Evaluating a subrogation potential of an insurance claim

• US 20070174094A1
• Filed: 01/24/2006
• Published: 07/26/2007
• Est. Priority Date: 01/24/2006
• Status: Abandoned Application

• Current Assignee: International Business Machines Corporation
• Original Assignee: International Business Machines Corporation
• Inventors: Ramsey, Mark
• Application Number:
  US11/338,414
• Publication Number:
  US 20070174094A1
• Time in Patent Office: Days
• US Class Current: 705/4
• CPC Class Codes: G06Q 10/0635 Risk analysis of enterprise or organisation activities
• CPC Class Codes: G06Q 30/0185 Product, service or business identity fraud
• CPC Class Codes: G06Q 40/08 Insurance

Abstract

A method, system and computer program product for evaluating a subrogation potential of a target insurance claim is disclosed. A peer group of claims that are expected to include similar behaviors as the target claim and have been successfully subrogated is established to determine a normal behavior that the target claim is supposed to include. A behavior of the target claim is compared to the normal behavior to evaluate a subrogation potential of the target claim. Proper subrogation solutions are prospectively chosen based on the determined normal behavior to increase efficiency.

Claims

1. A method for evaluating a subrogation potential of a target claim for insurance payment, the method comprising steps of:

selecting a peer group of claims that are expected to include a similar behavior as the target claim and have been successfully subrogated;

identifying a set of behavioral attributes of the peer group;

determining a normal behavior of the peer group regarding the identified set of behavioral attributes; and

comparing a behavior of the target claim to the normal behavior regarding the identified set of behavior attributes to evaluate the subrogation potential of the target claim.

2. The method of claim 1, wherein the normal behavior determining step includes collecting behaviors of the peer group and analyzing the collected behaviors of the peer group regarding the identified set of behavioral attributes.

3. The method of claim 1, wherein the comparing step includes steps of:

comparing the behavior of the target claim with the normal behavior with respect to each of the identified set of behavioral attributes; and

combining a result of the comparison with respect to each of the identified set of behavioral attributes to generate an overall comparison result.

4. The method of claim 1, wherein the peer group selecting step includes a step of determining a similarity between and among the target claim and other claims for insurance payment with respect to claim attributes other than the set of behavioral attributes.

5. The method of claim 1, further including a step of prospectively investigating the subrogation potential based on a result of the comparing step.

6. A system for evaluating a subrogation potential of a target claim for insurance payment, the system comprising:

means for selecting a peer group of claims that are expected to include a similar behavior as the target claim and have been successfully subrogated;

means for identifying a set of behavioral attributes of the peer group;

means for determining a normal behavior of the peer group regarding the identified set of behavioral attributes; and

means for comparing a behavior of the target claim to the normal behavior regarding the identified set of behavior attributes to evaluate the subrogation potential of the target claim.

7. The system of claim 6, further including:

means for collecting behaviors of the peer group; and

means for analyzing the collected behaviors of the peer group regarding the identified set of behavioral attributes.

8. The system of claim 6, further including:

means for comparing the behavior of the target claim with the normal behavior with respect to each of the identified set of behavioral attributes; and

means for combining a result of the comparison with respect to each of the identified set of behavioral attributes to generate an overall comparison result.

9. The system of claim 6, wherein the peer group selecting includes determining a similarity between and among the target claim and other claims for insurance payment with respect to claim attributes other than the set of behavioral attributes.

10. The system of claim 6, further including means for prospectively instructing an investigation the subrogation potential based on a result of the behavior comparing.

11. A computer program product for evaluating a subrogation potential of a target claim for insurance payment, the computer program product comprising:

computer usable program code configured to;

select a peer group of claims that are expected to include a similar behavior as the target claim and have been successfully subrogated;

identify a set of behavioral attributes of the peer group;

determine a normal behavior of the peer group regarding the identified set of behavioral attributes; and

compare a behavior of the target claim to the normal behavior regarding the identified set of behavior attributes to evaluate the subrogation potential of the target claim.

12. The program product of claim 11, wherein the program code is further configured to collect data of behaviors of the peer group and analyze the collected behavior data of the peer group regarding the identified set of behavioral attributes.

13. The program product of claim 11, wherein the program code is further configured to:

compare the behavior of the target claim with the normal behavior with respect to each of the identified set of behavioral attributes; and

combine a result of the comparison with respect to each of the identified set of behavioral attributes to generate an overall comparison result.

14. The program product of claim 11, wherein the program code is further configured to determine a similarity between and among the target claim and other claims for insurance payment with respect to claim attributes other than the set of behavioral attributes.

15. The program product of claim 11, wherein the program code is further configured to prospectively instruct an investigation of the subrogation potential based on a result of the behavior comparison.

16. A method of generating a system for evaluating a subrogation potential of a target claim for insurance payment, the method comprising:

providing a computer infrastructure operable to;

select a peer group of claims that are expected to include a similar behavior as the target claim and have been successfully subrogated;

identify a set of behavioral attributes of the peer group;

determine a normal behavior of the peer group regarding the identified set of behavioral attributes;

compare a behavior of the target claim to the normal behavior regarding the identified set of behavior attributes to evaluate the subrogation potential of the target claim; and

communicate a result of the evaluation to a customer insurance company.

17. The method of claim 16, wherein computer infrastructure is further operable to collect data of behaviors of the peer group and analyze the collected behavior data of the peer group regarding the identified set of behavioral attributes.

18. The method of claim 16, wherein computer infrastructure is further operable to:

compare the behavior of the target claim with the normal behavior with respect to each of the identified set of behavioral attributes; and

combine a result of the comparison with respect to each of the identified set of behavioral attributes to generate an overall comparison result.

19. The method of claim 16, wherein computer infrastructure is further operable to determine a similarity between and among the target claim and other claims for insurance payment with respect to claim attributes other than the set of behavioral attributes.

20. The method of claim 16, wherein computer infrastructure is further operable to prospectively instruct an investigation of the subrogation potential based on a result of the behavior comparison.