How the Colossus Computer Program Estimates Accident Settlement Values

How Does Colossus Estimate the Settlement Value of a Case?

Colossus relies on data provided by an adjuster to calculate a range of values for a personal injury claim. The data Colossus uses can be grouped, broadly speaking, into two categories:

• non-claim data, which includes information about your lawyer (if you have one) and the outcomes of similar claims in the area where you live, and
• claim data, meaning information about your injury, the medical and other treatments you received, and your resulting disability (if any).

Keep in mind that the adjuster feeding Colossus this data is someone who works—directly or indirectly—for the insurance company. Their livelihood likely depends, at least to some degree, on keeping payouts within a range the company finds acceptable.

Non-Claim Data

Before it ever gets to the specifics of your claim, Colossus takes into consideration at least two key factors.

• Your lawyer. That's right—Colossus knows about many of the lawyers in your area. It's looking for lawyers who will settle for the first offer that's put on the table, and for lawyers who don't mind filing a lawsuit and going to court. Needless to say, Colossus will recommend paying more to claimants with lawyers in the second group than those with lawyers in the first. If you're not represented by an attorney? Let's just say that Colossus sees you as an easy target.
• Prior settlements in your area. Colossus is loaded with data about claim settlements from all over the country. When you show up with a claim, the program looks at what it's been told are similar claims in your area as a benchmark for the value of yours. Of course, the accuracy of this benchmark is only as good as the claims Colossus is told to consider. More on that later.

Claim Data

With that non-claim data safely tucked away, Colossus then turns to information about your claim. Most of this information comes from your medical records. Because your claim data depends on what's in your medical records, you're at the mercy of your treating doctors, nurses, and other staff. If they're thorough and conscientious about charting, that's likely a plus. If their recordkeeping is rushed and haphazard, Colossus won't have the information it needs to come up with a fair valuation.

Reports indicate that Colossus is programmed with between 600 and 720 different kinds of personal injuries. Each injury is coded with medical insurance diagnostic codes. The system assigns "severity points" to your injuries based on these codes. Those severity points translate to valuation dollars.

Colossus also analyzes a number of "factors" related to your injuries, treatments, and recovery. While the system is programmed with more than 12,000 factors, it likely will only look to a few dozen of them in evaluating any particular claim. The program's assessment of your injuries and these factors produces a range of values for your claim.

Here's a closer look at how Colossus views your injuries and some of the factors thought to play a prominent role in most valuations.

Your injuries. Colossus groups injuries into two general categories. "Demonstrable" injuries are those that are easy to see—think open wounds, broken bones, herniated discs, and injuries to organs. "Nondemonstrable" injuries are those that can't be seen, like sprains and strains. Demonstrable injuries get higher values than nondemonstrable injuries.

Other medical findings also can increase the value of a claim, including:

• muscle spasms
• dizziness
• radiating pain
• headaches
• restriction of movement
• nausea
• vision impairment
• neurosis
• depression, and
• anxiety.

One of the biggest keys to getting Colossus to compensate you for your injuries, treatments, therapy, and more is making sure they're all well documented in your medical records. Each injured body part needs its own diagnosis and diagnostic code. Health professionals often are fond of the saying "If it ain't in the record, it didn't happen." Colossus looks at the value of your claim in much the same way.

Did you go to the hospital? Colossus considers whether you were:

• taken from the accident scene to the hospital, or
• admitted to the hospital for your injuries.

Injuries that require a hospital visit or hospitalization are worth more than those that don't.

Your care, and who provided it. The value of your care depends on several factors, including the treatment you receive and who provides it. Care provided by specialist M.D.s or D.O.s—orthopedists, neurologists, surgeons, and the like—is weighted more heavily than treatment by general practitioners or family doctors.

Colossus will pay for some chiropractic care, but the system tends to look at chiropractors with suspicion. When chiropractic manipulations are recommended or approved by an M.D. or D.O., Colossus might view the treatment more favorably.

Physical therapy, massage therapy, and acupuncture are covered. Here too, it helps if an M.D. or D.O. makes a referral or otherwise approves the therapy, with an order and an entry in your chart. As with all treatments, it's important that the need for this care, its frequency, and its duration are clearly documented. Neck and back treatments, in particular, will get close scrutiny. Each treatment date should be recorded.

Here are some other treatments that Colossus is programmed to recognize:

• prescribed medications
• diagnostic procedures like X-rays, CAT scans, MRIs, and myelograms
• home traction
• medical equipment and assistive devices like a cane, walker, or wheelchair
• injections, and
• immobilizing devices like a neck collar, a splint, or a bandage.

How long your care lasted. Colossus takes into consideration the length of your care. The longer you need what the program sees as necessary care, the higher the value of your claim. The key, of course, is whether Colossus sees your care as necessary. For instance, chiropractic care lasting more than 60 to 90 days is likely to be rejected.

Delays and gaps in treatment. Colossus doesn't like treatment delays and gaps. When you wait for two weeks after the accident to go see your doctor, the program will want an explanation. If you treat with your doctor for 30 days, skip two months, and then start seeing a chiropractor, Colossus is likely to devalue or ignore your chiropractic care.

Make sure your medical records tell the whole story. Perhaps your symptoms or injuries didn't show up right away. A treatment delay might be explained by the fact that you were waiting to see if your symptoms would resolve on their own. A gap in care might be attributed to your symptoms initially improving but then flaring up again when you discontinued treatment.

Whether you have lasting or permanent disability. Colossus assigns value to documented, objective disability. The system calls it "duties under duress." This is just insurance-speak for daily activities you continue to do, but that cause you pain. It includes things like:

• returning to work but with lifting, walking, standing, light duty, or time restrictions
• lawn and household maintenance work you continue to do, but with difficulty, and
• hobbies and recreational activities you can only do for limited amounts of time or with increased discomfort.

There are two ways to document your disability. First, your doctor can do an "impairment rating" using the American Medical Association's Guides to the Evaluation of Permanent Impairment. Colossus gives significant weight to this rating, ranking it second behind the severity of your injuries.

Most primary care doctors don't do impairment ratings very often (or at all). If your doctor isn't comfortable doing it, ask for a referral to a rehabilitation medicine specialist. There will be a charge, but if your permanent disability is significant, it will be money well spent.

The second way to document your disability is simply to ask your doctor to put it in your medical record, without doing an impairment rating. If your disability is mild, this route will be less expensive. Colossus will factor the disability into your case valuation, but not as heavily as it will a formal impairment rating.