Most insurance companies evaluate your claim by a computer program called Colossus. Colossus
is a sophisticated program created for insurance companies to calculate the payout
on auto claims.
Colossus determines value by the format of the information. Although an attorney
can manage the process and evaluate your claim, you need to make sure that your
medical provider documents your medical situation and treatment.
For Colossus,
if it is not in writing, it does not exist. It is very important that your
healthcare provider document any of the following symptoms: muscle spasms, dizziness,
radiating pain, headaches, restrictions of movement, nausea, vision disturbances,
neuroses, depression, anxiety, bruises, contusions, or lacerations. Healthcare
providers must accurately and plainly state symptoms in your medical notes.
Colossus
assigns a numerical code to each symptom. After assigning a numerical code,
Colossus calculates its value of your claim. Various medical treatments are
recognized and valued differently. Colossus limits the number of visits for
chiropractic care and considers such care a sprain or strain of the neck and back. Colossus
adjusters will not accept a diagnosis of subluxations by a chiropractor. They
will interpret these only as sprains and strains. However, when a medical
doctor diagnoses a subluxation, they are classified as medical subluxations and
recognized as more serious and more valuable.
Visits to specialists have separate value. Specialists are orthopedic surgeons,
neurosurgeons, neurologists, psychiatrists and psychologists. Colossus generally
treats physical therapy, massage and acupuncture the same way. Colossus
factors in frequency and duration of this type treatment.
Colossus considers delays and gaps in treatment. If there is a gap or delay,
the provider must explain the gap or delay in the records. Colossus also inquires
about hospital visits or stays and what types of aids are used such as neck braces,
walking aids, etc. A significant factor in the Colossus assessment of a claim
is referred to as “duties under duress.” This refers to an injured
person having to continue working, performing household chores or attending school
even though doing so causes increased pain and discomfort. Inform your medical
provider about how you continue to perform duties under duress.
An impairment rating is also recognized by Colossus. Make sure your doctor
documents a prognosis. If you do not have a documented prognosis the adjuster
will enter into Colossus “resolution undetermined.” Such an entry
is not recognized with regard to any future problems.
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