“As far as the Colossus is concerned, the hospital treatment is equivalent to an average office visit.”
Those of you who have practiced law since the ’90s have seen an average dollar amount near $15,000 per claim. Now, you are lucky to get $5,500. Looking at the rising costs and prices not going down, what is the answer to the current drop per claim over 20-plus years? Well, the answer is simple. Insurance companies are a lot smarter, and rely on the new soft ware, Colossus, to evaluate personal injury claims. Ever since its creation, Colossus has been put to use by all the major insurance companies, including Allstate, State Farm, Progressive, Geico, Mercury, Property and Casualty, and Kemper.
Colossus is broken down into three categories. The first category is the value drivers; these are the symptoms that are associated with the car accident injury. Once an individual is involved in a wreck, they are going to develop the symptoms and the example is listed as concussion of the head, dizziness, headache, loss of sensation, burning pain numbness in the hands and legs, common neck and back pain, even bruises and broken bones. All of the symptoms listed will earn settlement points by the Colossus soft ware, therefore it’s imperative that your doctors mark and question the patient for each specific symptom they sustain as the result of the accident.
The second category includes the diagnosis sprain/strain, scaitica, ligament laxity, disc degeneration, headache, ankylosis of the joint, segmental dysfunction and the list goes on pending the injuries of the client. However, many of those diagnoses are missed by physicians, especially at the hospitals. The hospitals are there to clear the patient for a life threatening emergency, such as bleedings, fractures and dislocations. As far as the Colossus is concerned, the hospital treatment is equivalent to an average office visit and that’s why they release the patient with no prescribed narcotic meds and poor write up of the X-rays that are necessary to establish a dysfunction in the structural foundation of the spine, whether it’s cervical (neck) or lumbar (low back), which will always show up on the imaging study consistent with the diagnosis.
The third category is the impairment rating, which details how much of your client’s whole body will result in loss of function aft er the car accident. The impairment is given in percentages and follows the protocol of care, such as symptoms, diagnosis, ranges of motion, disc bulges, disc herniations, loss of enjoyment of life and loss of domestic duties. For example, John Doe has two herniated discs of his neck as shown on the MRI. He is not able to do carpentry as he was able to prior to the accident. He has 50 percent loss of use in his left arm, which is his dominant arm. This patient would qualify under Category 3 in the impairment guideline.
Finally, the documentation lies heavily in the hands of the physician who prepares the final narrative report listing the diagnosis based of the symptoms that will result in the impairment. Diagnosis will dictate the amount of care your client needs, so if your doctor gives you sprain/ strain, as your final diagnosis your client cannot possibly have a long-term whiplash injury that will last a year or two. Those of you who sustained a sprain injury working out at the gym know those injuries go away fast with the use of ice and rest. Then why is your client continuing to have residual pain and suffering after they have been treated for 90 days or so and receiving pain management aft er? Obviously, it is more than sprain/strain that caused the patient’s complaints.
Review your case management and underline each condition case-by-case and identify the matching category that your client will fall under to obtain the highest possible settlement that they deserve. After all, we are all professionals who have to defend the interest of our client who likes and trusts us. Dr. Alan Khiger
