How To Counter Colossus for Personal Injury Settlements
Insurers use Colossus to make unfair settlement valuations, now ZEUSclaim is on
your side!
Basic Overview:
The guidelines for processing private health insurance and Medicare claims
differ drastically from personal injury and auto accident claims. In fact, the
data required is so different that medical experts need two different electronic
health records.
Insurers hired consultants who created "Business Process Improvement" which
included the development of Colossus, the first software program that insurance
companies use today to evaluate bodily claims. Unfortunately for the injured,
the software is based on their own set of guidelines that is not the same as the
private insurance or Medicare guidelines that physicians use, and has this has
led to lower settlement valuation.
Doctors, lawyers and injured parties are at a severe disadvantage as standard
medical record and documentation systems based on private insurance and Medicare
guides are not designed to exchange full data for valuation into Colossus.
The Consumer Federation Of America published a recent report stating: insurance
companies make broad-scale lowball claims' payments to injured consumers that
are less than what they should receive under their insurance policies.
http://www.consumerfed.org/pdfs/Studies.ComputerClaims06-04-12.pdf
An
18-month targeted National Association of Insurance Commissioners (NAIC)
multi-state market conduct examination of Allstate's claims handling practices,
found the insurer software is BIASED and such Tuning Bias de-values injury
claims. This investigation was part of what resulted in Allstate agreeing
to pay a TEN MILLION DOLLAR ($10,000,000.00) Regulatory Settlement.
These Decision Point codes are used by auto insurers but are not part of private
insurance or Medicare guides:
10,720 Decision Points
14,357 Value Drivers
27,125 Severity Drivers
26,350 Standard Multipliers
33 Liability Drivers
15 Additional Increase Multipliers
Case Maximizers
Injury Severity Points
Prolonged Modifiers
The formula used by insurers to determine settlement valuation is called: "The
Point To Dollar Translation Percentage Multiplier". This is a process of
determining the settlement value of claims by translating the Decision Points
into settlement dollars based on each insurers rate and formula.
Furthermore, the insurance company's software assigns different codes and values
in the following categories:
Injury Severity Types & Effects (26
codes)
% Whole Person Impairment (represents
high value)
Duties Under Duress (60 codes)
Loss of Enjoyment (60 codes)
Administrative Codes
Legal Codes
Liability Drivers (33 Drivers)
Economic Codes
To
incorporate these codes in BOTH the doctors records as well as mirror them in
the attorney demand letter, we have created the ZEUS System so when doctors and
lawyers use ZEUS, they are able to present the insurer codes in the correct
terminology, format and sequence to interface and input value into a Colossus
claim.
Zeus assembles the insurer codes in both the medical and legal records on injury
claims.
Physicians should refrain from using record systems based on government Center
For Medicare Services guidelines on their injury patients as they are not able
to provide a sufficient exchange of insurer Decision Points to convey and input
data into an injury claim.
Data is missing or interpreted differently, collaboration is limited; it takes
longer to communicate with insurers and is not efficient. Exchanging data can be
a challenge due to the difference between private and Medicare insurance guides
and Colossus guides, language barriers, different specifications of formats,
sequencing and varieties of categorizations that differ from the private and
Medicare systems.
ZEUS should be used in personal injury cases to counter Colossus by identifying
the Decision Point and Value Driver Codes in both the doctor's documentation and
lawyer's demand letter to assemble the points in the correct terminology, format
and sequence to exchange information, interface and input added valuation into a
Colossus claim.
Simply stated; if the attorney or physician do not incorporate these codes and
factors, the windows' of the insurers' software do not open and compensation
associated with these injuries and factors is lost.
Zeusclaim is a physician record system for patients injured in auto accidents
and Zeusdemand is the legal system for the plaintiff attorney. When used, the
Zeus injury claim system will assemble the maximum amount of decision point
codes to open the value (dollar) windows and increase the settlement valuation.
EASY APPLICATION:
We have created Zeusclaim medical and Zeusdemand record systems for both
physicians and attorneys to document the complex medical, administrative, legal
and economic factors of a Colossus claim and assemble them to exchange the
factors and input added valuation into a Colossus injury claim.
GET THE HIGHEST, FAIREST SETTLEMENT VALUATION WITH ZEUS.
PHYSICIAN'S:
Use Zeusclaim electronic medical record (EMR) system on your personal injury
cases. It works on any computer or iPAD application and is cloud based. Upload
the VALUE DRIVER CODES, Decision, Validity & Severity Points to your computer
and backup on our our server which stores the electronic file in a paperless
application and converts your input notes into the medical documentation
containing the value driver codes. Data is accessible at any time.
ATTORNEY'S:
Use Zeusdemand CLAIM FINALIZATION AND DEMAND PRODUCER to assemble the
administrative, legal and economic code factors of the claim and then the Zeus
functionality will automatically bring the medical codes in to the demand to
generate added valuation.
The Zeus system interprets the data, incorporates the codes, uses the correct
phrases & terminology and formats the medical report and demand letter to
exchange the data in the manner required to sequence with the insurance
company's software and input the full code settlement valuation.
Zeusclaim and Zeusdemand have averaged an increase in settlement valuation by
4.5 times!
