Computers used to evaluate claims

For the last 20 years, many insurance companies have been using a computer program called: "Colossus"; to evaluate claims. As of a few years ago, 8 out of the top 10 insurance companies in the U.S. were using either Colossus or one of the other similar programs. The programs require the adjusters to collect certain information and then input it. Obviously, the results depend on the quality of the data input. Unfortunately, sensitive medical data, which may not be understood by the insurance adjuster, is often not correctly entered into the computer program.

If the adjuster is looking for called for information, but simply can't find it in the records, no entry will be made and the computer program will completely ignore that element of damage. Injured people and their lawyers never know whether the computer program has been used and if so how accurate the data was that was entered by the adjuster.

Many companies make it very difficult for an adjuster to vary significantly from the settlement number recommended by Colossus. It would certainly be reasonable that an adjuster, who was constantly requesting that more money than Colossus recommended to be offered, would not be favorably viewed by superiors.

These programs even include such minor information as delays or gaps in treatment. Missed appointments de-value the case although if the reason is listed for the missed appointment the effect is less. The doctor's records must describe, verify and justify home treatment or the program will assume that the injury was minor because there was little formal treatment. This makes it doubly important for clients to visit with attorneys that can get them into see doctors relatively quickly after an accident.

There are inherent limitations in these programs that do not allow them to understand complex medical and serious medical conditions. Unfortunately, if a client's lawyer does not have the skill and experience to know what a fair settlement is, these low, computer-generated offers will go unchallenged.