Method of expediting insurance claims

• US 20040148204A1
• Filed: 12/18/2003
• Published: 07/29/2004
• Est. Priority Date: 01/04/2003
• Status: Active Grant

• Current Assignee: Ultimate Claim Solutions Incorporated
• Original Assignee: Ultimate Claim Solutions Incorporated
• Inventors: Menendez, Dale
• Granted Patent: US 7,203,654 B2
• Time in Patent Office: Days
• US Class Current: 705/4
• CPC Class Codes: G06Q 10/10 Office automation; Time management
• CPC Class Codes: G06Q 40/08 Insurance
• CPC Class Codes: Y02A 90/10 Information and communication technologies [ICT] supporting adaptation to climate change, e.g. for weather forecasting or climate simulation

Abstract

A method and apparatus are provided for processing an insurance claim. The method includes the steps of receiving a claim for a loss from an insured through an Internet connection and determining a policy type from the claim. The method further includes the steps of retrieving a set of keywords based upon the policy type, matching the retrieved set of keywords with words contained within the received claim, assigning an adjuster to the claim when any matched words of the matching step meets a predetermined criteria and paying the claim without assigning the claim to an adjuster when the matching does not meet the predetermined criteria and any auxiliary criteria.

Claims

1. A method of processing an insurance claim comprising the steps of:

receiving a claim for a loss from an insured through an Internet connection;

determining a policy type from the claim;

retrieving a set of keywords based upon the policy type;

matching the retrieved set of keywords with words contained within the received claim;

assigning the claim to an adjuster when any matched words of the matching step meets a predetermined criteria; and

paying the claim without assigning the claim to an adjuster when the matching does not meet the predetermined criteria and any auxiliary criteria.

2. The method of processing the claim as in claim 1 further comprising defining the predetermined criteria as a match between any word of the retrieved set of keywords any word within the received claim.

3. The method of processing the claim as in claim 2 wherein the matching step further comprises selecting a description of how a loss occurred and matching the retrieved set of keywords with a text of the description.

4. The method of processing the claim as in claim 2 wherein the matching step further comprises retrieving and matching a set of keywords of property not covered.

5. The method of processing the claim as in claim 1 further comprising defining the predetermined criteria as an absence of a match between any keyword of property not covered and any word within the received claim.

6. The method of processing the claim as in claim 5 wherein the matching step further comprises selecting a description of how a loss occurred and matching the retrieved set of keywords with a text of the description.

7. The method of processing the claim as in claim 5 wherein the matching step further comprises selecting a description of building damage and matching the retrieved set of keywords with a text of the description.

8. The method of processing the claim as in claim 1 further comprising assigning the claim to an adjuster and/or investigator and/or other vendor/entity when the claim indicates that a third party may be responsible.

9. The method of processing the claim as in claim 1 further comprising assigning the claim to an adjuster and/or other vendors/resources when the claim indicates that emergency services are required.

10. The method of processing the claim as in claim 1 further comprising assigning the claim to an adjuster and/or investigator and/or other vendor/entity when the claim indicates potential employee dishonesty.

11. The method of processing the claim as in claim 1 further comprising assigning the claim to an adjuster when the policy type indicates a claim for damages with no coverage and/or a different deductable than claimed.

12. The method of processing the claim as in claim 1 further comprising assigning the claim to an adjuster when the claim indicates that a time period greater than a predetermined threshold has passed since the loss occurred.

13. The method of processing the claim as in claim 1 further comprising assigning the claim to an adjuster when the claim indicates that it exceeds a predetermined set of criteria for the number of claims submitted for a predetermined time period.

14. The method of processing the claim as in claim 1 further comprising assigning the claim to an adjuster when the claim meets a predetermined criteria used to identify potential fraudulent claims.

15. The method of processing the claim as in claim 1 further comprising assigning the claim to an adjuster when a total dollar value of the claim and/or subtotals exceed predetermined threshold limit values for building, personal property and/or expense.

16. The method of processing the claim as in claim 1 further comprising assigning the claim to an adjuster when the a time period between the loss and completion of a damages and/or proof of loss section of the claim exceeds a predetermined time threshold value.

17. The method of processing the claim as in claim 1 further comprising providing an online record, log and report allowing review of the claim and processing of payment or assigning an adjuster and further allowing servers/computers to exchange and query data to automate the payment and assignment process.

18. An apparatus for processing an insurance claim, such apparatus comprising:

means for receiving a claim for a loss from an insured through an Internet connection;

means for determining a policy type from the claim;

means for retrieving a set of keywords based upon the policy type;

means for matching the retrieved set of keywords with words contained within the received claim;

means for assigning the claim to an adjuster when the words matched by the means for matching meet a predetermined criteria; and

means for authorizing payment of the claim without assigning the claim to an adjuster when the matched words does not meet the predetermined criteria and any auxiliary criteria.

19. The apparatus for processing the claim as in claim 18 wherein the predetermined criteria further comprises a match between any word of the retrieved set of keywords and any word within the received claim.

20. The apparatus for processing the claim as in claim 19 wherein the means for matching further comprises means for selecting a description of how a loss occurred and matching the retrieved set of keywords with a text of the description.

21. The apparatus for processing the claim as in claim 19 wherein the means for matching further comprises means for selecting a set of keywords of property not covered.

22. The apparatus for processing the claim as in claim 18 further comprising defining the predetermined criteria as the absence of a match between any word of the retrieved set of keywords of property not covered and any word within the received claim.

23. The apparatus for processing the claim as in claim 22 wherein the means for matching further comprises means for selecting a description of how a loss occurred and matching the retrieved set of keywords with a text of the description.

24. The apparatus for processing the claim as in claim 22 wherein the means for matching further comprises means for selecting a description of building damage and matching the retrieved set of keywords with a text of the description.

25. The apparatus for processing the claim as in claim 18 further comprising means for assigning the claim to an adjuster and/or investigator and/or other vendor/entity when the claim indicates that a third party may be responsible.

26. The apparatus for processing the claim as in claim 18 further comprising means for assigning the claim to an adjuster and/or other vendors/resources when the claim indicates that emergency services are required.

27. The apparatus for processing the claim as in claim 18 further comprising means for assigning the claim to an adjuster and/or investigator and/or other vendor/entity when the claim indicates potential employee dishonesty.

28. The apparatus for processing the claim as in claim 18 further comprising means for assigning the claim to an adjuster when the policy type indicates a claim for damages with no coverage and/or a different deductable than claimed.

29. The apparatus for processing the claim as in claim 18 further comprising means for assigning the claim to an adjuster when the claim indicates that a time period greater than a predetermined threshold has passed since the loss occurred.

30. The apparatus for processing the claim as in claim 18 further comprising means for assigning the claim to an adjuster when the claim indicates that it exceeds a predetermined set of criteria for the number of claims submitted for a predetermined time period.

31. The apparatus for processing the claim as in claim 18 further comprising means for assigning the claim to an adjuster when the claim meets a predetermined criteria used to identify potential fraudulent claims.

32. The apparatus for processing the claim as in claim 18 further comprising means for assigning the claim to an adjuster when a total dollar value of the claim and/or subtotals exceed predetermined threshold limit values for building, personal property and/or expense.

33. The apparatus for processing the claim as in claim 18 further comprising means for assigning the claim to an adjuster when the a time period between the loss and completion of a damages and/or proof of loss section of the claim exceeds a predetermined time threshold value.

34. The apparatus for processing the claim as in claim 18 further comprising means for providing an online record, log and report allowing review of the claim and processing of payment or assigning an adjuster and further allowing servers/computers to exchange and query data to automate the payment and assignment process.

35. An apparatus for processing an insurance claim, such apparatus comprising:

a website adapted to receive a claim for a loss from an insured through an Internet connection;

a policy processor adapted to determine a policy type from the claim;

a set of keywords associated with the determined policy type;

a matching processor adapted to match the retrieved set of keywords with words contained within the received claim;

a criteria processor adapted to assign the claim to an adjuster when the words matched by the matching processor meet a predetermined criteria; and

a payment processor adapted to authorize payment of the claim without assigning the claim to an adjuster when the matched words does not meet the predetermined criteria and any auxiliary criteria.

36. The apparatus for processing the claim as in claim 35 wherein the predetermined criteria further comprises a match between any word of the retrieved set of keywords and a word within the received claim.

37. The apparatus for processing the claim as in claim 35 wherein the words contained within the received claim matched by the matching processor further comprises a description of how a loss occurred.

38. The apparatus for processing the claim as in claim 35 wherein the set of keywords further comprises a set of keywords that describe property not covered.

39. The apparatus for processing the claim as in claim 35 wherein the predetermined criteria used by the criteria processor further comprises the absence of a match between any word of the retrieved set of keywords and any word within the received claim.

40. The apparatus for processing the claim as in claim 39 wherein the words contained within the received claim matched by the matching processor further comprises a description of how a loss occurred.

41. The apparatus for processing the claim as in claim 35 wherein the words contained within the received claim matched by the matching processor further comprises description of building damage and matching the retrieved set of keywords with a text of the description.