Communication of insurance claim data

• US 10,685,401 B1
• Filed: 05/23/2014
• Issued: 06/16/2020
• Est. Priority Date: 10/13/2008
• Status: Active Grant

• Current Assignee: Allstate Insurance Company (Allstate Corporation)
• Original Assignee: Allstate Insurance Company (Allstate Corporation)
• Inventors: Hanson, Randall Martin, Ledder, James A., O'Halloran, Charles Ronald
• Primary Examiner(s): Maguire, Lindsay M
• Assistant Examiner(s): Warden, Michael J
• Application Number:
  US14/286,367
• Time in Patent Office: 2,216 Days
• Field of Search: 705 4, 705305, 705 314, 705400, 707999107
• CPC Class Codes: G06Q 10/06 Resources, workflows, human or project management; Enterprise or organisation planning; Enterprise or organisation modelling
• CPC Class Codes: G06Q 10/10 Office automation; Time management
• CPC Class Codes: G06Q 10/20 Administration of product repair or maintenance
• CPC Class Codes: G06Q 30/0283 Price estimation or determination
• CPC Class Codes: G06Q 40/08 Insurance

Abstract

Aspects of the invention are directed to methods and systems for efficiently communicating data between an insurer and a non-referral repair shop, e.g., vehicle repair shops that are normally not preapproved by the insurer to perform the estimating and repair work. The methods and systems described herein are particularly useful for insurers utilizing non-referral repair shops for servicing vehicles involved in insurance claims. According to aspects of this invention, the insured may be able to select a non-referral repair shop, not delegated or preapproved by the insurer, thereby generally allowing the insured to select any available vehicle repair shop.

Claims

1. An insurance claim system for improved interoperability between an insurance company data server and a vehicle repair estimating system to efficiently communicate data between an insurer and a non-referral repair shop, the system comprising:

a work request submitted to a non-referral vehicle repair shop, wherein the non-referral vehicle repair shop is not included within a pre-approved shop network associated with an insurance company, the work request including a set of assignment data with information about a customer, a corresponding vehicle, and a corresponding loss with the vehicle;

an insurance company data server at the insurance company comprising at least one computer processor and a user interface and coupled to a network, wherein the user interface includes an assignment user interface and an authentication user interface to enable the customer to enter a user name and a password;

a vehicle repair estimating system having at least one computer processor and interconnected with the insurance company data server via the network, the vehicle repair estimating system creating a vehicle repair estimate, wherein the repair estimate includes a set of estimate data and an image of the corresponding loss and damage of the vehicle; and

a vehicle insurance claim management application operating on the insurance company data server and the vehicle repair estimating system and executing a specific sequence of steps with the insurance company data server and the vehicle repair estimating system that causes the insurance claim system to;

receive the work request and the set of assignment data from the insurance company data server via the assignment user interface,

receive the vehicle repair estimate with the set of estimate data and the image from the non-referral vehicle repair shop, wherein the vehicle repair estimate is uploaded from the vehicle repair estimating system to the vehicle insurance claim management application,

translate and change the set of estimate data and the image into a format accepted by the vehicle insurance claim management application, wherein the translating includes encrypting the set of estimate data and the image,

calculate a rules-based intelligence score based on an analysis and audit of the set of estimate data, wherein the rules-based intelligence score is related to an identification of anomalies in the set of estimate data and includes a statistically-based analysis of historical estimate data,

determine a 3-tier intervention for the set of estimate data based on the rules-based intelligence score by the comparing the rules-based intelligence score to one of a low-range, mid-range, or high-range threshold, wherein the 3-tier intervention includes a first intervention of an automatic approval, a second intervention of a desk intervention, and a third intervention of a field intervention, and wherein the low-range, mid-range, and high-range threshold is determined and adjusted by the vehicle insurance claim management application, and further wherein the low-range, mid-range, and high-range threshold is configurable,

provide real-time updates between the vehicle insurance claim management application and the vehicle repair estimating system when one or more of the estimate data, the assignment data, the rules-based intelligence score, or the intervention changes,

transmit and communicate, over the Internet to the vehicle insurance claim management application and displayed on the user interface, the real-time updates of changes to one or more of the estimate data, the assignment data, the rules-based intelligence score, or the intervention,

wherein if the rules-based intelligence score correlates to the low-range threshold and the first intervention being the automatic approval, then the processor approves the vehicle repair estimate,

wherein if the rules-based intelligence score correlates to the mid-range threshold and to the second intervention being the desk intervention, then the processor transfers the vehicle repair estimate to a desk adjuster for a desk review and the processor further receives one of an approved estimate from the desk adjuster or a disapproved estimate from the desk adjuster, and

wherein if the rules-based intelligence score correlates to the high-range threshold and to the third intervention being the field intervention, then the processor transfers the vehicle repair estimate to a field adjuster for a field review and the processor further receives one of the approved estimate from the field adjuster or the disapproved estimate from the field adjuster.

2. The insurance claim system of claim 1, wherein the determination of the rules-based intelligence score includes a line-by-line review of the set of estimate data.

3. The insurance claim system of claim 1, wherein the determination of the rules-based intelligence score includes an aggregate review of the set of estimate data.

4. The insurance claim system of claim 1, wherein the vehicle insurance claim management application operating on the insurance company data server and the vehicle repair estimating system and executing a specific sequence of steps with the insurance company data server and the vehicle repair estimating system causes the insurance claim system further to:

store and provide payment status information for the plurality of work requests assigned to the non-referral vehicle repair shop.

5. The insurance claim system of claim 1, wherein the vehicle insurance claim management application operating on the insurance company data server and the vehicle repair estimating system and executing a specific sequence of steps with the insurance company data server and the vehicle repair estimating system causes the insurance claim system further to:

store and provide one or more performance metrics for the non-referral vehicle repair shop as compared to other vehicle repair facilities working with the insurance company.

6. The insurance claim system of claim 1, wherein the insurance company data server is coupled to a web server through which users interact with the vehicle insurance claim management application and the insurance claim system.

7. The insurance claim system of claim 6, wherein the web server includes a claim processing system used to store the set of assignment data for further processing.

8. The insurance claim system of claim 1, wherein the vehicle insurance claim management application operating on the insurance company data server and the vehicle repair estimating system and executing a specific sequence of steps with the insurance company data server and the vehicle repair estimating system causes the insurance claim system further to:

provide a timeline indicating a plurality of milestone dates corresponding to a displayed vehicle work request.

9. An insurance claim system for improved interoperability between an insurance company data server and a vehicle repair estimating system to efficiently communicate data between an insurer and a non-referral repair shop, the system comprising:

a first work request submitted to a direct repair vehicle repair shop, the first work request including a first set of assignment data with information about a first customer, a corresponding first vehicle, and a corresponding first loss with the first vehicle;

a second work request submitted to a non-referral vehicle repair shop, wherein the non-referral vehicle repair shop is not included within a pre-approved shop network associated with an insurance company, the second work request including a second set of assignment data with information about a second customer, a corresponding second vehicle, and a corresponding second loss with the second vehicle;

an insurance company data server comprising at least one computer processor and a user interface and coupled to a network, wherein the user interface includes an assignment user interface and an authentication user interface to enable the first customer and the second customer to enter a user name and password;

a first vehicle repair estimating system having at least one computer processor and interconnected with the insurance company data server via the network, the first vehicle repair estimating system creating a first vehicle repair estimate that includes a first set of estimate data and a first image of the corresponding first loss and damage of the first vehicle;

a second vehicle repair estimating system having at least one computer processor and interconnected with the insurance company data server via the network, the second vehicle repair estimating system creating a second vehicle repair estimate that includes a second set of estimate data and a second image of the corresponding second loss and damage of the second vehicle, wherein the second vehicle repair estimating system is different than the first vehicle repair estimating system; and

a vehicle insurance claim management application operating on the insurance company data server, the first vehicle repair estimating system, and the second vehicle repair estimating system and executing a specific sequence of steps with the insurance company data server, the first vehicle repair estimating system, and the second vehicle repair estimating system that causes the insurance claim system to;

receive the first work request and the first set of assignment data from the insurance company data server via the assignment user interface;

translate and change the first set of assignment data into a format accepted by the vehicle insurance claim management application;

transfer the translated first set of assignment data to the first vehicle repair estimating system;

receive the first vehicle repair estimate with the first set of estimate data and the first image from the first vehicle repair estimating system, wherein the first vehicle repair estimate is uploaded from the first vehicle repair estimating system to the vehicle insurance claim management application;

translate and change the first set of estimate data into a format accepted by the vehicle insurance claim management application;

review the translated first set of estimate data and the first image for compliance with a set of contract-based conditions;

receive the second work request and the second set of assignment data from the insurance company data server via the assignment user interface;

translate and change the second set of assignment data into a format accepted by the vehicle insurance claim management application;

transfer the translated second set of assignment data to the second vehicle repair estimating system;

receive the second vehicle repair estimate with the second set of estimate data and the second image from the second vehicle repair estimating system, wherein the second vehicle repair estimate is uploaded from the second vehicle repair estimating system to the vehicle insurance claim management application;

translate and change the second set of estimate data and the second image into a format accepted by the vehicle insurance claim management application;

calculate a rules-based intelligence score based an analysis and audit of on the second set of estimate data, wherein the rules-based intelligence score is related to an identification of anomalies in the second set of estimate data and includes a statistically-based analysis of historical estimate data;

determine a 3-tier intervention for the second set of estimate data based on the rules-based intelligence score by the comparing the rules-based intelligence score to one of a low-range, mid-range, or high-range threshold, wherein the 3-tier intervention includes a first intervention of an automatic approval, a second intervention of a desk intervention, and a third intervention of a field intervention, and wherein the low-range, mid-range, and high-range threshold is determined and adjusted by the vehicle insurance claim management application, and further wherein the low-range, mid-range, and high-range threshold is configurable;

provide real-time updates between the vehicle insurance claim management application, the first vehicle repair estimating system, and the second vehicle repair estimating system when one or more of the estimate data, the assignment data, the rules-based intelligence score, or the intervention changes; and

transmit and communicate, over the Internet to the vehicle insurance claim management application, the real-time updates of changes to one or more of the estimate data, the assignment data, the rules-based intelligence score, or the intervention,

wherein if the second set of estimate data and the rules-based intelligence score correlates to the low-range threshold and the first intervention being the automatic approval, then the processor approves the second vehicle repair estimate,

wherein if the second set of estimate data and the rules-based intelligence score correlates to the mid-range threshold and the second intervention being the desk intervention, then the processor transfers the second vehicle repair estimate to a desk adjuster for a desk review and the processor further receives one of an approved estimate data from the desk adjuster or a disapproved estimate data from the desk adjuster, and

wherein if the second set of estimate data and the rules-based intelligence score correlates to the high-range threshold and the third intervention being the field intervention, then the processor transfers the second vehicle repair estimate to a field adjuster for a field review and the processor further receives one of the approved estimate data from the field adjuster or the disapproved estimate data from the field adjuster.

10. The insurance claim system of claim 9, wherein the determination of the rules-based intelligence score includes a line-by-line review of the second set of estimate data and an aggregate review of the second set of estimate data.

11. The insurance claim system of claim 9, wherein the vehicle insurance claim management application operating on the insurance company data server, the first vehicle repair estimating system, and the second vehicle repair estimating system and executing a specific sequence of steps with the insurance company data server, the first vehicle repair estimating system, and the second vehicle repair estimating system causes the insurance claim system further to:

store and provide payment status information for the plurality of vehicle work requests assigned to the direct repair vehicle repair shops and the non-referral repair shops.

12. The insurance claim system of claim 9, wherein the vehicle insurance claim management application operating on the insurance company data server, the first vehicle repair estimating system, and the second vehicle repair estimating system and executing a specific sequence of steps with the insurance company data server, the first vehicle repair estimating system, and the second vehicle repair estimating system causes the insurance claim system further to:

store and provide a performance metric for the direct repair vehicle repair shops as compared to other vehicle repair facilities working with the insurance company.

13. The insurance claim system of claim 9, wherein the insurance company data server is coupled to a web server through which users interact with the vehicle insurance claim management application and the insurance claim system.

14. The insurance claim system of claim 13, wherein the web server includes a claim processing system used to store the first and second set assignment data for further processing.

15. The insurance claim system of claim 9, wherein the vehicle insurance claim management application operating on the insurance company data server, the first vehicle repair estimating system, and the second vehicle repair estimating system and executing a specific sequence of steps with the insurance company data server, the first vehicle repair estimating system, and the second vehicle repair estimating system causes the insurance claim system further to:

provide an interactive calendar through which the direct repair vehicle repair shops and the non-referral repair shops schedule repair of a vehicle corresponding to a displayed vehicle work request.

16. An insurance claim system for improved interoperability between an insurance company data server and a vehicle repair estimating system to efficiently communicate data between an insurer and a non-referral repair shop, the system comprising:

a first work request submitted to a direct repair vehicle repair shop, the first work request including a first set of assignment data with information about a first customer, a corresponding first vehicle, and a corresponding first loss with the first vehicle;

a second work request submitted to a non-referral vehicle repair shop, wherein the non-referral vehicle repair shop is not included within a pre-approved shop network associated with an insurance company, the second work request including a second set of assignment data with information about a second customer, a corresponding second vehicle, and a corresponding second loss with the second vehicle;

an insurance company data server comprising at least one computer processor and a user interface and coupled to a network, wherein the user interface includes an assignment user interface and an authentication user interface to enable the first customer and the second customer to enter a user name and password;

a vehicle repair estimating system having at least one computer processor and interconnected with the insurance company data server via the network, the vehicle repair estimating system creating a first vehicle repair estimate and a second vehicle repair estimate, wherein the first vehicle repair estimate includes a first set of estimate data and a first image of the corresponding first loss and damage of the first vehicle, and further wherein the second vehicle repair estimate includes a second set of estimate data and a second image of the corresponding second loss and damage of the second vehicle;

a vehicle insurance claim management application in communication with the insurance company data server and the vehicle repair estimating system that causes the insurance claim system to;

receive the first work request and the first set of assignment data from the insurance company data server via the assignment user interface;

translate and change the first set of assignment data into a format accepted by the vehicle insurance claim management application;

transfer the translated first set of assignment data to the vehicle repair estimating system;

receive the first vehicle repair estimate with the first set of estimate data and the first image from the vehicle repair estimating system, wherein the first vehicle repair estimate is uploaded from the vehicle repair estimating system to the vehicle insurance claim management application;

translate and change the first set of estimate data and the first image into a format accepted by the vehicle insurance claim management application;

review the first set of estimate data and the first image for compliance with a set of contract-based conditions;

receive the second work request and the second set of assignment data from the insurance company data server via the assignment user interface;

translate and change the second set of assignment data into a format accepted by the vehicle insurance claim management application;

transfer the translated second set of assignment data to the vehicle repair estimating system;

receive the second vehicle repair estimate with the second set of estimate data and the second image from the vehicle repair estimating system, wherein the second vehicle repair estimate is uploaded from the vehicle repair estimating system to the vehicle insurance claim management application;

translate and change the second set of estimate data and the second image into a format accepted by the vehicle insurance claim management application;

calculate a rules-based intelligence score based on an analysis and audit of the second set of estimate data, wherein the rules-based intelligence score is related to an identification of anomalies in the second set of estimate data and includes a statistically-based analysis of historical estimate data;

determine a 3-tier intervention for the second set of estimate data based on the rules-based intelligence score by the comparing the rules-based intelligence score to a low-range, mid-range, or high-range threshold, wherein the 3-tier intervention includes a first intervention of an automatic approval, a second intervention of a desk intervention, and a third intervention of a field intervention, and wherein the low-range, mid-range, and high-range threshold is determined and adjusted by the vehicle insurance claim management application, and further wherein the low-range, mid-range, and high-range threshold is configurable;

provide real-time updates between the vehicle insurance claim management application, the first vehicle repair estimating system, and the second vehicle repair estimating system when one or more of the estimate data, the assignment data, the rules-based intelligence score, or the intervention changes; and

transmit and communicate, over the Internet to the vehicle insurance claim management application, the real-time updates of changes to one or more of the estimate data, the assignment data, the rules-based intelligence score, or the intervention.

17. The insurance claim system of claim 16, wherein the determination of the rules-based intelligence score includes a line-by-line review of the second set of estimate data and an aggregate review of the second set of estimate data.

18. The insurance claim system of claim 16, wherein if the second set of estimate data and the rules-based intelligence score correlates to the low-range threshold and the first intervention being the automatic approval, then the processor approves the second vehicle repair estimate.

19. The insurance claim system of claim 16, wherein if the second set of estimate data and the rules-based intelligence score correlates to the mid-range threshold and the second intervention being the desk intervention, then the processor transfers the second vehicle repair estimate to a desk adjuster for a desk review and the processor further receives one of an approved estimate data from the desk adjuster or a disapproved estimate data from the desk adjuster.

20. The insurance claim system of claim 16, wherein if the second set of estimate data and the rules-based intelligence score correlates to the high-range threshold and the third intervention being the field intervention, then the processor transfers the second vehicle repair estimate to a field adjuster for a field review and the processor further receives one of the approved estimate data from the field adjuster or the disapproved estimate data from the field adjuster.