Patent Issued for System For Selection Of Data Records Containing Structured And Unstructured Data (USPTO 10,445,697)

2019 OCT 28 (NewsRx) -- By a News Reporter-Staff News Editor at Insurance Daily News -- Hartford Fire Insurance Company (Hartford, Connecticut, United States) has been issued patent number 10,445,697, according to news reporting originating out of Alexandria, Virginia, by NewsRx editors.

The patent’s inventors are Li, Bixia (South Windsor, CT); Drennan, III, Arthur Paul (West Granby, CT); Gooley, Brian J. (Farmington, CT).

This patent was filed on November 26, 2012 and was published online on October 28, 2019.

From the background information supplied by the inventors, news correspondents obtained the following quote: “Insurance claims arise in a variety of contexts, including insurance coverage for individuals, or personal lines, such as personal property coverage and personal automotive coverage, as well as business insurance coverage. Examples of categories of business insurance coverage include claims relating to employee injuries, including workers compensation claims, short term disability claims and long term disability claims. These types of claims are often underwritten by insurance companies, or are self-insured by large employers. The costs associated with these claims for insurance companies and self-insuring employers include the cost of medical services provided to injured employees, and income replacement payments provided to employees during a period when the employees are unable to perform their customary job duties.

“While insurance provides for medical expenses and partial replacement of lost income, generally regardless of responsibility for the injury, in some cases, another party is legally responsible for the injury. For example, in the event of an automobile accident, an individual insured driver or an employee of an insured business may be injured. If the negligence of another driver caused the automobile accident, then the insurance company or, in the case of the injured employee, a self-insuring employer, may be entitled to subrogation. By subrogration, the insurance company or self-insured employer stands in the shoes of the injured individual and can seek civil damages or a settlement from the negligent party, or the negligent party’s insurer. Similarly, in the event of a claim for covered property damage, the property owner’s insurance coverage may pay a claim to cover the cost of repairs, but then seek subrogation against a responsible party.

“A wide variety of factual circumstances may give rise to a right in the insurance company or self-insured employer to subrogation. For example, an employee may be injured as a result of malfunctioning equipment. The malfunction may result from defective design or manufacture of the equipment or a part, or incorrect maintenance by a contractor. Similarly, property of an insured individual may be damaged as a result of defective manufacture or maintenance of such items as household appliances, heating, ventilation and air conditioning systems, and other items.

“If a claim handler identifies that a claim may be suitable for subrogation, the claim handler refers the claim to an insurance claims recovery operation of the insurance company. However, the claim handler may not accurately identify all claims that have subrogation potential, thereby resulting in an absence of subrogation recovery. For example, the claim handler may be provided with rules such as excluding all injuries of certain types from consideration for subrogation. On the other hand, if a claim handler refers to a claims recovery operation excessive numbers of claims with little or no subrogation potential, the resources of the claims recovery operation are misdirected to review of those low potential referred claims.

“Systems and methods that provide for superior identification of subrogation opportunities would be desirable.”

Supplementing the background information on this patent, NewsRx reporters also obtained the inventors’ summary information for this patent: “In an embodiment, a computer system for processing data relating to determination of suitability for subrogation of insurance claims includes one or more data storage devices storing: data relating to the insurance claims, the stored data comprising: structured data and unstructured data, the unstructured data comprising data indicative of communications between claim handlers and one or more other persons; data defining a predictive model for assessing suitability for subrogation of claims based on review of the structured data and words and phrases extracted from the data indicative of the unstructured data. The system further includes at least one processor in communication with the one or more data storage devices and configured to, on a periodic basis: determine a set of claims for review including new claims and selected previously-reviewed claims; apply text mining to the data indicative of the unstructured data to extract words and phrases from the unstructured data; and apply the predictive model to the structured data and the extracted words and phrases from the unstructured data to determine a subrogation score associated with each of the claims in the set. The one or more processors are further configured to, for each of the previously-reviewed claims, determine whether the subrogation score is greater than on previous review; and generate a report including at least some of the new claims and the previously reviewed claims having a greater subrogation score.

“In an embodiment, a computer-implemented method for processing data for determination of suitability for subrogation of insurance claims, includes on a periodic basis accessing by a processor from one or more data storage devices data relating to insurance claims to determine a set of claims for review, the selected claims including new claims and previously-reviewed claims, the stored data including structured data and unstructured data, the unstructured data including data indicative of communications between claim handlers and one or more other persons. The method further includes processing by the processor using text mining the unstructured data to extract words and phrases from the unstructured data, and applying, by the processor, a predictive model for assessing suitability for subrogation of claims based on review of the structured data and words and phrases extracted from the unstructured data, to the structured data and the extracted words and phrases from the unstructured data to determine a subrogation score associated with each of the claims in the set. The method further includes determining by the processor, for each of the previously-reviewed claims, whether the subrogation score is greater than on previous review; and generating by the processor a report including at least some of the new claims and the previously reviewed claims having a greater subrogation score.

“In an embodiment, a non-transitory computer-readable storage medium has stored processor-executable instructions, which instructions, when executed by a processor, cause the processor to: on a periodic basis, access from one or more data storage devices data relating to claims to determine a set of claims for review, the selected claims including new claims and previously-reviewed claims, the stored data comprising structured data and unstructured data, the unstructured data comprising data indicative of communications between claim handlers and other persons; process using text mining the data indicative of notes of the unstructured data to extract words and phrases from the unstructured data; apply a predictive model for assessing suitability for subrogation of claims based on review of the structured data and words and phrases extracted from the data indicative of notes of the unstructured data, to the structured data and the extracted words and phrases from the unstructured data to determine a subrogation score associated with each of the claims in the set; determine, for each of the previously-reviewed claims, whether the subrogation score is greater than on previous review; and generate a report including at least some of the new claims and the previously reviewed claims having a greater subrogation score.”

The claims supplied by the inventors are:

“What is claimed is:

“1. A computer system, comprising: one or more data storage devices storing: a plurality of data records, each data record comprising stored data, the stored data comprising: structured data and unstructured data, the unstructured data comprising data indicative of communications between two or more persons; a data storage device storing data defining a predictive model for determining a score indicative of suitability of data records for forwarding to an operation system, responsive to receipt of one of the data records, the predictive model configured to perform the determination based on review of the structured data and words and phrases extracted from the data indicative of the unstructured data of the data record, the predictive model comprising data values and coefficients associated with structured data, certain data values being negative and indicative of a reduced suitability for forwarding, and certain data values being positive and indicative of an increased suitability for forwarding; an analysis hardware server, in communication with the data storage devices and comprising a processor configured to, on a recurring and dynamic basis, in each of a plurality of cycles: determine a set of data records, from the plurality of data records, for review by the predictive model, the set comprising data records having no score determined in any prior cycle and selected data records assigned scores in one or more prior cycles, the selected data records assigned scores in one or more prior cycles comprising data records not forwarded to the operation system and having selected aging intervals; extract words and phrases from the unstructured data associated with the determined set of data records using data mining to identify words and phrases for extraction, comprising using text parsing logic to identify sentences, and tagging identified words to be associated with categories and subcategories; apply the predictive model to the structured data and the extracted words and phrases from the unstructured data to determine a current-cycle score associated with each of the data records in the set, and assign each of the data records of the set to one of a plurality of groups of equal numbers ordered in accordance with the determined current-cycle score; for each of the data records of the set for which a score was determined in a prior cycle, determine whether the current-cycle score is greater than a most-recently determined prior cycle score for the same data record; and generate a report including at least some of the data records having no score determined in any prior cycle and the data records assigned scores in one or more prior cycles determined to have a greater current-cycle score than the most-recently determined prior cycle score for the same data record; determine a velocity of change in group to which each data record is assigned; based at least in part on the determined velocity of change in group to which a data record is assigned, and based on whether a current-cycle score is at least a threshold value, select a plurality of the data records for forwarding to an operation system, wherein a positive velocity of change in group renders a data record more likely to be selected for forwarding, and a negative velocity of change in group renders a data record less likely to be selected for forwarding; and forward, via bulk download using xml documents, to the operation system, the data records selected for forwarding.

“2. The computer system of claim 1, wherein the data records comprise data indicative of workers compensation claims, and the data indicative of communications comprises at least notes based on conversations between claim handlers and one or more of injured individuals and employer representatives.

“3. The computer system of claim 1, wherein the generating a report comprises grouping claims by score.

“4. The computer system of claim 1, wherein the selected data records assigned scores in one or more prior cycles comprise data records not forwarded to the operation system and having selected aging intervals.

“5. The computer system of claim 1, wherein the data records comprise data indicative of workers compensation claims and the structured data values comprise an on premises indicator having a positive or negative value and nature of injury indicator.

“6. The computer system of claim 1, wherein the structured data values include a report lag indicator, having a positive coefficient for a short report lag value and a negative coefficient for a long report lag value.

“7. The computer system of claim 1, wherein the predictive model comprises a plurality of terms capable of extraction from unstructured data and positive and negative coefficients associated with the terms.

“8. The computer system of claim 7, wherein the terms comprise contractor and landlord, a positive coefficient being associated with those terms.

“9. The computer system of claim 7, wherein the data records comprise workers compensation claims and one or more of the coefficients are employer description dependent.

“10. The computer system of claim 1, further comprising a claim recovery operation hardware server in communication with the processor and configured to receive claim and likelihood of subrogation data.

“11. A computer-implemented method, comprising: storing in one or more data storage devices a plurality of data records, each of the data records comprising structured data and unstructured data, the unstructured data comprising data indicative of communications between two or more persons; on a recurring and dynamic basis on a cycle accessing by a processor of an analysis hardware server from the one or more data storage devices data relating to the data records to determine a set of data records for review, the set of data records including data records having no score determined in any prior cycle and data records assigned scores in one or more prior cycles, the selected data records assigned scores in one or more prior cycles comprising data records having selected aging intervals; processing by the processor using data mining the unstructured data to extract words and phrases from the unstructured data, comprising using text parsing logic to identify sentences, and tagging identified words to be associated with categories and subcategories; applying, by the processor, to each of the data records of the set, a predictive model for determining a current-cycle score indicative of suitability of data records for forwarding to an operation system, the predictive model being configured to perform the determination responsive to receipt of one of the data records based on review of the structured data and words and phrases extracted from the unstructured data, to the structured data and the extracted words and phrases from the unstructured data of the data record, the predictive model comprising data values and coefficients associated with structured data certain data values being negative and indicative of a reduced suitability for forwarding, and certain data values being positive and indicative of an increased suitability for forwarding, and assigning each of the data records of the set to one of a plurality of groups of equal numbers ordered in accordance with the determined current-cycle score; determining by the processor, for each of the data records in the set for which a score was determined in a prior cycle, whether the current-cycle score is greater than a most recently determined prior cycle score; generating by the processor a report including at least some of the data records having no score determined in any prior cycle and the data records assigned scores in one or more prior cycles determined to have a greater score than the most-recently determined prior score for the same data record; determining by the processor a velocity of change in group to which each data record is assigned; based at least in part on the determined velocity of change in group to which a data record is assigned, selecting by the processor a plurality of the data records for forwarding to an operation system, wherein a positive velocity of change in group renders a data record more likely to be selected for forwarding, and a negative velocity of change in group renders a data record less likely to be selected for forwarding; and forwarding, via bulk download using xml documents, to the operation system, the data records selected for forwarding.

“12. The computer-implemented method of claim 11, wherein the selected previously-reviewed data records comprise data records not forwarded to the operation system and having selected aging intervals.

“13. The computer-implemented method of claim 12, wherein the selected aging intervals include a first aging interval of between 10 and 45 days and a second aging interval of at least 180 days.

“14. The computer-implemented method of claim 11, further comprising storing in the one or more data storage devices data relating to the previously reviewed data records not having a greater score than a most-recently determined prior score for the same data record.

“15. The computer-implemented method of claim 11, wherein the predictive model comprises a plurality of structured data values and coefficients associated with each of the structured data values.

“16. The computer-implemented method of claim 11, wherein the data records comprise data records indicative of claims under property insurance policies.

“17. A non-transitory computer-readable storage medium, the computer-readable storage medium having processor-executable instructions stored, which instructions, when executed by a processor, cause the processor to: on a recurring and dynamic basis on a cycle, in each of a plurality of cycles, access from one or more data storage devices stored data relating to data records to determine a set of data records for review, the selected data records including data records having no score determined in any prior cycle and selected data records assigned scores in one or more prior cycles, the selected data records assigned scores in one or more prior cycles comprising data records having selected aging intervals, the stored data comprising structured data and unstructured data, the unstructured data comprising data indicative of communications between two or more persons; process using data mining the data indicative of the unstructured data to extract words and phrases from the unstructured data of the data records of the set of data records, comprising using text parsing logic to identify sentences, and tagging identified words to be associated with categories and subcategories; apply a predictive model for determining a current-cycle score indicative of suitability of data records for forwarding to an operation system, for each of the data records of the set, based on review of the structured data and words and phrases extracted from the unstructured data, to the structured data and the extracted words and phrases from the unstructured data to determine a score associated with each of the data records of the set, the predictive model comprising data values and coefficients associated with structured data certain data values being negative and indicative of a reduced suitability for forwarding, and certain data values being positive and indicative of an increased suitability for forwarding, and assign each of the data records to one of a plurality of groups of equal numbers ordered in accordance with determined current-cycle scores; determine, for each of the data records having a score determined in one or more prior cycles, whether the current-cycle score is greater than a most recently determined prior cycle score; generate a report including at least some of the data records having no score determined in any prior cycle and the data records assigned scores in one or more prior cycles determined to have a greater score than the most-recently determined prior score for the same data record; determine a velocity of change in group to which each data record is assigned; based at least in part on the determined velocity of change in group to which a data record is assigned, select a plurality of the data records for forwarding to the operation system, wherein a positive velocity of change in group renders a data record more likely to be selected for forwarding, and a negative velocity of change in group renders a data record less likely to be selected for forwarding; and forward, via bulk download using xml documents, to the operation system, the data records selected for forwarding.

“18. The non-transitory computer-readable storage medium of claim 17, wherein the instructions further cause the processor to select data records having no score determined in any prior cycle for inclusion in the report based on the determined score.

“19. The non-transitory computer-readable storage medium of claim 17, wherein the instructions further cause the processor to transmit the report to the operation server for further review.”

For the URL and additional information on this patent, see: Li, Bixia; Drennan, III, Arthur Paul; Gooley, Brian J. System For Selection Of Data Records Containing Structured And Unstructured Data. U.S. Patent Number 10,445,697, filed November 26, 2012, and published online on October 28, 2019. Patent URL: http://patft.uspto.gov/netacgi/nph-Parser?Sect1=PTO1&Sect2=HITOFF&d=PALL&p=1&u=%2Fnetahtml%2FPTO%2Fsrchnum.htm&r=1&f=G&l=50&s1=10,445,697.PN.&OS=PN/10,445,697RS=PN/10,445,697

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