Monday, December 5, 2016

How Modern Insurance Companies Value Your Car Wreck Injuries

How Modern Insurance Companies Value Your Car Wreck Injuries

Most insurance companies now use a Softwear program to evaluate your injury from a car wreck.

That’s right a computer, a machine NOT a person evaluates your case.The most well-known one is called Colossus.

It is the leading bodily injury claims adjusting software in the world and is being used by an increasingly large number of insurance companies. There are others. But 12 to 13 of the top 20 insurance companies use Colossus. Their goal is to minimize variances on cases and to minimize the value paid on injury cases.

Rumor has it that insurance companies are saving from 15 percent to 30 percent on injury claims payouts by using Colossus.

If you hire a lawyer that never tries cases in court you are stuck with these computer evaluations. If “one call” isn’t enough” you might want to investigate the attorney you hire before you sign anything.

The information they gather and enter into the computer is based on wrecks from all over the country. By looking at millions of cases over the years they understand what kinds of things cause low jury verdicts.

Some of the issues are not within your control.

They include things like;

1) What the police officer puts in his report about what the parties say, the amount of property damages, his opinion if anyone was hurt, who is charged in the wreck (ok maybe fault is something you can control.

2) The amount of property damage (even though many modern cars are made to withstand certain types of impacts, it still matters to adjusters and to jurors if you have a scratch, a dent or a totaled car).

3) What pain complaints the officer noted at the screen.

4) The information the ambulance driver or other emergency personnel notes on how the wreck happened or your pain complaints.

5) What test the emergency room doctor elects to run. Diagnostic (X ray, MRI, CAT Scan) or just a physical exam.

6) If the doctor keeps you in the Emergency room or admits you into the hospital or releases you.

7) The information the ER doctor notes on how the wreck happened or your pain complaints.

8) What your treating doctor records such as your complaints of limits on activities and pain.

9) If your doctor “codes” your prognosis and diagnosis in your records. If the doctor does not assign the code it will not be entered into the insurance company’s database.

Many of the issues for the computer evaluation that you can control.

They include:

1) What you tell the officer or emergency personnel at the scene. If you are in pain don’t say you are “ok”.

2) If you accept or reject a ride to the emergency room by ambulance.

3) Your failure to obtain medical treatment within three days of the wreck.

4) Don’t miss appointments with any medical provider. Any gaps in treatment are considered non compliant with medical treatment.

For example, if the physician tells you to go to therapy for 3 times a week for six weeks; well you need to be there then because if you don't take your treatment serious, neither will the insurance adjuster or the jury.

5) The type of medical provider you select (Therapist, Chiropractor, medical Doctor). Even the doctor being “Board Certified” helps.

6) What problems you have (that the doctor documents) reported in your medical records. For claims adjusting purposes if it isn’t in the medical records it don’t exist.

7) If you keep a list of you harms and losses and things you can no longer do and activities that cause you pain and a description of the location and type of pain (sharp, burning, dull, aching). This “diary” can operate as a reminder for you when visiting your doctor.

Basically, this computer software program is a database that evaluates claims based on information entered by the insurance adjuster. So the information provided to the adjuster and entered is very important to maximize the chances of settlement in your case without the long time and expense of a lawsuit.

The important information includes:

a) Fault at wreck;

b) Amount or significance of property damage;

c) Ambulance ride or not;

d) Emergency room treatment;

e) Diagnosis and prognosis in ER;

f) Type of medical provider (MD, DC, or Therapist);

g) Length of treatment.

The insurance company’s computer software programs do not value factors like:

a) pain and suffering,

b) the duration of your pain and suffering,

c) how your injuries affect your ability to work and carry on activities of daily living,
d) your inability to perform physical activities,

e) mental or emotional stress and effect of trauma,

f) your relationship with your spouse (loss of consortium),

g) Nor any number of other factors that a jury would consider in a trial.

This is why you explain your problems to your doctors; what you tell your doctors is what goes in medical records and what is entered into the computer.

Front line adjusters have no discretion in valuing your file.

We suggest to our clients that in order to increase the value of your case, when dealing with an adjuster who is relying on Colossus, you should consider the following:

• If you are injured at the scene report it to the police and emergency personnel, and if you are in pain take the ambulance to the hospital and get checked out.

• Be specific in describing your injuries. As a general rule, the more specific you can be the better. If you cannot perform certain activities, tell your doctor. If you continue to go to work but experience pain, tell your doctor about this as well.

•If the ER refers you to a specialist go see them.

•If treatment is recommended follow the recommendations and don’t skip any scheduled visits.

• Gaps in treatment will reduce the computer value of your case, so follow up with your doctors as directed on a regular basis. If you do have any interruptions in treatment, be sure you can explain the reasons for these gaps. In fact tell the nurse or the doctor why you missed.

•The single most important thing you can do to increase the value of your case is to TRUTHFULLY make sure all of your injuries, complaints, problems, preexisting conditions, pain, depression, anxiety, lost time from work, loss of life’s activities, and other relevant information are expressed to your doctors so that all information is recorded in your medical records. Always tell the truth.

• The Soft wear program generally opposes alternative medical treatments, such as acupuncture, massage, hot tube, yoga, etc. If you do seek alternative treatment, make sure that you do so with a doctor’s written referral.

• The Soft wear program values treatment according to time ranges such as one to three months, three months to six months, six months to nine months, and so on. This means that thirty days of physical therapy would make a case worth more than twenty-nine days of physical therapy.

• The Software program has other ways of assigning values to the length of treatment. For example, for the first three months, physical therapy visits might be valued at $50 per visit, but in the fourth month, they might be valued at $25 per visit, and by the sixth month, the amount might go down to $15 per visit. If you visit a medical doctor between the third and fourth month, then Colossus might bump the value back up to $50 or $100 per visit for the next ninety days.

• The Software program counts wearing a seat belt, which helps the value of your car wreck. If you were wearing a seat belt at the time of the wreck, be sure to tell this to the EMS, the police, the ER doctor and your treating physician so that it appears in your records.

Being properly informed of the strategies that insurance companies use to attempt to reduce the value of your personal injury case can often help you to properly develop your case to recover the most money.

Explain and tell the truth!

WHEN SEEING A DOCTOR DON'T DISCUSS:

(1) Settlement, or your wish to be fairly compensated - DO NOT EVER DISCUSS SETTLEMENT! Most physicians are looking for "money people who aren't really hurt...."

(2) Do not discuss if you have a lawyer, and don't tell them what I am telling you.

Complain only about your physical and/or psychological problems,

WHICH ARE THE DIRECT RESULT OF YOUR CAR WRECK INJURY!
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Now some cold hard facts.

If you have a case and you try to “tough it out” by things like:

1) Refusing medical treatment or transport at the scene.
2) Tell the officer you are fine or ok.
3) Not going to the emergency room.
4) Failing to follow doctor’s order.
5) Skip or miss appointments or treatments.
6) Ending your physical therapy sooner than prescribed.
7) Not follow up for all diagnostic treatment recommended by your doctor (X-rays, MRI, CAT scans).
8) Not seeing a specialist like a Neurologist or Orthopedic doctor.
9) Not reporting all your pain complaints and injuries to your treating doctor.
10) Participating in activities that effect your healing process.

The bottom line is if your case isn't properly documented by YOU, then the insurance company will never offer you a fair amount to settle your claim.

Your only option is to file a lawsuit.

Lawsuits are expensive and time consuming. Even a simple car wreck case with only a couple of witnesses and medical providers can easily increase your costs by $10,000.00 or $20,000.00. Litigation costs include things like doctor and witness depositions, court report fees, appearance fees (doctor can charge $1,000.00 an hour to testify), court fees, etc. With large cases, costs often run $100s of $1,000.00s of dollars.

Even if your lawyer advances these costs you are ultimately responsible at the end of the case to pay them from your portion of the recovery.

Juries aren’t allowed to know your costs, your attorney fees, or if you have health insurance or that the defendant has liability insurance.

The problems mentioned above that are problems for adjuster / computer evaluations, are usually problems for the judge and jury too.

If your case has any of these problems you may not find a lawyer willing to invest the time and expenses in proceeding to trial. Lawyers only get paid if you win.

Most experienced trial lawyers are in such demand that they will only file suit in cases with significant harms and losses and high policy limits.

There are many lawyers. Only some of them will file a law suit.

There are even fewer who are successful in the courtroom.

We wish you the Best of luck!
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The Spiva Law Group is dedicated solely to the representation of injured and families of deceased persons.

Make it a great day!
Howard Spiva
Howard@spivalaw.com (email)
www.Spivalaw.com (web page)
(912) 920-2000

In addition to making things safer, law suits save taxpayers money!

Personal injury fact: In addition to making things safer, law suits save taxpayers money!


 Personal injury fact:

 In addition to making things safer, law suits save taxpayers money!

Please keep in mind when we recover for a client and hold the at fault party accountable... 



That means the defendant and their insurance company pay the medical bills and future treatment instead of the tax payer or the public having to carry that burden



If not the losses could fall on the public...Medicaid, Medicare, ACA, Tri-Care, Campus, Social Security, etc.

 
MAKE IT A GREAT DAY!!
Howard Spiva


A Proud supporter of 
The Justice for Children Foundationwww.headsinhelmets.com
Children's injuries are no accident SPIVA LAW GROUP 
Trial Lawyers

1137 Mohawk Street
Savannah,Ga. 31419
(912)920-2000