DSS in Insurance Claims Departments: Personal Injury Evaluation Systems

Abstract

An increasing number of insurance claims departments use Personal Injury Evaluation Systems (PIES) to adjudicate the liability and settlement value of personal injury claims. Like the courts these claims departments face pressures from excessive caseloads, cost containment issues, administrative problems and rising expectations from those dealing with claims. Insurance claims departments, just like the judiciary, have sought relief in technology. While Judicial Decision Support Systems (JDSS) assist the courts in their decisions, preliminary evidence suggests a difference in the application and use of PIES by adjusters in determining personal injury claims. There are considerable philosophical and policy differences between the court's use of JDSS and the insurance industry's application of PIES in situations where both processes impact the personal well-being of both victim and offender. The evidence gathered to date suggests identifiable common areas as well as vast differences in the uses of JDSS and PIES. But data are not complete. Claims department use of PIES in terms of neutrality of data, choice and utility, ownership as well as discretion, consistency and predictability, suggests a possible but yet unconfirmed, strategical and partisan application. Further, the use of the powerful tools embedded within PIES may empower less trained adjusters with more than a support for decision-making. Evidence collected to date suggests that PIES may be an increasingly indispensable adjudicatory tool, controlling the claims process and increasingly eliminating the need for judgment.