Getting Colossus to Pay Up: Prognosis and Permanent Impairment

Insurance companies are well-known for offering low-ball to injured parties, especially if they have no attorney. The situation is only worse now that COVID has caused so much chaos in the Courts and economy.

We've learned that insurers rely primarily on Colossus and similar software programs to calculate and justify these ridiculous offers. Without a solid foundational understanding of how Colossus values or devalues claims, it is impossible to counteract this strategy.

Luckily, AutoAccident.com has decades of experience, and we know how to maximize the Colossus value. That doesn't necessarily mean we will recommend you take what Colossus offers. Sometimes, even after we attempt to max out value, the offer is still too low. Today, we will examine a related pair of the best and most overlooked Colossus "value drivers" - Prognosis and Permanent Impairment.

After a course of treatment for an injury, a treating physician is supposed to give a "prognosis" or a forecast of the likely course of the injury in the future. The doctor gives an idea of how successful the treatment was at healing an injury.

In the medical records and reports, prognosis is usually stated in terms of "Good," "Poor," or "Guarded." It is up to the treating physician to make a prognosis for an injury, and the language they use directly affects the value Colossus assigns or doesn't assign to the claim.

Crucially, prognosis must be given for each individual injury. For example, a neck sprain, lumbar sprain, and knee abrasion would each have their own prognosis statement. It makes sense – each injury requires different treatment, heals differently, and has a different chance of long-term recovery or re-injury.

If an injury is completely healed, the treating physician should give the duration of each individual injury. This is the only way to get the Colossus system to allocate the proper severity points for pain and suffering. Clients will miss out on much value without the duration of injury because Colossus simply won't recognize it.

According to Mark Romano, formerly in charge of all Colossus "tuning" at Allstate, the prognosis rating is the #3 value driver in the entire Colossus evaluation. This means that an adequately rendered prognosis will have a significant impact on the value of the claim. It also means an improperly rendered prognosis will receive no value and leave much potential recovery money on the table.

Mr. Romano also revealed that many doctors do not state prognosis ratings in a way that Colossus will value. While physicians typically use the excellent/guarded/poor ratings, Colossus has its own set of five prognosis categories:

• Resolution Undetermined
• No complaint / no further treatment required
• Complaint / no further treatment required
• Complaint / further treatment required
• Guarded (unstable)

The physician's prognosis statements won't be counted if they do not fit Colossus's categories. To make matters worse, the adjusters typically won't reveal if this information is missing. They won't tell you how to get more money from a claim; they will simply assign no value and leave the injured party scratching their head over the low-ball claim value.

Permanent Impairment refers to the lasting effect of an injury that prevents someone from living an everyday life. It is a percentage score, i.e., "10% permanent impairment," based on the American Medical Association's Guide to Permanent Impairment, 5th edition.

Colossus uses the percentage rating in a mathematical formula to determine a dollar value range. These effects are valued in terms of Economic Damages – things like lost wages and working capacity, and Non-Economic Damages – pain and suffering.

The economic damages of a permanent impairment rating are the #1 value driver in Colossus. The damages are calculated using "work-life expectancy," which refers to the average number of years a person is expected to participate in the workforce and earn money. This average number generates the money the injured party would have made at their present employment if they weren't injured.

In the accepted statistics published by Gamboa and Gibson, work-life expectancy is determined for each type of injury. For example, someone with a permanent physical impairment is expected to work an average of 13 years less than a person with no physical impairment. The work-life expectancy is reduced by a further percentage for cognitive impairments and even more for injured parties with multiple impairments.

To calculate the value of the lost work-life, the simple formula is multiplying the impaired person's salary plus benefits by the number of years lost until retirement age. For example, a person making $50,000 per year who was left with a physical impairment would have a ballpark lost work-life expectancy decrease of $50,000 x 13 years lost = $650,000.

The final step is to calculate the diminished earnings of the injured party. When the injured person could work, they likely operated in a diminished capacity due to the injuries. This reduced capacity results in lower wages, less opportunity for advancement, and many other problems.

The Bureau of Labor Statistics gives an average diminished capacity of 33% during the remaining work life of an impaired person. This means that the injured person is entitled to an additional 33% of the value of their labor for the rest of their remaining work life. In certain situations, it may make sense to hire an economist to report on the injured person's future financial life.

An AMA Permanent Impairment Rating is the #1 Value Driver in Colossus, and it is also the most overlooked and unused. The formula used to calculate value uses the impairment rating to get a percentage of a severity point score and reduces it proportionally by an "age discount." The formula looks like this: 150,000 Colossus Severity Points x AMA Impairment Percentage x Age Discount.

Remember that "age discount" refers to savings for the insurance company, not the injured party. Basically, the discount is made to account for less remaining potential work-life and potential years spent suffering due to age.

The age discount is based on a sliding scale. For people up to 25 years of age, there is no discount. These parties have a maximum potential work-life ahead of them. For people between the ages of 25 and 65, there is a 1% age discount per year after age 25. The discount caps at 40%, or 65 years of age.

For example, the Colossus severity point score for a 50-year-old man with a 10% AMA impairment rating would be calculated as 150,000 [base severity points] x 0.10  [10% impairment rating] x (1-.25) [age discount] = 11,250 severity point score.

Once a total number of severity points has been reached, Colossus uses its tier system to assign a value to each point. Colossus sorts claims into nine tiers based on the number of injuries and severity.

At the lowest range, Tier 1, each severity point is worth approximately $0.70. The per-point values increase with each successive tier. At the maximum value, Tier 9, each severity point is worth approximately $4.00.

Based on Colossus's own tier system, our example impairment rating alone is worth $7,875 to $45,000. Failing to provide permanent impairment information leaves all that money on the table!

Colossus does not evaluate severe injuries like brain injuries or facial scarring. In keeping with that trend, Colossus does not give impairment values on five kinds of permanent impairments:

1. Disorders of the brain
2. Disorders of the spinal cord
3. Psychiatric disorders
4. Impairment to facial function
5. Impairment of the skin

An actual adjuster evaluates the permanent impairment value of these kinds of injuries. Even Colossus recognizes when it cannot correctly evaluate the seriousness of an injury's impact.

Prognosis and Permanent Impairment are interrelated but completely different concepts. Each of them contributes its own separate value to the total Colossus valuation. Moreover, Colossus has hidden rules that affect the value determination.

For Colossus to accept an AMA Permanent Impairment rating value, all prognosis statements must be stable. Colossus will not consider a Permanent Impairment Rating if there are any "unstable" or "undetermined resolution" prognosis statements in the claim.

Once again, the adjusters often do not relay this crucial information to the other side, so injured parties and their attorneys are left to balk at the low value. These hidden rules make it even more critical for injured parties to have Colossus-literate representation who can manage cases with an eye for value drivers.

At AutoAccident.com, we doggedly drag the value determination out of the insurance company's shadowy electronic backroom and into the light of day. Our study and experience with the Colossus system have led to this strategy and our proven track record of success for our clients.

^{Editor's Note: updated 11.29.30 Photo by Pixabay MH cha [cs 1522]}