INSURANCE ADJUSTING SOFTWARE (continued)

Here are the next 6 comments covering where we left off on the last article “12 COMMENTS ON COLOSSUS AND THE USE OF “ADJUSTING SOFTWARE” BY U.S. INSURERS”

7) Identify factors in history of treatment (meds, traction, MRI, injections) –  Adjusting software is generally equipped to consider the use of devices such as cervical collars and TENS units, as well as the use of trigger point injections and the duration/type of certain types of medications.  As with the treatment history, breaking these items out in a spreadsheet with clearly marked durations of use, supported by the records if possible, is the best approach.

8 ) Comparative jury verdicts irrelevant — The reason for this is that software was created, in large part, to reduce insurer payouts for non-pecs, which were often calculated as a rough multiple of treatment expenses.  Under a Colossus-type regime, the software analyses type and duration of treatment to determine how much to offer…typically, medical expenses don’t factor into the equation of determining what the non-pec authority will be.

With insurers NOT utilizing software-based analysis, the typical comparative jury verdicts approach commonly used in BC may be worthwhile…another good reason to know which regime you labour under before drafting your demand.

9) Talk with the adjuster – are they bound by range, can they consider other factors, have all relevant “value drivers” been included.  Do they have room to move? — You may be surprised how much information you can glean from certain adjusters.  Some will offer no insight whatsoever into the “behind the scenes” processes at work.  Others, resentful of the loss of analytical control over their caseload that the software programs have brought about, are remarkably cynical about Colossus.  They may be even more open in discussing the regime they work under with the rare Canadian lawyer they see than they would with one of their “usual suspects” from their local plaintiff’s bar, who may have multiple open files with the adjuster at any given time, or a reputation that precedes him.  Use typical XFD strategy – be friendly, ask questions, and get them talking.  You may get some helpful hints on how to further enhance the claim’s value.

10) Mediation unlikely to increase settlement authority — Few of you would get to this stage without filing suit and involving a U.S. lawyer…but it’s worth knowing that if authority has been determined by computer, mediation, pre-trial settlement conferences and the like are not likely to squeeze any additional funds out of the insurer.  Some judges in Washington State are becoming very frustrated with this latter development, especially in cases where PTC’s are mandated by court rule and the parties are expected to appear in good faith.

11) Adjusters not generally allowed to consider litigation expenses – but “fees to winner” regime might work in your favour, or get you out of Colossus entirely — Typically, decisions about the balance between settlement and litigation costs are made at a corporate level far removed from the front-line adjuster, and as such, curry little favour in settlement talks.  However, since virtually no U.S. jurisdictions follow the “loser pays” rule for costs and disbursements, this would certainly be an issue you might want to hammer home in cases involving a U.S. defendant, a B.C. accident, and no serious dispute as to liability.  The possibility of facing a prevailing party costs award which exceeds the value of the underlying claim is simply not in the contemplation of the U.S. insurer or adjuster.  Use this factor to your advantage in negotiation – it may take your claim out of the software loop.

12) Software frequently recalibrated – if it’s been months/years since last evaluation, ask to have it re-examined.  You’ll always get the higher figure.