System and method for managing insurance claim processing

• US 5,950,169 A
• Filed: 11/09/1995
• Issued: 09/07/1999
• Est. Priority Date: 05/19/1993
• Status: Expired due to Term

• Current Assignee: CCC Information Services, Inc.
• Original Assignee: CCC Information Services, Inc.
• Inventors: Chen, Jeff, Ramamurthy, Githesh, Wilharm, Kathy, Ho, Margaret, Borghesi, Nancy, Stephen, Kelly, Mandler, Alan, Frankel, Charles
• Primary Examiner(s): Cosimano, Edward R.
• Application Number:
  US08/555,732
• Time in Patent Office: 1,398 Days
• Field of Search: 395/204, 345/329, 345/334, 345/335, 345/339, 345/340, 345/352, 364/400, 705/1, 705/2, 705/3, 705/4, 705/400, 707/104, 707/200
• US Class Current: 705/4
• CPC Class Codes: G06Q 30/0283 Price estimation or determination
• CPC Class Codes: G06Q 40/08 Insurance
• CPC Class Codes: Y10S 707/99945 Object-oriented database structure processing
• CPC Class Codes: Y10S 707/99948 Application of database or data structure, e.g. distributed, multimedia, or image

Abstract

A system and method for managing and processing insurance claims is provided that implements an object oriented graphic user interface. The system includes at least one remote computer for entering and viewing insurance claim information. A wide area network capable of communicating with the remote computer and a computer in communication with said wide area network are also included. An insurance datafile, generated at said remote computer, is transferrable over the network. The method includes the steps of transmitting a claim assignment from an insurance office computer to a mailbox in a communications server, retrieving the assignment at a remote computer and generating an insurance claim datafile containing all data pertinent to an insurance claim and allowing for bidirectional transmission of the datafile over a wide area network. A graphic user interface for use in managing an insurance claim from an initial claim to final settlement is also included. The interface has common workflow objects such as an in box, an in process box, and an out box, for managing and manipulating one or more workfiles.

Claims

1. A method of managing insurance claim processing comprising the steps of:

providing a remote computer in communication with a wide area network, said wide area network in communication with a computer in an insurance company home office;

sending an insurance claim work assignment from the insurance company home office computer to a communication server in the wide area network;

storing the insurance claim work assignment in an electronic mailbox in the communication server;

obtaining the insurance claim work assignment at the remote computer from the communication server;

generating an insurance claim datafile on the remote computer, said datafile corresponding to said insurance claim work assignment and configured to receive all data pertinent for processing an insurance claim;

allowing for bidirectional transmission of the datafile over the wide area network; and

building sections of the datafile at the remote computer using information accessed from an external source to the remote computer.

2. The method of claim 1 wherein said datafile contains data on an insured, data on a claim, and data on satisfying a claim.

3. The method of claim 1 further comprising the step of converting the entire datafile into a formatted datafile to allow transmission over said network.

4. The method of claim 1 wherein said insurance claim datafile comprises a vehicle insurance datafile and the step of generating an insurance claim datafile comprises the steps of:

Recording data in the datafile on an insured and an assigned insurance claims adjuster;

Recording data related to an insured vehicle in the datafile; and

Recording vehicle parts data relating to OEM, aftermarket, and salvage parts for repair of the insured vehicle.

5. The method of claim 1 wherein the step of building the insurance datafile comprises transmitting a predetermined amount of data related to calculating a vehicle total loss valuation to the server, receiving the total loss valuation at the remote computer, and appending the total loss valuation to the datafile.

6. The method of claim 1 wherein the step of building the insurance datafile comprises collecting a predetermined amount of data related to a vehicle, accessing a database containing vehicle valuation information, retrieving the vehicle valuation at the remote computer, and appending the valuation to the datafile.

7. The method of claim 1 further comprising the steps of:

generating an event log, said event log including information on actions taken on the claim; and

appending the event log to the datafile whereby a user may review the event log.

8. The method of claim 7 wherein the step of generating an event log comprises automatically generating event log entries.

9. The method of claim 7 wherein the step of generating an event log comprises manually selecting an event log entry.

10. The method of claim 1 wherein the entire formatted datafile is transmitted from the remote computer to the server via the wide area network, whereby said entire formatted datafile is retrievable from said server for future update.

11. The method of claim 10 wherein the step of formatting the datafile comprises formatting the datafile into network TCP/IP format, whereby the remote computer may readily communicate with, and transfer the entire datafile to, the computer in the home office.

12. The method of claim 11 further comprising the steps of a user selecting a portion of the insurance datafile from a predetermined list of portions that may be individually sent to a third party, and transmitting the selected portion of the insurance datafile to the third party.

13. A method of managing insurance claims processing comprising the steps of:

providing a remote computer in communication with a wide area network, said wide area network in communication with a computer in a home office;

generating an insurance claim datafile on the remote computer, said datafile containing data on an insured, data on a claim, data on satisfying a claim, wherein said datafile is configured to receive all data pertinent to the claim;

modifying the datafile at the remote computer to update the datafile with information accessed from an external source to the remote computer wherein the datafile contains an estimated total loss valuation and information for calculating a repair estimate; and

determining if a vehicle is approaching a total loss by automatically monitoring repair estimate calculations and the estimated total loss valuation.

14. A system for processing an insurance claim comprising:

a remote computer for entering data related to an insured;

a wide area network having a communication server capable of communicating with said remote computer;

a computer in communication with said wide area network; and

an insurance claim datafile, generated at said remote computer, wherein the entire datafile is transferrable over the network, said insurance claim datafile comprising;

data on an insured including the name and policy number of the insured, the insurance claim number, and the nature of the claim; and

an event log for listing a date and an author of each action taken on the insurance claim datafile whereby an insurance company may monitor efficiency of claim handling.

15. The system of claim 14 further comprising a plurality of remote computers capable of accessing an insurance claim datafile, wherein only one of said remote computers and said servers may access the entire datafile at a time.

16. The system of claim 14 further comprising a user interface for providing access to at least one insurance datafile.

17. The system of claim 16 wherein the interface comprises an in box for receiving at least one datafile from the communication server.

18. The system of claim 16 wherein the interface comprises an out box for temporarily storing at least one datafile, said out box for transmitting the at least one datafile to the communication server.

19. The system of claim 16 wherein the interface comprises an in process box for storing at least one datafile a user is currently working on.

20. The system of claim 14 wherein the insurance claim datafile further comprises:

data gathered concerning the extent of damage or injury suffered by the insured;

correspondence related to the claim, whereby the correspondence includes form letters sent to the insured; and

messages, related to the claim, sent between insurance company employees via electronic mail.

21. The system of claim 20 wherein the datafile further comprises electronic images created of insured subject matter.

22. The system of claim 21 wherein the insured subject matter is a vehicle.

23. The system of claim 22 wherein the datafile further comprises vehicle identification information and information on vehicle options.

24. The system of claim 22 wherein the data gathered concerning the extent of damage or injury suffered by the insured further comprises an inspection report.

25. The system of claim 22 wherein the insurance datafile further comprises salvage information.

26. The system of claim 22 wherein the insurance datafile further comprises a repair estimate having OEM, aftermarket and recycled parts costs.

27. The system of claim 22 wherein the insurance claim datafile further comprises insurance claim settlement information.

28. The system of claim 22 wherein the insurance datafile further comprises a total loss calculation.

29. A system for processing insurance claims comprising:

a remote computer for entering data related to an insured;

a wide area network capable of communicating with said remote computer;

a computer in communication with said wide area network;

an insurance claim datafile, generated at said remote computer, wherein the entire datafile is transferable between the remote computer and the computer, said datafile having inspection, repair estimate, total loss, and settlement information related to an automobile insurance claim; and

a user interface for managing insurance claim datafile processing pertaining to an insurance claim, said user interface allowing communication of input and output data, said user interface further comprising means for calculating and comparing repair and total loss values.

30. The system of claim 29 wherein the interface further comprises:

a display for viewing a universal entry screen;

means for entering data onto the display;

interface logic, coupled to the display for processing data entered on said data entering means and communicating said data to the universal entry screen on said display.

31. The system of claim 30 wherein the universal entry screen displays a datafile having a plurality of tabbed sections, each of said tabbed sections accessible by a user through said data entering means.

32. The system of claim 31 wherein the plurality of tabbed sections comprise:

an administrative data tab for insurance company claim administration information;

a vehicle information tab for information pertaining to an insured vehicle;

an estimate tab for gathering and computing information on vehicle repair costs;

a salvage tab for gathering and computing information on potential vehicle salvage values; and

a settlement tab for storing and updating claim settlement information.

33. The system of claim 32 wherein the tabbed sections further comprise:

a totals tab for viewing and manipulating estimate totals;

a total loss tab for viewing and manipulating a total loss calculation;

a notes tab containing user remarks regarding a claim;

a correspondence tab containing letters related to an insured;

a rates tab for containing labor, tax, and discount rates; and

an event log tab for maintaining a list of actions taken on the datafile.

34. A graphic user interface for use in managing an insurance claim from an initial claim to final settlement comprising:

an in box capable of holding at least one insurance datafile for a user to process;

an in process box, the in process box for holding at least one insurance datafile that the user has begun working on; and

an out box, the out box for holding at least one insurance datafile that the user has completed work on wherein said in box, in process box, and out box are concurrently visible to the user so that insurance claim processing workflow is readily apparent to the user.

35. The graphic user interface of claim 34 further comprising a datafile window for displaying an opened insurance claim datafile, said opened datafile in said datafile window having a plurality of overlapping sections, each section having a visible identification tab.

36. The graphic user interface of claim 34 further comprising a button bar having a plurality of user choices, said button bar including at least one context sensitive button representative of a relevant user choice for information currently being viewed in the datafile window.

37. A system for processing an insurance claim for a vehicle, the system comprising:

a first computer for generating an insurance claim assignment;

a communication server capable of communicating with the first computer over a communication network;

a second computer in communication with the communication server;

a plurality of insurance claim datafiles generated at the second computer, each insurance claim datafile transferable over the communication network, and a plurality of insurance claim assignments, each of the plurality of insurance claim datafiles associated with a respective one of the insurance claim assignments; and

a graphic user interface at the second computer, the graphic user interface comprising an estimate comparison screen for displaying information on a selected one of the plurality of insurance claim datafiles, the estimate comparison screen simultaneously displaying replacement cost data for original equipment manufacturer (OEM) parts, recycled parts, and after market parts, and displaying a part repair cost.

38. The system of claim 37, wherein the graphic user interface further comprises

a workflow management section, the workflow management section comprising an in box, an out box, and an in process box, wherein each of the in box, out box and in process box are configured to hold at least one insurance claim datafile, whereby insurance claim processing workflow is managed at the second computer.

39. The system of claim 37, wherein at least one of the plurality of insurance claim datafiles further comprises an event log, the event log containing a date and an author of each action taken on the at least one insurance claim datafile.