“Virtual Assistant For Recommendations On Whether To Arbitrate Claims” in Patent Application Approval Process (USPTO 20220005126): Allstate Insurance Company

2022 JAN 24 (NewsRx) -- By a News Reporter-Staff News Editor at Insurance Daily News -- A patent application by the inventors Gore, Caleb (Northbrook, IL, US); Jungwirth, Don (Northbrook, IL, US); Kelsh, John (Northbrook, IL, US), filed on September 20, 2021, was made available online on January 6, 2022, according to news reporting originating from Washington, D.C., by NewsRx correspondents.

This patent application is assigned to Allstate Insurance Company (Northbrook, Illinois, United States).

The following quote was obtained by the news editors from the background information supplied by the inventors: “Insurance providers receive insurance claims relating to vehicular accidents involving policy holders. The insurance providers must determine the liability of the policy holders and pay the appropriate entities for covered losses. However, in many cases, third parties (and not the policy holders) may be at fault for the accidents. In such cases, the insurance providers may seek subrogation from the third parties and/or the insurance providers of the third parties. If the third parties and/or the insurance providers of the third parties refuse to reimburse for expenses incurred by the insurance providers of the policy holders, the insurance providers of the policy holders may submit the claim for arbitration by an arbitrator.

“Current approaches and processes for determining whether to arbitrate a claim are time-consuming as it involves interaction with multiple insurance providers, insurance agents, claims adjusters, subrogation representatives, individuals involved in the accident or a witness to the accident, and the like. Further, less experienced insurance adjusters might not know what information is needed for every possible scenario for use in determining whether a claim should proceed to arbitration. As a result, there is inconsistency among different insurance providers as to the information on which they are basing such determinations.

“Therefore, a need exists for improved approaches to processing claims where subrogation is involved to provide consistent and accurate determinations whether an insurance claim should proceed to arbitration.”

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

“Aspects of the disclosure involve a streamlined and efficient process for claims management and disclose methods, computer-readable media, and apparatuses for automating the determining whether claims related to an insured item should proceed to an arbitrating body. A virtual assistant (also referred to herein as an “arbitration assessment assistant”) installed in a computing device (e.g., computer, laptop, tablet computer, mobile phone, etc.) may be responsible for managing and assisting an insurance representative (e.g., an insurance adjuster, subrogation representative, etc.) in determining liability and fault relating to an insurance claim, conducting a subrogation process, and ultimately determining whether the insurance claim should be submitted for arbitration. In one or more aspects discussed herein, the process may be fully automated. That is, the arbitration assessment assistant, once triggered, may determine fault, attempt to subrogate the insurance claim, and output a recommendation as to whether the claim should be submitted for arbitration.

“The arbitration assessment assistant may also be responsible for analyzing the insurance claim, identifying missing information useful in determining whether the claim should be arbitrated, obtaining the missing information from various data sources, and analyzing the obtained information to perform the above-described functions (e.g., determining liability, fault, and/or whether to proceed to arbitration).

“Further aspects of the disclosure may be provided in a computer-readable medium having computer-executable instructions that, when executed, cause a computer, user terminal, or other apparatus to at least perform one or more of the processes described herein.”

The claims supplied by the inventors are:

“1. A system comprising: a processor; and a memory storing computer-readable instructions that, when executed by the processor, cause the processor to trigger execution of an arbitration assessment assistant, wherein the arbitration assessment assistant is configured to automatically: receive, from a first computing device, an insurance claim comprising a plurality of attributes and a plurality of attribute values; identify, based on the insurance claim, one or more individuals associated with the insurance claim; analyze the insurance claim to identify missing information; retrieve the missing information from one or more data sources; adjust a fault score for each of the one or more individuals associated with the insurance claim based on the missing information retrieved from the one or more data sources, the insurance claim, and a plurality of policies associated with the plurality of attributes, wherein the adjusting comprises increasing or decreasing the fault score based on preset values in each of the plurality of policies; identify, from the one or more individuals, a first individual associated with a highest fault score of the fault scores generated for each of the one or more individuals; transmit a subrogation request to a third-party associated with the first individual; responsive to a determination that the third-party has rejected the subrogation request, determine a confidence score indicative of a likelihood of success in an arbitration request associated with the third-party by: generating an ontology comprising a plurality of nodes interconnected by a plurality of edges, wherein each node of the plurality of nodes is associated with a respective attribute of the plurality of attributes; instantiating the ontology by associating each node of the plurality of nodes with an attribute value of the plurality of attribute values; determining, based on the ontology, the confidence score; and output a recommendation to a user based on the confidence score, wherein the recommendation comprises the confidence score and one or more factors used to determine the confidence score.

“2. The system of claim 1, wherein the outputting a recommendation to the user based on the confidence score comprises: comparing the confidence score to a minimum confidence score threshold; and outputting the recommendation based on a result of the comparing.

“3. The system of claim 1, wherein the analyzing the insurance claim to identify missing information comprises: determining a first attribute of the plurality of attributes; and determining missing information associated with the first attribute.

“4. The system of claim 1, wherein the retrieving the missing information from one or more data sources comprises: identifying a first database in which the missing information is likely to be found; and retrieving the missing information from the first database.

“5. The system of claim 1, wherein the insurance claim is related to an accident and wherein the missing information comprises one or more of: a number of vehicles involved in the accident; a number of witnesses to the accident; a damage severity level to one or more vehicles involved in the accident; and a location of the accident.

“6. The system of claim 1, wherein generating a fault score for each of the one or more individuals associated with the insurance claim further comprises accessing historical insurance claim data from a database.

“7. A non-transitory computer-readable storage medium having computer-executable program instructions stored thereon that when executed by a processor, cause the processor at least to: receive, from a first computing device, an insurance claim comprising a plurality of attributes and a plurality of attribute values; identify, based on the insurance claim, one or more individuals associated with the insurance claim; analyze the insurance claim to identify missing information; retrieve the missing information from one or more data sources; adjust a fault score for each of the one or more individuals associated with the insurance claim based on the missing information retrieved from the one or more data sources, the insurance claim, and a plurality of policies associated with the plurality of attributes, wherein the adjusting comprises increasing or decreasing the fault score based on preset values in each of the plurality of policies; identify, from the one or more individuals, a first individual associated with a highest fault score of the fault scores generated for each of the one or more individuals; transmit a subrogation request to a third-party associated with the first individual; responsive to a determination that the third-party has rejected the subrogation request, determine a confidence score indicative of a likelihood of success in an arbitration request associated with the third-party by: generating an ontology comprising a plurality of nodes interconnected by a plurality of edges, wherein each node of the plurality of nodes is associated with a respective attribute of the plurality of attributes; instantiating the ontology by associating each node of the plurality of nodes with an attribute value of the plurality of attribute values; determining, based on the ontology, the confidence score; and output a recommendation to a user based on the confidence score, wherein the recommendation comprises the confidence score and one or more factors used to determine the confidence score.

“8. The non-transitory computer-readable storage medium of claim 7, wherein the outputting a recommendation to the user based on the confidence score comprises: comparing the confidence score to a minimum confidence score threshold; and outputting the recommendation based on a result of the comparing.

“9. The non-transitory computer-readable storage medium of claim 7, wherein the analyzing the insurance claim to identify missing information comprises: determining a first attribute of the plurality of attributes; and determining missing information associated with the first attribute.

“10. The non-transitory computer-readable storage medium of claim 7, wherein the retrieving the missing information from one or more data sources comprises: identifying a first database in which the missing information is likely to be found; and retrieving the missing information from the first database.

“11. The non-transitory computer-readable storage medium of claim 7, wherein the insurance claim is related to an accident and wherein the missing information comprises one or more of: a number of vehicles involved in the accident; a number of witnesses to the accident; a damage severity level to one or more vehicles involved in the accident; and a location of the accident.

“12. The non-transitory computer-readable storage medium of claim 8, wherein generating a fault score for each of the one or more individuals associated with the insurance claim further comprises accessing historical insurance claim data from a database.

“13. A method, comprising: triggering execution of an arbitration assessment assistant, wherein the arbitration assessment assistant is configured to automatically cause: receiving, from a first computing device, an insurance claim comprising a plurality of attributes and a plurality of attribute values; identifying, based on the insurance claim, one or more individuals associated with the insurance claim; analyzing the insurance claim to identify missing information; retrieving the missing information from one or more data sources; adjusting a fault score for each of the one or more individuals associated with the insurance claim based on the missing information retrieved from the one or more data sources, the insurance claim, and a plurality of policies associated with the plurality of attributes, wherein the adjusting comprises increasing or decreasing the fault score based on preset values in each of the plurality of policies; identifying, from the one or more individuals, a first individual associated with a highest fault score of the fault scores generated for each of the one or more individuals; transmitting a subrogation request to a third-party associated with the first individual; responsive to a determination that the third-party has rejected the subrogation request, determining a confidence score indicative of a likelihood of success in an arbitration request associated with the third-party by: generating an ontology comprising a plurality of nodes interconnected by a plurality of edges, wherein each node of the plurality of nodes is associated with a respective attribute of the plurality of attributes; instantiating the ontology by associating each node of the plurality of nodes with an attribute value of the plurality of attribute values; determining, based on the ontology, the confidence score; and outputting a recommendation to a user based on the confidence score, wherein the recommendation comprises the confidence score and one or more factors used to determine the confidence score.

“14. The method of claim 13, wherein the outputting a recommendation to the user based on the confidence score comprises: comparing the confidence score to a minimum confidence score threshold; and outputting the recommendation based on a result of the comparing.

“15. The method of claim 13, wherein the analyzing the insurance claim to identify missing information comprises: determining a first attribute of the plurality of attributes; and determining missing information associated with the first attribute.

“16. The method of claim 13, wherein the retrieving the missing information from one or more data sources comprises: identifying a first database in which the missing information is likely to be found; and retrieving the missing information from the first database.”

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

URL and more information on this patent application, see: Gore, Caleb; Jungwirth, Don; Kelsh, John. Virtual Assistant For Recommendations On Whether To Arbitrate Claims. Filed September 20, 2021 and posted January 6, 2022. Patent URL: https://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=%2220220005126%22.PGNR.&OS=DN/20220005126&RS=DN/20220005126

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