Diagnosis Isn’t Enough: Prognosis Is What Unlocks Settlement Value

Is Prognosis properly outlined for each injury in your demand letters? You could be leaving money on the table. 

Modern claims evaluation is driven by software logic. Diagnosis codes and treatment dates are no longer sufficient to trigger full valuation. To move beyond baseline offers, plaintiff attorneys must address the one field that is not even on most lawyers radar—Prognosis.

Claims systems like Colossus, Liability Navigator, and ClaimIQ each assign value tiers based not only on what injuries are documented, but on how those injuries are expected to resolve. Prognosis determines whether an injury is classified as temporary, permanent, resolved, or indeterminate. These classifications directly affect both severity scoring and future damages calculations. And yet, prognosis is rarely addressed properly in most demand packages.

Why Prognosis Matters in Evaluation Logic

All major claims evaluation systems incorporate prognosis scoring into their valuation algorithms. This is core logic. Without a clearly documented prognosis linked to each injury, systems default to a conservative assumption, typically treating the condition as either resolved or undetermined. Both result in valuation suppression.

While most attorneys invest time capturing diagnosis codes and referencing treatment summaries, prognosis is often overlooked or buried in narrative language. As we’ve written in other posts, structured data—not general descriptions—is what activates valuation logic.

Prognosis in Colossus: Categorical Triggers

The Colossus system uses defined prognosis categories, each tied to a specific scoring logic. Settlement Intelligence structures prognosis data in alignment with this logic to ensure maximum recognition.

Here are the core categories as interpreted by Colossus:

• Complaints, Further Treatment Required
  Triggered when the most recent provider note references ongoing symptoms and a treatment plan. This is the highest short-term prognosis value. It signals that the claimant has not reached MMI and that the file should remain open for future exposure.

• Complaints, No Further Treatment Required
  Applied when symptoms persist but the treatment plan is vague, p.r.n., or entirely absent. This classification reduces the injury’s valuation weight and limits eligibility for future medicals or pain and suffering enhancements.

• Guarded
  Common in early or acute injury phases, especially when diagnostic testing, surgical consults, or procedures are pending. This prognosis suggests uncertainty, and depending on how it is documented, may increase or decrease valuation depending on the stage of treatment.

• No Complaints / No Further Treatment Required
  Signals resolution. Unless paired with a permanent impairment rating or loss-of-function indicator, this designation effectively closes the valuation window for the related injury.

• Undetermined
  The default fallback category—assigned when no prognosis is clearly stated. In Colossus and similar systems, this suppresses the claim value across nearly all injury types.

Variations in Liability Navigator and ClaimIQ

While Colossus uses categorical prognosis mapping, Liability Navigator and ClaimIQ employ weighted scoring models. Here, prognosis impacts both duration of injury and risk of future complications, with multipliers applied to general damages based on residual symptoms and likelihood of permanent impairment.

Liability Navigator, for instance, links prognosis to future risk indicators, such as likelihood of re-injury, surgical follow-up, or diminished earning capacity. Omission of prognosis disables these flags, placing the case in a lower-tier outcome track.

ClaimIQ takes a similar approach, emphasizing whether the prognosis supports continued limitations, medical follow-up, or any long-term restrictions. Without that data, the AI treats the injury as resolved—regardless of how serious it appeared during initial treatment.

Connecting Prognosis to Each Injury

The most common mistake we see in demand letters is the use of global or vague prognosis language—e.g., “prognosis is fair” or “patient is improving.” These phrases are neither machine-readable nor actionable.

To activate claims software logic, prognosis must be:

• Linked to a specific injury or diagnosis code,

• Stated explicitly in the physician’s note,

• Tied to a treatment plan or lack thereof, and

• Positioned in structured, indexed format within the demand letter.

Settlement Intelligence automates this process. Our patent-pending system extracts prognosis directly from the medical record, pairs it with the relevant diagnosis, and presents it in the format required by insurer algorithms.

Why is this important? Because each claims evaluation system interprets prognosis differently and uses different language and categories. Settlement Intelligence's platform is the only one that is backed by reverse-engineered processes that let you generate demand letters specially designed to trigger insurer logic. 

Structured Prognosis = Higher Valuation

When structured correctly, prognosis data influences:

• Future medical expenses,

• General damages range,

• Duration of pain and suffering,

• Residual injury scoring,

• MMI timing and permanence assumptions.

Failure to include this data results in valuation gaps, even in high-severity cases. As with Permanent Impairment Ratings, small oversights in structure translate into thousands of dollars in lost value.

Conclusion

Prognosis is not a narrative detail, it is a required data field. If you are submitting demand letters that list ICD-10 codes without corresponding prognoses, you are leaving money on the table. Claims systems will assume resolution unless explicitly told otherwise. That assumption suppresses settlement offers across every system—Colossus, Liability Navigator, and ClaimIQ alike.

Settlement Intelligence ensures prognosis is captured, linked, and formatted for full AI recognition. Whether a case is guarded, unresolved, or requires long-term care, the data must be presented correctly to unlock value.

Don’t let vague language override your client’s injury severity. Structure your prognosis data. Subscribe to Settlement Intelligence today at app.demandletters.ai/signup

 

Disclaimer: Settlement Intelligence, Inc. is not a law firm. The materials on this site do not constitute legal advice and should not be interpreted as such. Legal advice must be tailored to the specific circumstances of each case, and nothing provided on this site should be used as a substitute for advice of competent counsel.