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Insurance Abstract
A system and method for performing insurance claim reinspections
is disclosed. The system includes an insurance company computer
in communication with a communications server, at least one remote
terminal in communication with the communications server, and an
insurance claim workfile having a loss estimate section, an appraisal
section and a reinspection section. The method includes the steps
of providing an insurance claim profile and exception priority information,
comparing an estimate in an insurance workfile to the insurance
claim profile, and generating exception indicators based on the
comparison.
Insurance Claims
1. A method of reinspecting insurance claim appraisals wherein each
of said insurance claim appraisals are contained in a respective
one of a plurality of insurance claim workfiles, each insurance
claim workfile comprising all pertinent data for processing an insurance
claim, said method comprising the steps of: automatically notifying
a reinspector that an insurance claim assignment has been made when
said insurance claim assignment is transmitted to one of an appraiser
and a repair shop; automatically transmitting status information
to said reinspector as said insurance claim assignment is processed;
automatically assessing claim cycle time by monitoring said status
information; providing an insurance claim profile database and an
exception priority database, the insurance claim profile database
comprising a set of appraisal rules; comparing the insurance claim
workfiles to said insurance claim profile database; and generating
a list of exceptions based on said comparison.
2. The method of claim 1 further comprising the steps of: comparing
the list of exceptions to said exception priority database; and
generating rating information based on said comparison to said exception
priority database.
3. The method of claim 2 further comprising the steps of: providing
a first computer in communication with a wide area network, said
wide area network in communication with a second computer, said
wide area network comprising a communications server; sending said
insurance claim workfile from the second computer to said communications
server over said wide area network; storing said insurance claim
workfile in an electronic mailbox in said communications server;
retrieving said insurance claim workfile at the first computer from
said communications server; and building a reinspection section
for said retrieved insurance claim workfile at the first computer
using the list of exceptions and information derived from an analysis
of data contained in other sections of said insurance claim workfile.
4. The method of claim 3, wherein the step of building a reinspection
file further comprises the steps of: recognizing an insurance company
identifier in the insurance claim workfile and retrieving exception
rule information associated with the insurance company identifier
from an exception rule database at the first computer; and applying
the exception rule information to the reinspection section of the
insurance claim workfile to generate a reinspection report.
5. The method of claim 3, wherein the step of building a reinspection
file further comprises the steps of: recognizing an insurance company
identifier in the insurance claim workfile and retrieving calculation
format information associated with the insurance company identifier
from a calculation format database at the first computer; and applying
the calculation format information to the reinspection section of
the insurance claim workfile to generate a reinspection report.
6. The method of claim 3, wherein the step of building a reinspection
file further comprises the steps of: recognizing an insurance company
identifier in the insurance claim workfile and retrieving insurance
claim status reminder information associated with the insurance
company identifier from an insurance claim status reminder database
at the first computer; and applying the insurance claim status information
to the reinspection section of the insurance claim workfile to generate
an insurance claim status reminder associated with the insurance
claim workfile.
7. The method of claim 3, wherein the step of building a reinspection
file further comprises the steps of: recognizing an insurance company
identifier in the insurance claim workfile and retrieving at least
one reinspection report form associated with the insurance company
identifier from reinspection report form database at the first computer;
and generating a reinspection report with the reinspection report
form at the first computer.
8. The method of claim 3, wherein the step of building a reinspection
file further comprises the steps of: formatting said rating information
into a report; storing said report in an electronic mailbox in said
communications server; and retrieving said report from said communications
server at the first computer whereby a user may analyze the report
at the first computer.
9. A system for reinspecting an insurance claim workfile comprising:
a first computer in communication with a wide area network, said
first computer capable of generating insurance claim workfiles,
said wide area network capable of bidirectional transmission of
said insurance claim workfiles; at least one of the insurance claim
workfiles comprising a loss estimate section, an appraisal section
and a reinspection section, the reinspection section having data
on a reinspection of an insurance claim estimate; insurance claim
workfile filter means for automatically filtering a plurality of
insurance claim workfiles based on predetermined criteria comprising
repair status; an insurance claim profile database comprising appraisal
rules and threshold information; a comparator capable of comparing
at least one of said insurance claim workfiles to said insurance
claim profile database, and an appraisal review generator configured
to identify exceptions to said appraisal rules and threshold information
and generate appraisal review information and a priority rating
for each insurance claim workfile based on said appraisal rules
and threshold information.
10. The system of claim 9 further comprising a reinspection tool
stored in a computer readable medium residing on a second computer,
said second computer in communication with said wide area network,
wherein said reinspection tool provides means for adding data to
said reinspection section of said insurance claim workfile using
information derived from an analysis of data contained in other
sections of said insurance claim workfile.
11. The system of claim 9 further comprising: a communications
server in communication with said wide area network capable of receiving
and transmitting at least one of said insurance claim workfiles
between said first computer and said server and between said second
computer and said server; an electronic mailbox in said communications
server capable of storing said at least one insurance claim workfile;
and wherein said reinspection tool further provides means for retrieval
of said insurance claim workfile from said electronic mailbox.
12. The system of claim 9 wherein each of said insurance claim
workfiles contains data on an insured, data on a claim, data on
satisfying a claim and data on reinspection activity.
13. The system of claim 10 further comprising: a status generator
capable of monitoring an activity associated with each of said insurance
claim workfiles and generating status information based on said
activity; a communications server in communication with said wide
area network capable of receiving and transmitting said status information
between said first computer and said server and between said second
computer and said server; an electronic mailbox in the server capable
of storing said status information; and wherein said reinspection
tool further provides means for retrieval of said status information
from said electronic mailbox.
14. The system of claim 9 further comprising a file converter capable
converting the entire insurance claim workfile into a formatted
insurance claim workfile to allow transmission over said wide area
network.
15. The system of claim 14 wherein the entire formatted insurance
claim workfile is transmitted from a remote computer to a communications
server via the wide area network whereby said entire formatted insurance
claim workfile is retrievable from said server.
16. The system of claim 14 wherein said file converter comprises
means for formatting the insurance claim workfile into network TCP/IP,
whereby a remote computer may readily communicate with, and transfer
the entire insurance claim workfile to, a computer in a home office.
17. (canceled)
18. The system of claim 9 further comprising: a communications
server report generator capable of formatting said appraisal review
information and priority rating into a report; and an electronic
mailbox in the server, wherein said electronic mailbox is capable
of storing said report; and further wherein said reinspection tool
further provides means for retrieval of said report from said electronic
mailbox.
19. (canceled)
20. The system of claim 9 wherein said at least one insurance claim
workfile is retrievable based on pre-defined criteria defined by
a user.
21. A method of reinspecting insurance claim appraisals comprising
the steps of: providing a remote computer in communication with
a wide area network, said wide area network in communication with
a computer in a home office; generating at least one insurance claim
workfile, each of said insurance claim workfiles containing data
on an insured, data on a claim, data on satisfying a claim, data
on the reinspection, wherein each of said insurance claim workfiles
is configured to receive all data pertinent to the claim; reinspecting
each of said insurance claim workfiles at the remote computer and
determining that the data contained in the insurance claim workfile
conforms to pre-defined criteria; and modifying each of said insurance
claim workfiles at the remote computer to update the insurance claim
workfile with information determined from reinspecting said insurance
claim workfiles.
22. The method of claim 21 wherein the reinspecting step further
comprises the steps of: prioritizing each of said insurance claim
workfiles based upon said pre-defined criteria; selecting one of
said insurance claim workfiles to reinspect; reviewing estimate
data contained in said one of said insurance claim workfiles, said
estimate data comprising information relating to an extent of loss
in an insurance claim represented by said one of said insurance
claim workfiles; reviewing appraisal data contained in said one
of said insurance claim workfiles, said appraisal data comprising
information relating to a value of an insured property; and analyzing
said estimate data and appraisal data and compiling said analyzed
estimate data and appraisal data into reinspection data.
23. A system for reinspecting insurance claim appraisals comprising:
a first computer having a memory containing insurance claim assignment
data; and a second computer having means for entering data related
to a reinspection of estimate data in an insurance claim workfile
generated from the insurance claim assignment data, the insurance
claim workfile containing data on an insured and data on a claim,
wherein said insurance claim workfile is transferable over a wide
area network; said wide area network having a communications server
in communication with said first and second computers, said communications
server having insurance claim profile data comprising threshold
information on a vehicle loss.
24. The system of claim 23 wherein the insurance claim workfile
is an electronic workfile comprising: claim estimate data describing
the extent of an insurance claim; claim appraisal data describing
the value of an insured property; claim reinspection data describing
an analysis of said estimate data and said appraisal data in conjunction
with the insurance claim profile data.
25. The system of claim 23 further comprising a user interface
for providing access to at least one insurance claim workfile.
26. The system of claim 25 wherein the interface comprises an in
box for receiving said at least one insurance claim workfile from
the communications server.
27. The system of claim 25 wherein the interface comprises an out
box for temporarily storing said at least one insurance claim workfile,
said out box for transmitting the at least one insurance claim workfile
to the communications server.
28. The system of claim 25 wherein the interface comprises an in
process box for storing at least one insurance claim workfile a
user is currently working on.
Insurance Description
MICROFICHE APPENDIX
[0001] A Microfiche Appendix of the presently preferred source
code is attached and comprises 62 sheets having a total of 5,602
frames. The Microfiche Appendix contains material which is subject
to copyright protection. The copyright owner has no objection to
the facsimile reproduction by anyone of the Microfiche Appendix,
as it appears in the Patent and Trademark Office patent files or
records, but otherwise reserves all copyright rights whatsoever.
FIELD OF THE INVENTION
[0002] This invention relates to a system and method for managing
the reinspection process of insurance claim appraisals and estimates.
More particularly, this invention relates to a method and system
of reinspecting individual insurance claims from the initial claim
filing to post-completion of the final settlement, as well as overall
management and control of the reinspection process.
BACKGROUND OF THE INVENTION
[0003] Insurance companies generally process a claim by performing
a number of related tasks that include numerical cost estimates,
information management, and communications between, for example,
insurance company offices and employees in the field. The sum of
tasks performed in claims processing make up the claim settlement
process. The claim settlement process includes making estimates
of losses and appraising values of damaged property. The estimates
and appraisals are usually conducted by an appraiser or a repair
shop. Reinspection is the process of auditing and evaluating the
accuracy, quality and timeliness of claim estimates and appraisals.
[0004] Many insurance companies have weak or non-existent control
over their appraisal process because reinspection is an exceptionally
manual process. For appraisals and estimates, insurance companies
evaluate the quality of the appraisal or estimate only after the
appraisal or estimate has been completed. Desk reviewers manually
review appraisals or estimates to ensure that the correct rates
have been used. To perform this review, the desk reviewer will manually
compare the appraisal or estimate with profile information defined
by the insurance company. This profile information includes company
specified rules and threshold values for estimate amounts, property
damage limitations, loss limitations or discounts. The desk reviewer
then completes paper forms to document the profile exceptions--where
the appraisal or estimate deviates beyond the threshold values given
in the profile. After completing the paper form, the desk reviewer
may call the repair shop to negotiate a change in the estimate.
A problem with reinspections is that they often are unable to affect
the severity of the claim settlement (i.e., the money paid out)
due to the time necessary to complete the reinspection process.
[0005] Management of the performance of the appraiser or repair
shop is performed by manually logging any items found during the
reviews onto paper forms for each appraisal reviewed. The results
of the individual reinspections are then manually aggregated into
a report that can be used to audit the performance of the appraiser
or repair shop. Management of the reinspectors performance is typically
cursory and insurance companies often find it difficult to evaluate
the productivity of a reinspector because they have no ability to
monitor their activity.
[0006] Accordingly, there is a need for a comprehensive system
and method of managing the reinspection process of insurance claims
to assist insurance companies in managing estimate and appraisal
quality and timeliness. Further, it would be advantageous to provide
an automated tool to address the entire reinspection process in
order to reduce costs and leverage existing resources.
SUMMARY OF THE INVENTION
[0007] The present invention provides a system and method for achieving
the foregoing. Preferably, a preferred embodiment of the system
and method is able to capture the reinspection work early in the
claims cycle, as close to the loss report and appraisal assignment
as possible. According to a first aspect of the present invention,
a method of reinspecting insurance claim appraisals is disclosed
wherein the insurance claim appraisals are each contained within
a respective electronic workfile, each of the workfiles holding
all pertinent data for processing an insurance claim. The method
includes the steps of providing an insurance claim profile and exception
priority information, comparing a workfile to the insurance claim
profile and identifying a list of exceptions based on the comparison.
[0008] According to another aspect of the present invention, an
system for reinspecting an insurance claim workfile is disclosed.
The system includes a first computer in communication with a wide
area network where the first computer is capable of generating insurance
claim workfiles and the wide area network is capable of bidirectional
transmission of the workfiles. At least one of the insurance claim
workfiles includes a loss estimate section, an appraisal section
and a reinspection section, the reinspection section contains data
on a reinspection of an insurance claim estimate. A reinspection
tool is preferably stored in a computer readable medium residing
on a second computer. The second computer is in communication with
the first computer over the wide area network. In one embodiment,
the reinspection tool provides means for creating a reinspection
section of a workfile, or adding data to an existing reinspection
of a workfile, using information derived from an analysis of data
contained in other sections of said workfile. The method and system
permit for efficient, automated reinspection of processed insurance
claims.
BRIEF DESCRIPTION OF THE DRAWINGS
[0009] FIG. 1 illustrates a preferred system for appraisal assignment,
appraisal audit and reinspection for a vehicle insurance claim.
[0010] FIG. 2 is a block diagram illustrating an insurance claim
workfile for use in the system at FIG. 1.
[0011] FIG. 3 is a block diagram illustrating the reinspection
section of the workfile of FIG. 2.
[0012] FIG. 4 is a block diagram of a system for use in managing
insurance claim processing that may be used in the system of FIG.
1.
[0013] FIG. 5 is a block diagram of a reinspection terminal for
use in the system of FIG. 1
[0014] FIG. 6 is detailed flow chart illustrating the preferred
method of managing the reinspection process for insurance claim
processing.
[0015] FIG. 7 is a block diagram of an insurance company insurance
claim profile.
[0016] FIGS. 8A-8C are an example of an appraisal review report
generated by the Communications server of FIG. 1.
[0017] FIG. 9 is a preferred screen from a graphic user interface
for use with the system of FIG. 1 illustrating the filter and sort
functions.
[0018] FIG. 10 is a preferred screen from a graphic user interface
for use with the system of FIG. 1 illustrating the reinspection
section of the workfile.
DETAILED DESCRIPTION OF THE PRESENTLY PREFERRED EMBODIMENT
[0019] FIG. 1 shows a preferred embodiment of a system 10 for managing
the reinspection process of insurance claims. Preferably, the system
10 incorporates seamless or integrated PC-based applications with
a common workfile/workflow-driven user interface. The system 10
includes a communications server 12 in communication with various
remote computers 14, including those located at vendors, body shops,
salvage yards, insurance companies, and other terminals which may
be used in an insurance processing environment. The communications
server 12 communicates with the remote computers 14 through a communication
layer 16. The communication layer may communicate with event tracking
software 18, electronic appraisal review software 20, and a data
warehouse 22 at the communications server 12. One suitable communications
server is an AIX server available from IBM. Alternatively, the communications
server may be a distributed network of computers. A suitable communication
layer is EZNet.TM. software available from CCC Information Services
Inc. The remote terminals 14 preferably communicate over standard
telephone lines via modem. As will be apparent to those of ordinary
skill in the art, other communication formats (wireless, T1, and
so on) may also be used.
[0020] Referring to FIG. 2, a particular insurance claim to be
processed is preferably configured in an electronic datafile referred
to herein as a workfile 24. Each workfile 24 represents one particular
insurance claim. Each workfile is preferably stored in a memory
device such as a hard disk drive or other commonly known storage
device. The datafile is transferable, in its entirety, to remote
computers and may be copied in part or in whole to provide status
information to insurance company managers, claims office personnel,
and reinspectors and others involved in the insurance claims process
The workfile 24 contains all the necessary information for field
processing of the insurance claim. This information includes information
regarding the loss estimate 26 on the extent of the claim and appraisal
information 28 on the value of the insured property. The workfile
also contains insurance claim reinspection information 30 including
analysis data of the estimate and appraisal information. As illustrated
in FIG. 3, this reinspection information includes: administrative
information 32, exception categories and codes 34, reinspection
results 36 and numerical data 38 computed by the reinspector. In
addition, the reinspection section also contains a work log 40 which
logs all reinspection activity on the particular insurance claim.
In one embodiment, the workfile is an evolving database entity that
begins with the basic information on an insurance claim and an insured
and has sections appended to it, such as the reinspection section,
as the claim is processed.
[0021] The presently preferred system provides a user with the
networking capability for transferring all or part of the workfile
between computers. Thus, an appraiser can download a workfile from
the communications server 12 to work on the appraisal for a claim
which can then be sent back to the communications server 12 when
complete. One suitable software package for allowing remote handling
of insurance claim workfiles is the Pathways.RTM. Quality Advisor.TM.
software available from CCC Information Services Inc. in Chicago,
Ill. In a preferred embodiment of the present invention, the automated
reinspection process is provided in the form of a software application
such as disclosed in the attached microfiche appendix. Using this
automated reinspection process, a reinspector can download completed
workfiles and review the appraisal and estimate data in order to
write a reinspection which is then uploaded for analysis by insurance
company management. Protocol and formats for handling transmission
of the workfile may be adjusted by the user within an "in box"
and an "out box" provided in a graphic user interface
as described below.
[0022] The communications server 12, or network provider, preferably
has a plurality of flexible memory locations, or mailboxes, for
storing insurance workfiles and communications. The data warehouse
22 of the communications server may be a mass storage device capable
of storing insurance claim profiles (described below). In addition,
it is preferable that the appraisal review function 20 of the server
12 have the ability to compare stored insurance claim profiles with
workfiles also stored on the server and process the results into
raw data or formatted reports for transmission to other computers
in communication with the server. In one embodiment, this capability
is provided by insurance processing software such as Quality Advisor
Appraisal Review (QAAR) available from CCC Information Services
Inc.
[0023] As mentioned above, computers 14 located at an appraiser,
direct repair program (DRP) facility, or independent appraiser are
also in communication with the server 12 over a communication line.
The communications server preferably holds the master copy of each
insurance datafile unless the assigned appraiser, Direct Repair
Point (DRP) shop or independent appraiser is working on the specific
insurance claim assignment associated with a workfile, or for completed
assignments, the specific insurance claim is undergoing reinspection.
The reinspector's computer preferably holds a copy of each insurance
datafile that is associated with a respective specific insurance
claim assignment currently assigned to an appraiser, DRP shop or
independent appraiser.
[0024] Each remote computer 14 in the system 10 preferably has
a processor, a display monitor, and memory. The processor, display
monitor and memory may be embodied as an IBM-compatible personal
computer. The memory may be embodied as a mass storage device. The
processor is coupled to the mass storage device and display monitor.
The mass storage device may a hard disk, compact disk, optical disk
or other computer storage device. The mass storage device may also
be used for archiving data. The main memory includes video memory
which stores display format information for presentation on the
display monitor. The information may be text, graphics, or a combination
thereof The mass storage device stores a data base of text and graphics
images that may in compressed digital form.
[0025] In other embodiments, one or more of the remote terminals
14 may be a local area network 48 as shown in FIG. 4. The local
area network 48 may include one computer designated as a file server
50. The file server may comprise a computer having at least one
floppy drive 51 of preferably 1.44 megabyte capacity, a tape backup
drive 52, a CD ROM drive 53, and a hard drive 54 such a 2 gigabyte
SCSI drive. The file server preferably also includes a processor
suitable for use in IBM-compatible personal computers, such as the
PENTIUM processor manufactured by INTEL corp., and an internal memory
that may have 32 megabytes of RAM. A network connection maybe provided
through a network card 57. The local area network 48 shown in FIG.
4 may operate with network software provided by any one of a number
of commonly known manufacturers of network software. For instance,
one suitable network software package is Netware 3.12 produced by
Novell, Inc. Each of the remaining computers 55 preferably has a
processor that may be used in an IBM-compatible personal computer.
A hard drive memory is also preferred. The user of a single user
system interacts with insurance claim workfiles via a monitor 56,
a keyboard 58 and a computer mouse 60. Other input devices such
as computer pens or touch screens may also be used. Optionally,
a printer 62 may be used to print out reports. Each computer communicates
with other databases and other computers outside the LAN via a modem
64 connected to a wide area network 66 over regular telephone lines.
The individual computers and file server may all be connected via
a communications line 66 such as an ethernet coaxial network cable.
One or more computers 55 may also be portable computers remotely
connected to the LAN 48 server for ease of use by field appraisers
and adjusters.
[0026] As shown in FIG. 5, a remote terminal 14 for use by a reinspector
includes several customizable databases for storing predetermined
exception rules 63, calculations 65, status reminders 67, and report
forms 68 for each insurance company utilizing the system 10. The
exception rules 63, as explained in greater detail below, are guidelines
for determining whether an appraisal meets with a particular insurance
company's practice. The calculations database 65 preferably contains
insurance company-specific formulas for use in the appraisal process.
The status reminders database 67 is a custom set of automated schedule
reminders for follow up work (faxes, telephone calls, etc.) necessary
to conclude processing of a workfile. The report forms database
68 preferably contains electronic forms customized to each insurance
company's standards for the reinspector to use in preparing reports
to appraisers and repair shops on their performance. The report
forms database 68 may also contain forms for the reinspector to
prepare and send directly to an insurance company concerning the
performance of appraisers/repair shops performing work for the insurance
company. In order to preserve confidentiality between insurance
companies utilizing one or more parts of the system 10, each reinspector
will only have access to the portions of the customized databases
pertinent to the insurance company or companies he works for. Also,
the communications server 12 will only allow a reinspector access
to workfiles specifically assigned to that reinspector. An advantage
of the disclosed system and method for reinspection of insurance
claims is that multiple insurance companies can utilize the system
and implement customized processing procedures through the use of
configurable databases at the communications server 12 and at the
remote terminals 14 such as the exception rules 63, calculations
65, status reminder 67, and report form 68 databases. Also, revisions
to these customizable databases can be centrally implemented at
the communications server and sent to remote terminals any time
a user at a remote terminal communicates with the communications
server. For example, updated database information may be automatically
sent to reinspectors every time a reinspector communicates with
the communications server to upload or download workfile assignments
and data in a preferred embodiment.
[0027] A workfile memory 71 in the remote terminal 14 contains
all the workfiles assigned to the reinspector. A processor 69 in
the terminal 14 executes reinspection software 73 residing on the
terminal 14 to process a selected workfile downloaded from the communications
server 12 and residing in memory 71. The processor 69 accesses the
appropriate customized features from the various databases 63, 65,
67, 68 as necessary during preparation of a reinspection report.
[0028] Referring to FIG. 6, there is illustrated the preferred
method of managing the workflow of the reinspection process utilizing
the system 10 disclosed above. The process begins with the insurance
company home office computer sending (at step 70) a claim assignment
to the communications server 12. This claim assignment is generated
when the insurance company receives a loss report by one of its
insured. According to a preferred embodiment, the communications
server routes the assignment to the mailbox of the appropriate appraiser/adjuster
or body shop who will handle the claim (at step 72). The communications
server also routes a copy of the assignment to the responsible reinspector
who will handle the reinspection of the claim (at step 74). When
the shop or appraiser downloads the assignment and completes an
appraisal, key status updates such as "assignment downloaded,"
"estimate completed," "repairs scheduled, started
or completed" are sent via the communications server to the
responsible reinspector's mailbox, allowing her to review the time
it takes the appraiser or body shop to process the claim, also known
as the claim cycle time (at steps 76, 78). In addition, when an
assignment is completed by the appraiser or shop, the completed
workfile is uploaded to the communications server (at step 80).
The communications server routes this completed workfile to the
responsible reinspector's mailbox and performs an electronic appraisal
review 82 of the workfile (at steps 82, 84).
[0029] The electronic appraisal review is performed by executing
a comparator program 86 which compares the information contained
within the workfile with profile information provided by the company
(at step 86A). This profile information can include company specified
rules 122 and threshold values 124. As illustrated in FIG. 7, in
a preferred embodiment, the profile information 120 is a datafile
stored on the communications server 12 containing rules 122 and
threshold values 124 for analyzing estimate amounts, property damage
limitations, loss limitations or discounts. The comparison of insurance
claim workfile to the profile produces a list of exceptions where
the information contained in the workfile deviates from the model
information contained in the profile (at step 86B). An example of
a rule 122 would be instructions to flag a loss estimate as an exception
if the supplement amount exceeds 20% of the original estimate. A
supplement amount refers to an additional cost added to the original
estimate by the appraiser (or repair shop). Supplements typically
indicate that the appraiser/repair shop overlooked some damage in
the initial damage appraisal and thus may indicate inefficient claims
processing.
[0030] Based on guidelines provided by the insurance company, these
exceptions are prioritized by severity levels or categories such
as A, B or C where A=high priority, B=moderate priority and C=low
priority. The comparator program 86 assigns the overall workfile
a rating based on the exceptions generated which can be used to
prioritize the workfile among other workfiles in the reinspector's
workload (at step 86C). In one preferred embodiment, the electronic
appraisal review comparator program is the Quality Advisor Appraisal
Review (QAAR) software available from CCC Information Services Inc.
Preferably, the comparator program running on the communications
server provides the reinspector at the remote terminal with ASCII
text and data from which to generate a reinspection section of a
workfile, or add to an existing reinspection section in a workfile.
[0031] An advantage of the profile information being stored on
the communications server in that it may be easily updated and revised
as the insurance company's policies change. In a preferred embodiment,
the communication, server 12 is in communication with multiple insurance
companies, each operating with its own profile data requirements.
In this embodiment, the communications server 12 maintains a database
of the profile information for each insurance company utilizing
the services of the communications server. The workfiles for each
insurance company include insurance company identifying information
so that the appropriate profile information is compared to the appropriate
insurance claim workfile.
[0032] The results of the electronic appraisal review are routed
to the responsible reinspector's mailbox in a report format (at
step 88). FIGS. 8A-8C illustrate a preferred report 130 generated
by the communications server based on the comparison of profile
information to information in a workfile. The report 130 includes
identifying information 132 such as claim number, vehicle information,
and the names and addresses of all those involved in processing
the insurance claim. The appraisal review results 134 are provided
in a series of columns. The columns include a rule description 136,
the actual result of the appraisal 138 related to the described
rule, the numerical or boolean exception threshold of the rule profile
140, the percentage difference 142 between the actual appraisal
result 138 and the threshold 140, and the exception code 144 assigned
to the comparison of the rule and the actual appraisal.
[0033] The raw result data is available for transmission or downloading
for analysis by management using reporting tools (at step 90). In
one embodiment, a reporting tool residing on the communications
server 12 may be used to generate suitable reports. Using this data,
insurance company management is able to review the reinspection
process by analyzing the reinspection data for trends in the reinspection
work of a particular reinspector or reinspectors in a geographical
area (at step 92). As with the comparator program, the reporting
tools are also available for use by any number of different insurance
companies. Preferably, the reporting tools gather information from,
and only permit access to, an insurance company's own insurance
workfiles.
[0034] Periodically, the responsible reinspector downloads the
claim assignment copies, completed estimate and supplemental reports
and data, claim assignment status information and electronic audit
results that form the workfile (at step 94). In a preferred embodiment,
this can be done by a reinspector at a terminal remotely located
from the server 12. Preferably, a user interface on the reinspector's
terminal 14 is configured for accessing the workfiles and performing
the reinspections. The remote reinspector's terminal allows tracking
of all claim activity, prioritization of workfiles to be worked
on and documenting of the client's reinspections. The reinspector
has the ability to review all workfiles assigned to him and contained
within his mailbox (at step 96). He can prioritize, sort or filter
the workfiles to suit his priorities or tasks for that day. As illustrated
in FIG. 9, the reinspector can use a sort or filter function 97,
through a graphic user interface 98, to sort and filter workfiles
based on criteria such as: repair status (Open, Scheduled, Started,
Closed, and etc.), new work (by date assigned), electronic appraisal
review exception priorities which have been provided by the electronic
audit performed by the comparator program running on the communications
server 12, total loss status 100 (Yes or No), total appraisal amount
102, vehicle type 104, last appraisal written and associated amount
106, whether the vehicle is driveable 108; vehicle owner 110, or
claim number 112. As referred to above, appraisals may include supplements
added at a later time. A total appraisal amount is the sum of the
original appraisal and any supplements for the vehicle. The last
appraisal refers to the most recent supplement written for a vehicle
that has already received an original appraisal.
[0035] After sorting or filtering, the reinspector selects a workfile
to process, reviews the administrative information and writes a
reinspection of the selected file (at steps 114 and 116). The user
interface 98 provides the ability to juxtapose data from other sections
of the workfile, such as estimate information, with the reinspection
data for comparison and analysis. To reinspect the appraisal, the
reinspector opens the file and looks at the results from the comparator
program sent from the communications server. Preferably, the reinspector's
remote terminal possesses a complete listing of the insurance company
claim profiles stored on a computer readable medium. The reinspector
then calculates what the appraisal should have been, according to
the insurance company claim profiles, and enters that amount into
the workfile through the user interface 98. Upon completion of a
reinspection, the reinspector will document any discussions with
the appraiser or shop, and whether a supplement and/or a re-reinspection
is required (at step 118). This information creates follow up entries
in the work log maintained in the workfile. The reinspection work
log automatically creates a time-stamped entry in the workfile indicative
of any actions taken by the reinspector. The reinspector will then
lock the reinspection using a file locking function available through
the reinspection tab of the user interface 98 (at step 120). This
step of locking protects the data in the workfile from accidental
editing, moves it to the out box 122 and readies it for uploading
back to the communications server 12 or for direct transmission
to the appropriate insurance company.
[0036] The results of the reinspection are stored (at step 121)
on the remote computer and available for management reporting on
the unit. The reinspector will use preloaded reinspection report
forms available at the remote terminal to the various reports to
assess appraiser or shop performance. The reinspection report forms
may include information such as insurance company specific criteria
on percentage satisfaction. The percentage satisfaction criteria
represents a claim processing efficiency rating. Each individual
insurance company may have its own formulation for efficiency and
the appropriate formulation or formulations are preferably available
to reinspectors on the remote terminal 14. By way of example, one
formula for percentage satisfaction may be a ratio of the total
appraisal to an ideal appraisal based on the particular insurance
company's appraisal rules less a variable based on the amount of
time the appraiser took to process the claim. As mentioned above,
once the workfile is uploaded back to the communications server,
the results are available for analysis by management for an insurance
company through a reporting tool such as CCC's Quality Advisor for
Guidepost Online.TM. (QAGO) which provides viewing and analysis
functions including consolidated reporting, automated comparisons
and trend analysis (at step 90).
[0037] Each reinspector or authorized insurance company employee,
whether using a stand alone computer or a computer in a local area
network, may access the assigned or pertinent claim workfile through
the graphic user interface. The graphic user interface displays
at least one workfile/datafile in addition to visual objects representative
of actions to be taken on a workfile. In a preferred embodiment,
an opened insurance claim workfile appears on a display monitor
as a plurality of tabbed sections, each tabbed section representing
a separate view of the workfile. A user may access each of the tabs
by using a keyboard or other user input means.
[0038] As illustrated in FIG. 10, a preferred graphic user interface
for use with the preferred embodiment method and system allows an
authorized user to access the reinspection processing workflow for
one or more insurance claim workfiles. The graphic user interface
not only permits a user to enter and retrieve information from a
workfile, but also permits the user to execute tasks involved in
reinspection processing such as manipulating a plurality of claim
workfiles, opening a specific work file and working on estimate
data or correspondence related to the open file. The interface also
provides for communicating with repair facilities and insurance
company staff. The graphic user interface may be constructed using
known software tools and languages such as Visual C++ produced by
Microsoft Corp., RATIONAL ROSE produced by Rational Corp., and the
IBM CUA Library produced by IBM, Inc.
[0039] The graphic user interface 124 includes a perspective bar
having a-plurality of user objects representing basic office workflow.
The user objects represented on the display monitor mirror the objects
used by a typical user in an everyday work environment. The perspective
bar 124 has an in box 126 for receiving assignments that have been
processed, an in process box 128 for holding workfiles and information
that a user is working on, and an out box 122 for completed workfiles.
Access to storage locations which may be a hard disk drive, is provided
through a storage icon 130. Report forms are accessible through
a report icon 132.
[0040] The graphic user interface also includes a tool bar made
up of objects that allow the user to perform necessary tasks such
as printing, and context sensitive buttons that appear on the bar
when certain tasks may be required by the screen presently being
viewed. According to a preferred embodiment, the context sensitive
buttons, such as the "Delete" button in FIG. 9, will disappear
when the screen on the display monitor does not require the option
represented by the context sensitive button. The interface also
includes a menu bar having one or more pull-down menus and a title
bar, which may include general information concerning the filename
of the displayed file and the user's location in the claims processing
workflow.
[0041] The perspective panel 124 may be selected as always visible
regardless of what point in the reinspection processing a user is
at. Regardless of whether a user is using a local area network (LAN),
a wide area network (WAN) or a stand alone computer, the in box
126 retains all the mail addressed to that particular user. The
out box 122, which is located on the same screen as the in box,
is also essentially independent of the type of network or stand
alone computer a user happens to be working on. Mail is sent from
the out box whenever a user confirms the completion of the files
contained in the out box. Both the in box and the out box will connect
to the communications server 12 or other desired destinations so
that assignments, entire workfiles, and miscellaneous claim information
may be passed back and forth: In one preferred embodiment, users
do not have individual in and out boxes but are able to filter the
contents of a central in or out box so that it may selectively view
the contents. In another preferred embodiment, each individual user
is assigned an in box containing only those electronic workfiles
relevant to the particular user.
[0042] The in process box 128 is used for those workfiles a reinspector
is working on. A workfile remains within the in process box for
as long as it takes to complete the various steps or transactions
required for reinspection of the workfile. This time will of course
vary with the complexity of the claim that the workfile represents.
When the in process box 128 is selected, the graphic user interface
displays the number of items or work files in process, with each
workfile appearing as a folder in the main screen area. Each folder
is identified by the insured's name; make of the vehicle; and the
job number assigned. To open a particular workfile with a mouse,
the user can either double-click on the desired folder or use the
"open" button provide near the top of the screen. Keyboard
access to work files may be achieved through use of arrow keys,
the space bar and the "enter" key.
[0043] Within the in process box, an individual workfile opened
for work is displayed. The workfile preferably comprises a plurality
of individual sections represented by tabs that designate the contents
of that section. In one preferred embodiment, a section tab extension
is included to allow for extra sections to be referenced without
cluttering up a viewer's screen. Within each of the sections of
the workfile, a frame switching button bar having a number of frame
switching buttons is included.
[0044] Once a particular workfile in the in process box has been
opened, the user is provided with the overlapping tab format, visible
to a user as overlapping folders, or tab icons, summarizing categories
of information applicable to the workfile. As described above, the
section tabs may include text and graphic designations for subjects
such as administrative information, vehicle data, estimates, total
loss information and reinspection information. A user may view or
manipulate the data accessible in each of the tabs.
[0045] Reinspection information stored in the "REINSPECTION"
tab includes several frames of information accessible through the
frame switching button bar inside the tab. Preferably, the information
comprises administrative information, customized exception categories
and codes, reinspection results and a listing of any follow-up activities
that need to be completed, and numerical data computed by the reinspection
software on the reinspector terminal 14. Further, the administration
information preferably provides the ability to juxtapose data from
other sections of the workfile with data contained in the reinspection
section to allow comparison and transfer of data. The user interface
acts to seamlessly connect the different functional modules used
to calculate and process discrete steps of an insurance claim reinspection
task.
[0046] From the foregoing, a comprehensive system and method for
managing the reinspection process of insurance claims has been described.
The system includes at least one remote computer, a mainframe computer
(or server), and a network connecting the computers wherein an insurance
claim datafile containing information pertinent to a particular
claim may be transferred, accessed and processed by authorized parties
to add reinspection information. A common graphic user interface
allows users to manage reinspection workflow, including filtering
and prioritizing of assigned workfiles. Additionally, a method of
reinspecting an insurance claim has been described that permits
a reinspector to manage a reinspection from the initial claim assignment
through the completed estimate and appraisal as well as manage large
numbers of simultaneous reinspection assignments. Further, the method
described provides for management reporting, analysis and control
of the entire reinspection process.
[0047] Using the system and method described above, an insurance
company can manage the severity of, and control, loss adjustment
expenses, manage large numbers of claims efficiently, improve claim
cycle time, streamline the appraisal and reinspection process, and
provide positive feedback to repair shops and appraisers to allow
them to write higher quality estimates and appraisals in the future.
[0048] It is intended that the foregoing detailed description be
regarded as illustrative rather than limiting, and that it be understood
that the following claims, including all equivalents, are intended
to define the scope of this invention.
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