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Part IV of damages in personal injury: Piercing the veil on computer-based claims modeling.

Photograph: blended image of computer screen turning into a roadway with cars.

In our last blog post, at Part III [https://www.jimsnyderlaw.com/blog/2018/10/26/what-are-damages-in-personal-injury-part-iii-settlement-versus-trial-and-whats-colossus], we began the discussion about the insurance industry utilizing computer software to analyze personal injury claims, including equalizing claims payments across localities, regions and the U.S. generally.  The name of this computerized game is “Reduce Risk, Raise Profits, Repeat.” 

To really understand the liability insurance business in America, you have to grasp just one concept: risk.  That is all the insurance companies care about: minimizing, reducing and even eliminating risk that they will have to pay money -- big money, little money, any money at all -- to resolve a claim for damages against their insureds.

Computerized claims processing helps the insurance industry enormously in that effort.     

There are a number of different computer-based modeling programs insurance companies use to evaluate claims, including Colossus, ClaimIQ, ISO Claims Outcome Advisor, and others.  They used to hide in the dark, mysterious, staying out of sight of the injured parties and their lawyers.  But no more.  Now the companies that write and sell those programs are happy to hawk their wares -- and their promises to reduce risk -- openly on the internet. 

You can look them up.  We did.  Let’s take a look at some of what the manufacturers of these software products claim:

Colossus

Website:

http://www.dxc.technology/p_and_c_general_insurance/offerings/26121/57637-colossus

Text from the publicly-available Colossus website homepage:

Give adjusters more confidence.

Colossus® is the insurance industry’s leading expert system for assisting adjusters in the evaluation of bodily injury claims. Colossus provides adjusters access to your company’s claims data within a defined business process management framework for evaluating injuries, treatment, resolution, impairment and general damage settlements. Colossus helps your adjusters reduce variance in payouts on similar bodily injury claims.

Your adjusters can quickly interpret medical reports and look up definitions of injuries, treatments, complications and permanent impairments using AMA 5th edition data. Through a series of interactive questions, Colossus guides your adjusters through an objective evaluation of medical treatment options, degree of pain and suffering, degree of permanent impairment to the claimant’s body, and the impact of the injury on the claimant’s lifestyle. At the conclusion of a Colossus consultation, a summary of the claim is provided, including a recommended settlement range.

Colossus is equally effective for personal or commercial lines.

Minimize Payout Variance

Colossus ensures consistency in how bodily injury claims are evaluated across your entire claims organization, thereby reducing payout variance. With Colossus, you can:

·       Increase fairness to all customers by ensuring consistent companywide best practices

·       Increase your adjusters’ confidence in the negotiation process

·       Improve your adjusters’ investigative questioning skills (at all levels, from new adjusters to the most experienced).

Free Up Valuable Resources with a Hosted Solution

Do you have multiple IT projects competing for limited time and resources? DXC can host Colossus for you, freeing your IT department to focus on other business priorities. Our Web hosting resources are virtually limitless, and we offer a variety of hosting options. We’ll support your Colossus implementation with experienced resources and best-in-class processes.

Gain More Insight with Advanced Reporting Tools

DXC has chosen the industry leader in reporting to bring you the easiest, most comprehensive reporting tool for your Colossus data. Our Business Analytics reporting software, based on SAP BusinessObjects XI solutions, gives you the ability to produce user-defined, real-time reports, run predefined reports, create graphs and charts within your reports, generate automatic management alerts, and much more. This allows Colossus to provide a wealth of insight into your company’s claims activity. With the easy-to-use report builder, managers and end users can create customized reports without significant training or IT support.

ClaimIQ:

Website: 

https://www.mitchell.com/products-services/auto-casualty-claims-management/liability-general-damages-assessment-software

Text from the publicly-available Claim IQ website homepage:

Auto Casualty Liability & General Damages Assessment

Streamline the casualty claims process with ClaimIQ®

Mitchell ClaimIQ® is a comprehensive, modular solution that helps drive accuracy and consistency across three critical areas of claims handling: Investigation, Evaluation and Negotiation

Consistent Investigation

Liability 1231, if performed on a consistent basis, can make a significant impact on your bottom line. However, most apply comparative negligence to only 3–5% of all claims files. Without clear guidelines, adjusters often pay at 100% of liability, significantly overpaying on claims settlements.

ClaimIQ® provides a clear investigation framework—and it can be tailored to your organization’s specifications. Apply your organization’s best practices to each and every claim investigation, evaluation and negotiation:

·       Consistency leads to better results since everyone is using the same framework

·       A systematic process guides adjusters through the various steps of liability assessment, so they can more precisely identify comparative negligence situations

·       Damages Evaluation

Once negligence is established, ClaimIQ supports a best practice approach to evaluating damages. With ClaimIQ, you can:

·       Clearly identify injuries

·       Review medical specials via integration with Mitchell  DecisionPoint or Mitchell SmartAdvisor

·       Evaluate general damages, using best practice severity factors

·       Assess applicable no-fault and/or tort threshold breach factors

Negotiations can be challenging under the best of circumstances, and harder still with hundreds of claims to investigate, evaluate and settle quickly. ClaimIQ assists adjusters in preparing successful negotiation parameters, helping to:

·       Establish separate evaluation ranges for liability and damage determinations

·       Automatically reference and organize all aspects of the claim file into a Negotiation T-Chart that details the strengths and weaknesses of each  party’s case

·       Review other parties' negotiation tactics and settlement track record experience prior to initiating negotiations

·       Use management reports to isolate trends for coachable moments to improve negotiation skills

ISO Claims Outcome Advisor:

Website:

https://www.verisk.com/insurance/products/manage-personal-injury-claims-more-effectively/#

Text from the publicly-available ISO Claims Outcome Advisor website homepage:

ISO Claims Outcome Advisor | Manage personal injury claims more effectively

Services for the UK and Global Market

With ISO Claims Outcome Advisor®(COATM), you can manage personal injury claims more effectively — from simple soft-tissue injuries to complex injuries involving multiple body parts and prolonged treatment plans.

ISO Claims Outcome Advisor, our core solution for the global market, helps both compensators and claimant representatives:

·       consistently identify the severity of injuries following an accident to arrive at an accurate valuation of general damages (pain and suffering) compensation

·       compare a claim to similar cases

·       make more effective claim settlement decisions

Using those analytics, you can ascertain an appropriate settlement amount and accelerate the entire claim-handling process. As a result, you can attain fair solutions faster, minimising the risk of over- or underpayment.

No matter how complex the claim, ISO Claims Outcome Advisor simplifies the process and provides clear guidance to ensure accurate and consistent assessments.

ISO Claims Outcome Advisor operates continually throughout the life cycle of a claim and provides multiple assessments and reevaluations.

It provides settlement guidelines based on claim variables such as:

·       extent and severity of trauma

·       degree of temporary or permanent disability

·       your company’s historical settlement trends

Your claim handlers can deliver a higher level of customer service to third-party claimants with a tool that accelerates a fair outcome — while still leaving room for a claim handler’s judgment and experience.

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Hard to be more frank that that.  Clearly these software vendors such as Colossus are no longer hiding their products, or what they can do for insurance carriers, behind some magical veil of mystery. 

Minimize risk, minimize payments, equalize payments across regions, states and the U.S. Increased profits will follow directly.

That’s what people injured by the negligence of others are up against.  And it is the landscape a personal injury lawyer representing those people must intelligently and creatively negotiate.  Stay tuned.    

 

James Snyder