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How Do Insurance Companies Evaluate My Injury Claim?

When someone else makes a decision that results in you being injured, the expenses and losses can add up quickly. In the event of something like a car accident or fall on someone’s property, you may be dealing with insurance companies if you’re seeking compensation for the damages you’ve incurred. If this is the case, you’ll likely want to know how the insurance company will evaluate your injury claim.

Insurance companies are often looking out for their bottom line. As a result, you may receive a settlement offer that’s less than what you deserve. That’s why it’s important to work with an experienced law firm, so they can handle the insurance company and adjuster for you and ensure you receive full and fair compensation. Let’s take a look at the factors that go into insurance company injury evaluations.

Evaluating Injury Claims

If you’re making a claim with the insurance company of the person you believe caused your injuries, you’re filing a third-party claim. The insurance company will assign an adjuster to the case and they will likely start by getting the at-fault party’s side of the story. In addition to that, they will read any accident reports related to the incident.

After they’ve collected that base information, they’ll want to speak to you. They’ll look into your history to determine if you’ve filed injury claims in the past. When you speak to the adjuster, it’s imperative to have a lawyer present. If you don’t, you could say something that could jeopardize your claim.

The adjuster will request numerous documents like medical bills, proof of earnings, tax returns, and proof of property damage. They will go through all documentation that you submit thoroughly to determine the losses you’ve suffered.

When considering what to evaluate an injury claim at monetarily, the adjuster will look at what your chances are of winning at trial if a personal injury lawsuit was filed and how much a jury could potentially award you in damages. Depending on their findings, you may be offered a settlement. If that’s the case, it’s likely the settlement amount was determined using claims adjusting software.

Tools Insurances Companies Use to Value Claims

Claims adjusting software is used by insurance companies to analyze claims made against them. It projects a case’s potential value to assist an adjuster in trying to make a settlement offer. These programs work by having the insurance adjuster enter data collected from the injured party’s medical records and assigning severity points to the injuries. Most programs have hundreds of injury codes that are used to denote how serious an injury is and assign an amount of money to it.

In addition to assessing the injuries, claims adjust software takes into consideration whether or not you were hospitalized for your injuries, the type of length of medical treatment, necessary medications or physical therapy treatments, and the severity of impairment.

Colossus: The Injury Claim Calculator 

Developed and licensed by The Continuum Company, Colossus is one of the largest computer service corporations in the United States. This specialized program is sold to insurance companies with the promise to “ensure an objective valuation and consistency” for personal injury claim damages. In many cases, Colossus is used to give insurance companies a way to reduce the amount they pay out to settle claims.

A number of big insurance companies use Colossus software to determine settlement offers for personal injury cases. Some of those companies include:

  • Aetna
  • Allstate
  • Erie
  • Farmers
  • MetLife
  • Travelers
  • USAA

If your claim is brought up against one of those companies, it’s likely Colossus will be used to determine what you’re owed. It’s important to note that the weight given to the value of injuries varies from company to company, and possibly from adjustor to adjustor. This means that more experienced adjustors may have the ability to alter what an injury is worth.

When categorizing an injury, Colossus deems it either demonstrable or non-demonstrable. Demonstrable injuries can be objectively verified by a definitive medical test. For example, an X-ray can show whether a bone is broken. Non-demonstrable injuries, like soft tissue injuries, are harder to place a monetary award on.

To ensure your claim is evaluated properly and not undervalued by a computer program, it’s important to work with an attorney when filing a personal injury claim against an insurance company.

The Problem with Claims Adjusting Software  

Depending on your situation, you may receive a compute-generated letter from the insurance company stating the Colossus or a similar program will be used to evaluate your claim. Aside from the fact that claims adjusting software generally undervalue claims, there are a number of other problems claimants can run into when they’re used.

For example, adjusters don’t always fully understand programs like Colossus and the rules by which they attribute value to the injury information. If an adjuster fails to input the correct data, a significant part of your claim may not be considered.

In addition to that, claims adjusting software removes the individuality from your claim. The programs are incapable of evaluating your pain and suffering and do not take personal testimony into consideration when determining value.

The problems associated with these types of programs have not gone unnoticed. In 2010, the Consumer Federation of America released a consumer alert warning Americans about Colossus. To ensure a fair settlement offer is made, they recommend the following tips:

  • Find out if a computer program is being used to evaluate your claim.
  • Demand to see the range of results generated by the program.
  • Do not accept low settlement offers and considering making a counteroffer.
  • If the insurer does not agree to settle at the high end of the compensation range, consider filing a complaint with the state insurance commissioner.

In addition to those steps above, a lawyer can ensure your rights are protected and your injury claim is evaluated properly.

File Your Claim with Shrager, Sachs, & Blanco

Our personal injury lawyers understand how frustrating it can be when your claim is undervalued by an insurance company. When you work with Shrager, Sachs, & Blanco, we’ll fight for your right to fair compensation. After we conduct a thorough investigation of your accident and injuries and speak to experts about your situation, we’ll have a concrete idea of what you’re owed and why. We won’t let a computer program decide what you’re owed.

Filing a claim takes time and negotiating with insurance companies can seem challenging. That’s why it’s important to get in touch with a lawyer as soon as possible after a personal injury. To learn more about the process and what you’re owed for your losses, contact us today.

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