fbpx

How Insurers Use Evaluation Software to Place a “Fair” Value on Claims

Have you ever wondered how auto insurance companies determine the value of an accident case?

While insurance companies are secretive about the formulas they use to calculate settlement offers, the common belief is that they use a computer model, or “claim evaluation software,” to place a “fair” value on insured claims. Some outcomes even suggest that insurance companies manipulate this software in a way that produces low settlements.

Because every car accident case is unique, computer programs cannot possibly grasp the nuances of an individual victim’s injuries. Software is incapable of feeling your pain and suffering or applying human empathy to your situation. Software does, however, appear to give a financial boost to insurance companies.

Unlike the insurance company—which cares primarily about profits—Graham & Graham’s goal is to maximize your recovery. In our experience, when an insurer makes a low initial settlement offer, denies a client’s claim, or unfairly assigns blame, we are often able to “call their bluff” by filing a lawsuit.

About Insurance Company Software

Insurance adjusters typically have hundreds of case files to evaluate. There is simply not enough time for them to thoroughly investigate a case to accurately determine its value.

Evaluation software helps adjusters process claims more quickly. Adjusters feed injury information from a claimant’s medical records—such as the type of injury, whether hospitalization was necessary, and the type and length of treatment—into the program, and it calculates a settlement value based upon the data collected from previous claims and settlements in similar situations.

But these equations are designed only to establish general damages. They cannot assess, for example, a person’s career and lifestyle and how an injury might impact their future income and ability to enjoy life.

Not only that, but insurance companies may rig software programs in order to lower payments and increase profits. According to an article in the Post and Courier, a former Allstate executive turned whistleblower says that Allstate “turned the knobs” of the software in order to pay less than people otherwise would have received. The same article describes how Allstate’s profit-making plan included making lowball offers to people without lawyers and discouraging customers from hiring lawyers.

Our Experience with Insurance Adjusters

During our many years of handling car accident claims, the lawyers at Graham & Graham have seen all kinds of insurance adjuster tactics. We generally can only assume that the valuations we receive are run through insurance company software. If we feel that the insurance company’s findings are unfair, however, we may file a lawsuit. Although most cases settle prior to trial, simply filing a lawsuit can force the insurance company to change their behavior.

Sometimes, we file a lawsuit in response to a low initial insurance company offer, and lo and behold, the offer increases almost immediately. In other cases, the insurance company denies liability and says their insured wasn’t at fault—only to then offer the limits of the insurance policy after we file a lawsuit.

Insurance adjusters are not attorneys. Occasionally, an adjuster unlawfully assigns a percentage of fault to an injured party. We, along with others, believe that, in fact, some insurance companies set their software to automatically assign a certain level of fault to every evaluation, just to reduce settlements.

Under Ohio comparative negligence law, insurance companies have a financial incentive to shift blame to victims. An adjuster once told us that our client should have realized that the at-fault party was going to run the red light and should’ve slowed down. We’ve even heard horror stories of adjusters assigning some percentage of fault to vehicle passengers! Often times, if an adjuster assigns our client a level of fault that contradicts the evidence, once we file a lawsuit, negligence on behalf of the other party is then admitted.

Getting Accident Victims the Compensation They Deserve

There’s a reason why insurance companies discourage claimants from hiring lawyers: Claimants who hire lawyers tend to get better results.

Insurance company tricks won’t work when you hire a personal injury attorney from Graham & Graham to represent you. As our client, we will communicate with the insurance company on your behalf, negotiate a fair settlement, and file a lawsuit should it become necessary. Contact us today for your free consultation.