SYSTEM AND METHOD FOR WORKERS COMPENSATION DATA PROCESSING AND TRACKING

• US 20110295623A1
• Filed: 05/26/2010
• Published: 12/01/2011
• Est. Priority Date: 05/26/2010
• Status: Abandoned Application

• Current Assignee: Hartford Fire Insurance Company (The Hartford Financial Services Group, Inc.)
• Original Assignee: Hartford Fire Insurance Company (The Hartford Financial Services Group, Inc.)
• Inventors: McCollum, JulieeAnn, Behringer, Jill Rich, Chickerella, Marlene G.
• Application Number:
  US12/787,934
• Publication Number:
  US 20110295623A1
• 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

The present invention relates to a workers compensation related insurance complaint management, processing and reporting system. According to some embodiments, an insurance complaint is received at a conversion system for processing. The received information may be converted to a specified format to populate an interactive web form. The web form may be augmented by various third party data sources and information may be additionally pre-filled through the conversion process. Automated complaint management reminders are generated by the system.

Claims

11. A workers compensation complaint processing system comprising:

a communication device for receiving and transmitting workers compensation related complaint information via a communication network;

a processor coupled to the communication device for processing complaint related information; and

a storage device in communication with said processor and storing instructions adapted to be executed by said processor to;

provide a complaint input form via the communication device for receiving complaint related information;

process complaint related information to produce insurance complaint data in an electronic data format;

store the insurance complaint data in the electronic data format;

validate the insurance complaint data with one or more validation rules,

augment the validated insurance complaint data with additional data associated with at least a portion of the insurance complaint data; and

transmit at least one status message related to the complaint related information.

12. The workers compensation complaint processing system of claim 11, wherein validating the complaint document comprises determining if the complaint information is related to a direct regulatory complaint.

13. The workers compensation complaint processing system of claim 11, wherein augmenting the data comprises accessing one or more third party databases for complaint related information.

14. The workers compensation complaint processing system of claim 11, wherein processing the insurance complaint information into an electronic data format comprises performed error corrected speech to text translation.

15. The workers compensation complaint processing system of claim 11, wherein the status message is an electronic mail message to a workers compensation related vendor.

16. The workers compensation complaint processing system of claim 11, wherein the status message is a voicemail message to an insurance company employee including information related to the complaint.

17. A computer-readable medium storing instructions adapted to be executed by a processor to perform an insurance complaint processing method in a workers compensation complaint tracking system, said method comprising:

receiving workers compensation complaint information via an intelligent web form rendered on a communication device,

validating the complaint information based on one or more business rules to determine if the complaint information qualifies for tracking;

augmenting the validated complaint information in the intelligent web form with data related to the complaint information;

tracking resolution progress of the complaint based on date based milestones in the intelligent web form; and

transmitting an electronic indication of the resolution progress to at least one other communication device.

1. A workers compensation complaint tracking system for facilitating resolution of workers compensation related complaints comprising:

a server comprising a processor, and a storage device;

a complaint intake module configured for workers compensation related complaint data input, the complaint intake module providing a dynamic intake form for receiving and capturing complaint data from a user and storing said data in said storage device;

a validation engine module for validating the complaint information in conjunction with a one or more complaint validation rules; and

a reporting module configured to furnish reports of the validated complaints for both regulatory compliance and internal insurance company guidelines;

wherein each of said modules is implemented on the server for access by one or more users.

2. The workers compensation complaint tracking system of claim 1, wherein the complaint intake module includes a speech to text conversion processor.

3. The workers compensation complaint tracking system of claim 1, wherein the complaint intake module performs pre-filling of the dynamic intake form using a predictive model based on historical workers compensation related complaint information.

4. The workers compensation complaint tracking system of claim 1, further comprising a display screen, wherein the dynamic intake form provides pre-defined selections of workers compensation related information to the user via the display screen.

5. The workers compensation complaint tracking system of claim 4, wherein the pre-defined selections of workers compensation related information relate to at least one of an address, a claim number and a category of complaint.

6. The workers compensation complaint tracking system of claim 1, wherein the complaint intake module is coupled to an automatic speech recognition module for converting telephone based communications to text for input to one or more input fields in the dynamic form.

7. The workers compensation complaint tracking system of claim 1, wherein pre-filling of the workers compensation related information is performed using a third party database concurrent with receiving complaint data from the user.

8. The workers compensation complaint tracking system of claim 1, further comprising a communications interface including an electronic mail server configured to deliver electronic mail message at resolution milestones related to the complaint.

9. The workers compensation complaint tracking system of claim 1, wherein the validation module determines if the complaint originates directly from a regulatory agency.

10. The workers compensation complaint tracking system of claim 1, further comprising a tracking module for generating a voice based reminder message based on one or more of the input fields in the dynamic form.

18. The computer-readable medium of claim 17, wherein the method further comprises:

receiving incremental resolution information related to the complaint from one or more remote communication devices.

18-1. The computer-readable medium of claim 17, wherein the method further comprises:

establishing a baseline timestamp upon first receiving insurance complaint information via the intelligent web form, the timestamp relating to the resolution progress of the complaint.

19. A computerized method for processing workers compensation related complaints, the method comprising:

receiving, via an electronic intake interface, verbal insurance complaint information via an automated speech to text facility for populating one or more dynamic input fields of an intelligent web form having a plurality of dynamic input fields rendered on a communication device,

populating, via a processing interface, one or more additional fields of the dynamic input fields based on one or more of historical complaint related data and employer policy data; and

generating, via a communications interface, one or more electronic reminder messages related to resolution progress of the complaint.

20. The computerized method of claim 19, further comprising:

correlating, via the processing interface, one or more of the dynamic input fields with one or more resolution tasks for resolution of the complaint.