Patent Application Titled “Communication Of Insurance Claim Data” Published Online (USPTO 20240127357): Allstate Insurance Company

2024 MAY 07 (NewsRx) -- By a News Reporter-Staff News Editor at Insurance Daily News -- According to news reporting originating from Washington, D.C., by NewsRx journalists, a patent application by the inventors Hanson, Randall M. (Grayslake, IL, US); Ledder, James A. (Prairie Grove, IL, US); O’halloran, Charles Ronald (Downers Grove, IL, US), filed on December 27, 2023, was made available online on April 18, 2024.

The assignee for this patent application is Allstate Insurance Company (Northbrook, Illinois, United States).

Reporters obtained the following quote from the background information supplied by the inventors: “Mob Vehicle repair shops and insurance companies can gain efficiencies and improve quality of service by interoperating electronically to exchange data and documents such as repair requests, estimates, photos, authorizations, invoices, and payments. Some claim-handling systems used by insurance companies can support such interoperability with repair shop systems, known as estimating systems.

“An insurer claim-handling system is typically designed to work with a specific brand of estimating system, thus requiring vehicle repair shops to use that brand to interoperate with the insurance company. Different insurance companies may specify or require the use of different estimating systems, which means that vehicle repair shops wanting to interoperate with or perform repairs for two or more insurance companies may have to purchase and maintain two or more estimating systems. The costs of purchasing, using, training, maintaining, and supporting multiple systems are inefficient for any vehicle repair shop and can be prohibitive to smaller vehicle repair shops that would otherwise want to work with multiple insurance companies.”

In addition to obtaining background information on this patent application, NewsRx editors also obtained the inventors’ summary information for this patent application: “The following presents a simplified summary of the invention in order to provide a basic understanding of some aspects of the invention. This summary is not an extensive overview of the invention. It is not intended to identify key or critical elements of the invention or to delineate the scope of the invention. The following summary merely presents some concepts of the invention in a simplified form as a prelude to the more detailed description provided below.

“To overcome limitations in the prior art described above, and to overcome other limitations that will be apparent upon reading and understanding the present specification, the present invention is directed to methods and systems for providing a vehicle insurance claim management application (VICMA) that will improve communication and streamline collaboration between the vehicle repair shop and an insurance company in three general task groups: assignment management (comprising work requests, estimates/photos, and reinspections), financial management, and performance measurement. The invention also provides interoperability with different types of estimating systems.

“Additionally, the present invention is directed to methods and systems for efficiently communicating data between an insurer and a non-referral repair shop, e.g., vehicle repair shops that are normally not preapproved by the insurer to perform the estimating and repair work. The methods and systems described herein are particularly useful for insurers utilizing non-referral repair shops for servicing vehicles involved in insurance claims.

“A first aspect of the invention provides one or more computer storage media storing computer readable instructions that, when executed, provide a vehicle insurance claim management application (VICMA). The VICMA comprises an adapter module and a non-referral module. The adapter module may be defined by the computer readable instructions. Additionally, the adapter module may translate data between the application and a vehicle repair estimating system. The non-referral module may also be defined by the computer readable instructions. The non-referral module may receive a set of assignment data from an insurance company pertaining to a plurality of work requests submitted to a non-referral vehicle repair shop. The non-referral vehicle repair shop may not be included within a pre-approved shop network associated with the insurance company. Additionally, the non-referral module may receive a set of estimate data from the non-referral vehicle repair shop and determine whether the non-referral repair shop is in a staffed market or a non-staffed market. Further, the non-referral module may determine a rules-based intelligence score based on the estimate data, wherein the rules-based intelligence score is defined as low-range, mid-range, or high-range. The non-referral module may also determine an intervention level for the estimate based on the rules-based intelligence score and whether the non-referral repair shop is in the staffed market or the non-staffed market. The intervention level may include an automatic approval level, a desk adjuster level, and a field adjuster level. Furthermore, if the estimate data has a low-range rules-based intelligence score, the intervention level is the automatic approval level and the non-referral module may approve the estimate data. Additionally, if the estimate data has a mid-range rules-based intelligence score, the intervention level is the desk adjuster level and the non-referral module may transfer the estimate data to a desk adjuster for a desk review and the non-referral module may further receive one of an approved estimate data from the desk adjuster or a disapproved estimate data from the desk adjuster. Also, if the estimate data has a high-range rules-based intelligence score and the non-referral repair shop is in a staffed market, the intervention level is the field adjuster level and the non-referral module may transfer the estimate data to a field adjuster for a field review and the non-referral module may further receive one of the approved estimate data from the field adjuster or the disapproved estimate data from the field adjuster. In addition, when the estimate is not approved, the non-referral module may allow the adjuster to create a “review” or “change” request which may be electronically sent to the non-referral repair shop. The non-referral repair shop may respond electronically to the review request.

“A second aspect of the invention further includes the above described aspect of the VICMA with a financial module that stores, captures, and/or provides payment status information for the vehicle repair claims assigned to the non-referral vehicle repair shop.

“Another aspect of the invention further includes the above described aspect of the VICMA with a performance module that stores, captures, and/or provides performance metrics for the non-referral vehicle repair shop as compared to other vehicle repair facilities, both referral vehicle repair shops and non-referral vehicle repair shops, working with the insurance company. The performance metrics may be stored and/or captured by the insurance company. In an embodiment of the invention, the performance metrics may not be shared with the non-referral repair shops.

“Another aspect of the invention is a method for a vehicle insurance claim management application (VICMA) for use with a non-referral vehicle repair shop. The method comprises a number of steps. First, the VICMA receives a set of assignment data from an insurance company pertaining to a plurality of work requests submitted to a non-referral vehicle repair shop. Next, the VICMA receives a set of estimate data from the non-referral vehicle repair shop. The VICMA then determines whether the non-referral repair shop is in a staffed market or a non-staffed market, determines whether the estimate is original or supplement, and determines if the assignment is a conversion. Next, the VICMA calculates and determines a rules-based intelligence score based on the estimate data. Following the determination of the intelligence score, the VICMA determines an intervention level for the estimate based on the rules-based intelligence score and the staffed market and non-staffed market, estimate version and assignment type, wherein the intervention level includes an automatic approval level, a desk adjuster level, and a field adjuster level. The VICMA then approves the estimate data if the estimate data has a low-range rules-based intelligence score and the intervention level is the automatic approval level. Also, the VICMA transfers the estimate data to a desk adjuster for a desk review if the estimate data has a mid-range rules-based intelligence score and the intervention level is the desk adjuster level and further receiving one of an approved estimate data from the desk adjuster or a disapproved estimate data from the desk adjuster. In addition, when the estimate is not approved, the non-referral module may allow the adjuster to create a “review” or “change” request which may be electronically sent to the non-referral repair shop. The non referral repair shop may respond electronically to the review request.

“Next, the VICMA transfers the estimate data to a field adjuster for field review if the estimate data has a high-range rules-based intelligence score and the non-referral repair shop is in a staffed market and the intervention level is the field adjuster level and further receiving one of the approved estimate data from the field adjuster or the disapproved estimate data from the field adjuster. In addition, when the estimate is not approved, the non-referral module may allow the adjuster to create a “review” or “change” request which may be electronically sent to the non-referral repair shop. The non referral repair shop may respond electronically to the review request.

“In addition to the above aspect of the invention, the VICMA may also track a real-time financial status for the repair. The VICMA may also compile a set of vehicle repair shop performance data.”

The claims supplied by the inventors are:

“1. A system comprising: an insurance company data server coupled to a network; and a vehicle insurance claim management application communicatively coupled, through the network, to the insurance company data server and a vehicle repair shop system of a vehicle repair shop, the vehicle insurance claim management application configured to: receive a work request and assignment data from the insurance company data server; translate and change the assignment data into a format accepted by the vehicle repair shop system; provide a real-time update to the vehicle repair shop system with at least one of the work request or assignment data changes; transmit and communicate the translated and changed assignment data to the vehicle repair shop system; determine, if the vehicle repair shop is in a staffed market or a non-staffed market; receive a repair estimate with estimate data associated with the work request from the vehicle repair shop system; responsive, at least in part to, not receiving the vehicle repair estimate before an expiration of a time period and determining the vehicle repair shop is in the staffed market, assign a field estimate assignment to a field adjuster in the staffed market; and responsive, at least in part, to not receiving the vehicle repair estimate before the expiration of the time period and determining the vehicle repair shop is in the non-staffed market, contact the vehicle repair shop.

“2. The system of claim 1, wherein the vehicle repair shop is a non-referral repair shop.

“3. The system of claim 1, wherein translating and changing the assignment data includes encrypting the assignment data.

“4. The system of claim 1, wherein the staffed market is associated with a market in which field adjusters are available and the non-staffed market associated with a market in which no field adjusters are available.

“5. The system of claim 1, the vehicle insurance claim management application further configured to: determine the time period in which a repair estimate must be received from the vehicle repair shop system; and determine, if the repair estimate was received before expiration of the time period.

“6. The system of claim 1, wherein the vehicle insurance claim management application is further configured to: receive the repair estimate with the estimate data from the vehicle repair shop system of the vehicle repair shop within the time period; and responsive, at least in part, to receiving the vehicle repair estimate within the time period: translate and change the estimate data into a format accepted by the vehicle insurance claim management application, wherein the translating includes encrypting the estimate data, calculate a rules-based intelligence score based on an analysis and audit of the estimate data, wherein the rules-based intelligence score is related to an identification of anomalies in the estimate data and includes a statistically-based analysis of historical estimate data, determine a 3-tier intervention level for the estimate data based on the rules-based intelligence score by comparing the rules-based intelligence score to one of a low-range, mid-range, or high-range threshold, wherein the 3-tier intervention level is one of a plurality of intervention levels, and wherein the low-range, mid-range, and high-range threshold is determined and adjusted by the vehicle insurance claim management application, and further wherein the low-range, mid-range, and high-range threshold is configurable, provide real-time updates between the insurance company data server and the vehicle repair shop system when any information changes, and transmit and communicate to the vehicle insurance claim management application, the real-time updates of any information changes.

“7. The system of claim 6, the vehicle insurance claim management application further configured to: responsive to determining a low-range intervention level for the estimate data, automatically transmit an estimate approval notification to the vehicle repair shop system.

“8. A system comprising: an insurance company data server coupled to a network; and a vehicle insurance claim management application communicatively coupled, through the network, to the insurance company data server, a first vehicle repair shop system of a first vehicle repair shop, and a second vehicle repair shop system of a second vehicle repair shop, the vehicle insurance claim management application configured to: receive a first work request including first assignment data from the insurance company data server; translate and change the first assignment data into a format accepted by the vehicle insurance claim management application; provide a real-time update to the vehicle repair shop system with at least one of the work request or assignment data changes, transfer the translated first assignment data to the first vehicle repair shop system; receive a first vehicle repair estimate with a first estimate data corresponding to a first vehicle from the first vehicle repair shop system; translate and change the first estimate data into a format accepted by the vehicle insurance claim management application; review the translated and changed first estimate data for compliance with contract-based conditions; receive a second work request and second assignment data relating to a second vehicle from the insurance company data server; translate and change the second assignment data into a format accepted by the vehicle insurance claim management application; transfer the translated and changed second assignment data to the second vehicle repair shop system; determine if the second vehicle repair shop is in a staffed market or a non-staffed market; responsive, at least in part to, not receiving a second vehicle repair estimate before the expiration of a time period and determining the second vehicle repair shop is in the staffed market, assign a field estimate assignment to a field adjuster in the staffed market and transmit and communicate to the vehicle repair shop system in real-time, through the vehicle insurance claim management application, an updated assignment data corresponding to the assigned field estimate assignment; and responsive, at least in part, to not receiving the second vehicle repair estimate before the expiration of the time period and determining the second vehicle repair shop is in the non-staffed market, contact the first vehicle repair shop.

“9. The system of claim 8, wherein the first vehicle repair shop is a direct repair vehicle repair shop.

“10. The system of claim 8, wherein the second vehicle repair shop is a non-referral vehicle repair shop.

“11. The system of claim 8, wherein translating and changing the first assignment data and the second assignment data includes encrypting the first assignment data and the second assignment data.

“12. The system of claim 8, wherein the staffed market is associated with a market in which field adjusters are available and the non-staffed market associated with a market in which no field adjusters are available.

“13. The system of claim 8, wherein the vehicle insurance claim management application is further configured to: receive the second vehicle repair estimate with a second estimate data from the second vehicle repair shop system within the time period; and responsive, at least in part, to receiving the second vehicle repair estimate within the time period: translate and change the second estimate data into a format accepted by the vehicle insurance claim management application, wherein the translating includes encrypting the second estimate data, calculate a rules-based intelligence score based on an analysis and audit of the second estimate data, wherein the rules-based intelligence score is related to an identification of anomalies in the second estimate data and includes a statistically-based analysis of historical estimate data, determine a 3-tier intervention level for the second estimate data based on the rules-based intelligence score by comparing the rules-based intelligence score to one of a low-range, mid-range, or high-range threshold, wherein the 3-tier intervention level is one of a plurality of intervention levels, and wherein the low-range, mid-range, and high-range threshold is determined and adjusted by the vehicle insurance claim management application, and further wherein the low-range, mid-range, and high-range threshold is configurable, provide real-time updates between the insurance company data server and the second vehicle repair shop system when any information changes, and transmit and communicate to the vehicle insurance claim management application, the real-time updates of any information changes.

“14. The system of claim 13, the vehicle insurance claim management application further configured to: responsive to determining a low-range intervention level for the second estimate data, automatically transmit an estimate approval notification to the second vehicle repair shop system.”

There are additional claims. Please visit full patent to read further.

For more information, see this patent application: Hanson, Randall M.; Ledder, James A.; O’halloran, Charles Ronald. Communication Of Insurance Claim Data. U.S. Patent Application Number 20240127357, filed December 27, 2023 and posted April 18, 2024. Patent URL (for desktop use only): https://ppubs.uspto.gov/pubwebapp/external.html?q=(20240127357)&db=US-PGPUB&type=ids

(Our reports deliver fact-based news of research and discoveries from around the world.)