Personal Injury: Why Insurance Claims Take So Long

Posted about 4 years ago. 4 helpful votes

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It can take a very long time for an injury claim to percolate through the insurance claims handling process. It is frustrating for the injured person, waiting for a settlement offer, but it is just as frustrating for the attorney who wants to close a case and have a satisfied client. Here's why it takes so long: After all of the documentation of the injury is submitted to the insurance company, insurance company bean counters actually scrutinize all of the medical bills to ascertain whether they are reasonable, necessary and related specifically to the accident related injuries. Then, those medical review notes are sifted into a computer review program. The claims handlers comb through the medical records and other documents looking for key indicators that are fed into the computer data base. For example, a "subluxation" diagnosed by a medical doctor is given one rating, while the same subluxation diagnosed by a chiropractor is given a different rating. Periods of disability, the extent of lost wages and other aspects of the injured person's diagnosis, prognosis and treatment are all keyed into the system in accordance with data codes. Then the program kicks out a settlement range. This is reviewed by a supervisor, before the adjuster is given authority to enter into negotiations with your attorney. Some insurance companies still deny that a computer performs the evaluation. However, the "Colossus" program was one of the first developed in the early 90's with the goal of making insurance claim evaluations more efficient and uniform, leaving less to the discretion of individual adjusters. However, at several levels, even though the process has largely been computerized, there is human review, and when the insurance company individuals are inevitably unavailable due to vacations, frequent seminars, meetings, leaves of absence, sickness and many other excuses, the claim does not move forward.

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This guide is offered for informational purposes only. It is not offered as, and does not constitute, legal advice. Laws vary widely from state to state. You should rely only on the advice given to you during a personal consultation by a local attorney who is thoroughly familiar with state laws and the area of practice in which your concern lies.

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