COMPREHENSIVE HEALTH SERVICES PERSONAL INJURY CLINIC

3543 N. 7th Street

Phoenix, Arizona 85014

Fax: (602) 263-3697

Office (602) 263-8484

       

 

Robert L. Gear III, DO
Emergency and Family Practice Medicine
Muscle & Joint Injury Osteopathic Manipulative Medicine

Brent J. Gear, DO
Emergency Medicine
Muscle & Joint Injury Osteopathic Manipulative Medicine

Bronislavia Shafran, MD, Neurology

Referring specialist

Michael Steingart, D.O., Orthopedics

Referring specialists

 

 

Re: A computer program called name "Colossus".

 

 

Dear Attorney,

 

I manage a multi-specialty personal injury clinic that is simply tired of the way insurance companies use Colossus software to manipulate patient’s records in order to minimize the values determined for injuries.  

 

Second only to providing quality medical care, our clinic focuses on emphasizing the facts in our records that maximize Colossus value to our patients.   Our growing list of experienced examiners are board certified M.D.’s or D.O’s with clean personal records, able to appear in court if necessary and accept liens.  In addition we can, and often do, work with any physician(s) in the community to facilitate their record keeping in accordance with our focus on maximizing Colossus value.   After first being seen in our clinic we will refer patients to specialists in the community as needed to complete their evaluation and treatment and provide that specialist with our “Colossus checklist” that they later return to us to incorporate in our report.  In addition our patients use our daily checklist diary at home, designed with Colossus in mind, to further document their symptoms.   In this way we maintain continuity and provide your client with real ammunition to fight their insurance company.

 

Did you know that:

 

When a physician treats patients who make claims against insurers for injuries suffered in automobile collisions, the (Colossus-derived) value of the "cases" they treat are recorded and associated with the physician's federal tax ID number or Social Security number. Colossus follows the artificial intelligence operational behavior - this means that Colossus may have devalued most of your cases last year because the physicians you worked with took poor notes; failed to refer for second opinions; had illegible handwriting; or used the "wrong" terminology (more about that later); the offers it comes up with for claims you manage this year will be correspondingly lower. But that's not all: The attorney on the case also is tracked and (depending on his or her track record) can also affect future claim offers. Moreover, the physicians are linked (again, by the federal tax ID or SS number) to the attorneys. So you become digitally linked and branded in such a way that the settlement amounts offered by Colossus for your clients claims may be lower than average…

 

Dr Croft

National Personal Injury Expert

 Today, the name "Colossus" is most often associated with a computer program developed originally in Australia for the purpose of personal-injury claims review and valuation... Colossus is now implemented by 70 or more of the major insurers in the U.S. Its use is quite simple: The claims adjustor sits in front of the computer, inputs case data, and Colossus spits out a settlement offer in dollars and cents. (What the insurer does with that figure is another issue.)

Colossus code is based on what is referred to as artificial intelligence (AI), meaning that the program code continuously evolves based on user input… But in any AI-based system, evolving code can only be as reliable and useful as the data it has digested; bad data makes for dubious code.

Herein lies one of the dubious features of the AI of Colossus, and also a fact physicians should come to appreciate. This is probably the most important point I can make: Virtually all of the major influences of the Colossus output are based on the physician's daily notes and other documents. Moreover, what is written in the notes - and often, the specific words or phrases used - can have a significant impact on the value Colossus attaches to the claim. Again, in plain English: The doctor's records are the chief data source for Colossus…

…Another program physicians should know about it ISO's ClaimSearch, which serves as a clearinghouse of information about hundreds of millions of liability, property and bodily-injury claims. It is a cooperative effort of more than 3,500 insurance companies, representing more than 90 percent of all policies written. It allows them to search through virtual mountains of digital data, extracting vital information about claimants, such as their previous health profiles, prior claims, etc. What most physicians and plaintiff lawyers don't realize, however, is that they, too, are profiled by these computer Goliaths - not just their medical profiles, but also their practice profiles

The closer one examines Colossus, the more one comes to realize it is consistently manipulated to downgrade claims over time, rather than evolving, like most true AI programs, on the basis of newer, more accurate, unbiased information…

…Colossus reasons that in any case in which a second opinion is sought, the claim should be worth more. Therefore, referrals are a value driver. So, if an insurer sends the patient out for a defense medical examination, it may effectively inflate the case's value. Not surprisingly, many insurers withhold this information from Colossus.

Earlier, I noted that certain words or phrases were particularly influential for Colossus. At present, its code is based on approximately 10,400 value drivers. (This is the fuel that drives the value of a claim.) However, Colossus does not always value findings in a way that is concordant with general medical thinking. For example, in the last several years, there have been several reports in the literature that initial losses of cervical spine range of motion are important prognostic features of whiplash injury. Individuals with greater initial limitations generally don't fare as well as those with minimal initial limitations. Similarly, the American Medical Association and the American Academy of Orthopedic Surgeons have long considered permanent loss of range of motion an important factor in terms of impairment. On the other hand, muscle spasm, as a finding, is fairly nonspecific and offers little in the way of reliable or meaningful outcome forecasting. Nevertheless, Colossus apparently attaches at least as much significance to muscle spasm as it does to loss of range of motion. In fact, if the physician notes three different points of muscle spasm, the condition is that much more severe in the view of Colossus.

...the more contusions present, the greater the claim value is likely to be in Colossus' digitally glaucomatous vision. Many physicians might not normally document each and every contusion or point of muscle spasm and would unknowingly deflate the claim's value. Needless to say, physicians who write illegibly or fail to document other important findings deprive Colossus of the very substrate claims adjustors put into it to assess the claim…

…Most of what we now know comes from disaffected claims adjustors, former defense attorneys, and evidence leaked from bad-faith trials that have transmogrified into the public domain.

To say that Colossus is indelibly and irretrievably flawed, from a scientific or medical basis, is probably too charitable...  Not only do the insurers make up the rules of the Colossus game, they also decide when (and if) they will follow them. However, for the most part, insurers are private or public businesses and can jolly well do whatever they like when it comes to managing their bottom line. Like it or not, Colossus and other programs mentioned here will be with us for the long haul, so it is helpful for physicians to understand some of the inner workings of these programs so that their patients can be dealt with as fairly as possible by the insurers who use them.

…Concerning the issue of impairment or disability, lamentably, Colossus will not give credence to reports from chiropractors. They must come from a medical doctor. (DeShaw believes this general bias against chiropractic may stem from the fact that the original program was developed in Australia during a time when chiropractors were not fully recognized by the government.)

... if use of terms otherwise medically synonymous to physicians (e.g., extrusion, protrusion, prolapse, or herniation) may actually result in a diagnostic error based on the idiosyncrasies of the Colossus code, physicians should act accordingly and translate terms in such a way that Colossus will not misinterpret their significance. Physicians also should be sure to make their daily SOAP (Subjective Symptoms, Objective Symptoms, Assessment & Plan) notes complete, legible and understandable, and should avoid the use of nonstandard shorthand. After all, SOAP notes are one of the chief data sources for Colossus. "

As an example, the following is a partial list of issues to consider and items of information to provide to an adjuster relying on COLOSSUS:

  1. multiple provable diagnoses outside of neck and back injuries;
  2. specific levels of the cervical spine (or other locations), rather than generic regions, e.g. "pain to cervical area";
  3. specific details of headaches (frequency, duration and location), rather than simplistic information, e.g. "patient suffers headache." (What does that mean?);
  4. pain scales that document degrees of complaints from injury onset until discharge;
  5. documented residual issues and unresolved pain upon release (very important);
  6. details on changes and hindrances in the activities of daily living (dates, specific activities, frequency and duration); and
  7. potential diagnoses (deserving of special attention) that include, but are not limited to, concussion or airbag, which may lead to a finding of a traumatic head injury.

In addition, the following also affect value:

    • Liability – use of a seatbelt increases value, as does absence of intoxication
    • Chiropractor – referral from a regular doctor, documented in the medical records, increases value
    • Spine Treatment – must be documented specifically as to injury and why treatment is related to injury
    • Medical Aids – medically documented needs for aids like walkers or crutches and time needed are considered by the program
    • Neck Collars – different types of neck collars are treated differently
    • Treatment Gaps – delays in treatment decrease value so provide explanations for any, and document this in the medical records
    • Permanency – COLOSSUS uses 4th Edition of the AMA Guidelines to Permanency and uses ratings only to body as a whole
    • Loss of Enjoyment of Life – can be considered if documented in medical records or reports
    • Future Medical Bills and Wage Loss – documentation from treating doctor needed for each to be considered
    • Complaints – all complaints should be documented by medical records
    • Pre-existing Condition – aggravation of it should be documented
    • Aggravation – degree of aggravation and permanency should be documented
    • Hospital – exact days of hospital stay and bed rest should be noted
    • Treatment – duration of treatment and any permanent use should be documented
    • Pain, Depression, Anxiety – must be documented in medical records/reports

 

I would like to stop by, when you have time, to meet you and discuss how we might work together in a more coordinated way to provide a better overall service to our patients/clients.  

 

Best Personal Regards,

 

Dr. Robert L. Gear

President, Comprehensive Health

Care Personal Injury Clinic