Claim Recovery: Guidance for Counsel Maximizing Settlement Offers by - - PowerPoint PPT Presentation

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Claim Recovery: Guidance for Counsel Maximizing Settlement Offers by - - PowerPoint PPT Presentation

May 28, 2023 339 likes •1.61k views

Presenting a live 90-minute webinar with interactive Q&A Leveraging Colossus in Auto Accident Claim Recovery: Guidance for Counsel Maximizing Settlement Offers by Understanding Insurance Adjustment Software THURSDAY, SEPTEMBER 24, 2015 1pm

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The audio portion of the conference may be accessed via the telephone or by using your computer's

  • speakers. Please refer to the instructions emailed to registrants for additional information. If you

have any questions, please contact Customer Service at 1-800-926-7926 ext. 10.

Presenting a live 90-minute webinar with interactive Q&A

Leveraging Colossus in Auto Accident Claim Recovery: Guidance for Counsel

Maximizing Settlement Offers by Understanding Insurance Adjustment Software

Today’s faculty features:

1pm Eastern | 12pm Central | 11am Mountain | 10am Pacific THURSDAY, SEPTEMBER 24, 2015

  • Dr. Matthew J. DeGaetano, Program Director and Founder, Personal Injury Institute, Dallas

Richard P . Hastings, Founding Partner, Hastings Cohan & Walsh, Ridgefield, Conn.

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FOR LIVE EVENT ONLY

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Continuing Education Credits

In order for us to process your continuing education credit, you must confirm your participation in this webinar by completing and submitting the Attendance Affirmation/Evaluation after the webinar. A link to the Attendance Affirmation/Evaluation will be in the thank you email that you will receive immediately following the program. For additional information about continuing education, call us at 1-800-926-7926

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FOR LIVE EVENT ONLY

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Program Materials

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FOR LIVE EVENT ONLY

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Personal Injury Institute

  • Dr. Matthew J. DeGaetano

drmatt@personalinjuryinstitute.com

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THE HISTORY OF COLOSSUS

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  • Computer Software Program
  • The adjuster
  • The program accesses over 10,720

rules

  • The program computes a settlement
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Insurance Industry Application of Colossus

Other Processors

  • TEACH – State Farm
  • Decision Point – Progressive
  • Claims Outcome Advisor (COA) – GMAC & Fireman's fund
  • Injury IQ
  • Claims IQ
  • MYND
  • Injury Claims Evaluation (ICE)
  • And one of the newest XM
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Insurance Industry Application of Colossus

Other Processors

  • TEACH – State Farm
  • Decision Point – Progressive
  • Claims Outcome Advisor (COA) – GMAC & Fireman's

fund

  • Injury IQ
  • Claims IQ
  • MYND
  • Injury Claims Evaluation (ICE)
  • And one of the newest XM
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Insurance Industry Application of Colossus

Other Processors

  • TEACH – State Farm
  • Decision Point – Progressive
  • Claims Outcome Advisor (COA) – GMAC & Fireman's

fund

  • Injury IQ
  • Claims IQ
  • MYND
  • Injury Claims Evaluation (ICE)
  • And one of the newest XM
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What are value drivers?

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Colossus & related software arrives at an evaluation by assigning points to value drivers associated with each injury.

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The actual assignment of points is determined by each individual insurer.

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They become the baseline data by which all injury values are arrived at.

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Each insurer has the ability to manipulate this point assignment and database any time it wishes.

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The points are represented by “value drivers” in a mathematical equation.

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Some of the “value drivers” have multipliers as well.

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These multipliers add significant points to each “value driver”.

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The mathematical equation consists of:

  • Injury
  • Symptoms
  • And other components
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10,720+ and growing…

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Example 1

Headache

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Headache ICD 9

339.21 Acute Traumatic Headache

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Headache ICD 10

G44.319 Acute post- traumatic headache

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Example 2

Radiating Neck Pain

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Radiating Neck Pain ICD 9

723.3 Cervical Radiculopathy

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Radiating Neck Pain ICD 10

M54.12 Radiculopathy, cervical region, M54.13 Radiculopathy, cervicothoracic region

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Example 3

Shoulder Injury

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Shoulder Injury ICD9

840.0 Shoulder Sprain/Strain

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Shoulder Injury ICD 10

S43.80XA Sprain of other specified parts

  • f unspecified shoulder girdle, initial

encounter S43.50XA Sprain of unspecified acromioclavicular joint, initial encounter S23.420A Sprain of sternoclavicular (joint) (ligament), initial encounter

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Example 4

Radiating Low Back Pain

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Radiating LBP ICD 9

724.4 Lumbar Radiculopathy

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Radiating LBP ICD 10 M54.17 Radiculopathy, lumbosacral region, G54.1 Lumbosacral plexus disorders G54.4 Lumbosacral Root disorders, not elsewhere classified

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Example 5

Memory Problems

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Memory Problems ICD 9

780.93 Post Traumatic Amnesia

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Memory Problems ICD 10

R41.2 Retrograde amnesia R41.3 Other amnesia

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Symptoms Accepted By Auto Insurance Companies

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Symptom #1 Radiculopathy

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Symptom #2 Range of Motion Deficiencies

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Symptom #3 Tension Headache

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Symptom #4 Predominant disturbance of emotions (Anxiety, Panic State)

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Symptom #5 Temporomandibular joint disorders

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Symptom #6 Sleep Disturbance

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Symptom #7 Spasm of muscle

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Symptom #8 Other malaise and fatigue (Anxiety/Depression)

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Symptom #9 Dizziness

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Symptom #10 Visual Disturbance

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Symptom #11 Atrophy (Common to Ligamentous injuries – Documented with measuring tape)

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Symptom #12 Stiffness

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  • Which all must be indicated in the

medical records and be specifically stated in the demand from the attorney.

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The Number 1 Value Driver Or Factor For Personal Injury

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The Number 1 Value Driver Or Factor For Personal Injury

  • Diagnoses
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The Number 1 Value Driver Or Factor For Personal Injury

  • Diagnoses
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The Number 1 Value Driver Or Factor For Personal Injury

  • Diagnoses (ICD 9 to ICD 10)
  • The “Type of Diagnoses'”
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Soft Tissue Injuries

  • The current industry percentage
  • f these claims which would

involve “soft tissue” injuries varies between 85 and 90 percent.

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THE CONTINUUM COMPANY

  • Australia based computer software

company creates Colossus.

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THE CONTINUUM COMPANY

Designed to evaluate claims based on:

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THE CONTINUUM COMPANY

Designed to evaluate claims based on:

  • Injuries
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THE CONTINUUM COMPANY

Designed to evaluate claims based on:

  • Injuries
  • Treatment Specifics
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THE CONTINUUM COMPANY

Designed to evaluate claims based on:

  • Injuries
  • Treatment Specifics
  • Symptomology
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THE CONTINUUM COMPANY

Designed to evaluate claims based on:

  • Injuries
  • Treatment Specifics
  • Symptomology
  • Future need for Treatment
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THE CONTINUUM COMPANY

Designed to evaluate claims based on:

  • Injuries
  • Treatment Specifics
  • Symptomology
  • Future need for Treatment
  • Impairments and Disabilities
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COMPUTER SCIENCE CORPORATION

Licensed Colossus from the Australian Firm (Continuum Company)

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COLOSSUS MORE THAN JUST A SOFTWARE PROGRAM It is an Artificial Intelligence Program!

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The Colossus equation is designed to establish:

  • Economic Damages or Special

Damages – Medical Bills & Loss of Income.

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The Colossus equation is designed to establish:

  • Economic Damages or Special

Damages – Medical Bills & Loss of Income.

  • Non – Economic Damages or

General Damages – Pain & Suffering.

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Colossus

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Colossus

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PROVIDERS HAVE BEEN DATABASED

  • The offer it comes up with for claims

you manage this year will be even lower!

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Top 7 reasons why colossus devalued PI cases:

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Top 7 reasons why colossus devalued PI cases:

1. Poor soap notes

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Top 7 reasons why colossus devalued PI cases:

1. Poor soap notes 2. Failed to refer for a second opinion

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Top 7 reasons why colossus devalued PI cases:

1. Poor soap notes 2. Failed to refer for a second opinion 3. Used the wrong terminology

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Top 7 reasons why colossus devalued PI cases:

1. Poor soap notes 2. Failed to refer for a second opinion 3. Used the wrong terminology 4. Used the wrong prognoses

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Top 7 reasons why colossus devalued PI cases:

1. Poor soap notes 2. Failed to refer for a second opinion 3. Used the wrong terminology 4. Used the wrong prognoses 5. Did not objectify findings with diagnostics

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Top 7 reasons why colossus devalued PI cases:

1. Poor soap notes 2. Failed to refer for a second opinion 3. Used the wrong terminology 4. Used the wrong prognoses 5. Did not objectify your findings with diagnostics 6. Did not use active care procedures

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Top 7 reasons why colossus devalued PI cases:

1. Poor soap notes 2. Failed to refer for a second opinion 3. Used the wrong terminology 4. Used the wrong prognoses 5. Did not objectify your findings with diagnostics 6. Did not use active care procedures 7. Poor diagnostic evaluations

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8 clinical tools that we have seen make a significant difference.

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1. Full Flexion / Extension Views

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Clinical Tools that should be used…

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Clinical Tools that should be used…

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1. Full Flexion / Extension Views 2. Lateral Flexion Open Mouth views bilateral

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APOM VIEW Alar & Accessory Ligament Damage

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APOM VIEW Alar & Accessory Ligament Damage

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APOM VIEW Alar & Accessory Ligament Damage

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APOM VIEW Alar & Accessory Ligament Damage

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1. Full Flexion / Extension Views 2. Lateral Flexion Open Mouth views bilateral 3. Flexion oblique views bilateral

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RIGHT OBLIQUE FLEXION VIEW Capsular Ligament Damage

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LEFT OBLIQUE FLEXION VIEW Capsular Ligament Damage

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1. Full Flexion / Extension Views 2. Lateral Flexion Open Mouth views bilateral 3. Flexion / Extension oblique views bilateral 4. Digital Motion X-Ray

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1. Full Flexion / Extension Views 2. Lateral Flexion Open Mouth views bilateral 3. Flexion / Extension oblique views bilateral 4. Digital Motion X-Ray 5. EMG / NCV – Certified Neurologist

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1. Full Flexion / Extension Views 2. Lateral Flexion Open Mouth views bilateral 3. Flexion / Extension oblique views bilateral 4. Digital Motion X-Ray 5. EMG / NCV – Certified Neurologist 6. Diagnostic Ultrasound – Certified Radiologist

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1. Full Flexion / Extension Views 2. Lateral Flexion Open Mouth views bilateral 3. Flexion / Extension oblique views bilateral 4. Digital Motion X-Ray 5. EMG / NCV – Certified Neurologist 6. Diagnostic Ultrasound – Certified Radiologist 7. Proton Density MRI ( Upper Cervical Studies )

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1. Full Flexion / Extension Views 2. Lateral Flexion Open Mouth views bilateral 3. Flexion / Extension oblique views bilateral 4. Digital Motion X-Ray 5. EMG / NCV – Certified Neurologist 6. Diagnostic Ultrasound – Certified Radiologist 7. Proton Density MRI ( Upper Cervical Studies )

8. AMA Guides For Permanent Impairment

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Soft Tissue Injuries and the Attack by the Insurance Companies

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Soft Tissue Injuries and the Attack by the Insurance Companies

  • Most doctors treat Soft Tissue Injuries
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Soft Tissue Injuries and the Attack by the Insurance Companies

  • Most doctors treat Soft Tissue Injuries
  • All doctors should be looking for.

“CONNECTIVE TISSUE INJURIES”

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IV Phases You Should Know

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UNDERSTANDING THE EQUATION

  • No human intuitive abilities
  • Depends on the input of the claim handler

alone

  • Garbage In – Garbage Out
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IN THE ABSENSE OF COMMUNICATION, THE PATIENT IS THE VICTIM

We need to speak the language of Colossus

  • Symptoms
  • Diagnosis
  • Treatment
  • Prognosis
  • Additional Factors
  • Permanent Impairments
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What Is The Second Most Important Factor for PI Cases:

  • Permanent Impairments.
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Permanent Impairment

  • A medical condition resulting from trauma or

work related disease or illness

  • A deviation from normal function of a body

part or organ system

  • Something the body or body part can no longer

perform normally

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Permanent Impairment

Permanent Impairment can only be entered in the software when the injury has become:

  • Stable : Stopped Receiving treatment
  • Static : When a period of time has passed since

treatment has stopped and the condition of the injury has not improved.

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How does permanent impairment differ from disability:

Disability is how the impairment affects and changes the person’s ability to perform, social, or employment demands:

  • Impairment is a medical assessment
  • Disability is a non-medical assessment

NOTE: Colossus is not capable of establishing an impairment rating, only a qualified medical physicians can assess impairment ratings.

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S

Tips and Techniques for Adding Value to Your Client’s Claim with Adjusters who are using Colossus

Richard Hastings Hastings Cohan & Walsh RPHASTINGS@SNET.NET

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The four main players that can affect the value of a personal injury claim and what to do with each party

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The Claimant’s Attorney

S Choreography

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The Client

S Educate

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The Healthcare Providers

S Understanding restrictions and providing detailed medical

records

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The Adjuster

S

Constant contact and updating

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Adding Value Through Your Client’s Medical Records

S Educate your client S Specifically describing pain complaints S How do these problems affect them S Duties under duress S Home health activities and aids

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Value Drivers

S Medical bills SSpecialists SPositive diagnostic testing SBuzz words and key phrases SUse of medical devices and aids

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Value Drivers

SDocumented out-of-pocket expenses SMedical insurance premiums SProperty damage to your client’s vehicle SDocumenting lost time from work SDuties under duress

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Think Like an Adjuster

S Pain S Suffering

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Case Evaluation

S Plaintiffs’ Counsel S Defense Counsel S Mediators and Arbitrators S Claims Adjuster S Peer Review

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What is the Adjuster Doing?

S Know your client’s file S Keep your client controlled, involved and have

them regularly treat to improve their condition

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Intangibles

S The value intangibles bring cannot be stressed

enough

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Putting it all Together

S Client Education S Be proactive in the management of your files S Robust medical records S Detail all client challenges S Constant communication with adjuster

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Adjuster Secrets: Attorney & Adjuster Tips & Techniques That Guarantee Larger Settlements

www.adjustersecrets.com Download FREE Chapter

118

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A resource you may need.

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  • Case issues
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You can contact me directly at:

972-978-2525

Or send me an email:

drmatt@personalinjuryinstitute.com

Personal Injury Institute