The Consumer Federation of America released a report in June 2012 that contained some interesting information about how insurance companies may manipulate information that is input into their claims adjusting software. While it is certainly not acceptable for providers to elevate injury claims by providing false, incomplete or misleading information it is equally unacceptable for insurance companies to engage in this behavior to reduce or deny patient benefits.
The Consumer Federation of America is an association of nearly 300 nonprofit consumer organizations that was established in 1968 to advance the consumer interest through research, advocacy and education. This report shows instances of insurance adjusters with no formal medical education or credentials second guessing medical professionals by altering details of the medical reports and choosing injury/diagnosis codes that yield lower recommended settlement values. Many consumers are unaware that these “claims adjusting” systems are even being used. There are many different types of these systems with some of the most widely used being Colossus and TEACH. Information concerning the diagnosis and treatment is input into these systems and the recommended settlement offers are produced by the computers. More information is becoming available that suggests that these systems can be manipulated at any time in an effort to reduce payment to the injured party. If you are interested in reading the entire report please click here.
