The NFL teams handed these lawsuits over to their business insurance companies – including Travelers, to defend the lawsuits. Not only did Travelers refuse to defend those claims against their insureds, the company actually filed suit seeking a declaration that they had no obligation to defend against these new, “unexpected” claims.

Sometimes, insurance companies will resort to much simpler tactics to save on claims, such as misidentifying or misrepresenting the type and amount of coverage that is available under a policy. In a recent situation in South Dakota, a woman who was seriously injured in a motor vehicle accident submitted a claim to her own insurance company – a Travelers Insurance subsidiary – for settlement. 

When asked for a full copy of the insurance policy, the company allegedly provided a document that ended on the page prior to the detailing of $1 million in uninsured/underinsured motorist coverage that the woman actually had. Eventually, this resulted in a “bad faith” lawsuit against the Travelers subsidiary and a jury verdict that included $2.75 million in punitive damages against the insurance company for its actions.

Computerized Claim Evaluation

Travelers Insurance is just one of many automobile liability insurance companies that use the Colossus claims evaluation software (and similar programs) to place dollar values on individuals’ personal injury claims.  These programs have been around for more than two decades now, and have become very popular with insurance companies for one simple reason – they save the insurance companies money.  There are a couple of different ways that they do so.

First, these computer claims programs save insurance companies money by saving them time. Properly and fairly evaluating an injured person’s claim takes time and effort – thoroughly reviewing the evidence of their injuries and the consequences of their injuries mean a careful examination of medical records, wage loss information, and reports from those who know the injured individual on the negative impacts from their injuries. 

“Time is money” for the insurance companies, however, and rather than paying an adjuster to spend four hours reviewing a claimant’s submitted medical records and other claim documentation, the insurance companies would sooner pay that same adjuster to spend a half-hour inputting “injury codes” and numbers into a computer program that spits out a claim value range that limits the adjuster’s settlement authority. “Efficiency” goes up, while adjuster payroll costs – and claim evaluation accuracy – go down.

Second, Colossus and similar programs become “black boxes” into which numbers are input and checkboxes are checked and from which claim value numbers are output with no clear explanation of how they are calculated. If it’s been determined that a particular injury has a base value of $15,000 and a finding of “muscle spasms” in the medical records adds a 5% “bonus” value, then it becomes all too tempting for the insurance company to save money on claims the next year by simply tweaking those numbers to $14,000 and 4.5%.

 

An experienced personal injury attorney will be prepared to prove and vigorously argue for thorough and complete client claim valuations. However, many folks handling their own claims (and even some inexperienced attorneys) many simply accept the valuation that Colossus has produced.

Autoaccident.com Cases, Settlements & Verdicts Against Travelers Insurance

A few years back, the Law Offices of Edward A. Smith (Autoaccident.com) represented a schoolteacher in her 50s who was injured in a rear-end traffic collision that was caused by a defendant insured by Travelers Insurance.  Liability for the accident was clear and undisputed. However, Travelers – and the defense attorney hired by Travelers once the case entered litigation – insisted that the collision did not have enough force to cause the significant injury symptoms that our client suffered.

Although the collision resulted in less than $5,000 in repair costs to our client’s vehicle, she immediately experienced persistent low back pain after the accident.  Because she belonged to a health insurance organization (HMO) that tries to keep costs down by pinching pennies on patient care, she initially only received a limited amount of “conservative” care – some medication and a handful of physical therapy sessions.  When Travelers was provided updates on our client’s initial course of medical care, it became clear that they were giving her claim a very minimal initial value.

A Change in Care and a Change in Claim Evaluation

Having dealt many, many times with our client’s HMO in the past, we encouraged her to overcome their penny-pinching ways by becoming the “squeaky wheel” that’s often necessary to get additional testing and treatment from that type of medical provider. 

Eventually, her doctors agreed that she needed an MRI exam of her lumbar spine, and a disc bulge – fortunately not a severe one – was revealed as the source of her persistent pain. This diagnosis also spurred her provider to authorize a more adequate amount of physical therapy to help our client rehabilitate from her injuries and reach a stage where she no longer had persistent symptoms.

Travelers Insurance, however, had become stuck on its early evaluation of the claim based upon the modest amount of initial medical care and vehicle damage.  They refused to budge from their inadequate offers during informal settlement negotiations, and it became necessary to file suit in court and proceed into litigation.

Although litigation has additional costs and certainly takes extra time, it can also help get a fresh evaluation of a personal injury claim by the opposition.   The defense attorneys hired by the insurance companies to defend their policyholders are skilled professionals, some of whom have handled thousands of personal injury litigation cases.  They can often provide helpful feedback and more accurate claim evaluations to the insurance adjusters on their cases.

For this particular client, it was fortunate that the experienced attorney on the other side recognized that Travelers’ claim evaluation was both out-of-date and lacking in recognition of the newer injury diagnoses.  Although it took some months in the “discovery” phase of litigation for the defense to recognize the full value of our client’s claim, the defense attorney’s evaluation and feedback to the Travelers adjuster helped achieve a $60,000 settlement for our client.

An experienced personal injury attorney will recognize when an insurance company like Travelers has become fixated on an inadequate or incomplete claim evaluation and will know the steps necessary to get a proper valuation – like filing suit to get a fresh set of eyes on the defense to take a more thorough look at the claim.

For more information on insurance companies, their claim tactics, and how an experienced personal injury attorney should deal with them, see:

• Types of Auto Coverage and First and Third-Party Claims
• Insurance Company Tactics: Dirty Tricks Insurance Companies Play in Accident Claims
• Our Tools — How an Experienced Personal Injury Attorney Deals with Insurance Company Tactics
• The Insurance Industry and Individual Companies — Huge and Hugely Profitable