System and process for electronic subrogation, inter-organization workflow management, inter-organization transaction processing and optimized web-based user interaction

• US 7,962,385 B2
• Filed: 07/30/2004
• Issued: 06/14/2011
• Est. Priority Date: 11/08/2002
• Status: Active Grant

• Current Assignee: Arbitration Forums, Inc.
• Original Assignee: Arbitration Forums, Inc.
• Inventors: Falk, Robert J., Radi, Richard J.
• Primary Examiner(s): Apple; Kirsten S
• Assistant Examiner(s): Basit; Abdul
• Application Number:
  US10/903,630
• Publication Number:
  US 20050010454A1
• Time in Patent Office: 2,510 Days
• Field of Search: 705/4, 705/35
• US Class Current: 705/35
• CPC Class Codes: G06Q 10/10 Office automation; Time management
• CPC Class Codes: G06Q 40/00 Finance; Insurance; Tax strategies; Processing of corporate or income taxes
• CPC Class Codes: G06Q 40/02 Banking, e.g. interest calculation or account maintenance credit or loans G06Q40/03
• CPC Class Codes: G06Q 40/08 Insurance

Abstract

An intelligent electronic subrogation network (“ESN”) automates intra-organization workflow, inter-organization workflow and collaboration for insurance subrogation. This ESN is facilitated by a novel system architecture and process that includes an inter-organizational workflow management system, an inter-organizational transaction processing system, and a unique mechanism for optimizing and enriching web-based user interaction within any such system.

Claims

1. A method for issuing and negotiating and settling, using a first computer, insurance subrogation claims between at least two parties through an electronic subrogation network, said method comprising:

providing at least one electronic subrogation file associated with party-specific rules with subrogation information from the first computer, the electronic subrogation file containing structured claim information and unstructured supporting documents in a form that can be accessed by multiple on-network and off-network parties using at least one second computer, wherein the supporting documents are converted from an original format into a format for universal viewing, the party-specific rules including rules for the multiple on-network and off-network parties;

permitting entry according to the party-specific rules, through electronic communication means, by one or more of said multiple on-network and off-network parties using the at least one second computer, of one or both of claim information and supporting documents to said subrogation file;

permitting access according to the party-specific rules, through electronic communication means, by one or more of said multiple on-network and off-network parties using the at least one second computer, to one or both of said structured claim information and said unstructured supporting documents; and

issuing subrogation demands through electronic communication means, using the first computer, to both on-network and off-network parties.

2. The method of claim 1, wherein said permitting entry includes automatically entering paper documents received by fax or high-speed scanner into the electronic file.

3. The method of claim 1, wherein said electronic communication means comprises a network.

4. The method of claim 1, and further including establishing audit and business rule functions that permit said at least one electronic subrogation file to be electronically audited based on said party-specific rules.

5. The method of claim 1, wherein said multiple parties include a demanding party, a responding party, and one or more supporting/facilitating parties, and further including routing a demand to an appropriate responding party based on a responding party'"'"'s routing rules.

6. The method of claim of 5, wherein said routing includes using a routing algorithm that combines a demanding party specific index and a heuristic algorithm to correctly determine an appropriate responding party and further a specific individual or group within said responding party that is to initially handle the demand.

7. The method of claim 1, and further including using a state-based model to manage inter-party subrogation workflow.

8. The method of claim 1, and further including permitting intra-party subrogation workflow functions, including follow-up action plans and party-specific workflow.

9. The method of claim 1, and further including providing collaboration functions that allow selected parties to exchange information and negotiate using said electronic communication means.

10. The method of claim 1, and further including providing a document management function that allows said multiple parties to update attachments and manage document versions.

11. The method of claim 1, wherein said electronic communication means includes a network, and further including automatically generating alerts to on-network parties for exception conditions or violations of said party-specific rules.

12. The method of claim 1, and further including selectively assigning selected files and providing online access to third parties including arbitrators, litigators and outside service providers.

13. The method of claim 1, wherein said electronic communication means includes a network, and further including generating customizable online management reports.

14. The method of claim 1, and further including settling subrogation claims between parties automatically based on the parties'"'"' business rules.

15. The method of claim 1, and further including automatically generating counterclaim demands based on liability percentage and comparative negligence rules of a responding party.

16. The method of claim 1, and further including triggering an automatic funds transfer based on a response of a responding party.

17. The method of claim 1, and further including netting payments between parties involved in a subrogation claim, including:

tracking payments owed and payments due over a given period of time for a member;

netting payments either bilaterally between parties or multilaterally between a party and an electronic subrogation network representing all other parties participating in a netting process;

configuring netting periods; and

managing information to allocate netted payments to each claim file.

18. The method of claim 1, and further including allowing members to benchmark parameters of their subrogation and/or claims operation against an aggregate based on information contained in said electronic subrogation files.

19. The method of claim 1, and further including assessing a best course of action within a subrogation process, including performing a cost-benefits analysis of pursuing a particular course of action.

20. The method of claim 1, and further including assessing the validity of a subrogation demand including performing an electronic audit for selected conditions based upon configurable parameters of a demanding party, and one or more responding parties, said configurable parameters including, but not limited to, required data or documents, claim liability and damages, and vehicle valuation conditions.

21. The method of claim 1, and further including routing subrogation demand to one or more responding parties using a routing algorithm, which combines a heuristic algorithm to correctly determine the identity of the responding party and routing rules defined by the responding party.

22. A system for issuing and negotiating and settling insurance subrogation claims between at least two parties through an electronic subrogation network, said system comprising:

at least one electronic subrogation file associated with party-specific rules with subrogation information from the first computer, the electronic subrogation file containing structured claim information and unstructured supporting documents in a form that can be accessed by multiple on-network and off-network parties wherein the supporting documents are converted from an original format into a format for universal viewing, the party-specific rules including rules for the multiple on-network and off-network parties;

means for permitting entry according to the party-specific rules, through electronic communication means, by one or more of said multiple on-network and off-network parties of one or both of said structured claim information and unstructured supporting documents to said subrogation file;

means for permitting access according to the party-specific rules, through electronic communication means, by one or more of said multiple on-network and off-network parties to one or both of said structured claim information and said supporting documents; and

means for issuing subrogation demands through electronic communication means to both on-network and off-network parties.

23. The system of claim 22, wherein said means for permitting entry includes means for automatically entering paper documents received by fax or high speed scanner into the electronic file.

24. The system of claim 22, wherein said electronic communication means comprises a network.

25. The system of claim 22, and further including means for establishing audit and business rule functions that permit said at least one electronic subrogation file to be electronically audited based on said party-specific rules.

26. The system of claim 22, wherein said multiple parties include a demanding, a responding party, and one or more supporting/facilitating parties, and further including means for routing a demand to an appropriate responding party based on a responding party'"'"'s routing rules.

27. The system of claim of 26, wherein said means for routing includes a routing algorithm that combines a demanding party specific index and a heuristic algorithm to correctly determine an appropriate responding party and further a specific individual or group within said responding party that is to initially handle the demand.

28. The system of claim 22, and further including a state-based model for managing inter-party subrogation workflow.

29. The system of claim 22, and further including means for permitting intra-party subrogation workflow functions, including follow-up action plans and party-specific workflow.

30. The system of claim 22, and further including means for providing collaboration functions that allow selected parties to exchange information and negotiate using said electronic communication means.

31. The system of claim 22, and further including means for providing a document management function that allows said multiple parties to update attachments and manage document versions.

32. The system of claim 22, wherein said electronic communication means includes a network, and further including means for automatically generating alerts to on-network parties for exception conditions or violations of said party-specific rules.

33. The system of claim 22, and further including means for selectively assigning selected files and providing online access to third parties including arbitrators, litigators and outside service providers.

34. The system of claim 22, wherein said electronic communication means includes a network, and further including means for generating customizable online management reports.

35. The system of claim 22, and further including means for settling subrogation claims between parties automatically based on the parties'"'"' business rules.

36. The system of claim 22, and further including means for automatically generating counterclaim demands based on liability percentage and comparative negligence rules of a responding party.

37. The system of claim 22, and further including means for triggering an automatic funds transfer based on a response of a responding party.

38. The system of claim 22, and further including means for netting payments between parties involved in a subrogation claim, including:

means for tracking payments owed and payments due over a given period of time for a member;

means for netting payments either bilaterally between parties or multilaterally between a party and the ESN representing all other parties participating in the netting process;

means for configuring netting periods; and

means for managing information to allocate netted payments to each claim file.

39. The system of claim 22, and further including means for allowing members to benchmark parameters of their subrogation and/or claims operation against an aggregate based on information contained in said electronic subrogation files.

40. The system of claim 22, and further including means for assessing a best course of action within a subrogation process, including means for performing a cost-benefits analysis of pursuing a particular course of action.

41. The system of claim 22, and further including means for assessing the validity of a subrogation demand including means for performing an electronic audit for selected conditions based upon configurable parameters of a demanding party, and of one or more responding parties, said configurable parameters including, but not limited to, required data or documents, claim liability and damages, and vehicle valuation conditions.

42. The system of claim 22, and further including means for routing subrogation demand to one or more responding parties using a routing algorithm, which combines a heuristic algorithm to correctly determine the identity of the responding party and routing rules defined by the responding party.