“Computer System For Processing Of Determinate And Indeterminate Data And Associated User Interfaces” in Patent Application Approval Process (USPTO 20200273115)

2020 SEP 14 (NewsRx) -- By a News Reporter-Staff News Editor at Insurance Daily News -- A patent application by the inventors Bostic, Daniel Lee (Naugatuck, CT); Edwards, Paul J. (West Hartford, CT); Reed, Andrew J. (Peori, AZ); Scott, Michael Adam (Carmel, IN); Shemesh, Keren (West Haven, CT), filed on May 11, 2020, was made available online on August 27, 2020, according to news reporting originating from Washington, D.C., by NewsRx correspondents.

This patent application is assigned to Hartford Fire Insurance Company (Hartford, Connecticut, United States).

The following quote was obtained by the news editors from the background information supplied by the inventors: “An insurer may provide payments when claims are made in connection with an insurance policy. For example, an employee who is injured while working might receive payments associated with a workers’ compensation insurance policy purchased by his or her employer. The insurer may assign a claim handler to communicate with a claimant, an employer, another insurer, and/or medical service providers to help determine the appropriate amount of payment.

“In some cases, an insurer may have an opportunity to recover some or all of the payments made in connection with an insurance claim. Consider, for example, an insurance claim associated with a claimant who fell while walking on a sidewalk. In this case, another insurer associated with a construction company that was working on the sidewalk when the injury occurred may be responsible for some or all of the claimant’s injury. In the case of a property insurance claim, as another example, a damaged piece of property may still have some salvage value that may be recovered by the insurer. Typically, a claim handler working for an insurer will manually review an insurance claim to determine if any recovery opportunities exist. However, manually determining if recovery opportunities exist can be a time consuming and error prone task, especially when there are a substantial number of claims, of many different types and/or from many different locations, to be processed. For example, an insurer might receive tens of thousands of new insurance claims each year (which might represent a substantial number of potential recovery opportunities to be uncovered and processed). It would therefore be desirable to provide systems and methods to facilitate the detection and/or processing of recovery opportunities in an automated, efficient, and accurate manner.”

In addition to the background information obtained for this patent application, NewsRx journalists also obtained the inventors’ summary information for this patent application: “According to some embodiments, systems, methods, apparatus, computer program code and means may facilitate the detection and/or processing of recovery opportunities. In some embodiments, data may be received indicative of a plurality of insurance claims. A recovery opportunity platform processor may, based on the received data, identify an insurance claim as being associated with a potential recovery opportunity. For the identified insurance claim, the recovery opportunity platform processor may automatically arrange for a potential recovery user interface to be displayed to a claim handler and may receive, via the potential recovery user interface, recovery details from the claim handler. A summary report may be automatically generated for a plurality of insurance claims based in part on the recovery details received from the claim handler, and an indication of the summary report may be transmitted.

“A technical effect of some embodiments of the invention is an improved and computerized method to facilitate the detection and/or processing of recovery opportunities. With these and other advantages and features that will become hereinafter apparent, a more complete understanding of the nature of the invention can be obtained by referring to the following detailed description and to the drawings appended hereto.”

The claims supplied by the inventors are:

“1. A computer system, comprising: a communication device to receive data indicative of a plurality of insurance claims submitted in connection with insurance policies, the received data including determinate data and indeterminate data; a computer storage unit, in communication with the communication device, for receiving and storing said data indicative of the plurality of insurance claims; a risk transfer opportunity platform processor in communication with the storage unit, wherein the processor is configured for: based on the received determinate and indeterminate data, automatically determining, employing a computerized predictive model trained on historical claim data including at least monetary information, demographic information, and claim notes, and prior risk transfer results, and further trained subsequently on current claim data and risk transfer results, whether, for a plurality of the insurance claims, there is another party potentially responsible for the insurance claim, the claims for which there is another party potentially responsible for the claim being identified as being associated with a potential risk transfer opportunity, wherein the historical claim data is scrubbed of erroneous values and subjected to data reduction to reduce variables associated with one another, categorizing of raw values to reduce granularity, and data transformations to improve interpretability, model fit or adherence to modeling assumptions prior to training the computerized predictive model; responsive to the determination, proceeding to one of (a) or (b): (a) for the insurance claims for which another party is determined to be potentially responsible: automatically arranging for a potential risk transfer user interface to be displayed to a claim handler, and receiving, via the potential risk transfer user interface, recovery details from the claim handler, including an overall total damages value and a risk transfer value; (b) for the insurance claims for which no other party is determined to be responsible, identifying the claims for normal insurance claim processing, without automatically arranging for a potential risk transfer user interface to be displayed to a claim handler.

“2. The system of claim 1, wherein the potential risk transfer interface includes fields for entry of data regarding at least a name of a potentially responsible party, a type of association with the claim of the potentially responsible party, and a liability percentage.

“3. The system of claim 1, wherein, for the insurance claims for which another party is determined to be potentially responsible, the system is further configured to automatically generate in the potential risk transfer user interface a pop-up window that displays a set of planned activities including a review of risk transfer activity having a due date, priority, and assigned claim handler,

“4. The system of claim 1, wherein the computerized predictive model is further configured to identify potential salvage recovery opportunities, and further comprising a property salvage recovery opportunity platform processor configured to automatically communicate potential salvage recovery opportunities identified by the computerized predictive model to salvage specialists and determine property salvage recovery amounts based on information received from salvage specialists via a graphical user interface.

“5. The system of claim 1, wherein, for the insurance claims for which another party is determined to be potentially responsible, the system is further configured for: automatically generating a summary report associated with a plurality of insurance claims based in part on the overall total damages value and risk transfer value received from the claim handler, and transmitting an indication of the summary report.

“6. The system of claim 1, wherein the system is adapted to process insurance claims associated with any of: (i) automobile insurance, (ii) homeowners insurance, (iii) property insurance, (iv) general liability insurance, (v) commercial insurance, (vi) personal insurance, and (vii) workers’ compensation insurance.

“7. The system of claim 1, wherein the risk transfer opportunity platform processor is further configured for: automatically transmitting an indication of a recovery amount to at least one of: (i) an email server, (ii) a workflow application, (iii) a report generator, (iv) a calendar application, and (v) a payment facilitation device.

“8. The system of claim 1, wherein the computerized predictive model comprises at least one of: (i) a neural network, (ii) a Bayesian network, (iii) a Hidden Markov model, (iv) an expert system, (v) a decision tree, (vii) a collection of decision trees, (viii) a support vector machine, and (ix) weighted factors.

“9. The system of claim 1, wherein the determining whether there is another party potentially responsible for the insurance claim is based at least in part on rules associated with transitions between subrogation statuses and a type of insurance associated with the insurance claim.

“10. The system of claim 1, wherein the information on which the computerized predictive model is trained further includes medical bill information.

“11. A computer-implemented method, comprising: receiving, by a communication device, data indicative of a plurality of insurance claims submitted in connection with insurance policies, the received data including determinate data and indeterminate data; receiving from the communication device, and storing, by a computer storage unit, said data indicative of the plurality of insurance claims; based on the received determinate and indeterminate data, automatically determining by a risk transfer opportunity platform processor employing a computerized predictive model trained on historical claim data including at least monetary information, demographic information, and claim notes, and prior risk transfer results, and further trained subsequently on current claim data and risk transfer results, whether, for a plurality of the insurance claims, there is another party potentially responsible for the insurance claim, and the claims for which there is another party potentially responsible for the claim being identified as being associated with a potential risk transfer opportunity; wherein the historical claim data is scrubbed of erroneous values and subjected to data reduction to reduce variables associated with one another, categorizing of raw values to reduce granularity, and data transformations to improve interpretability, model fit or adherence to modeling assumptions prior to training the computerized predictive model; responsive to the determination, proceeding to one of (a) or (b): (a) for the insurance claims identified as being associated with a potential risk transfer opportunity, automatically arranging by the risk transfer opportunity platform processor for a potential risk transfer user interface to be displayed to a claim handler, and receiving, via the potential risk transfer user interface by the recovery opportunity platform processor, recovery details from the claim handler, including an overall total damages value and a risk transfer value; and (b) for the insurance claims for which no other party is determined to be responsible, identifying, by the risk transfer opportunity platform processor, the claims for normal insurance claim processing, without automatically arranging for a potential risk transfer user interface to be displayed to a claim handler.

“12. The computer-implemented method of claim 11, wherein the potential risk transfer interface includes fields for entry of data regarding at least a name of a potentially responsible party, a type of association with the claim of the potentially responsible party, and a liability percentage.

“13. The computer-implemented method of claim 11, further comprising, for the insurance claims identified as being associated with a potential risk transfer opportunity, automatically generating by the risk transfer opportunity processor in the potential risk transfer user interface a pop-up window that displays a set of planned activities including a review of risk transfer activity having a due date, priority, and assigned claim handler.

“14. The computer-implemented method of claim 11, further comprising: determining, by the risk transfer opportunity platform processor, employing the computerized predictive model, potential salvage recovery opportunities, receiving, by a property salvage recovery opportunity platform processor, data indicative of the potential salvage recovery opportunities; automatically communicating, by the property salvage recovery opportunity platform processor, potential salvage recovery opportunities identified by the computerized predictive model to salvage specialists; and determining, by the property salvage recovery opportunity platform processor, property salvage recovery amounts based on information received from salvage specialists via a graphical user interface.

“15. The computer-implemented method of claim 11, further comprising, for the insurance claims identified as being associated with a potential risk transfer opportunity, automatically generating by the risk transfer opportunity platform processor a summary report associated with a plurality of insurance claims based in part on the overall total damages value and the risk transfer value received from the claim handler, and transmitting an indication of the summary report.

“16. The computer-implemented method of claim 11, wherein the method is adapted to process insurance claims associated with any of: (i) automobile insurance, (ii) homeowners insurance, (iii) property insurance, (iv) general liability insurance, (v) commercial insurance, (vi) personal insurance, and (vii) workers’ compensation insurance.

“17. The computer-implemented method of claim 11, further comprising: automatically transmitting an indication of a recovery amount to at least one of: (i) an email server, (ii) a workflow application, (iii) a report generator, (iv) a calendar application, and (v) a payment facilitation device.

“18. The computer-implemented method of claim 11, wherein the computerized predictive model comprises at least one of: (i) a neural network, (ii) a Bayesian network, (iii) a Hidden Markov model, (iv) an expert system, (v) a decision tree, (vii) a collection of decision trees, (viii) a support vector machine, and (ix) weighted factors.

“19. The computer-implemented method of claim 11, wherein the determining whether there is another party potentially responsible for the insurance claim is based at least in part on rules associated with transitions between subrogation statuses and a type of insurance associated with the insurance claim.

“20. The computer-implemented method of claim 11, wherein the information on which the computerized predictive model is trained further includes medical bill information.”

URL and more information on this patent application, see: Bostic, Daniel Lee; Edwards, Paul J.; Reed, Andrew J.; Scott, Michael Adam; Shemesh, Keren. Computer System For Processing Of Determinate And Indeterminate Data And Associated User Interfaces. Filed May 11, 2020 and posted August 27, 2020. Patent URL: http://appft.uspto.gov/netacgi/nph-Parser?Sect1=PTO1&Sect2=HITOFF&d=PG01&p=1&u=%2Fnetahtml%2FPTO%2Fsrchnum.html&r=1&f=G&l=50&s1=%2220200273115%22.PGNR.&OS=DN/20200273115&RS=DN/20200273115

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