Insurance claim capitation and predictive payment modeling

• US 9,996,886 B1
• Filed: 04/17/2017
• Issued: 06/12/2018
• Est. Priority Date: 09/20/2012
• Status: Active Grant

• Current Assignee: Allstate Insurance Company (Allstate Corporation)
• Original Assignee: Allstate Insurance Company (Allstate Corporation)
• Inventors: Hanson, Randall, Johnson, Robert H., Stricker, Kurt M., Marlow, Clint J.
• Primary Examiner(s): Hamilton, Lalita M
• Application Number:
  US15/489,071
• Time in Patent Office: 421 Days
• CPC Class Codes: G01S 19/13 Receivers
• 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
• CPC Class Codes: G07C 5/008 communicating information to a remotely located station transmission systems for measured values G08C

Abstract

A claim-based capitation model is proposed for handling vehicle repair insurance claims. Rather than determining a detailed estimate of the expected actual cost of repair, the estimate may be determined using a simpler model. For example, the insurance company and a repair facility may agree to following a predictive payment model in which the insurance company pays a fixed predicted capitated amount of money for each repair claim, regardless of the amount of repair work that will be needed. Alternatively, the insurance company may pre-pay a fixed capitated amount for a predicted number of future insurance claims.

Claims

1. A system for efficiently using computing resources to process insurance claims, comprising:

a processor;

a non-transitory computer-readable medium storing instructions that, when executed by the processor, cause the system to;

store, in the non-transitory computer-readable medium, first data representing a model, wherein the model associates a first set of loss attributes of a plurality of loss attributes with a plurality of multipliers and associates a second set of loss attributes of the plurality of loss attributes with a plurality of costs;

receive, via a communication network, second data that comprises information about a vehicle and that comprises vehicle sensor data generated by a sensor device of the vehicle;

select, based on the second data, at least a first loss attribute from the first set of loss attributes and at least a second loss attribute from the second set of loss attributes;

determine a capitated cost of repair of the vehicle based on one or more of the plurality of multipliers associated with the at least the first loss attribute and based on one or more of the plurality of costs associated with the at least the second loss attribute;

identify one or more factors of a customer associated with the vehicle to create a statistical model with the one or more factors;

predict, based on the statistical model in response to a first notice of loss, whether the customer associated with the vehicle is likely to allow an insurance company to manage repair of the vehicle; and

transmit a payment to a repair facility responsive to a determination that the customer associated with the vehicle has accepted an offer transmitted to the customer, wherein the offer is transmitted upon a prediction that the customer will let the insurance company manage the repair and wherein the payment includes an amount based on the capitated cost.

2. The system of claim 1, wherein the non-transitory computer readable medium stores instructions that, when executed by the processor, further cause the system to:

initiate, at the repair facility, repair of the vehicle for the capitated cost.

3. The system of claim 1, wherein determination of the capitated cost of repair of the vehicle comprises determining the capitated cost of repair of the vehicle without inspecting actual damage to the vehicle.

4. The system of claim 1, wherein the non-transitory computer readable medium stores instructions that, when executed by the processor, further cause the system to:

receive third data from the repair facility indicating an actual cost of repair; and

revise the model based on the third data.

5. The system of claim 1, wherein determination of the capitated cost of repair of the vehicle is performed in response to a first notice of loss of an insurance claim for the vehicle.

6. The system of claim 1, wherein the sensor device comprises a sensor and an on-board computing device communicatively coupled with the sensor.

7. The system of claim 1, wherein the sensor device comprises an accelerometer of the vehicle and the vehicle sensor data comprises acceleration data in accordance with a measurement of the accelerometer.

8. The system of claim 1,

wherein a determination of the capitated cost of repair of the vehicle comprises determining the capitated cost of repair of the vehicle based on the second data and historical costs.

9. The system of claim 1, wherein the sensor device comprises a global positioning system sensor of the vehicle and the vehicle sensor data comprises data indicating one or more locations of the vehicle.

10. The system of claim 1, further comprising the sensor device of the vehicle.

11. An apparatus for efficiently using computing resources to process insurance claims, comprising:

a processor;

a non-transitory computer-readable medium storing instructions that, when executed by the processor, cause the apparatus to;

store, in the non-transitory computer-readable medium, first data representing a model, the model associating one or more first loss attributes with a plurality of multipliers and associates one or more second loss attributes with a plurality of costs;

receive, via a communication network, vehicle sensor data that comprises information about a vehicle and is generated by a sensor device of the vehicle;

select, based on the vehicle sensor data, a first loss attribute from the one or more first loss attributes and at least a second loss attribute from the one or more second loss attributes;

determine a capitated cost of repair of the vehicle based on the plurality of multipliers associated with the first loss attribute and based on one or more of the plurality of costs associated with the second loss attribute;

identify one or more factors of a customer associated with the vehicle to create a statistical model with the one or more factors;

transmit, to the customer, responsive to a prediction that the customer associated with the vehicle is likely to allow an insurance company to manage repair of the vehicle, an offer to repair the vehicle, wherein the prediction is generated based on the statistical model in response to a first notice of loss; and

transmit a payment to a repair facility responsive to a determination that the customer associated with the vehicle has accepted an offer transmitted to the customer.

12. The apparatus of claim 11, wherein the non-transitory computer readable medium stores instructions that, when executed by the processor, further cause the apparatus to:

initiate, at the repair facility, repair of the vehicle for the capitated cost.

13. The apparatus of claim 11, wherein determination of the capitated cost of repair of the vehicle comprises determining the capitated cost of repair of the vehicle without inspecting actual damage to the vehicle.

14. The apparatus of claim 11, wherein the non-transitory computer readable medium stores instructions that, when executed by the processor, further cause the apparatus to:

receive third data from the repair facility indicating an actual cost of repair; and

revise the model based on the third data.

15. The apparatus of claim 11, wherein determination of the capitated cost of repair of the vehicle is performed in response to a first notice of loss of an insurance claim for the vehicle.

16. The apparatus of claim 11, wherein the sensor device comprises a sensor and an on-board computing device communicatively coupled with the sensor.

17. The apparatus of claim 11, wherein the sensor device comprises an accelerometer of the vehicle and the vehicle sensor data comprises acceleration data in accordance with a measurement of the accelerometer.

18. The apparatus of claim 11,

wherein a determination of the capitated cost of repair of the vehicle comprises determining the capitated cost of repair of the vehicle based on the vehicle sensor data and historical costs.

19. The apparatus of claim 11, wherein the sensor device comprises a global positioning system sensor of the vehicle and the vehicle sensor data comprises data indicating one or more locations of the vehicle.