Negotiation with Computers | Part 3

by | May 17, 2023 | Negotiating with Computers

Factors that Drive Case Value

Are you using the factors in the case to your advantage? Or are you unknowingly letting them devalue your client’s case so both of you walk away with less money?

A Quick Recap from Last Week

Remember that factors will determine the dollar value assigned to the value drivers. There are both negative and positive factors and all of them will build or reduce claim value. Value drivers are the pieces of information that can be entered into Colossus that will be given value. The total of the value drivers will determine what the case is settled for.

How Doctors Influence the Factors

The physicians your clients see are a factor by themselves, but they will also ultimately determine what value drivers are entered into Colossus and the interplay of how various factors build case value.

Remember that if the doctor does not put value drivers in the records, such as ICD diagnosis, CPT codes, and discuss duties under duress, Colossus treats them as if they never occurred. Quality records are worth more than their weight in gold. If you have been stumped why you received a low offer in an otherwise great case, it likely came down to the records [and your narrative style settlement demand].

While it may be a controversial opinion, you should refuse to work with providers that do not properly document injuries, treatments, and effects on their patients’ lives. If they expect you to work for them so that they get their lien paid, they need to uphold their end of responsibility and take the time to produce quality records.

One of the primary ways Colossus accounts for physicians is in the type of medicine they practice. The treatment and opinions of chiropractors are given significantly less weight than medical doctors, especially specialists.

Colossus will not give any credence to a future needs opinion given by a chiropractor. This must come from an MD. This is why every client should see a pain management type doctor to reinforce the injuries, mechanism of injuries, treatment, and complaints.

Doctors can become a negative factor within Colossus if they are believed to give more care than needed, adding CPT codes on the billing that were not actually given, or undertaking otherwise shady business practices. Colossus has an add-on program that tracks every provider/doctor in the country. If a provider is blacklisted, you can kiss any chance of a good offer goodbye.

You Are a Factor

In the same way that Colossus tracks medical providers, the program also tracks the performance of personal injury attorneys. Attorneys that accept lower settlement offers than the norm will be made lower offers right from the start because the insurance companies know they will not fight to get fair value. These settlement mill-type firms are loved by the insurance industry because the make offers in line with what they offer unrepresented claimants.

If you have a history of taking claims all the way through trial, you will get systematically higher offers. Insurance companies will quickly learn that they cannot get away with settling claims for unfair amounts. It is unclear exactly how this works within the Colossus program, but it is likely in the form of giving a higher dollar to each value driver. You should be taking at least two or three cases to trial every year to make a positive impact.

Treatment Delay & Gaps in Care

Colossus considers a delay in treatment to be more than four days following an accident. This is a very short period of time. If your client does not receive treatment until the fourth day or later, this will negatively affect the number of severity points assigned for every single value driver entered into Colossus. The longer the delay, the fewer points are assigned. What Colossus determines to be a gap in care depends on the injuries and treatment modalities they have been undergoing.

While this is something you rarely have control over with a client, there are ways in which you can make up for the delay. If the client avoided going to work, caring for their children, or simply laid in bed for several days, have the doctor document this extensively in the initial treatment records.

Delays also occur when a client thinks they should see their primary care physician first and cannot get an appointment right away. Have them document this! While there are never any guarantees, it does give you a chance to avoid Colossus devaluing the claim.

The same holds true for gaps in care. If the client does not go to treatment for a week but follows their doctor’s advice of bed rest and ice packs, this is not a gap in care. Of course, this assumes the doctor documented this in the records.

Home exercise is a very common reason clients may have a perceived gap in care. In reality, this not only proves there is not a gap in care, but this is a treatment modality that will be given value by Colossus. This can turn the tables of devaluing the claim to actually increasing the value of the claim.

Case Location Matters

Colossus is formatted to take into account whether the case will be filed in a conservative or liberal jurisdiction. Insurance companies keep track of jury verdicts and program this information into Colossus based on county. This will ultimately affect the entire case value one way or the other since factors are what determine the dollar value assigned to the value drivers.

If you have the option to file in a liberal county, or one in which jury verdicts are traditionally higher, this needs to be put in the demand. The adjuster will enter this county into Colossus and it has the potential to increase the settlement. This is also one of the many reasons similar cases in different areas can result in different offers.

Colossus evaluates the case based on the value drivers inputted into the program. The value drivers are weighted. For example, if the at-fault was driving while intoxicated, the value drivers are given greater weight. The same is true if you are in a plaintiff-friendly jurisdiction. A defendant-friendly jury population will have a negative effect on the value of the case.

Vehicle Damage

Colossus takes into consideration the severity of the impact. With most of the claim evaluation programs, this is simply in the form of Minor, Moderate, and Severe. This determination is subject to the bias of the adjuster. They will likely rely on the damage described in the traffic accident report if your local departments use a number scale.

It is not clear how the severity of impact affects case value, though more severe impacts will help support the mechanism of injury in complicated cases.

It has widely been reported over the years that claims involving less than $1,000 in property were automatically turned over to the carrier’s special investigations unit. Since a number of states require insurance companies to notify claimants if a case is being handled by an SIU adjuster, we know this is false. Note that some carriers will not make an initial offer above $5,000 for low impact claims, regardless of what is presented in the demand.

Nonetheless, claims with low property damage need to be addressed. There are things you can have your client do that will boost the value of the case. If the original property damage estimate comes out under $1,500, you should have your client take the vehicle to an independent appraiser or body shop. Make sure the body shop is only replacing parts with OEM parts. The independent estimate should come out significantly higher.

Keep in mind that it is sometimes worth having an independent appraiser perform the estimate and use someone that can opine on diminution of value claims as well.

It is well worth your time to befriend a body shop in your area and get to know them. Not only can you send them clients, but they can also refer you some as well! I have only ever known one personal injury firm that does this.

Colossus Demands

A properly formatted demand gives you the best opportunity to settle for maximum value, spend less time negotiating, and resolve more cases in less time. As is hopefully clear at this point, Colossus generates a higher settlement range the more information that is inputted into it. If you don’t know what to put in the demand, you are leaving money on the table in every case.

Clients that walk away with bigger and faster settlements are more likely to refer their family and friends to your firm, as well as write positive reviews on Google, Yelp, and Facebook. Additionally, bigger settlements mean you will not have to ask medical providers for big reductions. Doctors that get paid more will send you more clients! Free marketing while you make more money with less work.

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