Colossus is an “artificial intelligence” software program insurance companies use to lower the amount they pay 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 primary way the software saves the insurance company money. This intentional underpayment of claims is often bad faith or failure to settle the claim fairly, promptly, and reasonably. We disagree 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 proper 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.

Allstate created the Colossus software evaluation model in the 1990s. Twenty years ago, before 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 insurance companies a considerable amount of money by allowing them to “tune” down the possible range of claim values the system generates. For example, an insurance company that is 10% short in a business cycle can reduce 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

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

Colossus evaluates claims based on a severity scale by providing weight to injuries and other factors as “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 on 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. The system programmers assign severity points to an injury, and the insurance company sets the sliding dollar value per point.

Colossus’s internal point-based system assesses injuries in terms of “Colossus Factors.” The system uses 720 diagnoses and approximately 12,500 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 from sources like medical records. Adjusters enter the information into the program like a video game with an enjoyable interface and sound effects.

To do the data entry, the adjuster uses a “Dissection Sheet, with 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, significantly limiting the claim’s value. Moreover, Colossus has typically only allowed seven diagnoses per claim. Thus, claim value will dramatically decrease if the information in the demand is not ordered correctly.

To generate values and weighting, Colossus and its successors have highly 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, and recent trial verdicts in the local Court.

The insurance companies will share this data with one another. The resulting data treasure trove gives 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.

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

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 correct information to get a good result and getting the claim out of Colossus if a fair evaluation is impossible.

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 severe 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 ensure 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 correct order. Using the aforementioned “Dissection Sheets,” we have learned which information to put where in demand to ensure the biggest value drivers end up on the Dissection Sheet. The settlement value will be maximized if all the right factors make it into the claim.

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

Sometimes, Colossus does not allow for a fair evaluation of a particular claim. This could happen for many 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 among 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. The injured party had a heart attack
21. Inhalation of chemicals
22. Food poisoning
23. Miscarriage/pregnancy complications
24. Cases involving celebrities and professional athletes

The adjuster has often incorrectly entered the information and missed one of these factors. If these factors aren’t present, the only way to take the claim out of the Colossus system is to file a lawsuit in court. That way, a jury of 12 people, not a computer algorithm that cannot understand pain, will decide the claim’s value.

^{Editor’s Note: updated 11.29.30 Photo by Kaitlyn Baker on Unsplash mh [cs 1393]}