These days nearly every major insurance carrier utilizes some form of claim assessment software for the purpose of evaluating bodily injury claims. The purpose of this software is to take the guess work out of the claims evaluation process by breaking each claim down into factors that can be evaluated identically regardless of the adjuster or the claimant. Generally, once an adjuster receives a demand letter from an attorney, they simply input the information contained within this letter into the claim assessment program. The program then calculates a value range for the claim and the adjuster is tasked with the responsibility of settling the case within this range.
As plaintiff’s attorneys have gained a better understanding of the inner workings of these claim assessment programs they have begun to adjust their practices accordingly. For instance, many attorney’s are now making a concerted effort to create demand letters that specifically address the factors that are used by claims assessment software to evaluate claims. These factors include, but are not limited to a detailed description of all injuries and complaints of pain, treatment received, duration of symptoms, pain experienced while performing various activities and loss of enjoyment of life.
However, simply mentioning these factors in a demand letter is not sufficient. For the most part, all factors must be documented by a treating physician before an adjustor will input them into the claims assessment program. This is where communication with a treating physician can prove vital in increasing the value of a claim. In my practice, I find that physicians will generally make reference to factors such as injuries, complaints, treatment and duration of symptoms. Despite this, it is still essential that a patient communicate all of their injuries and complaints of pain with their physician to ensure that these factors are adequately noted. More importantly, I frequently find that physicians will fail to adequately note a patient’s pain while performing specific activities and loss of enjoyment of life unless these factors are specifically mentioned by the patient. This is why I encourage all of my clients to make a point of openly communicating with their physicians regarding all of the ways in which their injuries have impacted their lives.
Some examples of factors that can drive up the value of a claim if properly documented are working or attending classes while in pain and performing household chores such as laundry, vacuuming, landscaping and mowing the lawn despite pain. Any limitations and/or inability to perform any of these activities due to pain will also add to the value of a claim, as will limitations and/or inability to participate in recreational activities such as sports, workouts or travel.