The Secret to Prevent Adjusters and IMEs from Denying, Disputing and Omitting Factors for your PI Claim.
FEATURE
Frank Liberti
If you’re a chiropractor who treats personal injury patients, there’s no doubt you’ve had various factors of your claim challenged, denied, disputed, and even omitted. It is commonplace for adjusters and IMEs to have varying opinions about your findings and it seems difficult to have your opinion accepted as having the greater weight. But there is now an effective way to eliminate differing opinions among adjusters and IMEs to prevent unfair claims acts and enhance claim settlement valuation.
Dr. Frank Liberti, author of “Unfair, Unrealistic Settlements Not Accepted” says, “It’s what you don’t know that can hurt you!” You have to be knowledgeable about today’s third party, commercial insurer injury guidelines while insurers try to keep you in the dark.
It’s no secret that the insurance industry has an armory of claims handling software and computer programs such as Colossus (and 80 other software versions), equipped with “cost containment measures” to limit bodily injury settlements and make it difficult for chiropractors to oppose claims without specific knowledge of how such software programs work.
A new report released by the Consumer Federation of America (CFA) states that:
“Computerized claims systems as Colossus, used by most of the nation’s largest insurance companies, can be EASILY ADJUSTED to make broad-scale ‘lowball ’ claims payments to injured consumers that are less than what they should receive under their insurance policies. ”
Mark Romano, CFA’s Claims Project Director, says:
“This report is a wake-up call for consumers, doctors, lawyers and regulators who are not aware of the many ways that computer claims software can be manipulated to de-value claims, deny payments, cut fees, and produce unjustifiably low injury payments to consumers and tens of millions of dollars in illegitimate ‘savings for insurers. ”
Sylvia Hsieh, Lawyers USA (2006):
“Insurance claims are processed through this software, yet doctors and attorneys are not keeping up with the insurance companies, andfor the most part are getting beaten by the system. ”
To use claims settlement software such as Colossus, an adjuster
inputs the commercial insurer data about a claim, referred to as “Decision Points, ” and Colossus calculates a range of values for the claim’s worth. The formula insurers use to determine settlement valuation is called the “Decision Point to Dollar Translation Percentage Multiplier. ” The problem is that the Colossus program can evaluate 10,720 Decision Points, most of which aie not contained within Electronic Health Record Systems used by chiropractors.
Electronic health record (EHR) systems aie based on the government’s Center For Medicare Service (CMS) Guidelines, and the insurance companies ai e independent third parties that have created their own set of commercial guidelines. These guidelines aie vastly different from the EHR systems used by chiropractors. There aie missing Decision Points in the chiropractic records involving injury claims, so data is not exchanged and personal injury claims aie being denied and disputed as a result.
Lawyer and Colossus Expert Aaron DeShaw:
“Only a minority of lawyers and doctors have a clue what’s going on. ”
Research shows 80% of Decision Points are found missing in the average EHR CMS based chart note system.
Created by “Case Audit Settlement Evaluators ” (CASE) to effectively counter Colossus, “Zeusclaim ” is a personal injury EMR built on the same Decision Point guides used by the insurers and that aie not found in existing government CMS electronic health record systems.
Proven a breakthrough for chiropractors after beta testing over the past five years, Dr. Frank Liberti, consultant to CASE, is now strategically partnering with many of the industry’s EHR’s to make this available to the entire profession through upgrades to their current EHR system. This makes it affordable and accessible to everyone who practices in personal injury.
One of the advanced features of Zeusclaim is its automated Decision Support System (DSS) to search, tag, and extract Decision Points that aie not contained in standard government CMS-based electronic health record systems. Zeus formulates the Decision Point data in the correct language, format, and sequence to interface and input value into Colossus injury claims.
This is a form of ambient “intelligence, ” linking the chiropractor to “evidencebased” data, research, and Colossus insurer Decision Points through haptic computer, or "things that think. " Such context-aware computing allows human-to-computer interaction with access to artificial intelligence and research in a learning environment to counter Colossus, adjusters and IMEs when they deny, dispute or devalue.
‘ fiThere are missing Decision Points in the chiropractic records involving injury claims, so data is not exchanged and personal injury claims are being denied and disputed as a result. ï Ï
The insurance companies have software, adjusters, IMEs, and attorneys on their side. Now, chiropractors have “computer-aided decision making” - a decision support system (DSS) which is an adaptive and evolving information system meant to implement several of the functions of a support team that would otherwise be needed to help the medical decision-maker overcome the constraints of commercial auto insurer/Colossus personal injury assessment and documentation that operates according to their own set of guides.
Chiropractors have to overcome evidence challenges against Colossus Decision Point factors that are often missing or complex and complicated. Zeusclaim is the tool now being used by peers to win the “greater weight” of these evidence challenges to eliminate disputes, denials, omissions and the conflicting opinions of adjusters and IMEs. This process is the first in our profession that allows a chiropractor ’s opinion to assert the preponderance of the evidence over adjusters and IMEs.
E reer advice Dr. spanning Frank on personal Liberti 35 years. injury has a His has cabeen published extensively and his work has appeared in broadcasts of NBC, CNN as well as Entrepreneur Magazine. He has consulted over 35,000 doctors and lawyers on the subject of personal injury and is a keynote speaker on personal injury across the United States. Early in his career he set precedent at the New Jersey State Supreme Court on the subject of personal injury and has authored fh’e books on personal injury mandates of litigation. He has been a keynote speaker for many state Trial Lawyer Association meetings, the Law Institute of Rutgers University and the only chiropractor asked to address the Judicial College. Log on to our website www. order.zeusclaim. com to see a listing of the EHR companies we have partnered with and to arrange a demonstration of the Ze usclaim system.
