HOW INSURANCE COMPANIES SETTLE BODILY INJURY CLAIMS CAUSED BY CAR ACCIDENTS

What you need to know about how insurance companies settle bodily injury claims caused by car accidents.

Did you know that many automobile insurance companies use “personal injury” software programs to “evaluate” your claim ?

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Basically, the program requires the adjuster to provide data into the software program and the program spits out a “settlement range.” The adjuster than purportedly after evaluating your claim makes a “fair offer.”

The program relies mainly on the contents of your medical records. “Severity points” are assigned for your injuries, it also considers the history of your lawyer involved (if any), the location of your accident, i.e., state, city etc . . . is also taken into consideration and some other factors (liability, comparative negligence) and then a settlement range is “calculated.”

Different insurance companies give different weight to the “calculation.” Some insurance companies follow it closely and direct their adjusters to follow the “calculation.” Other insurance companies use it as a guide to assist the adjuster who makes the ultimate call on what to offer.

There is more than one “personal injury” software program which is believed to be used by most of the top auto insurance companies to “calculate” the settlement value of minor to moderate car accident injury claims. Insurance companies believed to use such software programs include Aetna, Allstate, CNA, Erie, Farmers, Metropolitan, Ohio Casualty, The Hartford, MetLife, Travelers, USAA and Zurich. (Many other insurance companies use other form of injury valuation software.)

Neither the insurance companies that use these software evaluation programs nor the designers of such software will reveal their criteria / algorithm. Not much precise information about the software is available.

Some general information has been disclosed through security leaks, mainly through former adjusters. According to a report in the Chicago Tribune a former Allstate Insurance Company claims manager offered insight into computerized auto injury payouts. The Chicago Tribune reports that a former Allstate Insurance Company claims manager Mark Romano stated the computerized auto injury system can be manipulated. Mr. Ramo criticized the injury settlement software that he worked on while at Allstate Insurance Company.

Basically the software program considers various factors, assuming they enter the data correctly. First is the type of injury. Higher values are given to objective, easy-to-verify car accident injuries such as broken bones and herniated discs. Soft tissue injuries (aches, sprains and strains) are given lower values. Some medical findings can increase the evaluation of a claim.

In software programs keyword injuries such as:

anxiety
depression
dizziness
headaches
muscle spasms
nausea
neurosis
radiating pain
restriction of movement
vision impairment

The use of these key words can increase the “evaluation” of a claim. It is important these symptoms are documented and included in your medical report.

Apparently the software programs essentially ignore whatever you say, i.e., initial questionnaire that you fill out for your doctor. The software will recognize your medical records and their content as authoritative.

The software scoring systems generally give higher evaluation if you were taken from the scene to the hospital and whether you were hospitalized. As well, the type of treatment is important. The software programs will generally only recognizes certain diagnoses from chiropractors, such as sprains and strains of the neck and back. Other chiropractic diagnosis are ignored. Often the software will ignore or devalue more than 20 or 25 chiropractic visits. Physical therapy is considered but must be accurately documented. The software ascribes a value to physical therapy. Generally accepts 90 days of physical therapy is considered “up to three months of treatment,” while 91 days of treatment is considered “three to six months of treatment,” the latter is often given a higher value by the software.

Delays and gaps in treatment unless explained and documented in your medical records can cause a serious devaluation of your claim by the software. If a delay or gap in treatment occurs it must be addressed in your medical records.

The software also considers medications that you were on and for how long and whether you have suffered any permanent impairment per guidelines set forth in the American Medical Association’s Guides to the Evaluation of Permanent Impairment.

I hope the above gives you an understanding of what hurdles we face in handling a personal injury claim caused by a car accident. You need to know about the evaluation software because most insurance companies are using it. That is why it can often take months or years to settle a personal injury claim fairly. The adjustor is often given “marching orders” by his/her superior and the computer. Offers will start unrealistically low and over time weeks, months, years will increase. Patience is the key word.

These software programs do not know you. The software program is not given many of the specifics of your claim. Of course a software program cannot feel the pain you suffered and cannot understand the harm and losses you have.

In the event the car accident caused you or someone you love personal injuries or worse, you should contact a personal injury attorney.

Do not be afraid to contact a personal injury attorney for advice. I, Richard M. Katz, Esq., am here to answer your questions and give you help. For a free consultation, please feel free to give me a call. 626-796-6333 or contact me through my website http://www.lawyer-personal-injury-law.com/

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