System and method for externalization of formulas for assessing damages

• US 7,430,515 B1
• Filed: 06/23/2000
• Issued: 09/30/2008
• Est. Priority Date: 06/23/2000
• Status: Expired due to Term

• Current Assignee: Computer Sciences Corporation (DXC Technology Company)
• Original Assignee: Computer Sciences Corporation (DXC Technology Company)
• Inventors: Spann, Allison W., Wolfe, Brian
• Primary Examiner(s): Zeender; F.
• Assistant Examiner(s): Frenel; Vanel
• Application Number:
  US09/603,308
• Time in Patent Office: 3,021 Days
• Field of Search: 705/2, 705/3, 705/4, 705/1, 707/102
• US Class Current: 705/4
• CPC Class Codes: G06Q 10/10 Office automation; Time management
• CPC Class Codes: G06Q 40/08 Insurance

Abstract

A method and system for externalization of formulas for assessing bodily injury general damages. An insurance company may use an expert system to develop a knowledge base in the form of business rules and formulas to process insurance claims. The business rules may execute the formulas to assist an insurance claims adjuster in assessing bodily injury general damages. The task of creation and maintenance of the formulas, used in calculating a trauma severity value, may be automated by the externalization of formulas. The user may create a formula data table and use a translator program to create a static instance of a formula class of objects for each row in the formula data table. The business rules may invoke the calculate method to execute the formulas. Changing the data stored in the formula data table and using the translator program to create a static instance of a formulas class of objects for each row, may accomplish updating and/or customizing the formulas.

Claims

1. A system comprising:

a rules engine which is operable to assess a value of an insurance claim as a function of a plurality of rules, wherein said plurality of rules comprise formulas to assess said value of said insurance claim;

a database which stores formula data, wherein said database is separate from said rules engine, wherein said formula data are configured to be modified as a function of business requirements of an insurance organization to form modified formula data; and

a translator program which is operable to read said formula data from said database and transform said formula data into said formulas of said plurality of rules;

wherein said translator program is configured to be modified as a function of business requirements of an insurance organization to form a modified translator program; and

wherein said modified translator program is configured to read said modified formula data from said database and transform said modified formula data into a modified plurality of formulas.

2. The system of claim 1,

wherein said formula data is stored in a tabular format in said database.

3. The system of claim 1,

wherein said formula data comprises alphanumeric values stored in said database.

4. The system of claim 1,

wherein said formulas are configured to be updated by updating said formula data stored in said database.

5. The system of claim 1,

wherein said formula data comprises a plurality of entries in said database,

wherein at least one entry comprises a formula identifier.

6. The system of claim 1,

wherein said formula data comprises a plurality of entries in said database,

wherein at least one entry comprises a sequence number.

7. The system of claim 1,

wherein said formula data comprises a plurality of entries in said database,

wherein at least one entry comprises a section description.

8. The system of claim 1,

wherein said formula data comprises a plurality of entries in said database,

wherein at least one entry comprises a page identifier.

9. The system of claim 1,

wherein said formula data comprises a plurality of entries in said database,

wherein at least one entry comprises a prompt identifier.

10. The system of claim 1,

wherein said formula data comprises a plurality of entries in said database,

wherein at least one entry comprises an answer identifier.

11. The system of claim 1,

wherein said formula data comprises a plurality of entries in said database,

wherein at least one entry comprises a mathematical function.

12. The system of claim 1,

wherein said formula data comprises a plurality of entries in said database,

wherein at least one entry comprises a numeric value.

13. The system of claim 1,

wherein said formulas are usable in real-time by said plurality of rules to assess the value of the insurance claim.

14. The system of claim 1,

wherein said insurance claim comprises a bodily injury claim, and wherein said value of said insurance claim comprises a bodily injury general damages value.

15. The system of claim 14,

wherein said plurality of rules use said formulas to determine a trauma severity value associated with said bodily injury claim.

16. The system of claim 1, further comprising:

a CPU;

a memory coupled to the CPU, wherein said rules engine comprises program instructions which are stored in said memory and executable by said CPU.

17. The system of claim 1,

wherein said rules comprise logical instructions for assessing said value of said insurance claim.

18. The system of claim 1,

wherein each rule comprises a premise and one or more resulting actions for assessing said value of said insurance claim.

19. The system of claim 1,

wherein each of said formulas comprises one or more inputs and one or more functions operating on said one or more inputs to compute one or more outputs.

20. A method comprising:

providing a rules engine which is operable to assess a value of an insurance claim as a function of a plurality of rules, wherein said plurality of rules use formulas to assess said value of said insurance claim;

providing a database which stores formula data, wherein said database is separate from said rules engine, wherein said formula data are configured to be modified as a function of business requirements of an insurance organization to form modified formula data;

providing a translator program, wherein said translator program is configured to be modified as a function of business requirements of an insurance organization to form a modified translator program and wherein said modified translator program is configured to read said modified formula data from said database and transform said modified formula data into a modified plurality of formulas;

reading said formula data from said database; and

transforming said formula data into said formulas usable by said plurality of rules.

21. The method of claim 20,

wherein said insurance claim comprises a bodily injury claim, and wherein said value of said insurance claim comprises a bodily injury general damages value.

22. The method of claim 21, further comprising:

assessing said value of said insurance claim as a function of said plurality of rules and said plurality of formulas by determining a trauma severity value associated with said bodily injury claim.

23. The method of claim 20,

wherein said formula data is stored in a tabular format in said database.

24. The method of claim 20,

wherein said rules engine comprises program instructions which are executable by a computer.

25. The method of claim 20,

wherein said rules comprise logical instructions for assessing said value of said insurance claim.

26. The method of claim 20,

wherein each rule comprises a premise and one or more resulting actions for assessing said value of said insurance claim.

27. The method of claim 20,

wherein said formulas data comprises alphanumeric values stored in said database.

28. The method of claim 20, further comprising:

updating said formulas by updating said formula data stored in said database.

29. The method of claim 20, further comprising:

updating said formula data in said database;

reading said updated formula data from said database; and

transforming said updated formula data into updated formulas for use by said plurality of rules.

30. The method of claim 20, further comprising:

modifying said formula data in response to business requirements of an insurance organization to form customized formula data.

31. The method of claim 30, further comprising:

modifying said formulas to form modified formulas by using said modified formula data.

32. The method of claim 20,

wherein said formula data comprises a plurality of entries in said database,

wherein at least one entry comprises a formula identifier.

33. The method of claim 20,

wherein said formula data comprises a plurality of entries in said database,

wherein at least one entry comprises a sequence number.

34. The method of claim 20,

wherein said formula data comprises a plurality of entries in said database,

wherein at least one entry comprises a section description.

35. The method of claim 20,

wherein said formula data comprises a plurality of entries in said database,

wherein at least one entry comprises a page identifier.

36. The method of claim 20,

wherein said formula data comprises a plurality of entries in said database,

wherein at least one entry comprises a prompt identifier.

37. The method of claim 20,

wherein said formula data comprises a plurality of entries in said database,

wherein at least one entry comprises an answer identifier.

38. The method of claim 20,

wherein said formula data comprises a plurality of entries in said database,

wherein at least one entry comprises a mathematical function.

39. The method of claim 20,

wherein said formula data comprises a plurality of entries in said database,

wherein at least one entry comprises a numeric value.

40. A computer readable medium comprising program instructions, wherein said program instructions are computer-executable to implement:

providing a rules engine which is operable to assess a value of an insurance claim as a function of a plurality of rules, wherein said plurality of rules use formulas to assess said value of said insurance claim;

accessing a database which stores formula data, wherein said database is separate from said rules engine, wherein said formula data are configured to be modified as a function of business requirements of an insurance organization to form modified formula data;

providing a translator program, wherein said translator program is configured to be modified as a function of business requirements of an insurance organization to form a modified translator program and wherein said modified translator program is configured to read said modified formula data from said database and transform said modified formula data into a modified plurality of formulas;

reading said formula data from said database; and

transforming said formula data into said formulas usable by said plurality of rules.

41. The computer readable medium of claim 40,

wherein said insurance claim comprises a bodily injury claim, and wherein said value of said insurance claim comprises a bodily injury general damages value.

42. The computer readable medium of claim 41, wherein said program instructions are further computer-executable to implement:

assessing said value of said insurance claim as a function of said plurality of rules and said plurality of formulas by determining a trauma severity value associated with said bodily injury claim.

43. The computer readable medium of claim 40,

wherein said formula data is stored in a tabular format in said database.

44. The computer readable medium of claim 40,

wherein said rules engine comprises program instructions which are executable by a computer.

45. The computer readable medium of claim 40,

wherein said rules comprise logical instructions for assessing said value of said insurance claim.

46. The computer readable medium of claim 40,

wherein each rule comprises a premise and one or more resulting actions for assessing said value of said insurance claim.

47. The computer readable medium of claim 40,

wherein said formulas data comprises alphanumeric values stored in said database.

48. The computer readable medium of claim 40, wherein said program instructions are further computer-executable to implement:

updating said formulas by updating said formula data stored in said database.

49. The computer readable medium of claim 40, wherein said program instructions are further computer-executable to implement:

updating said formula data in said database;

reading said updated formula data from said database; and

transforming said updated formula data into updated formulas for use by said plurality of rules.

50. The computer readable medium of claim 40, wherein said program instructions are further computer-executable to implement:

modifying said formula data in response to business requirements of an insurance organization to form modified formula data.

51. The computer readable medium of claim 50, wherein said program instructions are further computer-executable to implement:

modifying said formulas to form modified formulas by using said modified formula data.

52. The computer readable medium of claim 40,

wherein said formula data comprises a plurality of entries in said database,

wherein at least one entry comprises a formula identifier.

53. The computer readable medium of claim 40,

wherein said formula data comprises a plurality of entries in said database,

wherein at least one entry comprises a sequence number.

54. The computer readable medium of claim 40,

wherein said formula data comprises a plurality of entries in said database,

wherein at least one entry comprises a section description.

55. The computer readable medium of claim 40,

wherein said formula data comprises a plurality of entries in said database,

wherein at least one entry comprises a page identifier.

56. The computer readable medium of claim 40,

wherein said formula data comprises a plurality of entries in said database,

wherein at least one entry comprises a prompt identifier.

57. The computer readable medium of claim 40,

wherein said formula data comprises a plurality of entries in said database,

wherein at least one entry comprises an answer identifier.

58. The computer readable medium of claim 40,

wherein said formula data comprises a plurality of entries in said database,

wherein at least one entry comprises a mathematical function.

59. The computer readable medium of claim 40,

wherein said formula data comprises a plurality of entries in said database,

wherein at least one entry comprises a numeric value.