Lee Fogle has reached out to save his 12 pounds. Yorkshire Terrier Nemo as a pit bull rushes forward. The attacking dog’s jaws tightened on his left hand, sending him to a clinic for sutures and starting a 10-month insurance battle.
“It appears that in dog park etiquette, the winning dog must provide insurance or payments to the losing dog,” Fogle said.
Fogle had worked in insurance technology for 27 years, so he had a pretty good idea of the value of his claim. But he was frustrated with the freezing pace of the process, the insurance adjuster’s refusal to return phone calls, and his attorney’s 40% reduction from the $ 15,000 settlement.
There had to be a better way.
About two years after the dog park incident, Fogle founded Injury Claims Express, a company that makes software that uses data to estimate the value of a potential plaintiff’s claim. He said his patented system offers a solution for people who seek compensation from insurers for minor injuries and prefer not – or cannot – hire a lawyer.
Fogle isn’t the only entrepreneur bringing applied analytics to people. Justpoint, a business started by healthcare technologist Victor Bornstein, allows victims of medical errors to document the details of their injury and find a lawyer with the right qualifications and experience.
The two entrepreneurs turn the tide in the insurance industry by using data analytics as a means of pricing claims – but for the claimant. The two men say their products will also benefit insurers by managing the expectations of potential plaintiffs who sometimes make overly optimistic assumptions about the value of their claims.
“Every Joe on the street thinks they’ve won the lottery,” Fogle said. “They have an unmanaged wait.”
Injury Claims Express is Fogle’s second attempt to launch a claims data analytics product. In 2001, he founded Claims Outcome Advisor, which produces software that estimates the value of personal injury claims. Fogle said his company created the Quantum Book for the Republic of Ireland. The document offers guidelines for determining the appropriate compensation for claimants with personal injury claims. He sold the company to Verisk shortly after launch.
Fogle said consumers who use ICE must agree to pay his business 3% of any settlement amount up to a maximum of $ 500 – far less than a lawyer’s usual contingency fee. He said the app allows potential claimants to attach medical bills and other relevant documents and stores the information in a file accessible by the adjuster assigned to the claim.
Users can negotiate with the claims adjuster directly using the app. But even if the expert refuses to accept an invitation to log into ICE, the system is useful because it allows claimants to document their claims, estimate the value, and keep records of relevant medical bills, Fogle said. .
The app even informs the carrier of early settlement possibilities, for example when the claimant achieves maximum medical improvement. ICE also suggests reasonable settlement amounts based on the nature of the injury and the degree of disability or disfigurement. Medical providers can also enter data into the system.
Fogle said about 3 million people are injured in crashes in the United States each year. About 50% of them hire a lawyer, although 96% of these injuries are not serious. He said claimants who make unreasonable demands are delaying settlement by persuading the insurer to step up on their heels.
With ICE, claimants can claim a settlement that reflects what insurers paid to people who suffered similar injuries.
“The PDF that we create for the applicant is basically your letter of formal notice,” he said.
Personal experience also influenced Victor Bornstein’s decision to launch Justpoint, the app that helps victims of malpractice find a lawyer to represent them. Bornstein said his own mother was injured due to a medical error as a boy growing up in Brazil. Despite being only 7 years old at the time, Bornstein said he still remembers his mother being in a coma for two weeks and almost died from the mistake.
Bornstein said Justpoint customers are at their lowest point. He said the app could help them by aligning their expectations with reality.
Justpoint gives consumers an estimate of the value of their malpractice claim. The app also operates a database of information on 900 plaintiff law firms to find professionals with a track record of success and relevant experience, Bornstein said.
Bornstein said that often people injured by medical error are unable to find a lawyer because the perceived value of the claim is too low. In some states, for example, health care providers cannot be held liable for non-economic damages. Often the statute of limitations has passed.
“We are going to tell them the truth whether they have a complaint or not,” he said.
Bornstein said he first marketed the proposed technology to insurers. He said his system can be of great help to claims professionals by notifying them of potential damages. He said the ineffectiveness of the professional liability line was “frightening”.
“Most of the money spent is not spent on claims,” he said. “In cases of malpractice, most of the costs relate to claims processing and underwriting.”
Harry Langenberg, founder of Optima Tax Relief, and Vivek Garipalli, founder of Clover Health, were among the investors who provided $ 1 million in seed funding to Justpoint last fall.
But Bornstein has since changed his strategy because he found that insurers were acting too slowly. In an ongoing second round of funding, he is looking for investors in the area of litigation finance.
Justpoint is still in the “pre-income” stage, but Bornstein said he intends to negotiate finder’s fees with lawyers who accept referrals from the system.
Bornstein said healthcare providers could benefit from its app as well. The company has learned a lot about medical errors, he said. He said his research revealed two claims against the same doctor at the same hospital who made the same mistake both times. He also found two allegations of sexual abuse of minors by the same staff member at a Florida hospital.
“My goal is to work with hospitals to prevent these incidents from happening,” he said.
Martin Ellingsworth, analyst at Celent, said the services offered by Injury Claims Express and Justpoint appear to be a natural next step in the evolution of applied analytics. He said research into juror verdicts has been around for about as long as court proceedings have been published.
“When you have a number to generate, there are often two sides – often three or four – with an opinion of what the number should be.”
Ellingsworth said the analytics can deliver value to consumers as well as insurers. “Advanced analytics isn’t just limited to electronic discovery and forensic auditing, it can help consumers understand the value of their claim so they can make informed decisions,” he said. declared.
Data also creates opportunities. Years ago, Ellingsworth wrote a program that analyzes unstructured data contained in written accounts in claim files to find possibilities for subrogation. The same program can be extended to detect potential fraud.
Ellingsworth said Paradigm Outcomes’ business is data driven: the company has a deep understanding of what it costs to treat people with catastrophic injuries, so they can accept block fees from workers’ compensation insurers to take care of seriously injured workers, speed up recovery by sending “swarms” of specialists.
Likewise, Ellingsworth said installing video cameras in commercial trucks can help insurers avoid the cost of pursuing a claim that should be quickly resolved, or showing that the truck driver was not at fault.
“It’s good for everyone,” he said. “This reduces the costs of argumentation, for example. I don’t have a problem with having the facts, because that takes away all the expense. “
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