pricing software program and then enter the reduced bill amounts into Colossus.
  • Encourage adjusters to determine that claimants are comparatively negligent, and are thus responsible for paying part of the cost of their treatment.

These are just some of the methods used.

The Report offers a number of suggestions for the National Association of Insurance Commissioners (NAIC) the States to monitor and evaluate the usage of Colossus and similar systems to make sure injured persons received fair settlements. Some of these include:

  • Regulate all companies that sell claims’ adjustment software products, such as CSC.
  • Examine and monitor the use of computerized claims’ assessment systems by major insurers.
  • 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.

Until these insurers and the tactics are exposed and regulated, injured persons will continue to receive unfair settlement offers.

CONCLUSION

An insurance company makes money by collecting premium; they lose money by paying claims. To maximize profits insurance companies have a financial incentive to pay as little possible to injured people. By using computerized claims systems, such as Colossus, insurers have found a way to minimize the amount offered to injured persons. Insurers can manipulate these systems in various ways to pay accident victims far less than these deserve.

The full report can be found here: Low Ball: An Insider’s Look at How Some Insurers Can Manipulate Computerized Systems to Broadly Underpay Injury Claims.

USEFUL INFO ABOUT MOTOR VEHICLE ACCIDENTS

ABOUT LAPIN LAW OFFICES

Lapin Law OfficesLapin Law Offices is familiar with Colossus and which insurance companies use it. If you have been injured in a automobile or other motor vehicle accident, please contact us anytime (24/7) at 402-421-8033 (Lincoln), 888-525-8819 (toll free) or through our website: Lapin Law Offices.  We offer a free consultation and do not charge an attorney fee unless we collect money for you.

The following two tabs change content below.

Jeffrey Lapin

Lawyer, Founder and Owner at Lapin Law Offices
I am a trial lawyer and the Founder and Owner of Lapin Law Offices. I represent injured, abused and disabled clients with caring, passion and dedication in Lincoln and throughout Nebraska.

Latest posts by Jeffrey Lapin (see all)

->