System and process for electronic subrogation, inter-organization workflow management, inter-organization transaction processing and optimized web-based user interaction

• US 20040111302A1
• Filed: 11/07/2003
• Published: 06/10/2004
• Est. Priority Date: 11/08/2002
• Status: Abandoned Application

• Current Assignee: Siteras Technologies II LLC
• Original Assignee: Siteras Technologies II LLC
• Inventors: Falk, Robert J., Radi, Richard J.
• Application Number:
  US10/704,460
• Publication Number:
  US 20040111302A1
• Time in Patent Office: Days
• US Class Current: 705/4
• CPC Class Codes: G06Q 10/10 Office automation; Time management
• CPC Class Codes: G06Q 40/00 Finance; Insurance; Tax strategies; Processing of corporate or income taxes
• CPC Class Codes: G06Q 40/02 Banking, e.g. interest calculation or account maintenance credit or loans G06Q40/03
• CPC Class Codes: G06Q 40/08 Insurance

Abstract

An intelligent electronic subrogation network (“ESN”) automates intra-organization workflow, inter-organization workflow and collaboration for insurance subrogation. This ESN is facilitated by a novel system architecture and process that includes an inter-organizational workflow management system, an inter-organizational transaction processing system, and a unique mechanism for optimizing and enriching web-based user interaction within any such system.

Claims

1. A method for issuing and negotiating and settling insurance subrogation claims between at least two parties through an electronic subrogation network, said method comprising:

providing at least one electronic subrogation file, capable of containing structured claim information and unstructured supporting documents in a form that can be accessed by multiple parties;

permitting entry, through electronic communication means, by one or more of said multiple parties of one or both of claim information and supporting documents to said subrogation file based on party-specific rules; and

permitting access, through electronic communication means, by one or more of said multiple parties to one or both of said structured claim information and said unstructured supporting documents based on party-specific rules.

2. The method of claim 1, wherein said permitting entry includes automatically entering paper documents received by fax or high-speed scanner into the electronic file.

3. The method of claim 1, wherein said electronic communication means comprises a network, and further including issuing subrogation demands through electronic communication means to both on-network and off-network parties.

4. The method of claim 1, and further including establishing audit and business rule functions that permit said at least one electronic subrogation file to be electronically audited based on said party-specific rules.

5. The method of claim 1, wherein said multiple parties include a demanding party, a responding party, and one or more supporting/facilitating parties, and further including routing a demand to an appropriate responding party based on a responding party'"'"'s routing rules.

6. The method of claim of 5, wherein said routing includes using a routing algorithm that combines a demanding party specific index and a heuristic algorithm to correctly determine an appropriate responding party and further a specific individual or group within said responding party that is to initially handle the demand.

7. The method of claim 1, and further including using a state-based model to manage inter-party subrogation workflow.

8. The method of claim 1, and further including permitting intra-party subrogation workflow functions, including follow-up action plans and party-specific workflow.

9. The method of claim 1, and further including providing collaboration functions that allow selected parties to exchange information and negotiate using said electronic communication means.

10. The method of claim 1, and further including providing a document management function that allows said multiple parties to update attachments and manage document versions.

11. The method of claim 1, wherein said electronic communication means includes a network, and further including automatically generating alerts to on-network parties for exception conditions or violations of said party-specific rules.

12. The method of claim 1, and further including selectively assigning selected files and providing online access to third parties including arbitrators, litigators and outside service providers.

13. The method of claim 1, wherein said electronic communication means includes a network, and further including generating customizable online management reports.

14. The method of claim 1, and further including settling subrogation claims between parties automatically based on the parties'"'"' business rules.

15. The method of claim 1, and further including automatically generating counterclaim demands based on liability percentage and comparative negligence rules of a responding party.

16. The method of claim 1, and further including triggering an automatic funds transfer based on a response of a responding party.

17. The method of claim 1, and further including netting payments between parties involved in a subrogation claim, including:

tracking payments owed and payments due over a given period of time for a member;

netting payments either bilaterally between parties or multilaterally between a party and an electronic subrogation network representing all other parties participating in a netting process;

configuring netting periods; and

managing information to allocate netted payments to each claim file.

18. The method of claim 1, and further including allowing members to benchmark parameters of their subrogation and/or claims operation against an aggregate based on information contained in said electronic subrogation files.

19. The method of claim 1, and further including assessing a best course of action within a subrogation process, including performing a cost-benefits analysis of pursuing a particular course of action.

20. The method of claim 1, and further including assessing the validity of a subrogation demand including performing an electronic audit for selected conditions based upon configurable parameters of a demanding party, and one or more responding parties, said configurable parameters including, but not limited to, required data or documents, claim liability and damages, and vehicle valuation conditions.

21. The method of claim 1, and further including routing subrogation demand to responding parties using a routing algorithm, which combines a heuristic algorithm to correctly determine the identity of the responding party and routing rules defined by the responding party.

22. A method for organizing and modeling subrogation-specific business information comprising:

providing entities, attributes and relationships specific to subrogation workflow;

translating incoming data formats to a unified data model format; and

maintaining consistency in said translating.

23. A method for managing the workflow between two or more organizations within a subrogation process, said method comprising:

providing a subrogation-specific workflow model that includes inter-organization workflow states, transitions, conditionality, status and action flags; and

managing organization-specific workflow within the context of community workflow.

24. The method of claim 23, and further including providing real-time status information to said organizations.

25. The method of claim 23, and further including managing organization-specific workflow based upon the events and exception conditions within the workflow.

26. A system for issuing and negotiating and settling insurance subrogation claims between at least two parties through an electronic subrogation network, said system comprising:

at least one electronic subrogation file, capable of containing structured claim information and unstructured supporting documents in a form that can be accessed by multiple parties;

means for permitting entry, through electronic communication means, by one or more of said multiple parties of one or both of said structured claim information and unstructured supporting documents to said subrogation file based on party-specific rules; and

means for permitting access, through electronic communication means, by one or more of said multiple parties to one or both of said structured claim information and said supporting documents based on party-specific rules.

27. The system of claim 26, wherein said means for permitting entry includes means for automatically entering paper documents received by fax or high speed scanner into the electronic file.

28. The system of claim 26, wherein said electronic communication means comprises a network, and further including means for issuing subrogation demands through electronic communication means to both on-network and off-network parties.

29. The system of claim 26, and further including means for establishing audit and business rule functions that permit said at least one electronic subrogation file to be electronically audited based on said party-specific rules.

30. The system of claim 26, wherein said multiple parties include a demanding, a responding party, and one or more supporting/facilitating parties, and further including means for routing a demand to an appropriate responding party based on a responding party'"'"'s routing rules.

31. The system of claim of 30, wherein said means for routing includes a routing algorithm that combines a demanding party specific index and a heuristic algorithm to correctly determine an appropriate responding party and further a specific individual or group within said responding party that is to initially handle the demand.

32. The system of claim 26, and further including a state-based model for managing inter-party subrogation workflow.

33. The system of claim 26, and further including means for permitting intra-party subrogation workflow functions, including follow-up action plans and party-specific workflow.

34. The system of claim 26, and further including means for providing collaboration functions that allow selected parties to exchange information and negotiate using said electronic communication means.

35. The system of claim 26, and further including means for providing a document management function that allows said multiple parties to update attachments and manage document versions.

36. The system of claim 26, wherein said electronic communication means includes a network, and further including means for automatically generating alerts to on-network parties for exception conditions or violations of said party-specific rules.

37. The system of claim 26, and further including means for selectively assigning selected files and providing online access to third parties including arbitrators, litigators and outside service providers.

38. The system of claim 26, wherein said electronic communication means includes a network, and further including means for generating customizable online management reports.

39. The system of claim 26, and further including means for settling subrogation claims between parties automatically based on the parties'"'"' business rules.

40. The system of claim 26, and further including means for automatically generating counterclaim demands based on liability percentage and comparative negligence rules of a responding party.

41. The system of claim 26, and further including means for triggering an automatic funds transfer based on a response of a responding party.

42. The system of claim 26, and further including means for netting payments between parties involved in a subrogation claim, including:

means for tracking payments owed and payments due over a given period of time for a member;

means for netting payments either bilaterally between parties or multilaterally between a party and the ESN representing all other parties participating in the netting process;

means for configuring netting periods; and

means for managing information to allocate netted payments to each claim file.

43. The system of claim 26, and further including means for allowing members to benchmark parameters of their subrogation and/or claims operation against an aggregate based on information contained in said electronic subrogation files.

44. The system of claim 26, and further including means for assessing a best course of action within a subrogation process, including means for performing a cost-benefits analysis of pursuing a particular course of action.

45. The system of claim 26, and further including means for assessing the validity of a subrogation demand including means for performing an electronic audit for selected conditions based upon configurable parameters of a demanding party, and of one or more responding parties, said configurable parameters including, but not limited to, required data or documents, claim liability and damages, and vehicle valuation conditions.

46. The system of claim 26, and further including means for routing subrogation demand to responding parties using a routing algorithm, which combines a heuristic algorithm to correctly determine the identity of the responding party and routing rules defined by the responding party.

47. A system for organizing and modeling subrogation-specific business information comprising:

means for providing entities, attributes and relationships is specific to subrogation workflow;

means for translating incoming data formats to a unified data model format; and

means for maintaining consistency in said translating.

48. A system for managing the workflow between two or more companies within a subrogation process, said system comprising:

means for providing a subrogation-specific workflow model that includes inter-organization workflow states, transitions, conditionality, status and action flags; and

means for managing organization-specific workflow within the context of community workflow.

49. The system of claim 48, and further including means for providing real-time status information to said organizations.

50. The system of claim 48, and further including means for managing organization-specific workflow based upon the events and exception conditions within the workflow.

51. A method for optimizing and enriching an interaction between a client and a server as compared to a server-based HTML approach, said method comprising:

reducing the bandwidth requirement for the transmission of data between a client and a server;

reducing the number of interactions required to between a client and a server by a factor of two or more;

reducing response time as experienced by an end-user operating the client; and

reducing a number of processing cycles required by the server for communication of application information between a server and a client.

52. The method of claim 51, and further including providing for communication of structured and unstructured information to and from the server.

53. The method of claim 51, and further including, compared to a server-based HTML approach, effecting a message-based communication channel with a server that simplifies the construction of processing logic that handles each message.

54. The method of claim 51, and further including providing for multiple independent and simultaneous communication channels with the server within the same end-user session.

55. The method of claim 51, and further including supporting a plurality of varying browser implementations.

56. The method of claim 51, and further including measuring and recording an actual response time experienced by an end-user operating the client.

57. The method of claim 51, and further including operating within the constraints of a basic thin client architecture.

58. A system for optimizing and enriching an interaction between a client and a server as compared to a server-based HTML approach, said system comprising:

means for reducing the bandwidth requirement for the transmission of data between a client and a server;

means for reducing the number of interactions required to between a client and a server by a factor of two or more;

means for reducing response time as experienced by an end-user operating the client; and

means for reducing a number of processing cycles required by the server for communication of application information between a server and a client.

59. The system of claim 58, and further including providing for communication of structured and unstructured information to and from the server.

60. The system of claim 58, and further including means for effecting a message-based communication channel with a server that simplifies the construction of processing logic that handles each message, compared to a server-based HTML approach.

61. The system of claim 58, and further including means for providing multiple independent and simultaneous communication channels with the server within the same end-user session.

62. The system of claim 58, and further including means for supporting a plurality of varying browser implementations.

63. The system of claim 58, and further including means for measuring and recording an actual response time experienced by an end-user operating the client.

64. The system of claim 58, and further including means for operating within the constraints of a basic thin client architecture.

65. A method for determining and maintaining workflow states of a business process/transaction involving multiple independent parties, said method comprising:

defining said workflow states and communicating at least one of said workflow states upon demand to each of said organizations in a framework that is generic to a specific business process/transaction;

defining one or more valid workflow completion targets and maintaining state information related to the progression towards a given workflow target;

tracking the state of one or more activities occurring simultaneously within said business process/transaction;

maintaining state data independently for each of the organizations involved within said business process/transaction;

maintaining data for each activity within said business process/transaction specifying which of said organizations is responsible for performing the next action related to said activity; and

maintaining a deterministic framework for all valid workflow conditions, states and transitions between states related to said business process/transaction.

66. The method of claim 65, and further including determining a set of valid operations that can be performed to effect workflow state changes or transactions, at any point during the business process/transaction.

67. The method of claim 65, and further including differentiating between and among a plurality of relationships that each said party has with respect to a given business process/transaction for the purpose of determining or maintaining valid workflow states.

68. The method of claim 65, and further including using a parameter-based implementation which does not require procedural programming logic or instructions that are specific to the business process/transaction.

69. A system for determining and maintaining workflow states of a business process/transaction involving multiple independent parties, said system comprising:

means for defining said workflow states and communicating at least one said workflow states upon demand to each of said organizations in a framework that is generic to a specific business process/transaction;

means for defining one or more valid workflow completion targets and maintaining state information related to the progression towards a given workflow target;

means for tracking the state of one or more activities occurring simultaneously within said business process/transaction;

means for maintaining state data independently for each of the organizations involved within said business process/transaction;

means for maintaining data for each activity within said business process/transaction specifying which of said organizations is responsible for performing the next action related to said activity; and

means for maintaining a deterministic framework for all valid workflow conditions, states and transitions between states.

70. The system of claim 69, and further including means for determining a set of valid operations that can be performed to effect workflow state changes or transactions, at any point during the business process/transaction.

71. The system of claim 69, and further including means for differentiating between and among a plurality of relationships that each said organization has with respect to a given business process/transaction for the purpose of determining or maintaining valid workflow states.

72. The system of claim 69, and further including a parameter-based implementation which does not require procedural programming logic or instructions that are specific to the business process/transaction.

73. A method for carrying out a business process/transaction involving multiple independent parties through an electronic network, said method comprising:

providing at least one electronic file, capable of containing structured information and unstructured supporting documents in a form that can be accessed by multiple parties;

permitting entry, through electronic communication means, by one or more of said multiple parties of one or both of said structured information and said supporting documents to said electronic file based on party-specific rules; and

permitting access, through electronic communication means, by one or more of said multiple parties to one or both of said structured claim information and said unstructured supporting documents based on party-specific rules.

75. The method of claim 73, wherein said permitting entry includes automatically entering paper documents received by fax or high speed scanner into the electronic file.

76. The method of claim 73, wherein said electronic communication means comprises a network, and further including processing business transactions through electronic communication means to both on-network and off-network parties.

77. The method of claim 73, and further including establishing audit and business rule functions that permit said at least one electronic file to be electronically audited based on said party-specific rules.

78. The method of claim 73, wherein said multiple parties include a primary party, a counter-party, and one or more supporting/facilitating parties, and further including routing a file to an appropriate counter-party based on the counter-party'"'"'s routing rules.

79. The method of claim of 78, wherein said routing includes using a routing algorithm that combines a primary party specific index and a heuristic algorithm to correctly determine an appropriate counter-party and further the specific individual or group within said counter-party that is to initially handle the file.

80. The method of claim 73, and further including means for using a state-based model to manage inter-party workflow.

81. The method of claim 73, and further including permitting intra-party workflow functions, including follow-up action plans and party-specific workflow.

82. The method of claim 73, and further including providing collaboration functions that allow selected parties to exchange information using said electronic communication means.

83. The method of claim 73, and further including providing a document management function that allows said multiple parties to update attachments and manage document versions.

84. The method of claim 73, wherein said electronic communication means includes a network, and further including automatically generating alerts to on-network parties for exception conditions or violations of said party-specific rules.

85. The method of claim 73, and further including selectively assigning selected files and providing online access to third parties including outside service providers.

86. The method of claim 73, wherein said electronic communication means includes a network, and further including generating customizable online management reports.

87. The method of claim 73, and further including assessing the validity of a business transaction including performing an electronic audit for selected conditions based upon configurable parameters of the primary party, and one or more counter-parties, said configurable parameters including, but not limited to, various required/optional data elements or documents.

88. The method of claim 73, and further including routing a given business transaction to counter-parties using a routing algorithm, which combines a heuristic algorithm to correctly determine the identity of the counter-party and routing rules defined by the counter-party.

74. A method for processing an application specific request, and generating an associated response, based on receipt of a message based-transaction request containing a collection of interrelated business objects, said method comprising:

providing a processing framework that does not rely on any specific message format from the originating system;

validating the identity and authority of an arbitrary requester that will be submitting transaction requests, and, upon said validating, establishing a “

requester context”

that will be used to validate any transaction requests;

validating whether or not a specific transaction request can be processed based on the requester context and, upon said validating, establishing a “

transaction context”

based on the specific request;

ensuring that any response to the transaction request contains correct business objects and related attributes based on a requester and transaction context;

ensuring that the input portion of any transaction request that will result in data modification contains only the business objects and attributes that are allowed to be modified based on the requester and transaction context;

allowing the application specific processing logic to be defined without regard to input or output filtering of objects and attributes that are indicated by a specific requester and transaction context;

ensuring that the transaction request can only access data objects within the database that are allowed based on the specific requester and transaction context;

supporting transaction requests from a plurality of originating systems and interfaces including, online HTML interface, background, automated electronic interface, and wireless device; and

enabling authorized requesting systems to automatically determine the types of requests that can be submitted and their associated request/response structures.

89. A method for organizing and modeling application-specific business information comprising:

providing entities, attributes and relationships specific to the given business process;

translating incoming data formats to a unified data model format; and

maintaining consistency in said translating.

90. A method for managing the workflow between two or more organizations within a business process, said method comprising:

providing a process-specific workflow model that includes inter-organization workflow states, transitions, conditionality, status and action flags; and

managing organization-specific workflow within the context of community workflow.

91. The method of claim 90, and further including providing real-time status information to said organizations.

92. The method of claim 90, and further including managing organization-specific workflow based upon the events and exception conditions within the workflow.

93. A method for modeling the business practices of each member of a network, and for handling workflow exception conditions, said method comprising:

permitting said members to configure company-specific business rules;

auditing files based upon the business rules of all members involved in the transaction; and

triggering alerts in response to exception conditions and violations of said business rules based upon member-specific parameters.

94. The method of claim 93, wherein said triggering includes triggering an alert to one of said members based upon parameters of another of said members.

95. A system for carrying out a business process/transaction involving multiple independent parties through an electronic subrogation network, said system comprising:

at least one electronic file, capable of containing structured information and unstructured supporting documents in a form that can be accessed by multiple parties;

means for permitting entry, through electronic communication means, by one or more of said multiple parties of one or both of said information and unstructured supporting documents to said electronic file based on party-specific rules; and

means for permitting access, through electronic communication means, by one or more of said multiple parties to one or both of said structured claim information and said supporting documents based on party-specific rules.

97. The system of claim 95, wherein said means for permitting entry includes means for automatically entering paper documents received by fax or high speed scanner into the electronic file.

98. The system of claim 95, wherein said electronic communication means comprises a network, and further including processing business transactions through electronic communication means to both on-network and off-network parties.

99. The system of claim 95, and further including means for establishing audit and business rule functions that permit said at least one electronic file to be electronically audited based on said party-specific rules.

100. The system of claim 95, wherein said multiple parties include a primary party, a counter-party, and one or more supporting/facilitating parties, and further including means for routing a file to an appropriate counter-party based on the counter-party'"'"'s routing rules.

101. The system of claim of 100, wherein said means for routing includes using a routing algorithm that combines a primary party specific index and a heuristic algorithm to correctly determine an appropriate counter-party and further the specific individual or group within said counter-party that is to initially handle the file.

102. The system of claim 95, and further including means for using a state-based model to manage inter-party workflow.

103. The system of claim 95, and further including means for permitting intra-party workflow functions, including follow-up action plans and party-specific workflow.

104. The system of claim 95, and further including means for providing collaboration functions that allow selected parties to exchange information and negotiate using said electronic communication means.

105. The system of claim 95, and further including means for providing a document management function that allows said multiple parties to update attachments and manage document versions.

106. The system of claim 95, wherein said electronic communication means includes a network, and further including means for automatically generating alerts to on-network parties for exception conditions or violations of said party-specific rules.

107. The system of claim 95, and further including means for selectively assigning selected files and providing online access to third parties including arbitrators, litigators and outside service providers.

108. The system of claim 95, wherein said electronic communication means includes a network, and further including means for generating customizable online management reports.

109. The system of claim 95, and further including means for assessing the validity of a business transaction including performing an electronic audit for selected conditions based upon configurable parameters of the primary party, and one or more counter-parties, said configurable parameters including, but not limited to, various required/optional data elements or documents.

110. The system of claim 95, and further including means for routing a given business transaction to counter-parties using a routing algorithm, which combines a heuristic algorithm to correctly determine the identity of the counter-party and routing rules defined by the counter-party.

96. A system for processing an application specific request, and generating an associated response, based on receipt of a message based-transaction request containing a collection of interrelated business objects, said system comprising:

means for providing a processing framework that does not rely on any specific message format from the originating system;

means for validating the identity and authority of an arbitrary requester that will be submitting transaction requests, and, upon said validating, establishing a “

requester context”

that will be used to validate any transaction requests;

means for validating whether or not a specific transaction request can be processed based on the requester context and, upon said validating, establishing a “

transaction context”

based on the specific request;

means for ensuring that any response to the transaction request contains correct business objects and related attributes based on a requester and transaction context;

means for ensuring that the input portion of any transaction request that will result in data modification contains only the business objects and attributes that are allowed to be modified based on the requester and transaction context;

means for allowing the application specific processing logic to be defined without regard to input or output filtering of objects and attributes that are indicated by a specific requester and transaction context;

means for ensuring that the transaction request can only access data objects within the database that are allowed based on the specific requester and transaction context;

means for supporting transaction requests from a plurality of originating systems and interfaces including, online HTML interface, background, automated electronic interface, and wireless device; and

means for enabling authorized requesting systems to automatically determine the types of requests that can be submitted and their associated request/response structures.

111. A system for organizing and modeling application-specific business information comprising:

providing entities, attributes and relationships specific to the given business process;

translating incoming data formats to a unified data model format; and

maintaining consistency in said translating.

112. A system for managing the workflow between two or more organizations within a business process, said system comprising:

providing a process-specific workflow model that includes inter-organization workflow states, transitions, conditionality, status and action flags; and

managing organization-specific workflow within the context of community workflow.

113. The system of claim 112, and further including means for providing real-time status information to said organizations.

114. The method of claim 112, and further including means for managing organization-specific workflow based upon the events and exception conditions within the workflow.

115. A system for modeling the business practices of each member of a network, and for handling workflow exception conditions, said system comprising:

means for permitting said members to configure company-specific business rules;

means for auditing files based upon the business rules of all members involved in the transaction; and

means for triggering alerts in response to exception conditions and violations of said business rules based upon member-specific parameters.

116. The system of claim 115, wherein said means for triggering includes triggering an alert to one of said members based upon parameters of another of said members.