Consumer group: Claims software helps insurers 'low-ball' customers

04.06.2012

"Consistency, in and of itself, is a legitimate goal," Romano said. "However, insurers aren't investing millions of dollars in this software just to achieve consistency. They're looking to save millions more by underpaying injury claims."

Insurance companies can tweak Colossus and similar software packages in several ways to lower claims payouts, the report said. Insurance companies can use the software to reduce payments by a predetermined percentage, and they can exclude high-cost claims from original tuning results used to determine the costs of injuries, the report said.

Insurers can also use the software to downgrade, en masse, the diagnosis of certain injuries, or pair the claims software with medical repricing software that reduces the "usual and customary" medical costs to be reimbursed, the report said.

The Consumer Federation of America called on state insurance commissioners to investigate claims software vendors and insurers for unfair business practices or unfair claims settlements.

The IDG News Service