METHOD AND COMPUTER SYSTEM FOR INSURANCE CLAIMS RECOVERY OPERATION
First Claim
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1. A method comprising:
- receiving in a computer an electronic file that represents a claim paid by an insurance company, the electronic file containing indicia as to whether (a) said claim involves another insurance company and (b) said other insurance company has admitted or is likely to admit liability for said claim; and
making a triage decision in said computer such that;
(i) if said indicia indicate that another insurance company is involved and has admitted or is likely to admit liability for said claim, said computer generates a demand letter to said other insurance company with respect to said claim and defers further action relating to said demand for at least 20 days after generating said demand letter; and
(ii) if said indicia either do not indicate that another insurance company is involved or indicate that the other insurance company has not admitted or is not likely to admit liability for said claim, said computer generates a demand letter to said other insurance company and routes the electronic file to an employee for further action.
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Abstract
A method includes receiving in a computer an electronic file that represents a claim paid by an insurance company. The electronic file indicates whether the claim involves another insurance company, and whether the other company has admitted or is likely to admit liability for the claim. The computer makes a triage decision to send a demand letter to the other company and then defer action if the other insurance company is likely to admit or has admitted liability. Otherwise, the computer sends the demand letter and routes the file for immediate follow-up.
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Citations
29 Claims
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1. A method comprising:
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receiving in a computer an electronic file that represents a claim paid by an insurance company, the electronic file containing indicia as to whether (a) said claim involves another insurance company and (b) said other insurance company has admitted or is likely to admit liability for said claim; and making a triage decision in said computer such that; (i) if said indicia indicate that another insurance company is involved and has admitted or is likely to admit liability for said claim, said computer generates a demand letter to said other insurance company with respect to said claim and defers further action relating to said demand for at least 20 days after generating said demand letter; and (ii) if said indicia either do not indicate that another insurance company is involved or indicate that the other insurance company has not admitted or is not likely to admit liability for said claim, said computer generates a demand letter to said other insurance company and routes the electronic file to an employee for further action. - View Dependent Claims (2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14)
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15. An apparatus comprising:
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a processor; and a memory in communication with said processor and storing program instructions, the processor operative with said program instructions to; receive an electronic file that represents a claim paid by an insurance company, the electronic file containing indicia as to whether (a) said claim involves another insurance company and (b) said other insurance company has admitted or is likely to admit liability for said claim; and make a triage decision such that; (i) if said indicia indicate that another insurance company is involved and has admitted or is likely to admit liability for said claim, said processor sends out a demand letter to said other insurance company with respect to said claim and defers further action relating to said demand for at least 20 days after said demand letter is sent; and (ii) if said indicia either do not indicate that another insurance company is involved or indicate that the other insurance company has not admitted or is not likely to admit liability for said claim, said processor sends out a demand letter to said other insurance company and routes the electronic file to an employee for further action. - View Dependent Claims (16, 17, 18, 19, 20, 21, 22, 23, 24)
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25. An article of manufacture comprising:
a computer usable medium having computer readable program code means embodied therein for making a triage decision with respect to a paid insurance claim, the computer readable program code means in said article of manufacture comprising; computer readable program code means for causing a computer to receive an electronic file that represents said claim, said claim having been paid by an insurance company, the electronic file containing indicia as to whether (a) said claim involves another insurance company and (b) said other insurance company has admitted or is likely to admit liability for said claim; and computer readable program code means for causing said computer to make a triage decision such that; (i) if said indicia indicate that another insurance company is involved and has admitted or is likely to admit liability for said claim, said computer sends out a demand letter to said other insurance company with respect to said claim and defers further action relating to said demand for at least 20 days after said demand letter is sent; and (ii) if said indicia either do not indicate that another insurance company is involved or indicate that the other insurance company has not admitted or is not likely to admit liability for said claim, said computer sends out a demand letter to said other insurance company and routes the electronic file to an employee for further action.
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26. A method comprising:
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receiving in a computer an electronic file that represents a claim paid by an insurance company, the electronic file containing indicia as to whether (a) said claim involves another insurance company and (b) said other insurance company has admitted or is likely to admit liability for said claim; and making a triage decision in said computer such that; (i) if said indicia indicate that another insurance company is involved and has admitted or is likely to admit liability for said claim, said computer generates a demand letter to said other insurance company with respect to said claim and defers further action relating to said demand for a predetermined period after generating said demand letter; and (ii) if said indicia either do not indicate that another insurance company is involved or indicate that the other insurance company has not admitted or is not likely to admit liability for said claim, said computer generates a demand letter to said other insurance company and routes the electronic file to an employee for further action. - View Dependent Claims (27, 28, 29)
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Specification