US 20040148204A1
(19) United States
(12) Patent Application Publication (10) Pub. N0.: US 2004/0148204 A1
Menendez
(43) Pub. Date:
Jul. 29, 2004
(54)
(76)
(21)
(22)
(60)
METHOD OF EXPEDITING INSURANCE CLAIMS
Dale Menendez, Fox River Grove, IL
(US)
Inventor:Correspondence Address:
Welsh & Katz, Ltd.
Jon P. Christensen 22nd Floor
120 South Riverside Plaza Chicago, IL 60606 (US) Appl. N0.: 10/740,066
Filed: Dec. 18, 2003
Related US. Application Data
Provisional application No. 60/438,019, ?led on Jan.
4, 2003.
Publication Classi?cation
(51) Int. Cl? G06F 17/60
(52) US. Cl. ... .. 705/4
(57) ABSTRACT
A method and apparatus are provided for processing an
insurance claim. The method includes the steps of receiving
a claim for a loss from an insured through an Internet
connection and determining a policy type from the claim.
The method further includes the steps of retrieving a set of
keywords based upon the policy type, matching the retrieved
set of keywords With Words contained Within the received claim, assigning an adjuster to the claim When any matched Words of the matching step meets a predetermined criteria and paying the claim Without assigning the claim to an
adjuster When the matching does not meet the predetermined criteria and any auxiliary criteria.
Coverage Analysis Flow Chart
Claim Report Completed and Claim Number Assigned
The data is analyzed to determine if the loss passes coverage or requires an adjuster to verify coverage.
If building cover is all risk and content is named peril and both have damage claimed then the more narrow coverage, named peril, applies. The client’s program will dictate the type of coverage.
Detailed List of Property Not Covered Animal
Vehicle
All Risk Coverage Named Peril Coverage
Detailed List Claim Report, Coverage and Detailed
of Policy and Data Analyzed Against Key Listed of
Insuring Words, Phrases, Dollar Limts, Covered
Agreement Time Periods, etc. I Perils Exclusions +
Property Not Covered m Matched Property Not Covered Matched
Passes to “Damage Veri?cation Process.”
Exclusions ?o_t Matched Exclusion Matched Coverage Peril Matched Coverage Peril M Matched
Claim Successfully Claim sent to the company
with recommendation to
Patent Application Publication
Jul. 29, 2004 Sheet 1 of 22
US 2004/0148204 A1
System for Processing Claims
10 Client Host 20 1s wc ws1
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CNG CP 36 - 34 Insured/ Claimant MP PP 12 ' 3s 40 PMT INTERNET <—> 42 16 - KW Insured/ Claimant ‘ 46 14 ' 44' R L R Agent 26 28 30 22 FIG. 1Patent Application Publication Jul. 29, 2004 Sheet 7 0f 22
US 2004/0148204 A1
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Patent Application Publication Jul. 29, 2004 Sheet 12 0f 22
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Patent Application Publication Jul. 29, 2004 Sheet 18 of 22
US 2004/0148204 A1
Damage Veri?cation Flow Chart
The Claim Report questionnaire identi?es the three categories of damages that can be claimed. Building Damage, and/ or Content Damage, and/ or Expense
Building Damage
Expense
Content Damage
Itemized Damages
Itemized Damages
Itemized Damages
Online Form Online Form Online Form
Damages totaled to create a
Sworn Statement In Proof Of Loss
The insured must sign the sworn statement thereby agreeing to the facts
reported and the dollar amount claimed recognizing that submitting false
or incorrect information will have legal consequences and may result in
disciplinary actions
System Analysis of Claim Data, Dollar Limits, and Property Not Covered Against Damage Veri?cation Information and Data Provided.
Claim and data Claim and data do not
success?illy complete pass coverage and
coverage and damage
damage analysis
analysis
Recommend claim be
Recommend Payment Referred To Adjuster
of Claim to Company by the company
Claim Log
I Completed
Patent Application Publication Jul. 29, 2004 Sheet 19 0f 22
US 2004/0148204 A1
Pay/ Referral Process
Flow Chart
Claim Record and Log '
The Claim Report Log is a virtual claim record and log between the company and FastTrackClaimm.
A record is created when a claim report is successfully completed and a claim number is assigned. At that point the claim is referred to an adjuster (RTA) if it does not pass the coverage analysis or it continues to the Damage Veri?cation process. If it does not successfully pass that process at any point
in the damage submission process the claim is referred to adjuster (RTA). If the claim successfully
passes Coverage Analysis and Damage Veri?cation it is on the log as a recommended payment to the company. The company may then choose to RTA or PAY the claim clearing the claim which will then
be closed on the FastTrackClaim'm Record and system.
Automatic Electronic Claim Payments
The company/ client is asked to assign a claim administrator to review and process the online Claim Record for payment or referral to adjuster. IfFl‘C recommends payment it is the company's option to pay the claim. Once the program is in process and live claims are being processed the procedure can be
manipulated and the system constraints adjusted for optimal results. Once claim payments become
routine and it is clear the system is functioning properly the process may be automated to electronically pay claims without direction from the claim administrator. Using EDI or other electronic data interface systems the company system and FTC system can exchange data and information as necessary to electronically automate the payment process paying claims based upon system information.
Claim Report Questionnaire
V
Claim Record
Coverage Analysis
+
Refer To Adjuster
Damage Veri?cation
(RTA)
Sworn Statement In Proof Of Loss
l
Claim Record Recommend To Pay
