System and method for identifying and assessing comparative negligence in insurance claims

• US 20040030587A1
• Filed: 08/07/2002
• Published: 02/12/2004
• Est. Priority Date: 08/07/2002
• Status: Active Grant

• Current Assignee: Metropolitan Property and Casualty Insurance Company (MetLife Incorporated)
• Original Assignee: Metropolitan Property and Casualty Insurance Company (MetLife Incorporated)
• Inventors: Hopkins, Sarah E., Murphy, James D., Heidenheim, Andre R., Lim, Soon, Shriner, Steven E., Danico, Angela G.
• Granted Patent: US 7,885,829 B2
• Time in Patent Office: Days
• US Class Current: 705/4
• 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

The invention is a method and system useful in determining the degree of comparative negligence of an insured person involved in an accident as compared to the comparable negligence of other parties involved in the accident, in particular the insurance claimant. The method and system of the invention include, at a minimum, the steps of gathering preliminary information concerning accident type, applying preliminary rules to the preliminary information to determine accident type, gathering additional information specific to the accident type, and applying accident-type-specific rules to the additional information to determine the degree comparative negligence of said insured person and/or the claimant.

Claims

1. A computer-based method for determining the degree of comparative negligence of a party involved in a loss, comprising the steps of:

categorizing said loss into an accident type based on a preliminary information about said loss;

generating a plurality of questions based on said accident type;

receiving responses to said plurality of questions from said party; and

determining degree of comparative negligence of said party from said responses.

2. The computer-based method of claim 1, further comprising the step of receiving said preliminary information about said loss from said party.

3. The computer-based method of claim 2, wherein the step of receiving comprises the steps of:

providing a plurality of preliminary questions relating to said loss to said party;

receiving answers to said plurality of preliminary questions from said party to provide said preliminary information; and

storing said preliminary information.

4. The computer-based method of claim 3, wherein a status of said party is either an insured, a claimant or a witness;

and wherein the step of providing includes the step of generating said plurality of preliminary questions relating to said loss based on said status of said party.

5. The computer-based method of claim 1, wherein the step of categorizing comprises the step of applying a set of preliminary rules to said preliminary information to determine said accident type.

6. The computer-based method of claim 1, wherein a status of said party is either an insured, a claimant or a witness;

and wherein the step of generating generates said plurality of questions based on said status of said party and said accident type.

7. The computer-based method of claim 6, wherein the step of receiving responses receives said responses to said plurality of questions from a claimant and an insured;

and further comprising the step of determining if there is a discrepancy between said responses received from said claimant and said insured.

8. The computer-based method of claim 7, wherein the step of receiving responses receives said responses to said plurality of questions from at least one witness;

and further comprising the step of resolving said discrepancy with said responses answers from said at least one witness if it is determined that there is a discrepancy between said responses received from said claimant and said insured.

9. The computer-based method of claim 7, further comprising the step of resolving said discrepancy with information contained in a police report, scene locus or vehicle appraisal regarding said loss.

10. The computer-based method of claim 1, wherein the step of determining comprises the step of applying rules for said accident type to said responses to determine said degree of comparative negligence of said party.

11. The computer-based method of claim 10, wherein said loss relates to an automobile accident;

and wherein the step of applying includes the steps of determining point of impact factors from said responses and determining an initial liability score of said party based on said point of impact factors.

12. The computer-based method of claim 11, wherein the step of determining includes the steps of determining line of sight factors from said responses and adjusting said initial liability score of said party based on said line of sight factors to determine said degree of comparative negligence of said party.

13. The computer-based method of claim 11, wherein the step of determining includes the steps of determining speed factors from said responses and adjusting said initial liability score of said party based on said line of sight factors to determine said degree of comparative negligence of said party.

14. The computer-based method of claim 11, wherein the step of determining includes the steps of determining evasive action factors from said responses and adjusting said initial liability score of said party based on said evasive action factors to determine said degree of comparative negligence of said party.

15. The computer-based method of claim 11, wherein the step of determining includes the step adjusting said initial liability score of said party based an issuance of a traffic citation to said party to determine said degree of comparative negligence of said party.

16. The computer-based method of claim 11, wherein the step of determining determines at least one of the following factors:

line of sight, speed, evasive actions and traffic citations, and includes the step of adjusting said initial liability score of said party based on said factors to determine said degree of comparative negligence of said party.

17. The computer-based method of claim 1, further comprising the step of modifying said plurality of questions based on said responses received from said party.

18. The computer-based method of claim 1, further comprising the step of generating a report summarizing details of said loss, said report including at least one of the following details:

recommended liability range, factors affecting liability, statements of various parties and disagreements between parties.

19. The computer-based method of claim 1, further comprising the step of generating a settlement report based at least one of the following:

claims office, state, date range and claims adjuster.

20. The computer-based method of claim 19, wherein the step of generating said settlement report includes the step of selecting said settlement report from one of the following reports:

all settled claims, assessments by creation date, assessments with no final offer, current offer with no final offer, claims denied, claims void, claims settled at 100%, payment rate, pending, system not required, settlements above range, settlements below range, settlements within range, settlement offers out of range, settlement offers out of range with no comments and no applicable range.

21. The computer-based method of claim 1, further comprising the step of generating an arbitration package based on said responses and said degree of comparative negligence of said party.

22. The computer-based method of claim 21, wherein the step of generating said arbitration package includes the step of generating an accident claim diagram based on said responses.

23. The computer-based method of claim 21, wherein the step of generating said arbitration package includes the step of generating a completed arbitration contention form based on said responses and said degree of comparative negligence of said party.

24. A system for determining the degree of comparative negligence of a party involved in a loss, comprising:

a pre-processing module for categorizing said loss into an accident type based on a preliminary information about said loss; and

a processing module for generating a plurality of questions based on said accident type, receiving responses to said plurality of questions from said party;

and determining degree of comparative negligence of said party from said responses.

25. The system of claim 24, wherein said pre-processing module is operable to receive said preliminary information about said loss from said party.

26. The system of claim 25, wherein said pre-processing module is operable to generate a plurality of preliminary questions relating to said loss, to receive answers to said plurality of preliminary questions from said party to provide said preliminary information, and to store said preliminary information.

27. The system of claim 26, wherein a status of said party is either an insured, a claimant or a witness;

and wherein said preprocessing module is operable to generate said plurality of preliminary questions relating to said loss based on said status of said party.

28. The system of claim 24, wherein said pre-processing module is operable to apply a set of preliminary rules to said preliminary information to determine said accident type.

29. The system of claim 24, wherein a status of said party is either an insured, a claimant or a witness;

and wherein said processing module is operable to generate said plurality of questions based on said status of said party and said accident type.

30. The system of claim 29, wherein said processing module is operable to receive said responses to said plurality of questions from a claimant and an insured, and to determine if there is a discrepancy between said responses received from said claimant and said insured.

31. The system of claim 30, wherein said processing module is operable to receive said responses to said plurality of questions from at least one witness;

and further comprising a conflict resolution module for resolving said discrepancy with said responses answers from said at least one witness if it is determined that there is a discrepancy between said responses received from said claimant and said insured.

32. The system of claim 30, further comprising a conflict resolution module for resolving said discrepancy with information contained in a police report, scene locus or vehicle appraisal regarding said loss.

33. The system of claim 24, wherein said processing module is operable to apply rules for said accident type to said responses to determine said degree of comparative negligence of said party.

34. The system of claim 33, wherein said loss relates to an automobile accident;

and further comprising a point of impact module for determining point of impact factors from said responses and determining an initial liability score of said party based on said point of impact factors.

35. The system of claim 34, further comprising a line of sight module for determining line of sight factors from said responses and adjusting said initial liability score of said party based on said line of sight factors to determine said degree of comparative negligence of said party.

36. The system of claim 34, further comprising a speed module for determining speed factors from said responses and adjusting said initial liability score of said party based on said line of sight factors to determine said degree of comparative negligence of said party.

37. The system of claim 34, further comprising an evasive actions module for determining evasive action factors from said responses and adjusting said initial liability score of said party based on said evasive action factors to determine said degree of comparative negligence of said party.

38. The system of claim 34, further comprising a citations module for adjusting said initial liability score of said party based an issuance of a traffic citation to said party to determine said degree of comparative negligence of said party.

39. The system of claim 35, further comprising:

a speed module for determining speed factors from said responses and adjusting said initial liability score of said party based on said line of sight factors to determine said degree of comparative negligence of said party;

an evasive actions module for determining evasive action factors from said responses and adjusting said initial liability score of said party based on said evasive action factors to determine said degree of comparative negligence of said party; and

a citations module for adjusting said initial liability score of said party based an issuance of a traffic citation to said party to determine said degree of comparative negligence of said party.

40. The system of claim 24, wherein said processing module is operable to modify said plurality of questions based on said responses received from said party.

41. The system of claim 24, wherein said processing module is operable to generate a report to an investigator summarizing details of said loss, said report including at least one of the following details:

recommended liability range, factors affecting liability, statements of various parties and disagreements between parties.

42. The system of claim 24, further comprising a reporting module for generating a settlement report based at least one of the following:

claims office, state, date range and claims adjuster.

43. The system of claim 42, wherein said settlement report is one of the following reports:

all settled claims, assessments by creation date, assessments with no final offer, current offer with no final offer, claims denied, claims void, claims settled at 100%, payment rate, pending, system not required, settlements above range, settlements below range, settlements within range, settlement offers out of range, settlement offers out of range with no comments and no applicable range.

44. The system of claim 24, further comprising an arbitration module for generating an arbitration package based on said responses and said degree of comparative negligence of said party.

45. The system of claim 44, wherein said arbitration package is operable to generate an accident claim diagram based on said responses.

46. The system of claim 44, wherein said arbitration package is operable to generate a completed arbitration contention form based on said responses and said degree of comparative negligence of said party.

47. A computer readable medium comprising code for determining the degree of comparative negligence of a party involved in a loss, said code comprising instructions for:

categorizing said loss into an accident type based on a preliminary information about said loss;

generating a plurality of questions based on said accident type;

receiving responses to said plurality of questions from said party; and

determining degree of comparative negligence of said party from said responses.

48. The computer readable medium of claim 47, wherein said code further comprises instructions for applying a set of preliminary rules to said preliminary information to determine said accident type.

49. The computer readable medium of claim 47, wherein a status of said party is either an insured, a claimant or a witness;

and wherein said code further comprises instruction for generating said plurality of questions based on said status of said party and said accident type.

50. The computer readable medium of claim 49, wherein said code further comprises instructions for receiving responses receives said responses to said plurality of questions from a claimant and an insured, and for determining if there is a discrepancy between said responses received from said claimant and said insured.

51. The computer readable medium of claim 50, wherein said code further comprises instructions for receiving responses receives said responses to said plurality of questions from at least one witness, and for resolving said discrepancy with said responses answers from said at least one witness if it is determined that there is a discrepancy between said responses received from said claimant and said insured.

52. The computer readable medium of claim 50, wherein said code further comprises instructions for resolving said discrepancy with information contained in a police report, scene locus or vehicle appraisal regarding said loss.

53. The computer readable medium of claim 47, wherein said code further comprises instructions for applying rules for said accident type to said responses to determine said degree of comparative negligence of said party.

54. The computer readable medium of claim 53, wherein said loss relates to an automobile accident;

and wherein said code further comprises instructions for determining point of impact factors from said responses and determining an initial liability score of said party based on said point of impact factors.

55. The computer readable medium of claim 54, wherein said code further comprises instructions for determining line of sight factors from said responses and adjusting said initial liability score of said party based on said line of sight factors to determine said degree of comparative negligence of said party.

56. The computer readable medium of claim 54, wherein said code further comprises instructions for determining speed factors from said responses and adjusting said initial liability score of said party based on said line of sight factors to determine said degree of comparative negligence of said party.

57. The computer readable medium of claim 54, wherein said code further comprises instructions for determining evasive action factors from said responses and adjusting said initial liability score of said party based on said evasive action factors to determine said degree of comparative negligence of said party.

58. The computer readable medium of claim 54, wherein said code further comprises instructions for adjusting said initial liability score of said party based an issuance of a traffic citation to said party to determine said degree of comparative negligence of said party.

59. The computer readable medium of claim 54, wherein said code further comprises instructions for determining at least one of the following factors:

line of sight, speed, evasive actions and traffic citations, and adjusting said initial liability score of said party based on said factors to determine said degree of comparative negligence of said party.

60. The computer readable medium of claim 47, wherein said code further comprises instruction for modifying said plurality of questions based on said responses received from said party.

61. The computer readable medium of claim 47, wherein said code further comprises instruction for generating a settlement report based at least one of the following:

claims office, state, date range and claims adjuster.

62. The computer readable medium of claim 61, wherein said code further comprises instruction for selecting said settlement report from one of the following reports:

all settled claims, assessments by creation date, assessments with no final offer, current offer with no final offer, claims denied, claims void, claims settled at 100%, payment rate, pending, system not required, settlements above range, settlements below range, settlements within range, settlement offers out of range, settlement offers out of range with no comments and no applicable range.

63. The computer readable medium of claim 47, wherein said code further comprises instruction for generating an arbitration package based on said responses and said degree of comparative negligence of said party.

64. The computer readable medium of claim 63, wherein said code further comprises instruction for generating an accident claim diagram based on said responses.

65. The computer readable medium of claim 63, wherein said code further comprises instruction for generating a completed arbitration contention form based on said responses and said degree of comparative negligence of said party.