How Insurance Companies Use Software to Price Your Injury Claim (and Why It Gets It Wrong)

Published January 8, 2025 · Injury Law Basics

You were hurt, you treated for months, and the adjuster finally called with a number. It was low, it came fast, and when you asked how they arrived at it, the answer was vague. There is a reason for that: in most injury claims, the first number does not come from a person thinking about your life. It comes from a computer program.

As the new year starts and many people are finishing treatment for injuries from last year's crashes and falls, it is worth understanding how that program works, what it rewards, and what it simply cannot see.

The adjuster is filling in a form

Most large auto and liability insurers handle bodily-injury claims through claim-valuation software. The details vary by company, and insurers do not publish how their systems are weighted. But the basic approach is well known among people who handle these claims.

The adjuster takes your medical records and bills and enters them into the system as codes: diagnosis codes for what is wrong with you, procedure codes for what was done, the number of visits, the type of provider, and the length of treatment. The software compares those entries against the company's own historical claims data and produces a range. The adjuster's settlement authority usually sits inside that range, and the first offer usually sits at the bottom of it.

In other words, the number you hear is less an evaluation than an output. Garbage in, garbage out, and the insurer controls the inputs.

What the software rewards

Because the program runs on codes, it gives weight to the things codes capture well:

• Objective findings. A fracture on an X-ray, a herniated disc on an MRI, a surgical procedure. Anything that can be seen on imaging or measured in an operating room carries more weight than a complaint of pain.
• Consistent treatment. A continuous course of care with no long gaps reads as a real injury. A gap of several weeks reads, to the software and the adjuster, as recovery.
• Specialist care. Treatment by an orthopedic surgeon, neurologist, or pain-management physician tends to be valued above treatment that ends with a family doctor or chiropractor.
• Documented duration. The length of treatment matters. Cut it short in the data entry, and the value drops.

None of this is secret, and none of it is unfair on its own terms. Objective proof and consistent care are exactly what we tell clients to build, which is why our guide chapter on focusing on treatment first spends so much time on gaps, referrals, and telling every provider every symptom.

What the software cannot see

The trouble is everything the codes leave out. Ohio law divides damages into two kinds. "Economic loss" covers wages, medical expenses, and other out-of-pocket costs, and "noneconomic loss" covers pain and suffering, disfigurement, mental anguish, and loss of companionship and "any other intangible loss." R.C. 2315.18(A)(2), (A)(4).

A computer is reasonably good at adding up the first category. It is poor at the second, because noneconomic loss is about a person, not a code. The software does not know that:

• You are a carpenter who can no longer climb a ladder, or a mother who cannot lift her toddler.
• Your pain is worse at night, so you have not slept through since the crash.
• You gave up coaching, running, hunting, or the garden.
• The scar is on your face, and you are 24.
• Your marriage is strained and you are anxious every time you get behind the wheel.

Unless these things are written into the medical records and documented by your own testimony and the people around you, they do not exist in the system. That is not because they are not real. It is because there is no box for them.

How the inputs get shaded

There is a second problem. Because the adjuster does the data entry, choices made at the keyboard can lower the number before the software ever runs. A diagnosis can be entered as a "soft tissue" injury rather than a disc injury. A period of treatment can be shortened. Bills can be run through a separate program that "reduces" them to what the company considers usual and customary.

This is not hypothetical. In Crawford v. American Family Insurance Co., 2024-Ohio-5345, decided by the Second District Court of Appeals here in Dayton in November 2024, the evidence showed that an adjuster entered 16 to 18 weeks of soft-tissue treatment into the company's software when the policyholder's treatment had actually lasted more than 28 weeks, and he could not recall why. The court reversed summary judgment for the insurer and held that a jury could find the company handled her uninsured-motorist claim in bad faith, and could consider punitive damages. As the court saw it, this was not an honest disagreement about value; it was a flawed method. We wrote about that decision in our post on claims software and bad faith.

Crawford involved the policyholder's own insurer, which owes a duty of good faith. The other driver's insurer owes you no such duty, so the same shading on a liability claim is not a separate lawsuit. It is simply a lower offer, and the remedy is to make the record impossible to discount.

Taking your claim out of the algorithm

A lawyer's job is not to argue with the software. It is to build a claim the software cannot capture and then make clear the case is headed somewhere software does not decide it: a jury.

That means:

1. Complete records. Getting the full chart, not summaries, so every diagnosis and every symptom is in the file and coded correctly.
2. Objective proof where it exists. Imaging, specialist opinions, and treating-physician statements about permanence and future care.
3. The human story, documented. Statements from family, coworkers, and employers; photographs of recovery; a symptom journal; your own account of what changed.
4. A demand built for a jury, not a spreadsheet. When the insurer knows the case is being prepared for trial, the software range stops being the ceiling.

Our guide chapter on what your case is worth explains how Ohio law values these losses, including the caps on noneconomic damages and the exceptions for permanent injuries, which software also tends to ignore.

What this means for you

If you have received an offer, ask yourself whether it reflects your life or only your bills. If the adjuster cannot explain the number beyond "that's what the claim is worth," you are likely looking at a software output. Do not sign a release until someone on your side has reviewed the records that went into it. Our chapter on dealing with insurance adjusters covers releases, recorded statements, and the other pressure points.

And if you are still treating, keep going, tell your providers everything, and keep a record of what the injury has taken from you. That is the evidence no algorithm generates on its own.