Communication of insurance claim data

• US 8,527,305 B1
• Filed: 08/31/2012
• Issued: 09/03/2013
• Est. Priority Date: 10/13/2008
• Status: Active Grant

• Current Assignee: Allstate Insurance Company (Allstate Corporation)
• Original Assignee: Allstate Insurance Company (Allstate Corporation)
• Inventors: Hanson, Randall, Ledder, James A., O'Halloran, Charles Ronald
• Primary Examiner(s): Le, Michelle
• Application Number:
  US13/601,019
• Time in Patent Office: 368 Days
• Field of Search: 705 1- 5
• US Class Current: 705/4
• CPC Class Codes: G06Q 10/06 Resources, workflows, human or project management; Enterprise or organisation planning; Enterprise or organisation modelling
• CPC Class Codes: G06Q 10/10 Office automation; Time management
• CPC Class Codes: G06Q 10/20 Administration of product repair or maintenance
• CPC Class Codes: G06Q 30/0283 Price estimation or determination
• CPC Class Codes: G06Q 40/08 Insurance

Abstract

Aspects of the invention are directed to methods and systems for efficiently communicating data between an insurer and a non-referral repair shop, e.g., vehicle repair shops that are normally not preapproved by the insurer to perform the estimating and repair work. The methods and systems described herein are particularly useful for insurers utilizing non-referral repair shops for servicing vehicles involved in insurance claims. According to aspects of this invention, the insured may be able to select a non-referral repair shop, not delegated or preapproved by the insurer, thereby generally allowing the insured to select any available vehicle repair shop.

Claims

1. One or more computer storage media storing computer readable instructions that, when executed, provide a vehicle insurance claim management application, the application comprising:

an adapter module defined by the computer readable instructions, wherein the adapter module translates data between the application and a vehicle repair estimating system; and

a non-referral module defined by the computer readable instructions, wherein the non-referral module;

receives a set of assignment data from an insurance company pertaining to a plurality of work requests submitted to a non-referral vehicle repair shop, wherein the non-referral vehicle repair shop is not included within a pre-approved shop network associated with the insurance company,

receives a set of estimate data from the non-referral vehicle repair shop,

determines a rules-based intelligence score based on the estimate data, wherein the rules-based intelligence score is a low-range, mid-range, or high-range score,

determines an intervention level for the estimate based on the rules-based intelligence score, wherein the intervention level includes an automatic approval level, a desk adjuster level, and a field adjuster level,

wherein if the estimate data has a low-range rules-based intelligence score, the intervention level is the automatic approval level and the non-referral module approves the estimate data,

wherein if the estimate data has a mid-range rules-based intelligence score, the intervention level is the desk adjuster level and the non-referral module transfers the estimate data to a desk adjuster for a desk review and the non-referral module further receives one of an approved estimate data from the desk adjuster or a disapproved estimate data from the desk adjuster, and

wherein if the estimate data has a high-range rules-based intelligence score, the intervention level is the field adjuster level and the non-referral module transfers the estimate data to a field adjuster for a field review and the non-referral module further receives one of the approved estimate data from the field adjuster or the disapproved estimate data from the field adjuster.

2. The computer storage media of claim 1, wherein the determination of the rules-based intelligence score includes a line-by-line review of the estimate data.

3. The computer storage media of claim 1, wherein the determination of the rules-based intelligence score includes an aggregate review of the estimate data.

4. The computer storage media of claim 1, wherein the determination of the rules-based intelligence score includes a line-by-line review of the estimate data and an aggregate review of the estimate data.

5. The computer storage media of claim 1, wherein the application further comprises a financial module defined by the computer readable instructions, the financial module storing and providing payment status information for the plurality of work requests assigned to the non-referral vehicle repair shop.

6. The computer storage media of claim 1, wherein the application further comprises a performance module defined by the computer readable instructions, the performance module storing and providing one or more performance metrics for the non-referral vehicle repair shop as compared to other vehicle repair facilities working with the insurance company.

7. The computer storage media of claim 1, wherein the estimate data provided to the insurance company by the assignment module comprises a photograph of a vehicle.

8. The computer storage media of claim 6, wherein the performance metric comprises a tier level and a ranking.

9. The computer storage media of claim 1, wherein the assignment module further provides a timeline indicating a plurality of milestone dates corresponding to a displayed vehicle work request.

10. One or more computer storage media storing computer readable instructions that, when executed, provide an internet-based vehicle insurance claim management application, the application comprising:

a plurality of adapter modules, each adapter module defined by the computer readable instructions and translating data between the application and one of a plurality of direct repair vehicle repair programs, and wherein a first adapter module translates data between the application and a first vehicle repair estimating system, and wherein a second adapter module translates data between the application and a second vehicle repair estimating system, different from the first vehicle repair estimating system;

an assignment module defined by the computer readable instructions, the assignment module;

receives a set of assignment data from an insurance company pertaining to a plurality of work requests submitted to the direct repair vehicle repair shop,

transfers the assignment data to the direct repair vehicle repair estimating system,

receives a set of estimate data from the direct repair vehicle repair estimating system,

reviews the estimate data for compliance with a set of front-end business rules,

transfers the estimate data to an insurance company system to be reviewed for compliance with a set of back-end business rules,

receives a set of reinspection data from the insurance company,

reviews the reinspection data from the insurance company, and

updates the estimate data based on the reinspection data; and

a non-referral module defined by the computer readable instructions, the non-referral module;

receives a set of assignment data from an insurance company pertaining to a plurality of work requests submitted to a non-referral vehicle repair shop, wherein the non-referral vehicle repair shop is not included within a pre-approved shop network associated with the insurance company

receives a set of estimate data from the non-referral vehicle repair shop,

determines a rules-based intelligence score based on the estimate data, wherein the rules-based intelligence score is a low-range, mid-range, or high-range score,

determines an intervention level for the estimate based on the rules-based intelligence score, wherein the intervention level includes an automatic approval level, a desk adjuster level, and a field adjuster level,

wherein if the estimate data has a low-range rules-based intelligence score, the intervention level is the automatic approval level and the non-referral module approves the estimate data,

wherein if the estimate data has a mid-range rules-based intelligence score, the intervention level is the desk adjuster level and the non-referral module transfers the estimate data to a desk adjuster for a desk review and the non-referral module further receives one of an approved estimate data from the desk adjuster or a disapproved estimate data from the desk adjuster, and

wherein if the estimate data has a high-range rules-based intelligence score, the intervention level is the field adjuster level and the non-referral module transfers the estimate data to a field adjuster for a field review and the non-referral module further receives one of the approved estimate data from the field adjuster or the disapproved estimate data from the field adjuster.

11. The computer storage media of claim 10, wherein the determination of the rules-based intelligence score includes a line-by-line review of the estimate data.

12. The computer storage media of claim 10, wherein the determination of the rules-based intelligence score includes an aggregate review of the estimate data.

13. The computer storage media of claim 10, wherein the determination of the rules-based intelligence score includes a line-by-line review of the estimate data and an aggregate review of the estimate data.

14. The computer storage media of claim 10, wherein the estimate data provided to the insurance company by the assignment module comprises a photograph of a vehicle.

15. The computer storage media of claim 10 further including a financial module defined by the computer readable instructions, the financial module storing and providing payment status information for the plurality of vehicle work requests assigned to the direct repair vehicle repair shops and the non-referral repair shops.

16. The computer storage media of claim 10 further including a performance module defined by the computer readable instructions, the performance module storing and providing a performance metric for the direct repair vehicle repair shops as compared to other vehicle repair facilities working with the insurance company.

17. The computer storage media of claim 16, wherein the performance metric comprises a tier level and a ranking.

18. The computer storage media of claim 10, wherein the assignment module further provides a timeline indicating a plurality of milestone dates corresponding to a displayed vehicle work request.

19. The computer storage media of claim 10, wherein the assignment module further provides an interactive calendar through which the direct repair vehicle repair shops and the non-referral repair shops schedule repair of a vehicle corresponding to a displayed vehicle work request.