Negotiating with Computers | Part 2

by | May 17, 2023 | Negotiating with Computers

How Value Drivers Drive Settlement Value

Value drivers are the pieces of information from the claim that will ultimately determine what the insurance company will settle your case for. If you do not know how to extract this information from the records and properly format your settlement demand to present that information, then you will not get the maximum settlement value.

The Difference Between Value Drivers and Factors

This week we are going to take a deeper dive into understanding how Colossus is working behind the scenes. In doing so, we will talk about value drivers and factors. Before we get underway, it is important to note that the words value drivers and factors are often mistakenly used interchangeably.

Value drivers are the pieces of information that can be entered into Colossus that will be given value. This primarily includes the ICD codes, CPT codes, and complaints. The whole person impairment rating is also a value driver, as are duties under duress and loss of enjoyment of life.

Factors are what will determine how much value is given to the value drivers. This includes everything from the age of your client, the location of the incident, property damage amount, gaps or delays in treatment, and treatment modalities. We will take a deeper look into Factors in our next article.

Value Drivers + Factors = Settlement Value

Remember that Colossus is essentially a complex mathematical formula. Based on what is entered into the program, a settlement range will be generated to resolve the case within. The more plugged into that formula, the greater the settlement range.

Inputting information into this formula is accomplished via the value drivers. Colossus then assigns a specific number of points to every value driver that is entered into the program.

It is understood that each value driver has a pre-assigned number of points. This includes items such as injury codes, types of treatment, impairment rating, and duties under duress.

More serious injuries are given a higher number of points than something such as general back pain, just as surgery is assigned more points than massage therapy.

Based on the factors associated with the case, the program then assigns a dollar value to each point. The dollar value assigned is dependent on the factors, including whether your client is male or female, their age, liability issues, and whether you will file in a conservative or liberal jurisdiction.

This is why clients with similar injuries and treatment may receive very different offers.

Negative factors will reduce the dollar value assigned per point, such as delays or gaps in treatment, comparative fault, income level, and among others. The result is a settlement range, typically with a 20% spread, that the adjuster cannot exceed to resolve the claim.

The number of severity points assigned to value drivers may be fluid at some insurers. Meaning that a younger client is assigned more points than an older client even though they suffered the same injury. At these insurers, the factors in the case will determine how many severity points are assigned to the value drivers and the dollar value assigned to the drivers.

As we all know, delays and gaps in treatment kill the value of a case, so consider the following example.

Client A is the driver in a low-end collision and suffers lumbar sprains and strains. They go to treatment immediately and undergo three months of chiropractic and physical therapy treatment. Client B is the passenger and has similar injuries, yet delays going to treatment for two weeks. Fewer severity points will be given to Client B even if they experienced identical injuries, treatment, etc. A lower dollar value will also likely be assigned to those value drivers. 

As discussed in previous weeks, Colossus has built-in expectations for the type and length of treatment required to resolve an injury. This is why an adjuster will say they are not paying for treatment past a certain date. Colossus will not assign any points to treatment it determines to be excessive.

Since the adjuster is not able to settle above the range generated by Colossus, their personal beliefs or opinions are irrelevant to the matter. The same holds true for types of treatment. If your client undergoes stem cell therapy, you may find it difficult to get the carrier to accept the treatment since it is a newer treatment method. Remember that all of this is happening within the Colossus program and not the brain of the adjuster.

Consider one final example for the time being. If your client is prescribed pain medication, this is a positive value driver. More points will likely be assigned for medication if your client is more significantly injured (a variety of diagnosis to different body areas). This is a good example of how the injuries and treatment work together to build claim value.

Categories of Value Drivers (Damages)

Colossus has four distinct categories of damages: trauma, permanent impairment, duties under duress, and loss of enjoyment of life. Trauma is the most heavily weighted of these categories, with permanent impairment coming in second.

Since we covered the other three categories in previous articles, it is time for us to turn our attention to how injuries and complaints work within Colossus.


Trauma represents the injuries your client has been diagnosed with as well as the treatment they receive as a result of those injuries.


Complaints are the objective signs of the injury and primarily help drive value in non-demonstrable injury claims. Complaints include muscle spasms, TMJ pain, headaches, dizziness, and visual disturbance, among other others. It is imperative to include a section in your demand that specifically lists the complaints discussed by the providers.

Ideally, the MD on the claim will see your client at least once a month and go into detail regarding what complaints your client is still experiencing, how it is affecting them in their day-to-day life, and how the treatment is working, or not, to resolve the issues. If the doctors are not going in-depth on the complaints, the adjuster may consider them to be of uncertain duration. If this happens, they will not enter the complaint into Colossus or include the duration being less than a month.

Diagnostic Codes

Undeniably, the biggest contributors to the value of your client’s claim are the diagnostic codes used by treating physicians. Colossus assigns severity points based on what is entered into it. Understandably, an ICD code of M54.2 is worth significantly less than M75.101 for a rotator cuff tear.

If the doctor does not list a diagnostic code in the records or billing, Colossus treats the injury as if it never occurred. This is true in situations where the doctor discusses the injury in the narrative but fails to provide the diagnostic code. An adjuster will not place value on injuries not formally diagnosed within the records and bills.

It is important to note that physical therapists (those without a doctorate), massage therapists, and nurses are not allowed to give a diagnosis in most states. Therefore, an adjuster will not consider any diagnosis given by these individuals.

You and your staff should be highly familiar with the ICD codes your clients are likely to be diagnosed with. It is imperative to understand what codes are more serious than others so that you can list appropriately in the demand.


In addition to the requirement of a formal diagnosis, the patient must also receive corresponding treatment for each injury. No treatment, no value. The rationale for this is understandable from the perspective of the insurance company. If someone is truly injured and suffering pain, they will seek out treatment. If a person is not getting treatment, then there is no injury in the eyes of the insurer.

It is worth sitting down with providers you work with on a regular basis to explain this so they provide more information regarding what the treatment is for, especially with physical therapists.

The treatment a person undergoes will work hand in hand with the diagnosis to be the biggest contributor to the overall settlement value. This is not to say simply racking up treatment visits will increase the settlement value. Colossus has built-in triggers to flag certain types of treatment, length of treatment, and treatment claimed to be duplicative in purpose.

Based on what ICD codes are entered into Colossus, the program has pre-defined expectations for the type and length of treatment needed to resolve each injury. As all injury attorneys are a testament to, clients experience injuries differently. Some fully recover after a couple of months of conservative treatment, while others with similar injuries may never reach pre-accident condition.

If your client undergoes treatment longer than these built-in expectations, Colossus will not give it value. It will be completely disregarded as excessive. Your client also risks being referred to as a malingerer by the adjuster. The same is true for the type of treatment the program expects your client to receive. Do not expect the insurer to give value for newer treatments, such as stem cell therapy.

Wrap Up

As we have hopefully made clear, you need to take the time to understand what value drivers are and that you need to format your demands to make it as easy as possible for the adjuster to find them. Otherwise, you are going to leave money on the table in every case.

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