Wednesday, January 2, 2008
Carrier using injury rating computer programs
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 andquot;toolandquot; 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 andquot;guidesandquot;, 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? 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?
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