CORONAVIRUS UPDATE: What We Are Doing to Protect Our Clients

What is Colossus?

keyboardWhat does Colossus Do?

Colossus is an “artificial intelligence” software program used by insurance companies to lower the amount they pay out on auto accident insurance claims. Colossus and similar programs evaluate nearly all auto accident injury cases. However, there are certain kinds of injuries that Colossus will not evaluate. When these injuries are present, the claim is removed from Colossus and given to an adjuster for evaluation.

Adjusters can set Colossus to intentionally underpay claims, typically by 12-20%. This is the main way the software saves the insurance company money. This intentional underpayment of claims is often bad faith, or failure to fairly, promptly, and reasonably settle the claim. We don’t agree with this method of claim evaluation because it unfairly tilts the table in the insurance companies’ favor. However, these systems are a fact of life in the current insurance industry.

Throughout this series of articles, we will take a deeper look at this software and show that, with the right knowledge, the Colossus system can be used to your advantage or even circumvented if necessary. At AutoAccident.com, we know how to present information to get the best result from Colossus, and how to get your claim out of Colossus if a fair evaluation is impossible.

Where, When, and Why Did Colossus Originate?

Allstate created the Colossus software evaluation model in the 1990s. Twenty years ago, prior to the advent of Colossus, adjusters were responsible for reviewing and assigning the value of each and every claim. It was real people reviewing the claims. After Colossus, a machine evaluates the claims and tells the real people what to say.

These programs save the insurance companies a huge amount of money by allowing companies to "tune" down the possible range of claim values that the system generates. For example, an insurance company that is 10% short in a business cycle can tune down all the system's payout offers by 10% to make up the shortfall. As a CSC Marketing Powerpoint for Colossus, obtained in litigation, stated:

“What does Colossus really do?"

  • Lowers indemnity payouts
  • Lowers loss rations
  • Improves competitive pricing ability
  • Increases surplus/profitability
  • Can improve best’s ratings
  • Generates consumer savings
  • Creates additional sales opportunities
Other Versions of Software That Accomplish the Same Goal

Today, there are several claims evaluation software programs, the most popular being Colossus, ClaimIQ, and Claims Outcome Advisor. Each program works a little differently, but they are all built on the Colossus model and made to achieve the same goal.

Colossus’s Internal Point System

Colossus evaluates claims based upon a severity scale by providing weight to injuries and other factors in the form of “severity points.” Injuries or “factors” do not have specific monetary values. Instead, each injury is given a certain number of severity points. The value of each point changes based upon the number of other severity points in the claim. The more points per claim, the more value each point in the claim has.

The system totals all the points to give an internal Colossus score for the claim and uses complex algorithms to assign a dollar value to this point total by weighing massive amounts of data. Essentially, the system programmers assign an amount of severity points to an injury, and the insurance company sets the sliding dollar value per point.

Colossus Factors

Colossus’s internal point-based system assesses injuries in terms of "Colossus Factors." The system uses 720 different diagnoses and approximately 12,500 of these factors to determine general damages in a case. Each factor represents a basis for valuing the claim, such as diagnoses, severity, length of treatment, pain ratings, and other information taken from sources like medical records. Adjusters enter the information into the program like a video game, complete with an enjoyable interface and sound effects.

To do the data entry, the adjuster uses something called a “Dissection Sheet, with the Dissection Sheet and writes down the first 60 factors listed in the demand. Accordingly, only the first 60 factors in the demand will be entered into the system, greatly limiting the value of the claim. Moreover, Colossus has typically only allowed seven diagnoses per claim. Thus, claim value will dramatically decrease if the information in the demand is not properly ordered.

Jurisdiction and Verdict Data

To generate values and weighting, Colossus and its successors have extremely sophisticated algorithms that track every kind of information that can affect what a claim is worth. For example, the algorithms track the county where the accident occurred, recent settlement values for similar cases in the area, and recent trial verdicts in the local Court.

The insurance companies will share this data with one another. The resulting data treasure-trove gives the insurance companies an edge against attorneys and accident victims. The companies sharing this data can "tilt the table" in their favor without the rest of the world knowing what they've done.

Using Attorney Data

Colossus’s tracking algorithms also track attorneys and law firms. The program knows the record of each attorney - how eager they are to go trial, how often they win, and their trial verdicts. It does this for every attorney and firm and often tracks individual paralegals as well. By building these profiles of aggregated data, the program can very accurately determine what course to take with a given law firm or attorney in order to get the result the insurance company wants. In some cases, the programs will even generate "negotiation advice," for adjusters.

Dealing with Colossus

It is clear that anyone seeking fair treatment from an insurance company needs to know how to navigate the Colossus landscape. Leaning on research and investigation by vanguards in the legal field, AutoAccident.com has developed a tried-and-true strategy for dealing with Colossus. This strategy has two parts: giving Colossus the right information to get a good result, and getting the claim out of Colossus if a fair evaluation is not possible.

As a preliminary matter, we determine if a claim is being evaluated by Colossus or a similar program. It is typically the default in most auto accidents without death or extremely serious injury, and these days, adjusters will often confirm that they are using claims evaluation software.

From the beginning, we keep track of factors such as property damage, injuries, and treatment to make sure that the values and records accurately reflect the facts in ways that will make them more valuable to Colossus.

Once we know the claim is in Colossus, we tailor our demand to present the most valuable information to the adjuster in the right order. Due to the use of the aforementioned “Dissection Sheets,” we have learned which information to put where in the demand to make sure the biggest value drivers end up on the Dissection Sheet. If all the right factors make it into the claim, the settlement value will be maximized.

Follow up with the adjusters is also extremely important. Most adjusters are overworked and will miss entering information. In fact, documents obtained in the case of Grong v. Farmers Insurance Exchange showed that adjusters had a 0% accuracy for entering data into Colossus. Therefore, it is crucial to have detailed follow up to make sure adjusters have entered all the information in the proper way. If the right factors are missing, the claim value will drop.

Getting Out of Colossus

Sometimes, Colossus simply does not allow for a fair evaluation of a particular claim. This could happen for many different reasons, such as adjuster mishandling or restricted claim value based on jurisdiction (location). When these situations occur, we take steps to get the claim out of Colossus and into the hands of an adjuster.

To do so, we first check if any injuries present are one of the approximately 24 categories, diagnoses, or injury types (Colossus Factors) that Colossus doesn’t evaluate. These injury types are:

  1. Death
  2. Quadriplegia
  3. Paraplegia
  4. Brain Injuries
  5. Spinal cord injuries
  6. Neurodegenerative/Autoimmune conditions
  7. CRPS
  8. Spinal instability
  9. Inner ear injury
  10. Dental Injuries other than TMJ
  11. Psychological injuries other than mild depression or anxiety
  12. Scarring, especially to the face
  13. Disfigurement
  14. PTSD
  15. Dog bites
  16. Burns
  17. Internal organ damage
  18. Breast damage from seatbelt
  19. Auto vs. pedestrian cases
  20. Injured party heart attack
  21. Inhalation of chemicals
  22. Food poisoning
  23. Miscarriage/pregnancy complications
  24. Cases involving celebrities and professional athletes

Many times, the adjuster has incorrectly entered the information and missed one of these factors. If these factors aren’t present, then the only way to take the claim out of the Colossus system is to file a lawsuit in court. That way, the value of the claim will be decided by a jury of 12 human beings, not a computer algorithm that cannot understand pain.

Photo by Kaitlyn Baker on Unsplash:mh bw eas [cs 1476] cha
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