Component based information linking during claim processing

• US 8,224,859 B2
• Filed: 07/11/2011
• Issued: 07/17/2012
• Est. Priority Date: 05/04/1999
• Status: Expired due to Fees

• Current Assignee: DUCK Creek Technologies Incorporated
• Original Assignee: Accenture Global Services Limited (Accenture PLC)
• Inventors: Guyan, George V., Pish, Robert H.
• Primary Examiner(s): AL HASHEMI, SANA A
• Application Number:
  US13/180,318
• Publication Number:
  US 20110270898A1
• Time in Patent Office: 372 Days
• Field of Search: 707/791, 707/793, 707/795, 707/796, 707/802, 707/803, 707/806, 707/812
• US Class Current: 707/791
• 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

A computer system includes a server computer and an insurance claim database. The insurance claim database stores data in electronic format and includes a claim folder that decomposes data of an insurance claim for an insured event into a plurality of levels, the plurality of levels including a policy level, a claim level, a participant level and a line level. The server computer is configured to generate a user interactive interface that interactively displays at least one of the plurality of levels reflecting information related to a policy, the claim, claimants and an insured person in a structured format to a plurality of users, and to allow each of the users to simultaneously interact with one of the plurality of levels to retrieve and enter data for the same insurance claim.

Claims

1. A computer system for displaying information about an insurance claim for an insured event on a screen of a visual display device, the computer system comprising:

a server computer comprising a hardware configuration of a central processing unit, a memory and an input/output adapter, the memory having stored thereon logic executable by the central processing unit including an event processor and a task engine that interacts with the event processor to enable said insurance claim to be processed; and

an insurance claim database coupled to the server computer and storing data in electronic format, the insurance claim database comprising a claim folder that decomposes data of an insurance claim for the insured event into a plurality of levels, the plurality of levels including a policy level, a claim level, a participant level and a line level,

wherein the server computer is configured to generate a user interactive interface that interactively displays on the screen of the visual display device at least one of the plurality of levels reflecting information related to a policy, the claim, claimants and an insured person in a structured format to a plurality of users, and to allow each of the users to simultaneously interact with one of the plurality of levels to retrieve and enter data for the same insurance claim;

wherein the event processor maintains encapsulation of responsibilities of said computer system for displaying information from said event processor, wherein said responsibilities do not include functions performed by said event processor, interacts with the insurance claim database to identify a data event that affects data in the claim folder, determines a response, identifies a system component to enable said claim to be processed and transmits the data event to the identified system component;

wherein when said identified system component is the task engine, the task engine evaluates the data event, determines claim characteristics and matches the characteristics to tasks to automatically generate a list of tasks to be taken by one of the plurality of users handling said insurance claim to direct a workflow for said insurance claim to be processed.

2. The system of claim 1 wherein the visual display device displays policy level information comprising information related to covered autos for auto claims, information related to covered property for property claims and information related to covered yachts for marine claims.

3. The system of claim 1 wherein the visual display device displays claim level information comprising details information, facts of loss information, events information and liability information.

4. The system of claim 1 wherein the visual display device displays participant level information comprising details information and contact information, information related to the insured event, injury information and disability management information.

5. The system of claim 1 wherein the visual display device displays line level information comprising information related to damaged vehicles for vehicle lines, information related to damaged property for property lines and information related to damaged yachts for marine lines, and information related to the insured events, damages and negotiation associated with the vehicles, property and yachts.

6. The system of claim 1, wherein the visual display device displays claim level information comprising details information, facts of loss information, events information and liability information.

7. The system of claim 1 wherein the visual display device displays participant level information comprising information related to persons involved in the claim, information related to the role of persons in the claim and contact information of the persons.

8. The system of claim 1 wherein the line level comprises a user interface enabling the capture of negotiation information.

9. The system of claim 1 further comprising a client computer in communication with the server computer, wherein the client computer is configured to provide information concerning an individual in the insured event and for allowing one of the plurality of users to link the individual to the insured event.

10. The system of claim 9 wherein the client computer is configured to display the user interface as a response to the communication with the server computer.

11. The system of claim 10 wherein the client computer is configured to allow one of the plurality of users to edit information associated with the plurality of levels.

12. The system of claim 10 wherein the database is configured to allow one of the plurality of users to search for information associated with one of the policy level, the claim level, the participant level and the line level.

13. The system of claim 1 wherein the visual display device displays participant level information comprising a category of historical information, a claim index and contact information.

14. The system of claim 1 wherein the visual display device displays policy level information comprising information on the claimants that are injured with disabilities.

15. The system of claim 1 wherein the visual display device displays policy level information comprising specific information on injuries suffered by the claimants.

16. The system of claim 15 further comprising a statistical model for claim practices and risk selection that uses the specific information on injuries suffered by the claimants, said specific information being stored in claims folders and accessible by said server computer.

17. The system of claim 15 wherein the specific information is represented by ICD-9 code.

18. The system of claim 1 further comprising a client computer in communication with said server computer, said client computer displaying a claim tree associated with said policy.

19. The system of claim 18 wherein said claim tree lists said policy, said insured person, claimants and related lines in a claim tree format.

20. The system of claim 18 wherein said client computer further displays claim level tabs.

21. The system of claim 18 wherein said claim folder displayed on a client computer can be changed between a view mode and an edit mode.

22. The system of claim 21 further comprising menu options displayed on said client computers, wherein said menu options depend upon whether said claim folder is in said view mode or said edit mode.

23. The system of claim 18 wherein the insurance claim database uses an optimistic locking mechanism when the claim tree is displayed to the plurality of users simultaneously.

24. A computer system that displays insurance claim information about an insured event, the computer system comprising:

an insurance claim database comprising data in electronic format, the insurance claim database comprising a claim folder that decomposes data of an insurance claim for the insured event into a plurality of levels, the plurality of levels including a policy level, a claim level, a participant level and a line level;

a server computer comprising executable logic stored on a memory including;

an event processor that identifies a data event, determines a response, identifies a system component to process an insurance claim and transmits information regarding the data event to the identified system component; and

a task engine that interacts with the event processor to enable the insurance claim to be processed; and

a user interactive interface that is generated by the server computer that interactively displays, on a screen of a hardware visual display device, information from at least one of the plurality of levels in a structured format to a plurality of users, allowing each of the users to simultaneously interact with one of the plurality of levels to retrieve and enter data for the same insurance claim, the entered data triggering the data event,

wherein when the event processor identifies the task engine as the system component to process the insurance claim, the task engine evaluates the event, determines claim characteristics for the event and matches the characteristics to tasks to automatically generate a list of tasks to be taken by one of the plurality of users handling the insurance claim to direct a workflow for the insurance claim to be processed.

25. A computer system for displaying insurance claim information comprising:

an insurance claim database comprising data in an electronic format, the insurance claim database comprising a claim folder that decomposes data of an insurance claim for an insured event into a plurality of levels, the plurality of levels include a policy level, a claim level, a participant level and a line level;

a server computer having a hardware configuration of a central processing unit, a memory, and an input/output adapter, and

a user interactive interface that is generated and interactively displays, on a screen of a hardware visual display device, information from at least one of the plurality of levels in a structured format to a plurality of users, wherein a plurality of users via a plurality of interfaces is allowed to simultaneously interact with one of the plurality of levels to retrieve and enter data on the same insurance claim;

wherein the server computer comprises executable logic stored on the memory including an event processor that identifies the entered data as a data event, determines a response for the data event and identifies a system component to process the response and transmits information for processing the claim to the identified system component.