Computer Programs used by the insurance companies and your San Diego Personal Injury Case

The following will give you a general overview of how the computer software programs are used in an injury claim. The claims adjuster will:

Input specific data about you in the computer program;

Input data about their own insured if, for example, the case is a car accident. Here, the computer will analyze the property damage to both vehicles and whether their insured was also injured. The property damage is an important piece of evidence that can help determine if the force of the collision was enough to cause bodily injury;

Input the zip code where the accident occurred. Eventually, the computer program will match your specific demographics to the nearest courthouse in the zip code where the accident happened. It will analyze jury awards in cases similar to yours. This is called “tuning” your injury case, and statistical data has to be continuously fed to the computer program in order for it to work in this way.This also makes having the computer program very expensive for the insurance company using it, and you have to ask yourself why is a particular insurance company spending millions of dollars every year to use a computer program in your injury case;

Input your injuries into the computer program. Your injuries are found in medical chart notes commonly known as International Classification of Diseases, Ninth Edition, (ICD-9 Codes). This is done to evaluate your injuries on a series of computer screens that ask for more information, depending on your injuries documented.

Thus, if you do not have proper medical evidence precisely documented, there is a good chance the computer will not give you credit, or what I call a “value driver,” in your specific injury case. Hence, this is where the crux of the matter lies, because if an adjuster makes a mistake or completely ignores a crucial piece of medical evidence on your injury claim, it can skew, to your detriment, what the computer is allowing as a fair settlement value of your claim.

To make matters worse, if your lawyer is unaware of this, the entire review can either increase the chance that a lawsuit will need to be filed or you will find yourself facing a low value settlement from the insurance company. Now, you can see why the insurance companies tend to like using the computer programs. The programs consolidate the claim review process into an efficient machine and train the adjusters to follow systematic rules of engagement on most injury cases, thereby taking the autonomy out of the claim review process. They remove the “human element” and help foster a cold, calculating negotiation process by the claims adjuster. However, all is not lost. It becomes paramount that your lawyer understands the computer programs and knows how to be proactive in documenting the medical findings in your injury case. Your attorney has to be diligent in following up with the injury claims adjuster to make sure every piece of evidence is being utilized in the claim review process and how to best communicate that to the adjuster. I call it “proving your case to the adjuster through the medical findings,” just like you would if you were showing medical evidence to a jury.

Remember, the insurance company will pay out what the computer dictates. If a soft tissue case is worth sixty thousand dollars because the medical evidence proves it, the computer will have no problem telling the claims adjuster this value.