Determining recommended settlement amounts by adjusting values derived from matching similar claims

• US 8,244,558 B2
• Filed: 06/06/2008
• Issued: 08/14/2012
• Est. Priority Date: 01/18/2008
• Status: Expired due to Fees

• Current Assignee: Computer Sciences Corporation (DXC Technology Company)
• Original Assignee: Computer Sciences Corporation (DXC Technology Company)
• Inventors: Scalet, Frank, Henry, Scott, Watters, Clifton, Dulock, Scott
• Primary Examiner(s): Poinvil, Frantzy
• Application Number:
  US12/134,997
• Publication Number:
  US 20090187430A1
• Time in Patent Office: 1,530 Days
• Field of Search: 705 4- 44
• US Class Current: 705/4
• CPC Class Codes: G06Q 10/10 Office automation; Time management
• CPC Class Codes: G06Q 40/08 Insurance
• CPC Class Codes: G06Q 50/188 Electronic negotiation

Abstract

Precedent claims that match a pending claim are identified. A general damages amount is determined based on the likelihood value for at least one of the matching precedent claims. A general damages amount is derived from the likelihood value for at least one of the matching precedent claims. Pending claim adjustments are calculated based on amounts associated with the pending claim. Pending claim adjustments are applied to the general damages amount to determine a recommended settlement amount.

Claims

1. A computer-implemented method for determining amounts for use in settling insurance claims, comprising:

automatically identifying, by a computer system, one or more closed claims that match a pending claim based on one or more characteristics of the pending claim;

determining, by the computer system, a likelihood value for at least one of the matching closed claims, wherein the likelihood value is a non-monetary, numerical value whose magnitude is a quantitative measure of the likelihood that a monetary amount associated with a closed claim represents an appropriate monetary amount for settling an pending claim, wherein a greater magnitude of the non-monetary, numerical likelihood value corresponds to a higher likelihood that the monetary amount associated with the closed claim represents an appropriate monetary amount for settling the pending claim, and wherein a lesser magnitude of the non-monetary, numerical likelihood value corresponds to a lower likelihood that the monetary amount associated with the closed claim represents an appropriate monetary amount for settling the pending claim;

determining, by the computer system, a general damages amount based at least in part on the likelihood value for at least one of the matching closed claims;

calculating one or more pending claim adjustments, wherein at least one of the pending claim adjustments is based on an amount associated with the pending claim; and

applying at least one of the pending claim adjustments to the general damages amount to determine a recommended settlement amount.

2. The method of claim 1, further comprising displaying the recommended settlement amount.

3. The method of claim 1, further comprising updating the recommended settlement amount based on at least one change to an amount associated with the pending claim.

4. The method of claim 1, wherein the general damages amount for the pending claim is a most likely amount, wherein the most likely amount is an amount mathematically most likely to represent a good value for settlement of a claim.

5. The method of claim 4, wherein the most likely amount corresponds to the matching closed claim with the highest likelihood value.

6. The method of claim 1, further comprising determining a most likely range of a monetary amount for the pending claim based at least in part on one of the likelihood values whose magnitude reflects the likelihood that a monetary amount associated with a closed claim represents an appropriate monetary amount for settling an pending claim.

7. The method of claim 1, further comprising:

displaying, by the computer system, a likelihood curve representing likelihood values of one or more closed claims as a function of monetary amount; and

determining which of the matching closed claims fall into a predetermined range within the likelihood curve for the matching closed claims.

8. The method of claim 7, wherein the predetermined range is about the top quartile of the likelihood curve for the matching closed claims.

9. The method of claim 1, further comprising determining a most likely settlement amount, wherein the recommended settlement amount is based at least in part on the estimated amount.

10. The method of claim 1, further comprising grouping one or more of the matching closed claims into one or more zones, wherein the recommended settlement amount is based at least in part on a value associated with at least one of the zones.

11. The method of claim 10, wherein the one or more zones comprises a mid-zone.

12. The method of claim 1, wherein the one or more pending claim adjustments comprise lost wages associated with the pending claim.

13. The method of claim 1, wherein the one or more pending claim adjustments comprise medical expenses estimated or actually incurred for the pending claim.

14. The method of claim 1, wherein the one or more pending claim adjustments comprise special damages associated with the pending claim.

15. The method of claim 1, wherein the one or more pending claim adjustments comprises an amount for disfigurement associated with the pending claim.

16. The method of claim 1, wherein the one or more pending claim adjustments comprise an amount for comparative negligence associated with the pending claim.

17. The method of claim 1, wherein the one or more pending claim adjustments comprise an amount for contribution associated with the pending claim.

18. The method of claim 1, wherein determining the likelihood value for at least one of the matching closed claims comprises performing a maximum likelihood estimation.

19. The method of claim 1, wherein determining the likelihood value for at least one of the matching closed claims comprises performing a kernel density estimation.

20. The method of claim 1, wherein the pending claim adjustment comprises an offset amount from general damages whose value is derived from characteristics of the pending claim, wherein the recommended settlement amount is determined by adding or subtracting the offset amount derived from the pending claim to or from a general damages amount derived from one or more of closed claims that match the pending claim.

21. A system, comprising:

a processor;

a memory coupled to the processor and configured to store program instructions executable by the processor to implement;

identifying one or more closed claims that match an pending claim based on one or more characteristics of the pending claim;

determining a likelihood value for at least one of the matching closed claims, wherein the likelihood value is a non-monetary, numerical value whose magnitude is a quantitative measure of the likelihood that a monetary amount associated with a closed claim represents an appropriate monetary amount for settling an pending claim, wherein a greater magnitude of the non-monetary, numerical likelihood value corresponds to a higher likelihood that the monetary amount associated with the closed claim represents an appropriate monetary amount for settling the pending claim, and wherein a lesser magnitude of the non-monetary, numerical value corresponds to a lower likelihood that the monetary amount associated with the closed claim represents an appropriate monetary amount for settling the pending claim;

determining a general damages amount based at least in part on the likelihood value for at least one of the matching closed claims;

calculating one or more pending claim adjustments, wherein at least one of the pending claim adjustments is based on an amount associated with the pending claim; and

applying one or more pending claim adjustments to the general damages amount to determine a recommended settlement amount.

22. A tangible, computer readable medium comprising program instructions, wherein the program instructions are computer-executable to implement:

identifying one or more closed claims that match an pending claim based on one or more characteristics of the pending claim;

determining a likelihood value for at least one of the matching closed claims, wherein the likelihood value is a non-monetary, numerical value whose magnitude is a quantitative measure of the likelihood that a monetary amount associated with a closed claim represents an appropriate monetary amount for settling an pending claim, wherein a greater magnitude of the non-monetary, numerical likelihood value corresponds to a higher likelihood that the monetary amount associated with the closed claim represents an appropriate monetary amount for settling the pending claim, and wherein a lesser magnitude of the non-monetary numerical value corresponds to a lower likelihood that the monetary amount associated with the closed claim represents an appropriate monetary amount for settling the pending claim;

determining a general damages amount based at least in part on the likelihood value for at least one of the matching closed claims;

calculating one or more pending claim adjustments, wherein at least one of the adjustments is based on an amount associated with the pending claim; and

applying at least one of the pending claim adjustments to the general damages amount to determine a recommended settlement amount.