Automated claim mediation system and associated methods

• US 8,015,036 B1
• Filed: 03/31/2008
• Issued: 09/06/2011
• Est. Priority Date: 04/02/2007
• Status: Active Grant

• Current Assignee: Claimassistant.Com, LLC
• Original Assignee: Claimassistant.Com, LLC
• Inventors: Leisure, Rebecca O.
• Primary Examiner(s): Merchant; Shahid R
• Assistant Examiner(s): GREGG, MARY M
• Application Number:
  US12/059,173
• Time in Patent Office: 1,254 Days
• Field of Search: None
• US Class Current: 705/4
• CPC Class Codes: G06Q 10/10 Office automation; Time management
• CPC Class Codes: G06Q 40/04 Trading; Exchange, e.g. stocks, commodities, derivatives or currency exchange
• CPC Class Codes: G06Q 40/08 Insurance

Abstract

An improved claim mediation process includes an automated feature permitting a software package to act as the mediator based upon a predetermined rule set. Open offers are made by both sides, but kept secret from the opposing party are criteria by which the offer can be adjusted and still be acceptable to that party. The system takes into account the open offers and the confidential adjustment criteria and, if possible according to the predetermined rule set, calculates and displays a settlement amount.

Claims

1. A computer-implemented method for automatically settling an insurance claim made by a claimant and an insurer comprising:

(a) receiving claims data electronically from each of a claimant and an insurer, the claims data comprising an initial settlement offer and a confidential best offer for damage to an insured item and using a processor to compare the received respective initial settlement offers and the confidential best offers;

(b) if the confidential best offers of the claimant and the insurer overlap, automatically calculating a settlement amount within a range between the initial settlement offers and the confidential best offers of the claimant and the insurer;

(c) electronically transmitting the settlement amount to the claimant and the insurer;

(d) if the confidential best offers of the claimant and the insurer do not overlap, using the processor to calculate from a breakdown of a plurality of elements comprising the damaged item, each element having associated therewith an initial settlement offer and a confidential best offer, if the confidential best offers for an element overlap;

(e) if the confidential offers for the element overlap, using the processor, automatically calculating a first element settlement amount within a range between the initial settlement offers and the confidential best offers for the element;

(f) electronically transmitting the first element settlement amount to the claimant and the insurer and remaining elements for which the confidential offers do not overlap;

(g) receiving from at least one of the claimant and the insurer a revised offer for at least one of the remaining elements;

(h) if the revised offer overlaps with the confidential best offer of the other of the claimant and the insurer, using the processor, automatically calculating a second element settlement amount within a range between the revised offer and the confidential best offer of the other of the claimant and the insured for the element; and

(i) electronically transmitting the second element settlement amount to the claimant and the insurer.

2. The method recited in claim 1, further comprising, following step (d):

if the confidential offers for the element do not overlap, receiving an itemized calculation for the element from the claimant;

electronically transmitting the itemized calculation to the insurer; and

receiving a revised offer from the insurer for the element.

3. The method recited in claim 2, further comprising receiving supporting documentation relating to the element from the claimant.

4. The method recited in claim 3, wherein the supporting documentation comprises at least one of a photograph, a receipt, and a work estimate from a repair company.

5. The method recited in claim 1, further comprising, following step (h), if the revised offer does not overlap with the confidential best offer of the other of the claimant and the insurer, automatically electronically transmitting an offer of an alternative dispute resolution method to the claimant and the insurer.

6. The method recited in claim 5, wherein the alternative dispute resolution method comprises:

entering data into the processor on the damage to the insured item into a plurality of software packages for calculating a repair estimate therefor;

using the processor to compare the calculated repair estimates;

if the repair estimates calculated by the plurality of repair estimate software packages differ by more than a predetermined amount, using the processor to generate an exception report; and

if the repair estimates calculated by the plurality of repair estimate software packages do not differ by more than the predetermined amount, using the processor to calculate an aggregated estimate and electronically transmitting the aggregated estimate to the claimant and the insurer.

7. The method recited in claim 5, wherein the alternative dispute resolution method comprises:

engaging an independent expert to provide an estimate for repairing the insured item; and

electronically transmitting the independent expert estimate to the claimant and the insurer.

8. The method recited in claim 5, wherein the alternative dispute resolution method comprises engaging a human mediator.

9. The method recited in claim 1, further comprising the step of electronically transmitting to the claimant and to the insurer a reminder of a task to be completed and a due date therefor.

10. The method recited in claim 1, wherein the claims data further comprise a narrative description of the damage to the insured item.

11. The method recited in claim 1, wherein the settlement amount comprises a raw settlement amount, and wherein the automatically calculating step (b) comprises using the processor to calculate a first and a second difference between the raw settlement amount and the initial settlement offers of the claimant and the insurer, respectively, and to weight a settlement amount toward the claimant or the insurer depending upon a lesser of the first and the second difference.

12. A system for automatically settling an insurance claim made by a claimant and an insurer comprising:

a host processor having means for interfacing with a network, the network accessible by a claimant computer and an insured computer;

a software package resident on the host processor comprising code segments adapted for;

(a) receiving claims data from the claimant and insurer computers, the claims data comprising an initial settlement offer and a confidential best offer for damage to an insured item;

(b) if the confidential best offers of the claimant and the insurer overlap, automatically calculating a settlement amount within a range between the initial settlement offers and the confidential best offers of the claimant and the insurer;

(c) displaying the settlement amount to the claimant and the insurer via the claimant and insurer computers;

(d) if the confidential best offers of the claimant and the insurer do not overlap, calculating from a breakdown of a plurality of elements comprising the damaged item, each element having associated therewith an initial settlement offer and a confidential best offer, if the confidential best offers for an element overlap;

(e) if the confidential offers for the element overlap, automatically calculating a first element settlement amount within a range between the initial settlement offers and the confidential best offers for the element;

(f) displaying via the claimant and insurer computers the first element settlement amount to the claimant and the insurer and remaining elements for which the confidential offers do not overlap;

(g) receiving from at least one of the claimant and the insurer computers a revised offer for at least one of the remaining elements;

(h) if the revised offer overlaps with the confidential best offer of the other of the claimant and the insurer, automatically calculating a second element settlement amount within a range between the revised offer and the confidential best offer of the other of the claimant and the insured for the element; and

(i) displaying via the claimant and insurer computers the second element settlement amount to the claimant and the insurer.

13. The system recited in claim 12, wherein the software package further comprises, following code segment (d), code segments for:

if the confidential offers for the element do not overlap, receiving an itemized calculation for the element from the claimant computer;

displaying the itemized calculation to the insurer via the insurer computer; and

receiving a revised offer from the insurer computer for the element.

14. The system recited in claim 13, wherein the software package further comprises a code segment for receiving supporting documentation relating to the element from the claimant computer.

15. The system recited in claim 14, wherein the supporting documentation comprises at least one of a photograph, a receipt, and a work estimate from a repair company.

16. The system recited in claim 12, wherein the software package further comprises, following code segment (h), a code segment for, if the revised offer does not overlap with the confidential best offer of the other of the claimant and the insurer, automatically offering an alternative dispute resolution method to the claimant and the insurer via the claimant and insurer computers, respectively.

17. The system recited in claim 16, wherein the offered alternative dispute resolution method comprises a code segment for:

receiving data on the damage to the insured item;

transmitting the received data into a plurality of software packages for calculating a repair estimate therefor;

receiving repair estimates calculated by the plurality of software packages;

if the repair estimates calculated by the plurality of repair estimate software packages differ by more than a predetermined amount, generating an exception report; and

if the repair estimates calculated by the plurality of repair estimate software packages do not differ by more than the predetermined amount, calculating an aggregated estimate and displaying the aggregated estimate to the claimant and the insurer.

18. The system recited in claim 16, wherein the offered alternative dispute resolution method comprises a code segment for:

retrieving data on an independent expert to provide an estimate for repairing the insured item;

receiving an estimate from the independent expert;

displaying the independent expert estimate to the claimant and the insurer.

19. The system recited in claim 16, wherein the software package further comprises a code segment for providing to the claimant and to the insurer a reminder a task to be completed and a due date therefor via the claimant and insurer computers, respectively.

20. The system recited in claim 12, wherein the settlement amount comprises a raw settlement amount, and wherein the automatically calculating code segment (b) comprises a code segment for determining a first and a second difference between the raw settlement amount and the initial settlement offers of the claimant and the insurer, respectively, and weighting a settlement amount toward the claimant or the insurer depending upon a lesser of the first and the second difference.