Your Claim Is Not Being Evaluated. It Is Being Scored.

Insurance adjusters devalue injury claims with software such as Colossus. It scores the wording of your medical records. They add three tactics: delay that drains your money, a fight over medical need when a scan is clear, and the minor-impact defense.

At some point you likely assumed a person was weighing what happened to you. In most cases that is not what is going on. Your injury is being turned into codes. Then software scores the codes.

Knowing how the scoring works is not cynical. It is the difference between being caught off guard and being ready.

Watch on YouTube: How insurance adjusters devalue injury claims and what you need to know

The scoring engine

Colossus is the most widely used system for pricing pain and suffering. It runs on a large set of secret rules. The video cites over 10,000. It is a closed system. That means the adjuster using it generally cannot check it either.

One result matters hugely, and claimants are almost never told about it: the severity score depends on the language in your medical records. Say the treating doctor does not write findings in the terms the system knows. Then the score drops. That is not because the injury is milder. It is because the record did not put it in a form the model reads.

The Consumer Federation of America showed how tuning these rules lowers the dollar value given to severity points. It also recorded the vendor’s own sales claim that the program would “immediately reduce the size of bodily injury claims by up to 20 percent.” Over one decade, CFA found, Allstate’s payout per premium dollar in auto injury cases fell from roughly 63 cents to 47 cents.

The bigger complaint follows from that. Adjusters are no longer using much judgment. They are typing data into a system that flags any offer above a preset range.

Dr. Gurpreet Singh Padda, MD, MBA, MHP walked through how Colossus and related claims systems work in an earlier talk. Xactimate is one of them. He showed how ZIP code and demographic data feed into the result:

Watch on YouTube: Your Case Is Not Being Read. It Is Being Scored.

Why do insurance adjusters delay injury claims?

For an insurer, an unpaid claim is money it can invest in the meantime. This is the well-known economics of insurance float, studied in insurance economics (the video credits this to Harrington and Niehaus).

The effect on people is simple. Repeat record requests and red tape stretch out the timeline. As the timeline stretches, the claimant’s money runs lower. Being willing to take a low offer is not a fixed trait. It depends on how long you can hold out.

This is why delay should be read as a strategy, not as sloppiness. The money pressure it creates also has effects on your body. The biology of that pressure

Why would an insurer deny treatment when your scan is clear?

The second move is to ask for a visible structural injury on a scan. If there is none, they treat that as proof that treatment was not needed. No fracture, no procedure.

This walls the injury off from what is really driving it. Ongoing cytokine signals (TNF-α, IL-6) keep up an inflammatory state that keeps the pain going. Central sensitization means the nervous system itself has been retuned. Pain is now made in the brain and spinal cord, often apart from the first injury site.

If pain can be labeled unexplained, then treatment for it can be labeled experimental and denied on that basis. The answer is objective records of what is causing the pain, not a louder claim about the symptom.

Does little car damage mean little injury?

MIST argues that low car damage means low injury to the people inside. It turns the physics upside down.

A stiff frame that does not crumple soaks up less energy and passes more of it to the person inside. The frame is, in effect, the fuse. When it does not blow, the load goes somewhere else. Low-speed crashes can send strong forces to the neck and head. The whip that follows can cause tiny tears in nerve fibers (axonal shearing). You do not have to strike your head to sustain a brain injury. How this is proven

The part that is hardest to hear

A body of research points to claim results that differ by race and by place. The injuries themselves do not explain the gap.

The best-recorded way this happens is not hidden at all, and it is not just a claim: race- and gender-based wage tables.

When an economist projects what an injured person would have earned over a lifetime, that projection has to start from some baseline. A large share of forensic economists have used race and gender numbers to build it. A National Association of Forensic Economics survey found 43.6% would use both race and gender data in projecting lost wages. Another 48.1% would use gender-specific data. Because women and people of color have earned less in the past, those tables give systematically lower projected lifetime earnings for the same injury and the same skills.

The effect is not small. In one widely reported case, a young Black woman’s projected future lost wages came to roughly half those of a white man. He was the same age, with the same schooling and the same injury.

Here is the logic, stated plainly. The method takes past, recorded discrimination and feeds it back in as a forecast of one person’s future. The gap is brought in from history, not seen in the person.

You do not have to take our word for it — a legislature agreed

This is the strongest evidence that the practice was real, because it is not an argument at all. It is a statute, a written law.

Martha Chamallas of Ohio State laid out how this works across US and Canadian cases in Loyola of Los Angeles Law Review (2005). She expanded on it with Jennifer Wriggins in The Measure of Injury: Race, Gender, and Tort Law (NYU Press, 2010).

California then acted on it. SB-41, now California Civil Code § 3361, was signed in 2019 and took effect January 1, 2020. Its key language is one sentence:

“Estimations, measures, or calculations of past, present, or future damages for lost earnings or impaired earning capacity resulting from personal injury or wrongful death shall not be reduced based on race, ethnicity, or gender.”

A legislature does not ban a practice that was not happening. California was the first state to do so. A federal version, the Fair Calculations in Civil Damages Act, has been introduced again and again in Congress. It has not been enacted.

What this means if your claim is in Missouri or Illinois. We looked, and we did not find a statute like § 3361 in either state. So far as we can tell, nothing in Missouri or Illinois law currently bars an economist from using race- or gender-based wage tables in projecting your future earnings. If your damages include lost earning capacity, ask your attorney straight out: what tables is the projection built on?

What peer review actually shows about claim adjudication

There is one strong study directly on whether insurers pay claims differently by race. It is worth describing exactly, not loosely.

Lin, Browne and Hofmann (Journal of Risk & Insurance, 2022) looked at earthquake insurance claims from eight Oklahoma earthquakes between 2010 and 2016. These were the induced quakes associated with oil and gas drilling. The authors linked Oklahoma Department of Insurance records to USGS and Census data. After controlling for other factors, they found that claims from areas with higher percentages of Black population were less likely to be paid, and when paid, were paid less.

The study also shuts the obvious escape hatch. A skeptic would suggest those areas just filed weaker claims. The authors tested that. They found no evidence that Black, Native or Asian population share was associated with filing weak claims. And areas with more Hispanic residents filed fewer weak claims.

Now the honest limits, which matter here. This is property insurance in Oklahoma, not bodily injury. It measures area-level racial makeup, not one claimant’s race. It does not show that your personal injury claim will be judged differently. What it does show is that unequal claim handling by racial makeup is a recorded fact in US insurance, not just a talking point. That is a very different place to start a talk with an adjuster.

How do you outsmart an insurance adjuster’s scoring software?

Not indignation. Density.

These systems mark down what you feel and reward what is on paper. That means objective findings: inflammatory markers, diagnostic blocks, neurocognitive testing (tests of thinking and memory), and biomechanical analysis. Add specific, dated losses in what you can do. Inflammation, sleep and movement are treated as clinical targets because they drive recovery, and because measuring them builds the record that a model cannot easily mark down.

Biologic line items are among the easiest for that process to shrink. The reason is usually a mix-up between coverage and evidence. Why not covered and not proven are different sentences.

Related reading: how insurers wear down low-income injury victims and insurance bias against minority plaintiffs.

Our physician-directed physiotherapy program is built the same way. Every visit is recorded at the time with clock times, settings and the patient’s signature, and progress is measured with the same questionnaire at the start and at each re-check.

Frequently asked questions

Why does my insurer keep asking for the same records?

Repeat requests stretch out the claim timeline. Insurers earn investment returns on money they have not paid out yet. Claimants’ savings run lower over time. So delay tends to help the insurer both ways.

There is more on this in You Are Looking at the Wrong Number.

Can the wording in my medical records change my settlement?

Yes. Claims-scoring software pulls severity from coded terms in the records. Records that do not use the terms it knows can give a lower score for the same injury.

What is the MIST defense?

Minor Impact Soft Tissue. It is the argument that small car damage means small injury. It gets the physics wrong, because a frame that does not bend passes more energy to the person inside, not less.

The Fear Every Honest Patient Carries goes through it in detail.

Is there really evidence of racial bias in claim settlements?

Yes, and the strongest proof is legislative rather than academic: California enacted Civil Code § 3361 in 2019, barring any reduction of lost-earnings damages “based on race, ethnicity, or gender.” Legislatures do not ban practices that are not happening. Separately, a 2022 study in the Journal of Risk & Insurance found earthquake insurance claims from areas with a higher Black population share were less likely to be paid. When they were paid, they were paid less. That study covers property insurance in Oklahoma, not bodily injury. So it does not directly predict personal injury results. But it shows the problem can be measured. It is not just claimed.

What should I do if I receive a lowball offer?

Speak with your attorney before you respond. Focus on building up the objective record: written records of lost function, and testing that does not rely on your own report. This article is not legal advice.

See You Are Looking at the Wrong Number.

Do Missouri or Illinois ban race-based wage tables?

We could not find a statute in either state comparable to California’s Civil Code § 3361, which took effect in 2020 and was the first of its kind. If your claim includes lost earning capacity, ask your attorney what wage data the projection uses. It is a fair question. In most states, this is still not regulated.

How Missouri and Illinois law differ on fault, doctor choice and uninsured drivers is covered in The River Decides More Than You Think.

What won’t an insurance adjuster tell you?

That your claim is usually not being weighed by a person. Your injury is turned into codes. Software such as Colossus scores the wording of your medical records. Delay is a strategy, because an unpaid claim is money the insurer can invest while your savings run down. And a clear scan is used to call treatment not needed, even when inflammation and central sensitization explain the pain.

What is the biggest mistake people make with an injury claim?

Building the record on how the injury feels instead of what it does that can be measured. Scoring systems mark down what you feel and reward what is on paper. Objective findings are far harder to mark down. These include inflammatory markers, diagnostic blocks, neurocognitive testing and biomechanical analysis, plus specific, dated losses in what you can do. The second mistake is letting delay push you into a low offer before you speak with your attorney.

Where is Injury Experts located?

Injury Experts is at 4477 Woodson Rd, Suite 202, St. Louis, MO 63134, next to Lambert International Airport, serving the St. Louis region in Missouri and Illinois. Call (314) 887-5866 or text (314) 886-5902.

Key takeaways

• Claims are scored by closed software. The score follows the wording of your records.
• Delay makes money sense for the insurer and piles up costs for you.
• “No fracture, no procedure” ignores inflammatory and central causes of pain.
• MIST turns the physics of energy transfer upside down.
• Published research reports settlement gaps by race and place. Read the sources yourself.

This article is for general education and is not medical or legal advice. It does not create a physician–patient or attorney–client relationship. Decisions about your claim should be made with your attorney.

Medically reviewed by Dr. Gurpreet Singh Padda, MD, MBA, MHP — Board Certified in Anesthesiology, Pain Medicine, Interventional Pain Management, Addiction Medicine, and Obesity Medicine.