Colossus Claim Adjusting Software is becoming increasingly popular, with most of the top auto insurers using it to calculate the amount they need to pay out to settle a car accident claim. Since this amount depends on the specific data regarding injury and treatment, it’s essential that every detail of a patient’s treatment is in the system and reflected correctly. Auto insurers compile this data and compare it to other similar claims, ensuring the insurance companies don’t pay out too much to settle claims.
What Specific Things Does Colossus Consider?
When gathering data, Colossus considers specific factors that will ultimately affect the amount of a car crash settlement. These are the most common things to be aware of in the event of a car wreck:
- Pre-existing Injuries. A car accident can aggravate pre-existing conditions. It’s crucial to have records that establish these injuries as occurring before the accident. Also, the degree of suffering from any pre-existing injuries will be in the notes.
- Injury Diagnostics. Injuries get categorized according to CPT codes, the medical codes that the healthcare industry, and Colossus use. The codes allow the information to be as accurate as possible and ensuring that you get compensated fairly.
- First Visit and Initial Treatment. The detail is critical when describing initial visits and treatments. Pertinent information includes a doctor’s prognosis, complications, immobilization, and anything else related to the issue at hand.
- Worker’s Compensation and Prior Injuries. All prior injuries, including any worker’s compensation claims, need to be in the Colossus system. It is necessary because the Colossus system won’t accept Chiropractor PPDs (Permanent Partial Disabilities).
- General Doctor Visits, Specialists, and Chiropractor Visits. Treatment ratings fall on a scale of importance for Colossus. In this system, chiropractor visits are at the same level as a regular visit to the Doctor. However, specialist visits get ratings for more importance.
- Physical Therapy and Home Exercise. To count towards a claim, you need to document any physical therapy. The records should include frequency and duration.
- Medications and Injections. Colossus can distinguish between injections and medicines for treatment and relief, so each medication will need inclusion and explanation.
- Treatment Delay. The longer the delay in treatment, the less the value of the claim. If treatment gets delayed for legitimate reasons, the reason will need to be in the patient profile.
Who Uses Colossus Software?
After an auto crash, it’s crucial to know how insurance companies weigh all of these factors and which insurance companies use them. All the companies below use Colossus:
- Utica
- USAA
- Travelers Property Casualty Insurance
- State Auto
- MetLife Home and Auto
- Motorist Mutual
- Mid-Century Insurance
- Metropolitan Group
- Keystone Insurance
- Great American Insurance Company
- Federated Insurance Group
- Farmers Insurance
- Esurance
- Encompass
- CNA
- AXA Insurance
- American National Property and Casualty
- American Family Mutual Insurance
- Allstate Insurance
- 21st Century Insurance
How to Appeal a Denied Claim in Texas
If your auto accident claim has been denied, you have the right to appeal. Here’s how to challenge the decision:
- Demand a Written Explanation: Under the Texas Insurance Code, you have the right to a specific explanation of the facts and the policy language used to deny your claim.
- Audit Your Policy: Check the “Exclusions” section. Insurers often use broad terms to deny claims that should actually be covered.
- Build an Evidence File: Do not rely on the insurer’s “investigation.” Gather your own photos, witness contact info, and medical records that prove the crash caused your specific injuries.
- Submit a Formal Appeal Letter: This isn’t just a “complaint,” it’s a legal document. It should reference the specific policy sections and the evidence that contradicts their denial.
- The TDI Option: You can file a formal grievance with the Texas Department of Insurance. While they cannot “force” a payment, a regulatory inquiry often makes an insurer take a second, more serious look at your file.
- Legal Intervention: If the insurer is stonewalling you, a car accident lawyer can file a lawsuit to gain access to internal adjuster notes and “black box” data they may be hiding.
Bad Faith Insurance Practices in Texas
Insurance companies in Texas are required by law to handle claims fairly and in good faith. When an insurer fails to meet this standard, it may be guilty of bad faith practices.
Common examples of bad faith in Texas include:
- Denying a valid claim without a reasonable basis
- Failing to conduct a proper investigation
- Delaying payment on an approved claim without explanation
- Misrepresenting policy language to avoid paying a claim
- Offering far less than a claim is worth without justification
- Failing to respond to communications in a timely manner
- Refusing to defend you against a third-party claim when your policy requires it
Under Texas Insurance Code Chapter 541 and the Texas Deceptive Trade Practices Act, you can take legal action against an insurer that acts in bad faith. If successful, you may be entitled to:
- The original amount owed under your policy
- Additional damages for economic losses caused by the delay or denial
- Up to three times your actual damages in some cases
- Attorney’s fees and court costs
If you suspect your insurance company is acting in bad faith, document every interaction and contact an experienced auto insurance lawyer. Joe Stephens has over 40 years of experience holding insurance companies accountable for unfair practices.
Time Limits for Disputing a Denial
Texas law sets specific deadlines for challenging an insurance claim denial:
- The 2-Year Rule (Personal Injury): You generally have two years from the date of the accident to file a lawsuit against the negligent driver.
- The 4-Year Rule (Contract): If you are suing your own insurance company for a breach of your policy (like an Uninsured Motorist claim), you typically have four years from the date they breached the contract.
- Prompt Payment Deadlines: Under Texas Insurance Code Chapter 542, insurers have strict deadlines (usually 15 days) to acknowledge your claim and either accept or reject it.
Missing these deadlines can cost you your right to compensation. If your claim has been denied, contact a lawyer right away to protect your options.
Call an Experienced Car Accident Lawyers in West Houston
Any experienced attorney knows how stressful a car accident can be, especially when there is an injury and lasting physical or mental damage. By being aware of the factors listed above, you will be more likely to get a fair settlement. However, if your insurer won’t give you the compensation you deserve, call The Stephens Law Firm for assistance. Our team is dedicated to helping victims of car wrecks so they can get the proper compensation.
The Stephens Law Firm, Car Accident Lawyers handles auto accident lawsuits across Texas, including these Houston cities.
Insurance companies may try to place the blame on you, but we won’t let them. We count with the experience to help you get the care and compensation you need to move forward.
