A few weeks ago, I posted about Colossus – the insurance company megaprogram to determine the settlement value of cases – and promised that after my return from Atlanta I would write about it at greater length. With no further ado…
1. What is Colossus?
Nearly every major insurance company uses Colossus or a similar computer program to value personal injury cases. Each of these programs uses another computer program, usually Marshall Medical Expert, to analyze the medical aspects of a case.
2. I send a demand letter. What happens?
The insurance adjuster inputs the medical information, especially diagnostic and CPT codes into the Medical software. After that, he puts certain other information into Colossus. Colossus only asks yes/no questions (with a few exceptions where an adjuster can enter a number).
Colossus will determine a settlement range. An insurance adjuster is promoted/praised/etc based on whether he settles at or below this range, whether the range is $3,000 to $5,000 or $300,000 to $500,000. The company will not settle above the range. The key to all settlements is getting the adjuster to put the right thing into the computer.
3. What adds value to a claim?
There are a number of “value drivers” that can add value to a claim. They are:
· Injuries – number and type
· Treatment modalities
· Physician type (MD, DC or Specialist)
· Complications (the only place to put pain)
· Duties under Duress
· Loss of Enjoyment
· Final Prognosis
o Current and Future medical cost
o Income Loss – current/future
o Disfigurement – (demand needs a monetary amount)
o Aggravating issue – (ie DUI – needs monetary amount)
o Loss of consortium – (only considered if claim is above $50,000, but typically 5-10% of value of underlying claim).
4. Tips for writing good demand letters:
· Use Diagnostic codes and procedural codes where available. Everything a doctor diagnoses corresponds to a numerical code. Write each code for each injury (ie. Typical whiplash case needs separate codes for cervical, lumbar and thoracic sprain/strain, cervical, lumbar and thoracic pain, etc. That would be six codes. The more codes, the more $).
- If you enclose a physician’s report, everything from the charts has to be in the doctor’s report, otherwise it won’t count.
- Likewise, everything in the chart and report must also be listed in the demand letter, otherwise it won’t count.
- For aggravating factors or loss of consortium, you need to put in a dollar figure, otherwise the adjuster isn’t supposed to consider it. The best way to do that is to use jury verdict reporters, and enclose them along with the demand. (ie “Your insured also pled guilty to DUI after the accident. Recklessness like this can typically add $15,000 to a claim, as seen in the 2006 Will County case of Smith v. Jones, enclosed).
- If you put in a number under $10,000, the adjuster can put it in on his own. If you put in a number above $10,000, the adjuster typically must get supervisor approval.
- Colossus will consider loss of enjoyment. This includes several sub-sets, like loss of enjoyment of life, domestic duties, household duties, hobbies, sport and work. Loss of enjoyment of work also includes loss of status, loss of job security, loss of promotional prospects, difficulty in performing duties and reduced quality of work.
- The course of treatment and symptoms for each injury should be clearly delineated (ie Broken Left Leg – treated May 15 2006 to July 7, 2006. Pain and numbness until November, 2006.)
This is hardly exhaustive, but will give attorneys a better idea of what to put in demand letters. At some point, I’ll probably post a little info for doctors and chiropractors who want to get their bills paid faster.