COMPUTER ASSISTED CLAIM EVALUATION PROGRAMS ARE UNFAIR TO AUTO-NEGLIGENCE VICTIMS

Mainstream media is beginning to expose the insurance industries secrets about the valuation software programs used by most major insurance carriers in auto-negligence injury claims. These programs make the injury claim adjuster little more than a data input clerk It has been reported that 80% of liability insurance companies are using some form of valuation software when adjusting and trying to settle injury claims. A recent segment on CNN’s  Anderson Cooper 360 and an article in Money magazine reveal that the problem with these programs is that they are subject to manipulation by the company using them and some are based upon incorrect medical assumptions about motor vehicle accident injuries. Just as unfair is that most insurance companies using these programs keep the criteria of the programs secret so that claimants (and their lawyers and doctors) are unaware of how a claim needs to be formatted and/or documented so that the claimant receives full credit. Simply put, they use technicalities and incorrect medical assumptions as an excuse to discount the value of legitimate claims. Most of the time adjusters have very little latitude to deviate from the computer generated “value” when trying to settle a claim. Recent reports and articles about these programs also show that adjusters receive very little training on how to use these programs and companies often “teach” their adjusters to deviate from the procedures and guidelines found in the training manuals for these programs. The most widely used software system is a program called Colossus, which is licensed by Computer Science Corporation (CSC). With the wide spread use of these programs, it is important for auto-negligence victims to have an attorney who is familiar with these type programs and who understands how they work and how auto-negligence claims should be presented to insure the claimant receives proper credit for all aspects of his or her claim.

Attorneys Attend Colossus Seminar: In January, Steve Moore and Mark Wolfe attended an extensive seminar devoted strictly to understanding injury valuation software programs used by insurance companies. The program had four hours devoted to Colossus and reviewed known value drivers and severity factors related to the program. In addition, Mark Wolfe has been extensively researching and reviewing information, articles and texts related to various valuation software programs. “For the most part the value drivers follow common sense and are similar to factors that would be favorably received by a jury if the claim were to have to go to Court,” said Wolfe. “The most interesting and disappointing thing I have found through my research is how technically abusive these programs can be. A company can ‘tune’ the program to discount or disallow an item of damage if the treating doctor does not chart or note a diagnosis or treatment in a specific way. Yet the way these programs are set up is different than how doctors might normally note or chart something for health insurance or medicare/medicaid billing,” explained Wolfe.

Moore & Wolfe Have Exclusive Rights to IMPACT forms ™.  To better present auto-negligence claims for their clients, M&W has acquired the exclusive rights for the use of  IMPACT forms ™ in the south Alabama area. These forms have been designed to supplement a claimant’s medical records and are designed to be compatible with the valuation software programs used by many insurance companies. “We reviewed a variety of software programs and forms for lawyers and doctors and we felt these forms and their related protocol would best compliment our current claim presentation process,” said Steve Moore. He said the biggest problem the firm faced when trying to decide what service or program to use was the fact that, while there were only four main valuation software programs available for insurance companies, each insurance company can “tune” or calibrate the program for so many variables and technicalities that there is no perfectly compatible program for lawyers and doctors.  Moore went on to say, “based upon our research into this issue, we believe these new forms will best compliment our goal of helping our clients recover the full amount of restitution owed under the law.”