Insurance Companies: Personal Injury Claims Software
Most major insurance companies now use software to adjust claims and come up with a range of settlement values. The most commonly used software are:
- Claims Outcome Advisor – want to see a brochure for the claims software?
- Injury Claims Evaluations
Adjusters are trained to scan your documents for key “value drivers,” what ClaimClinic calls data points, to input into the software. The majority of their data points come from your medical records. Adjusters analyze your medical records and then code your injuries, treatment, diagnosis, and prognosis. The software then performs calculations and adjustments and then gives the adjuster a permissible range of settlement values to offer you. The insurance companies can also “tune” the range up or down. Insurance companies will use the software’s value ranges as either guidelines only or they are hard stops and the adjuster’s job is only to negotiate between those two numbers.
Actual Insurance Adjuster Worksheets
Various insurance companies have made their internal claim dissection worksheets public as a result of being sued (and losing) for bad faith.
- Adjuster Claim Worksheet #1
- Adjuster Claim Worksheet #2
Garbage In Garbage Out
Colossus, one of the biggest claims software products, uses approximately 600 injury and 10,000 other factors in adjusting claims. The software is only as good as the data that is input into it. This is known in the software community as “garbage in, garbage out.” If you put garbage data into software, you will get a garbage result. For example, if the adjuster mis-characterizes the property damage to your car as “minor” when in fact it was “major,” then the resulting value range will be significantly less.
Adjusters will scan your Demand Letter and supporting evidence for data to input. Time spent making your Demand Letter a literary masterpiece is time wasted. Your claim’s value will only be increased by additional objective data. The Demand Letter should simply be a narrative of all the data in your claim. Think of it as a police report. ClaimClinic will teach you a system for dissecting all your claim’s data and presenting it in a data intensive demand letter, something no other DIY personal injury claim site does.
One technique that we will go into much greater detail later is to make sure your injuries are broken down in your records and letter to discrete body parts. For example, if you have shoulder pain radiating into your neck, you have a neck and a shoulder injury. Your medical records may just say shoulder pain. This is why it is a good idea to be as specific and delineated as possible with your doctors when telling them your pain and injuries.
Suspected Value Drivers
Even though claims software is patented and confidential, former adjusters and several lawsuits regarding unfair claims practices have shown us some of the data points the claims software uses to generate offer amounts.
- Active vs. Passive Treatment. It is thought that adjusting software gives more value to active medical treatments, such as physical therapy, as opposed to passive treatment, like chiropractic care.
- Length of Treatment and Number of Visits – these are known variables used by adjusting software. Your Demand Letter should break down these statistics for each person who treated you.
- Permanent Disability. This is thought to act as a multiplier to your claim’s value. If you are not completely healed at the end of your treatment, you need to ask your doctor to evaluate you for a permanent impairment rating.
- Use of “Devices.” Claims software looks for data wherever possible. Just like your medical treatment (duration and number of visits), you should clearly identify any “thing” you used during your treatment and how long you used it. For example, TENS units, home traction units, cervical collars, and even prescription medication are all objective data points. You will learn how to spot and document these data points when you learn how to dissect your medical records.
- Vehicle Damage. Property damage is one of the only objective pieces of evidence the software has to gauge the severity of impact, which in turn would justify your pain and injuries.