Claims software used by many large auto and homeowners insurancevendors in the U.S. has allowed the companies to manipulate claimpayments and "low-ball" customers, according to a new report fromthe Consumer Federation of America. Injury evaluation software, including CSC's Colossus package,allows insurance companies to "tune" payment perimeters andreclassify injuries as less serious than the diagnosis from adoctor, said the report, by Mark Romano, a former Colossus expertat Allstate Insurance, and Robert Hunter, a former insurancecommissioner for Texas. The claims software, adopted by many U.S. |
insurance companies inthe past 15 years, "has enabled many insurers to increase profitsby reducing the amount paid to consumers who filed bodily injuryliability claims," the report said . Some insurance vendors have touted savings of about 20 percentafter moving to claims software from using human adjusters, thereport said. The American Insurance Association, a trade group, questioned theresults of the study, saying that most insurers use other methods,in addition to claims software, to determine payouts. "While these useful tools help to apply fairness and consistency tothe claims handling process, generally, trained claims adjustersare involved throughout the process," Willem Rijksen, vicepresident of public affairs at the trade group, said in an email."Insurers are in the business of fairly and equitably paying claimsas overseen by a well regulated insurance marketplace." A representative of CSC did not respond to a request for comment onthe report.
More than half of the 20 largest auto and property insurancecompanies in the U.S. use CSC's Colossus, and many others usesimilar products from competitors, Hunter said. The claims softwaremarket is largely unregulated by state insurance agencies, and "I'mconvinced there are millions of Americans still at risk," he said. CSC originally marketed Colossus as a cost-savings product, butshifted to talking about the software as a way for insurancecompanies to achieve consistency in claims payouts, the reportsaid. Some insurance companies were uncomfortable with the softwaremarketing as a money-saving package, said the report, referencingCSC materials made public during a class-action lawsuit against the software vendor settled in 2009.
"Consistency, in and of itself, is a legitimate goal," Romano said."However, insurers aren't investing millions of dollars in thissoftware just to achieve consistency. They're looking to savemillions more by underpaying injury claims." Insurance companies can tweak Colossus and similar softwarepackages in several ways to lower claims payouts, the report said.Insurance companies can use the software to reduce payments by apredetermined percentage, and they can exclude high-cost claimsfrom original tuning results used to determine the costs ofinjuries, the report said. Insurers can also use the software to downgrade, en masse, thediagnosis of certain injuries, or pair the claims software withmedical repricing software that reduces the "usual and customary"medical costs to be reimbursed, the report said. The Consumer Federation of America called on state insurancecommissioners to investigate claims software vendors and insurersfor unfair business practices or unfair claims settlements.
Grant Gross covers technology and telecom policy in the U.S.government for The IDG News Service . Follow Grant on Twitter at GrantGross. Grant's e-mail address firstname.lastname@example.org.
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