Doctors, attorneys and accident victims are up against massive insurance industry computer software programs for Medical Determination and Claim Evaluation all designed to limit awards. In some regions of the country settlement amounts
are decreased 50% or more - from $15,800 reduced to $5,800.
86 different software programs are currently in use by the insurance industry.
These programs decide reasonable treatment charges and the monetary value of PI cases based on 10,720 value drivers, 17,000 severity drivers and 1,600 claim practices and procedures programs.
Medical Determination: These software programs include IMS, AIM, MEDICO, MBRS, ADP, Ingenix, HELP Systems, InjuryIQ, AIM, Mitchell Medical, Med-Data, and now IBM’s ‘Watson’.
Claim Evaluation: Theses software programs include Colossus, XM, TEACH, MYND, Decision Point, Injury IQ, COA, ICE to name just a few. Compounding the challenge, Claim Evaluation software relies upon a single national database maintained and manipulated by one company, Ingenix. (now Optum)
That’s a lot to be up against and maybe not even know it!
But even if you knew it, would you know what to do about it?
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