by tcope » Sat Dec 29, 2007 06:41 pm
This is really an industry question but I'll also explain some background:
Adjusters know that some insurance companies use software programs (COA, Colossus, etc) to determine a range that an injury claims usually settles for. The adjuster inputs all of the injury information and the location of the accident and the program spits out a settlement range.
Insurance companies who use these programs _claim_ that this range is just used as a reference to help the adjuster. They have to claim that, as requiring adjusters to settle within a computer generated range is illegal and carriers have lost lawsuits based on this issue. That is, the argument is that a computer program cannot account for all the issues that need to be addressed in an injury claim.
My view... I'm _100%_ against any carrier using these programs. Of course the ones that do, claim that it _is_ just a "tool" but anyone with any brains has/can see that it is not. In my last job the carrier was all about making reports look good. I received and kept an email from the Regional Manager in which he showed a chart or percentages in which adjusters settled below, within, and above the computer generated ranges. He complained that this year the percentages of times adjusters settled above the range increased. He then explained when an adjusters percentage of settlements above the range reached 35%, he'd send an email to that adjuster. Now we all know this email would not be sent for the fun of it... that is, it would require some action by the adjuster. So while the carriers state that the computer generated ranges are simply "guides", anyone who believes this is fooling themselves or just in denial.
Also, and this is more important, the computer generated range is only as good as the information put into the program. Any adjuster who has ever used one of these programs knows that some information just does not fit into the program. Most adjusters also don't know enough about the way the program works to put in accurate information (i.e. some programs don't allow ER visits to be imputed as they are assumed based on other entries, some systems require that certain types of visits be grouped together and inputed as 1 item, etc). If I asked 10 adjusters to enter the same medical information, there would be 10 different settlement ranges.
If an adjuster is put into the position of needing such a tool in order to determine what a good settlement would be... they should not be settling injury claims. I understand that at some point an adjuster needs to take a leap and _start_ handling these claims but they should then be reviewing the injury claim with other adjusters or a supervisor. Does it make any sense that this adjuster does not know what a good settlement should be but they are relied upon to input 100% correct information into a computer program?
Personally... as an adjuster working for insurance companies (and I love the industry). I'd be 100% behind any lawsuit against a company for using these programs. It's the only way to get them to stop.
Now that I've filled 5 paragraphs with my utter hate for these programs... anyone want to disagree? :lol: I think it might be obvious that I won't agree with any counter views but I'd also be an idiot for not listening with an open mind. Any comments?
Adjusters know that some insurance companies use software programs (COA, Colossus, etc) to determine a range that an injury claims usually settles for. The adjuster inputs all of the injury information and the location of the accident and the program spits out a settlement range.
Insurance companies who use these programs _claim_ that this range is just used as a reference to help the adjuster. They have to claim that, as requiring adjusters to settle within a computer generated range is illegal and carriers have lost lawsuits based on this issue. That is, the argument is that a computer program cannot account for all the issues that need to be addressed in an injury claim.
My view... I'm _100%_ against any carrier using these programs. Of course the ones that do, claim that it _is_ just a "tool" but anyone with any brains has/can see that it is not. In my last job the carrier was all about making reports look good. I received and kept an email from the Regional Manager in which he showed a chart or percentages in which adjusters settled below, within, and above the computer generated ranges. He complained that this year the percentages of times adjusters settled above the range increased. He then explained when an adjusters percentage of settlements above the range reached 35%, he'd send an email to that adjuster. Now we all know this email would not be sent for the fun of it... that is, it would require some action by the adjuster. So while the carriers state that the computer generated ranges are simply "guides", anyone who believes this is fooling themselves or just in denial.
Also, and this is more important, the computer generated range is only as good as the information put into the program. Any adjuster who has ever used one of these programs knows that some information just does not fit into the program. Most adjusters also don't know enough about the way the program works to put in accurate information (i.e. some programs don't allow ER visits to be imputed as they are assumed based on other entries, some systems require that certain types of visits be grouped together and inputed as 1 item, etc). If I asked 10 adjusters to enter the same medical information, there would be 10 different settlement ranges.
If an adjuster is put into the position of needing such a tool in order to determine what a good settlement would be... they should not be settling injury claims. I understand that at some point an adjuster needs to take a leap and _start_ handling these claims but they should then be reviewing the injury claim with other adjusters or a supervisor. Does it make any sense that this adjuster does not know what a good settlement should be but they are relied upon to input 100% correct information into a computer program?
Personally... as an adjuster working for insurance companies (and I love the industry). I'd be 100% behind any lawsuit against a company for using these programs. It's the only way to get them to stop.
Now that I've filled 5 paragraphs with my utter hate for these programs... anyone want to disagree? :lol: I think it might be obvious that I won't agree with any counter views but I'd also be an idiot for not listening with an open mind. Any comments?
Posted: Sun Dec 30, 2007 10:47 am Post Subject:
Well tcope as you well know....we don't make the rules, but we sure do have to live by them, don't we buddy...(damnit)... :roll:
I agree with you re: the injury evalutaion systems that are in place now in lots of companies...I fortunately stopped handling BI claims, so don't have to deal with them....
Before anyone can pose the argument, that we use similar systems to establish value on vehicles, etc...As tcope said there are just sooooooooo many variables on bi claims that you cannot plug in! Among them (and perhaps most important) is the human factor....
Now true some people get all emotional, about their ''baby'' (car) being wrecked (which makes me want to puke frankly)...but in all reality these are replaceable items....and a firm value can be attached to them..
Not so with an injury....claimant 'a', may have a high pain tolerance, and pretty much 'walk it off' while clm't ''b'', cries and whines and stays in bed for a week. which claim is worth more? The guy that while in pain STILL went out and did his job supporting his family, or the whiner? (assuming both had identical injury/specials)...You can't plug this into a program!
How do you plug in the stress and trauma of a mother before she can get to the back seat and get ahold of her child after they were just hit by a drunk? hmmm? and when she finally reaches that baby, it's arm is broke...how do you put that in the program? The broken arm you can cover (in the data entry) but how do you plug in that mother's three years of her life that she lost until she could get to her baby? (i'm being overly dramatic but you get the point!)....
He then explained when an adjusters percentage of settlements above the range reached 35%, he'd send an email to that adjuster
You and I both know where this comes from...Some of the 'big' suits, had a luncheon, or free weekend on some island with the salesmen of this computerized system. The insurance company agree to 'buy' it...so now the adjuster (and managers) are left to 'make' it work! They have a hard time admitting that they spent boo-koo bucks on some stupid system unless it is going to save boo-koo bucks....I don't see it in this scenerio...I can buy/understand the medical billing systems that check for over billing, medical necessity even...but injury settlements? nahhhhh....And think of it...if this would work...what the hell do you need an adjuster for?
I can see it now, the injured party wobbles up to a machine, fills out a punch card, sticks it into a slot, then out pops his b.i. settlement just like an atm machine....same thing isn't it?
I'm with you re: supporting class actions on this, but I don't see it happening on this particular thing, unless some smart attorney get ahold of these e-mails....reprimanding adjusters for getting outside of the 'range'..thennnnnnnnnn there may be a shot, because it changes from ''tool'' to ''rule''.......
(great post by the way....i'm sure the general public has/had no idea about this)
Posted: Sun Dec 30, 2007 01:45 pm Post Subject:
I have always wondered how they figure out what a claim is worth, some people walk away with a ton of money where others are left with practically nothing, even with an attorney involved, I have to wonder if the attornies offices that handle bodily injury claims have some type of software that they use?
I am with you on the whiner and the guys who go to work, we see it everyday in the employment industry with work related injury. One guy will get up, knock off the dust and go to work in pain, where the other will be completely disabled. Guess that human factor does come into play there huh, Lori. Some people can't afford to be off work, I could not afford to be off work that is for sure. But I get where you are coming from there.
When I see a new double wide being pulled down the road, I always say, "somebody got an insurance settlement", LOL. Probably should not be so sinical, but I have seen people hobble into a comp hearing and then skip out. One guy made the comment that "we must have god working in there, people go in limping and come out good as new", he is right. LOL, it is simply amazing.
thanks for the great post tscope.
Posted: Mon Dec 31, 2007 07:17 am Post Subject: What happens now-s-days!
Hey there!
I have always wondered how they figure out what a claim is worth, some people walk away with a ton of money where others are left with practically nothing, even with an attorney involved, I have to wonder if the attornies offices that handle bodily injury claims have some type of software that they use?
I do understand one thing that- if the underwriters use softwares now-a-days to determine the risks associated with prospects...then it would surely need them the help of those computing machines when they are actually trying to ascertain the exact measure of a real claim. Don't you all think alike!
Toyboy82
Posted: Mon Dec 31, 2007 09:54 am Post Subject:
When I see a new double wide being pulled down the road, I always say, "somebody got an insurance settlement", LOL.
"we must have god working in there, people go in limping and come out good as new",
Oh my gosh! I am soooooo crackin' up good natured! those are so funny....
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