What is Colossus Claims Adjusting Software?
Colossus Claims Adjusting Software is a computer program that is used by auto insurance companies to analyze auto accident claims made against insurance companies and project a case value range to assist insurance adjusters in analyzing claims for settlement negotiations. Colossus was developed and licensed by The Continuum Company. Now a subsidiary of Computer Sciences Corporation, Continuum is one of the largest computer service corporations in America. Colossus is a specialized program sold to insurance companies to “ensure an objective valuation and consistency” when assessing damages for personal injury claims arising out of car accidents. The ultimate purpose of Colossus is to minimize the exposure of insurance companies and enable them to reduce the amount they pay to settle claims made by accident attorneys and auto injury victims.
What Insurance Companies Use Colossus to Evaluate Claims?
In order to use Colossus, an insurance company must first purchase a license. Insurance companies licensed to use Colossus include:
- 21st Century Insurance
- Allstate Insurance
- American Family Mutual Insurance
- American National Property and Casualty
- AXA Insurance
- CNA
- Encompass
- Esurance
- Farmers Insurance
- Federated Insurance Group
- Great American Insurance Company
- Keystone Insurance
- Metropolitan Group
- Mid-Century Insurance
- Motorist Mutual
- MetLife Home and Auto
- State Auto
- Travelers Property Casualty Insurance
- USAA
- Utica
Each of these insurance companies uses the Colossus program differently when valuing personal injury cases. While most use Colossus as an evaluation tool, other companies, such as Allstate, use it almost exclusively when determining settlement value. The weight that is given to the Colossus output also varies from adjuster to adjuster. The more time and experience an adjuster has within a certain insurance company, the more latitude they are given when it comes to staying within the Colossus settlement range.
Other details that vary by insurance company include the program’s baseline set. This is because each insurance company chooses the number of settled cases in a particular region to determine the appropriate settlement range. The baseline for each insurer will also vary based on their prior valuation histories. This will make it clear if insurance companies are disclosing the appropriate verdicts for each case or if they have particularly low values in a certain area.
How Does Colossus Work?
The software requires auto insurance bodily injury claim adjusters to enter specific information regarding a claim including liability, specific injuries, treatment amounts, duties performed under duress, and future treatment probability. Colossus categorizes injuries as either ‘demonstrable’ or ‘non-demonstrable.’ Demonstrable injuries can be objectively verified by definitive medical means, such as an x-ray. Non-demonstrable injuries refer to soft tissue damages, more frequently seen with personal injury claims. Colossus then uses this information to predict an expected verdict range if the case goes to trial only on the issue of damages. Colossus is not equipped to evaluate severe physical trauma, death, and claims with a value exceeding $100,000.
The program requires each complaint regarding medical treatment and all data regarding the claimant’s injuries to be documented in the claimant’s medical records. Attorney and Claimant allegations are generally given no weight as evidence when it comes to injuries sustained or impairment endured. This is why it is absolutely critical that medical providers maintain detailed records of both the objective and subjective findings of the patient and how it affects their daily life. Chiropractors who keep limited records regarding these details will notice their patients receiving consistently lower values for their claims than those of other practitioners who clearly document the presence of muscle spasms, decreased range of motion, and other objective symptoms.
Colossus breaks down each injury sustained by the claimant, requiring the adjuster to input numerous entries in a detailed fashion. The adjuster has limited latitude in what can be taken into account, if there is no information on a specific variable, the value will be zero. This is why it is critical to document every detail regarding:
- Initial treatment
- Each individual injury and/or impairment sustained
- Each prognosis with respect to the individual injury
- The duration of treatment for the individual injury
- Future treatment probability regarding an individual injury.
Because this program was designed to create consistency when adjusters finalize a settlement value; once the data is collected and processed, the claim is compared to similar claims in the Colossus database, and a valuation range is assigned.
Specific Factors Considered by Colossus:
Nature of Pre-Existing Injury
When pre-existing injuries have been aggravated in an accident it may increase the value of the overall claim if properly documented. The respective condition must be documented in a medical record, along with the degree and permanency of the aggravation.
Injury Diagnostics
Because Colossus uses its own descriptive terms for injuries, be sure to use CPT codes when listing injuries in medical records. This will help prevent the adjuster from incorrectly inputting data and ensure your client is fairly compensated.
Initial Treatments and First Visits
Adjusters will be prompted to enter information about the first visit concerning a specific problem, the doctor’s prognosis, any immobilization or complications, and more. Be sure to spare no details when listing this information in medical records.
Prior Injuries and Worker’s Compensation Permanent Partial Disability
Adjusters will request information regarding prior injuries and workers’ compensation claims. While they will be aware of prior claims, they may not be able to identify those treating or the degree of the Permanent Partial Disability (PPD) assigned. It is important to note that Chiropractor PPDs are not accepted under the Colossus system. However, the adjuster will not be able to obtain a “consultation” until all of the information on prior injuries is disclosed and reflected in records of treatment.
Chiropractic Visits, General Physicians and Specialists
Colossus rates treatment based on what they value as “more” or “less” important. This means chiropractic visits are valued no greater than a general physician, whereas visits to medical specialists are considered “more” important treatment, and thus valued higher. If there is a medically documented referral to a chiropractor the value of the claim will increase.
Spinal Treatments
Any treatment of the spine must be documented specifically regarding the treatment, the injury, and why the treatment is relevant. Medically documented needs for aids, such as walkers and crutches, as well as the time of use, are all considered during the evaluation process. Office visits where the doctor does not see the patient will not count as a doctor’s visit. Colossus places a great level of importance on regularity and frequency.
Home Exercise and Physical Therapy
Home exercise can only result in points if it is documented in the medical notes. Physical therapy is categorized by the frequency and duration of each service applied. Be sure to ask and include this when recording your patient’s course of treatment.
Injections and Medications
Colossus is sophisticated enough to distinguish between certain injections and medications for treatment and/or relief of pain. For example, it treats cortisone steroid injections, epidurals, and nerve blocks as separate entities. The specific distinctions of each medication in medical records are vital because the Colossus system adds value to a claim when epidurals and nerve blocks are used. If this information is not reflected in the medical records it will not be considered in the overall claim value. Careful attention is also given to what medications are prescribed and actually taken by the client. Whether you are the prescribing doctor or not, it may be beneficial to the claim to document this in the patient’s history.
Soft Tissue Complaints
There are certain categories under soft tissue complaints Colossus considers compensable; however, there must be evidence of each complaint in the medical records. For example, while pain is not given value because it is assumed, “radiating” pain is considered a separate category that is compensable. Anxiety and depression complaints are considered only if the claimant received treatment or medication for them. Lastly, credit is not given to “possible” problems, only “probable” injuries are considered by the Colossus program. For example, identifying an ailment as “possible carpal tunnel syndrome” will not be entered by the insurance adjuster, whereas “probable carpal tunnel syndrome” will be.
Delay in Treatment
Any delay or lapse in treatment decreases the value of the Colossus claim. The longer and more inconsistent these gaps are, the more the value will be decreased. Any reasons for delay or interruption of treatment should be reflected in the medical records to help protect the patient’s claim value.
Duties under Duress
This area of the Colossus evaluation is one of only a few areas that allows the adjuster to apply a subjective opinion to an overall objective process. Claimants who return to work or attempt normal duties while “under duress” can add value to their claim. For example, returning to light-duty work or mowing the lawn while hurting can both add value to a claim while staying home from work or hiring someone else to mow the lawn does not. Again, the evidence of duties under duress must be documented in the claimant’s medical records.
Disfigurement
This is another area where an adjuster may add their subjective opinion to the claim value. The Colossus program does not create an assigned value for disfigurement but does allow a dollar amount to be assigned for this element. Claims with any type of deformity or scarring can get additional value if the respective elements are clearly documented. Thus, it is important that every scar or change, no matter how small, be documented so the adjuster has access to add value here.
Loss of Enjoyment of Life
This variable is only included if the claimant identifies a specific loss and that the loss is supported in the appropriate medical records. A permanent impairment may be required. For these reasons, it is imperative that the chiropractor interview the claimant and document the expected areas of impact that their patient will have to deal with as a result of the permanent injury.
Aggravating Factors
Colossus also allows adjusters to include specific factors including whether the injured patient was wearing a seatbelt, whether the patient is represented by an attorney, any medical liens on file, high property damage, and aggravated liability such as excessive speed or driving under the influence. While this information does not affect the overall claim value, the presence or absence of such factors can be used by the adjuster to offer the low or high end of a specific range, and in some cases abandon the range altogether. A medical professional can help by documenting any facts reported that may support aggravating factors tending to show high impact or negligence on the part of the defendant where appropriate.
Conclusion
Colossus is a tool that many insurance companies are using to evaluate claims. Medical professionals must be aware of this system and how it works if they want to be reimbursed for medical care at a fair rate. The medical provider must remember to take the time to fully document all of the patient’s complaints, conditions, and treatment. By being aware of and documenting the data that Colossus allows to be factored in, medical providers can provide their patients with a much better chance of receiving a fair settlement offer in their case.
At Simmons and Fletcher, P.C., our attorneys understand the complexities and consequences associated with Colossus and are committed to helping out clients and our client’s chiropractors and other medical professionals when dealing with insurance adjusters using similar systems.
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