System and method for performing reinspection in insurance claim processing

• US 8,095,391 B2
• Filed: 06/13/2003
• Issued: 01/10/2012
• Est. Priority Date: 08/05/1998
• Status: Expired due to Term

• Current Assignee: CCC Information Services, Inc.
• Original Assignee: CCC Information Services, Inc.
• Inventors: Obora, Karoline M., O'Connor, Sean P., Sailer, Dale A., Snyder, Gary C., Stiff, Thomas B., Wikman, Walter J., Heyward, Erica L., D'Souza, Thomas
• Primary Examiner(s): JOHNSON, GREGORY L
• Application Number:
  US10/470,605
• Publication Number:
  US 20050246206A1
• Time in Patent Office: 3,133 Days
• Field of Search: 705 2- 4
• US Class Current: 705/4
• CPC Class Codes: G06Q 10/10 Office automation; Time management
• CPC Class Codes: G06Q 40/08 Insurance

Abstract

A system and method for performing insurance claim reinspections is disclosed. The system includes an insurance company computer in communication with a communications server, at least one remote terminal in communication with the communications server, and an insurance claim workfile having a loss estimate section, an appraisal section and a reinspection section. The method includes the steps of providing an insurance claim profile and exception priority information, comparing an estimate in an insurance workfile to the insurance claim profile, and generating exception indicators based on the comparison.

Claims

1. A method of reinspecting insurance claim appraisals by a computer having a processor capable of executing the method, wherein each of said insurance claim appraisals are contained in a respective one of a plurality of insurance claim workfiles, each insurance claim workfile comprising all pertinent data for processing an insurance claim, said method comprising the steps of:

automatically notifying by the computer a reinspector that an insurance claim assignment has been made when said insurance claim assignment is transmitted to one of an appraiser and a repair shop;

automatically transmitting from the computer status information to said reinspector as said insurance claim assignment is processed;

automatically assessing by the computer claim cycle time by monitoring said status information;

providing by the computer an insurance claim profile database and an exception priority database, the insurance claim profile database comprising a set of appraisal rules;

comparing by the computer the insurance claim workfiles to said insurance claim profile database, wherein said insurance claim profile database contains rules and threshold values relating to estimate amounts, property damage limitations, or discounts; and

generating by the computer a list of exceptions based on said comparison, wherein at least one of the exceptions is based on a loss estimate that exceeds a specified percentage of an original estimate.

2. The method of claim 1 further comprising the steps of:

comparing by the computer the list of exceptions to said exception priority database; and

generating by the computer rating information based on said comparison to said exception priority database.

3. The method of claim 2 further comprising the steps of:

providing a first computer in communication with a wide area network, said wide area network in communication with a second computer, said wide area network comprising a communications server;

sending said insurance claim workfile from the second computer to said communications server over said wide area network;

storing said insurance claim workfile in an electronic mailbox in said communications server;

retrieving said insurance claim workfile at the first computer from said communications server; and

building a reinspection section for said retrieved insurance claim workfile at the first computer using the list of exceptions and information derived from an analysis of data contained in other sections of said insurance claim workfile.

4. The method of claim 3, wherein the step of building a reinspection section further comprises the steps of:

recognizing an insurance company identifier in the insurance claim workfile and retrieving exception rule information associated with the insurance company identifier from an exception rule database at the first computer; and

applying the exception rule information to the reinspection section of the insurance claim workfile to generate a reinspection report.

5. The method of claim 3, wherein the step of building a reinspection section further comprises the steps of:

recognizing an insurance company identifier in the insurance claim workfile and retrieving calculation format information associated with the insurance company identifier from a calculation format database at the first computer; and

applying the calculation format information to the reinspection section of the insurance claim workfile to generate a reinspection report.

6. The method of claim 3, wherein the step of building a reinspection section further comprises the steps of:

recognizing an insurance company identifier in the insurance claim

workfile and retrieving insurance claim status reminder information associated with the insurance company identifier from an insurance claim status reminder database at the first computer; and

applying the insurance claim status information to the reinspection section of the insurance claim workfile to generate an insurance claim status reminder associated with the insurance claim workfile.

7. The method of claim 3, wherein the step of building a reinspection section further comprises the steps of:

recognizing an insurance company identifier in the insurance claim workfile and retrieving at least one reinspection report form associated with the insurance company identifier from a reinspection report form database at the first computer; and

generating a reinspection report with the reinspection report form at the first computer.

8. The method of claim 3, wherein the step of building a reinspection section further comprises the steps of:

formatting said rating information into a report;

storing said report in an electronic mailbox in said communications server; and

retrieving said report from said communications server at the first computer whereby a user may analyze the report at the first computer.

9. A system for reinspecting an insurance claim workfile comprising:

a first computer in communication with a wide area network, said first computer capable of generating insurance claim workfiles, said wide area network capable of bi-directional transmission of said insurance claim workfiles;

at least one of the insurance claim workfiles comprising a loss estimate section, an appraisal section and a reinspection section, the reinspection section having data on a reinspection of an insurance claim estimate;

insurance claim workfile filter means for automatically filtering a plurality of insurance claim workfiles based on predetermined criteria comprising repair status;

an insurance claim profile database comprising appraisal rules and threshold information;

a comparator capable of comparing at least one of said insurance claim workfiles to said insurance claim profile database, wherein said insurance claim profile database contains rules and threshold values relating to estimate amounts, property damage limitations, or discounts; and

an appraisal review generator configured to identify exceptions to said appraisal rules and threshold information and generate appraisal review information and a priority rating for each insurance claim workfile based on said appraisal rules and threshold information, wherein the appraisal review generator is further configured to prioritize the insurance claim workfiles based on a pre-defined criteria.

10. The system of claim 9 further comprising a reinspection tool stored in a computer readable medium residing on a second computer, said second computer in communication with said wide area network, wherein said reinspection tool provides means for adding data to said reinspection section of said insurance claim workfile using information derived from an analysis of data contained in other sections of said insurance claim workfile.

11. The system of claim 9 further comprising:

a communications server in communication with said wide area network capable of receiving and transmitting at least one of said insurance claim workfiles between said first computer and said server and between said second computer and said server;

an electronic mailbox in said communications server capable of storing said at least one insurance claim workfile; and

wherein said reinspection tool further provides means for retrieval of said insurance claim workfile from said electronic mailbox.

12. The system of claim 9 wherein each of said insurance claim workfiles contains data on an insured, data on a claim, data on satisfying a claim and data on reinspection activity.

13. The system of claim 10 further comprising:

a status generator capable of monitoring an activity associated with each of said insurance claim workfiles and generating status information based on said activity;

a communications server in communication with said wide area network capable of receiving and transmitting said status information between said first computer and said server and between said second computer and said server;

an electronic mailbox in the server capable of storing said status information; and

wherein said reinspection tool further provides means for retrieval of said status information from said electronic mailbox.

14. The system of claim 9 further comprising a file converter capable of converting the entire insurance claim workfile into a formatted insurance claim workfile to allow transmission over said wide area network.

15. The system of claim 14 wherein the entire formatted insurance claim workfile is transmitted from a remote computer to a communications server via the wide area network whereby said entire formatted insurance claim workfile is retrievable from said server.

16. The system of claim 14 wherein said file converter comprises means for formatting the insurance claim workfile into network TCP/IP, whereby a remote computer may readily communicate with, and transfer the entire insurance claim workfile to, a computer in a home office.

17. The system of claim 9 further comprising:

a communications server report generator capable of formatting said appraisal review information and priority rating into a report; and

an electronic mailbox in the server, wherein said electronic mailbox is capable of storing said report; and

further wherein said reinspection tool further provides means for retrieval of said report from said electronic mailbox.

18. The system of claim 9 wherein said at least one insurance claim workfile is retrievable based on pre-defined criteria defined by a user.

25. The system of claim 9, further comprising:

a remote computer in communication with the first computer through the wide area network;

a user interface installed on the remote computer, where the user interface is configured to retrieve an insurance claim workfile from the first computer through the wide area network in response to a first command from a user, and where the user interface is configured to initiate an operation of the appraisal review generator to the retrieved insurance claim workfile in response to an appraisal command from a user.

26. The system of claim 25, where the remote computer is a stand-alone computer intermittently connected with the wide area network.

27. The system of claim 25, where the first command comprises forming a connection between the remote computer and the wide area network.

28. The system of claim 25, where the first command comprises selection of an inbox icon in the user interface.

29. The system of claim 25, where the user interface is further configured to upload a reviewed insurance claim workfile to the first computer in response to a second command from a user.

30. The system of claim 25, where the second command comprises selection of an outbox icon in the user interface.

31. The system of claim 9, wherein:

the appraisal review generator is further configured to identify a set of insurance claim workfiles having high priority ratings.

32. The system of claim 9, wherein:

the appraisal review generator is further configured to identify a set of insurance claim workfiles that have high priority ratings while meeting a user-selected criterion.

33. The system of claim 32, where the user-selected criterion is a vehicle type.

34. The system of claim 32, where the user-selected criterion is an appraisal source.

35. The system of claim 9, wherein the insurance claim workfiles include graphical images.

36. The system of claim 9, wherein the appraisal review generator is further configured to assess appraisal performance personnel based on the generated priority ratings.

37. The system of claim 9, wherein the appraisal review generator is further configured to generate performance feedback for appraisers.

38. The system of claim 37, where the appraisers include repair shops.

39. The system of claim 9, wherein the appraisal review generator is further configured to report trends in insurance claim estimates from an appraiser.

40. The system of claim 9, further comprising two or more second computers in communication with the first computer through the wide area network, where each of the two or more second computers is configured to access a shared insurance claim workfile from the first computer.

41. The system of claim 9, where the comparator is configured to flag a loss estimate in an insurance claim workfile as an exception if a supplement amount in the insurance claim workfile exceeds an original estimate in the insurance claim workfile by a predetermined amount.

42. The system of claim 41, where the predetermined amount is specified as a percentage of the original estimate in the insurance claim workfile.

43. The system of claim 9, further comprising:

a policy updating interface, useable by an insurance company to update appraisal rules in the insurance claim profile database.

44. The system of claim 43, where the insurance claim profile database comprises a plurality of insurance claim profiles corresponding to a plurality of client insurance companies.

45. The system of claim 9, further comprising:

a communications server report generator configured to generate reports with a format that presents appraisal review rules and appraisal review results, with appraisal review results adjacent to the corresponding appraisal review rules.

46. The system of claim 9, wherein the appraisal review generator is configured to automatically update an insurance claim workfile in response to actions taken by a reinspector.

47. The system of claim 46, wherein the appraisal review generator is configured to automatically create time-stamped entries in an insurance claim workfile indicative of actions taken by a reinspector.

19. A method of reinspecting insurance claim appraisals comprising the steps of:

providing a remote computer in communication with a wide area network, said wide area network in communication with a computer in a home office;

generating at least one insurance claim workfile, each of said insurance claim workfiles containing data on an insured, data on a claim, data on satisfying a claim, data on the reinspection, wherein each of said insurance claim workfiles is configured to receive all data pertinent to the claim;

reinspecting by the remote computer each of said insurance claim workfiles at the remote computer and determining that the data contained in the insurance claim workfile conforms to pre-defined criteria;

modifying by the remote computer each of said insurance claim workfiles at the remote computer to update the insurance claim workfile with information determined from reinspecting said insurance claim workfiles;

prioritizing each of said insurance claim workfiles based upon said pre-defined criteria;

selecting one of said insurance claim workfiles to reinspect;

reviewing estimate data contained in said one of said insurance claim workfiles, said estimate data comprising information relating to an extent of loss in an insurance claim represented by said one of said insurance claim workfiles;

reviewing appraisal data contained in said one of said insurance claim workfiles, said appraisal data comprising information relating to a value of an insured property; and

analyzing said estimate data and appraisal data and compiling said analyzed estimate data and appraisal data into reinspection data.

20. A system for reinspecting insurance claim appraisals comprising:

a first computer having a memory containing insurance claim assignment data; and

a second computer having means for entering data related to a reinspection of estimate data in an insurance claim workfile generated from the insurance claim assignment data, the insurance claim workfile containing data on an insured and data on a claim, wherein said insurance claim workfile is transferable over a wide area network;

said wide area network having a communications server in communication with said first and second computers, said communications server having insurance claim profile data comprising threshold information on a vehicle loss; and

wherein the insurance claim workfile is an electronic workfile comprising claim estimate data describing the extent of an insurance claim, claim appraisal data describing the value of an insured property, and claim reinspection data describing an analysis of said estimate data and said appraisal data in conjunction with the insurance claim profile data.

21. The system of claim 20 further comprising a user interface for providing access to at least one insurance claim workfile.

22. The system of claim 21 wherein the interface comprises an in box for receiving said at least one insurance claim workfile from the communications server.

23. The system of claim 21 wherein the interface comprises an out box for temporarily storing said at least one insurance claim workfile, said out box for transmitting the at least one insurance claim workfile to the communications server.

24. The system of claim 21 wherein the interface comprises an in process box for storing at least one insurance claim workfile a user is currently working on.