System and method for performing reinspection in insurance claim processing

• US 20050246206A1
• Filed: 06/13/2003
• Published: 11/03/2005
• Est. Priority Date: 08/05/1998
• Status: Active Grant

• Current Assignee: CCC Information Services, Inc.
• Original Assignee: CCC Information Services, Inc.
• Inventors: Snyder, Gary C., Heyward, Erica L., Stiff, Thomas B., O'Connor, Sean P., Obora, Karoline M., Wikman, Walter J., D'Sonza, Thomas, Sailer, Dale A.
• Granted Patent: US 8,095,391 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

Abstract

A system and method for performing insurance claim reinspections is disclosed. The system includes an insurance company computer in communication with a communications server, at least one remote terminal in communication with the communications server, and an insurance claim workfile having a loss estimate section, an appraisal section and a reinspection section. The method includes the steps of providing an insurance claim profile and exception priority information, comparing an estimate in an insurance workfile to the insurance claim profile, and generating exception indicators based on the comparison.

Claims

1. A method of reinspecting insurance claim appraisals wherein each of said insurance claim appraisals are contained in a respective one of a plurality of insurance claim workfiles, each insurance claim workfile comprising all pertinent data for processing an insurance claim, said method comprising the steps of:

automatically notifying a reinspector that an insurance claim assignment has been made when said insurance claim assignment is transmitted to one of an appraiser and a repair shop;

automatically transmitting status information to said reinspector as said insurance claim assignment is processed;

automatically assessing claim cycle time by monitoring said status information;

providing an insurance claim profile database and an exception priority database, the insurance claim profile database comprising a set of appraisal rules;

comparing the insurance claim workfiles to said insurance claim profile database; and

generating a list of exceptions based on said comparison.

2. The method of claim 1 further comprising the steps of:

comparing the list of exceptions to said exception priority database; and

generating rating information based on said comparison to said exception priority database.

3. The method of claim 2 further comprising the steps of:

providing a first computer in communication with a wide area network, said wide area network in communication with a second computer, said wide area network comprising a communications server;

sending said insurance claim workfile from the second computer to said communications server over said wide area network;

storing said insurance claim workfile in an electronic mailbox in said communications server;

retrieving said insurance claim workfile at the first computer from said communications server; and

building a reinspection section for said retrieved insurance claim workfile at the first computer using the list of exceptions and information derived from an analysis of data contained in other sections of said insurance claim workfile.

4. The method of claim 3, wherein the step of building a reinspection file further comprises the steps of:

recognizing an insurance company identifier in the insurance claim workfile and retrieving exception rule information associated with the insurance company identifier from an exception rule database at the first computer; and

applying the exception rule information to the reinspection section of the insurance claim workfile to generate a reinspection report.

5. The method of claim 3, wherein the step of building a reinspection file further comprises the steps of:

recognizing an insurance company identifier in the insurance claim workfile and retrieving calculation format information associated with the insurance company identifier from a calculation format database at the first computer; and

applying the calculation format information to the reinspection section of the insurance claim workfile to generate a reinspection report.

6. The method of claim 3, wherein the step of building a reinspection file further comprises the steps of:

recognizing an insurance company identifier in the insurance claim workfile and retrieving insurance claim status reminder information associated with the insurance company identifier from an insurance claim status reminder database at the first computer; and

applying the insurance claim status information to the reinspection section of the insurance claim workfile to generate an insurance claim status reminder associated with the insurance claim workfile.

7. The method of claim 3, wherein the step of building a reinspection file further comprises the steps of:

recognizing an insurance company identifier in the insurance claim workfile and retrieving at least one reinspection report form associated with the insurance company identifier from reinspection report form database at the first computer; and

generating a reinspection report with the reinspection report form at the first computer.

8. The method of claim 3, wherein the step of building a reinspection file further comprises the steps of:

formatting said rating information into a report;

storing said report in an electronic mailbox in said communications server; and

retrieving said report from said communications server at the first computer whereby a user may analyze the report at the first computer.

9. A system for reinspecting an insurance claim workfile comprising:

a first computer in communication with a wide area network, said first computer capable of generating insurance claim workfiles, said wide area network capable of bidirectional transmission of said insurance claim workfiles;

at least one of the insurance claim workfiles comprising a loss estimate section, an appraisal section and a reinspection section, the reinspection section having data on a reinspection of an insurance claim estimate;

insurance claim workfile filter means for automatically filtering a plurality of insurance claim workfiles based on predetermined criteria comprising repair status;

an insurance claim profile database comprising appraisal rules and threshold information;

a comparator capable of comparing at least one of said insurance claim workfiles to said insurance claim profile database, and

an appraisal review generator configured to identify exceptions to said appraisal rules and threshold information and generate appraisal review information and a priority rating for each insurance claim workfile based on said appraisal rules and threshold information.

10. The system of claim 9 further comprising a reinspection tool stored in a computer readable medium residing on a second computer, said second computer in communication with said wide area network, wherein said reinspection tool provides means for adding data to said reinspection section of said insurance claim workfile using information derived from an analysis of data contained in other sections of said insurance claim workfile.

11. The system of claim 9 further comprising:

a communications server in communication with said wide area network capable of receiving and transmitting at least one of said insurance claim workfiles between said first computer and said server and between said second computer and said server;

an electronic mailbox in said communications server capable of storing said at least one insurance claim workfile; and

wherein said reinspection tool further provides means for retrieval of said insurance claim workfile from said electronic mailbox.

12. The system of claim 9 wherein each of said insurance claim workfiles contains data on an insured, data on a claim, data on satisfying a claim and data on reinspection activity.

13. The system of claim 10 further comprising:

a status generator capable of monitoring an activity associated with each of said insurance claim workfiles and generating status information based on said activity;

a communications server in communication with said wide area network capable of receiving and transmitting said status information between said first computer and said server and between said second computer and said server;

an electronic mailbox in the server capable of storing said status information; and

wherein said reinspection tool further provides means for retrieval of said status information from said electronic mailbox.

14. The system of claim 9 further comprising a file converter capable converting the entire insurance claim workfile into a formatted insurance claim workfile to allow transmission over said wide area network.

15. The system of claim 14 wherein the entire formatted insurance claim workfile is transmitted from a remote computer to a communications server via the wide area network whereby said entire formatted insurance claim workfile is retrievable from said server.

16. The system of claim 14 wherein said file converter comprises means for formatting the insurance claim workfile into network TCP/IP, whereby a remote computer may readily communicate with, and transfer the entire insurance claim workfile to, a computer in a home office.

18. The system of claim 9 further comprising:

a communications server report generator capable of formatting said appraisal review information and priority rating into a report; and

an electronic mailbox in the server, wherein said electronic mailbox is capable of storing said report; and

further wherein said reinspection tool further provides means for retrieval of said report from said electronic mailbox.

20. The system of claim 9 wherein said at least one insurance claim workfile is retrievable based on pre-defined criteria defined by a user.

17. (canceled)

19. (canceled)

21. A method of reinspecting insurance claim appraisals comprising the steps of:

providing a remote computer in communication with a wide area network, said wide area network in communication with a computer in a home office;

generating at least one insurance claim workfile, each of said insurance claim workfiles containing data on an insured, data on a claim, data on satisfying a claim, data on the reinspection, wherein each of said insurance claim workfiles is configured to receive all data pertinent to the claim;

reinspecting each of said insurance claim workfiles at the remote computer and determining that the data contained in the insurance claim workfile conforms to pre-defined criteria; and

modifying each of said insurance claim workfiles at the remote computer to update the insurance claim workfile with information determined from reinspecting said insurance claim workfiles.

22. The method of claim 21 wherein the reinspecting step further comprises the steps of:

prioritizing each of said insurance claim workfiles based upon said pre-defined criteria;

selecting one of said insurance claim workfiles to reinspect;

reviewing estimate data contained in said one of said insurance claim workfiles, said estimate data comprising information relating to an extent of loss in an insurance claim represented by said one of said insurance claim workfiles;

reviewing appraisal data contained in said one of said insurance claim workfiles, said appraisal data comprising information relating to a value of an insured property; and

analyzing said estimate data and appraisal data and compiling said analyzed estimate data and appraisal data into reinspection data.

23. A system for reinspecting insurance claim appraisals comprising:

a first computer having a memory containing insurance claim assignment data; and

a second computer having means for entering data related to a reinspection of estimate data in an insurance claim workfile generated from the insurance claim assignment data, the insurance claim workfile containing data on an insured and data on a claim, wherein said insurance claim workfile is transferable over a wide area network;

said wide area network having a communications server in communication with said first and second computers, said communications server having insurance claim profile data comprising threshold information on a vehicle loss.

24. The system of claim 23 wherein the insurance claim workfile is an electronic workfile comprising:

claim estimate data describing the extent of an insurance claim;

claim appraisal data describing the value of an insured property;

claim reinspection data describing an analysis of said estimate data and said appraisal data in conjunction with the insurance claim profile data.

25. The system of claim 23 further comprising a user interface for providing access to at least one insurance claim workfile.

26. The system of claim 25 wherein the interface comprises an in box for receiving said at least one insurance claim workfile from the communications server.

27. The system of claim 25 wherein the interface comprises an out box for temporarily storing said at least one insurance claim workfile, said out box for transmitting the at least one insurance claim workfile to the communications server.

28. The system of claim 25 wherein the interface comprises an in process box for storing at least one insurance claim workfile a user is currently working on.

29-32. -32. (canceled)