There is a computer software program called Colossus which is used by many if not most car insurance companies to determine what is "reasonable, related & necessary" treatment, especially in car crash injury claims.
CSC, is the developer of that proprietary application. CSC states the following regarding their program:
"Colossus® is an expert system for assisting adjusters in the evaluation of bodily injury claims. Colossus provides a framework for evaluating injuries, treatment, resolution, impairment, and general damage settlements. Colossus helps adjusters to reduce the variance in payouts on similar bodily injury claims…"
Here we discuss the following issue: what are the factors or elements in the demand package that Colossus utilizes to analyze & determine the settlement value of a car accident case?
The specific factors or elements that Colossus utilizes to determine the settlement value of a car accident case may vary depending on the insurance company and the specific version of the program being used. However, some common factors that may be considered include:
It is important to note that Colossus is just one tool used by insurance adjusters to evaluate claims, and it is not the sole determinant of settlement value. Other factors, such as the specific circumstances of the accident and the negotiation skills of the lawyers involved, may also impact the final settlement amount.
While Colossus is primarily designed to evaluate the economic damages associated with a car accident claim, such as medical expenses and lost wages, it may also consider non-economic damages such as pain and suffering and the impact on quality of enjoyment of life. However, the way in which Colossus calculates these damages is often a subject of debate and criticism.
One of the main criticisms of Colossus is that it relies on a formulaic approach to calculating damages, which may not take into account the unique circumstances of each case. For example, the program may assign a certain value to pain and suffering based on the severity of the injuries sustained, without considering the individual's subjective experience of pain and suffering and other factors that an experienced and skilled advocate can articulate to a trier of fact at a formal trial. Colossus has no voice whatsoever in that context.
Additionally, some critics argue that Colossus may undervalue non-economic damages such as pain and suffering, as the program is primarily focused on minimizing payouts and reducing variance in settlements. This can be particularly problematic in cases where the injuries sustained have a significant impact on the individual's quality of life, as the program may not fully account for the long-term effects of the injuries. Also, certain legal concepts such as the "thin skull doctrine" can be argued by an experienced lawyer under the appropriate circumstances which Colossus would not be able to asses or discover on its own without proper representation.
Ultimately, while Colossus may consider non-economic damages such as pain and suffering and the impact on quality of enjoyment of life, it is important to remember that the program is just one tool used by insurance adjusters to evaluate claims. It is up to the parties involved in the claim to deftly negotiate a settlement that takes into account all of the relevant factual and legal factors, including the individual's subjective experience of pain and suffering and the long-term impact of the injuries on their quality of life.
The specific formula used by the program may vary depending on the insurance company and the version of the program being used. However, it is generally understood that Colossus uses a mathematical algorithm to evaluate the various factors and elements of a claim, such as the severity of injuries, impact on quality of life and enjoyment, medical expenses, therapy, debilitation, headaches, lost wages, liability, pre-existing conditions, geographic location, and settlement history, inter alia.
Based on these and other factors, Colossus may assign a value to each element and use a formula to calculate the overall settlement value of the claim. However, the exact formula used by the program is unknown and not publicly available, and insurance companies may use different versions of the program with different formulas and algorithms. Again, much of what comes out of Colossus depends on and can be manipulated by what is put into it by the adjustor.
It is important to note that while Colossus may use a formulaic approach to evaluating claims, the final settlement value is ultimately determined through negotiation between the parties involved in the claim. The formula used by Colossus is just one tool used by insurance adjusters to evaluate claims, and it is not the sole determinant of settlement value.
(General note and caveat: this article is for general informational and educational purposes, and not to be considered legal advice, which can only be on a case by case basis, and only after a lawyer, has been retained specifically for a matter by specific client, evaluated under the totality of the circumstances of that particular case.)