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Insurance Abstract
This invention relates to the management of insurance claims, the
processing steps broadly including the steps of obtaining information
on a claim, including items of property relating to said claim,
such information forming a claim datafile; selecting items of property
being claimed by consulting a property register configured and arranged
to store items of property owned by the person or entity making
a claim; obtaining information to establish a replacement value
for each of the items of property relating to the claim; and selecting
a method of settlement of the claim and calculating the replacement
values for each of the items of property to determine a settlement
value.
Insurance Claims
1. A method of managing an insurance claim, the method including
the steps of: a.) obtaining information on a claim, including items
of property relating to said claim, such information forming a claim
datafile; b.) selecting items of property being claimed by consulting
a property register configured and arranged to store items of property
owned by the person or entity making a claim; c.) obtaining information
to establish a replacement value for each of the items of property
relating to the claim; and d.) selecting a method of settlement
of the claim and calculating the replacement values for each of
the items of property to determine a settlement value.
2. A method according to claim 1 wherein in step b. a further process
is undertaken whereby an historical claims database is consulted
to check the claims history of the claimant.
3. A method according to claim 2 wherein in step b. if any items
being claimed match previous items claimed by consulting the historical
claims database, a flag is generated to provide an indication to
a user that further investigation may be warranted.
4. A method according to claim 1 wherein the property register
is periodically updated to ensure accuracy of the items of property.
5. A method according to claim 1 wherein the property register
is configured and arranged to be accessible by authorised third
parties over a communications network.
6. A method according to claim 1 wherein the steps of the method
are carried out by a website server configured and arranged to allow
access by authorised users.
7. A method according to claim 1 further including an archiving
step wherein the datafile associated with a settled claim is moved
to an archiving database wherein further changes to the datafile
are not permitted.
8. A method according to claim 1 further including a post archiving
revision step wherein the datafile associated with a settled claim
is accessed from an archive location and reviewed and altered as
required, and wherein an audit trail of the process is recorded.
9. A computer controlled method for managing an insurance claim,
the computer being programmed to carry out the steps of: a. generating
a claim datafile by receiving information relating to a claim, including
items of property relating to the claim; b. selecting items of property
being claimed by consulting a property register configured and arranged
to store items of property owned by the person or entity making
a claim; c. obtaining information to establish a replacement value
for each of the items of property relating to the claim; and d.
selecting a method of settlement of the claim and calculating the
replacement values for each of the items of property to determine
a settlement value.
10. A computer controlled method according to claim 9 wherein in
step b. an historical claims database is consulted to check the
claims history of the claimant, and if any items being claimed match
previous items claimed the claimant, a flag is generated to provide
an indication to a user that further investigation may be warranted.
11. A computer programmed to carry out the processing steps of
either claim 9 or claim 10.
12. A system of managing an insurance claim, the system including
a property register configured and arranged to store items of property,
the property register being configured and arranged to be updatable
with current schedules of items of property, the database having
means to accept a request to add or delete or update an item of
property, and to allow access by authorised users to consult the
items of property.
13. A method according to claim 1 substantially as herein described.
14. A computer controlled method according to claim 9 substantially
as herein described.
15. A system of managing an insurance claim substantially as herein
described with reference to any one of the accompanying drawings.
Insurance Description
TECHNICAL FIELD
[0001] This invention relates to methods and systems for managing
insurance claims and property.
BACKGROUND ART
[0002] The processing steps of settling an insurance claim has
to date generally been a largely manual and labour intensive task.
Although various computer software programs have been implemented
to assist the task of processing claims, they have generally been
ad hoc developments and have only automated a few steps in the process
from first handling a claim application to full settlement of the
claim. Further, the use of additional consultative electronic databases
such as claims histories and property registers have not been considered
or used.
[0003] A further step in the standard process of settling an insurance
claim has been the use and reliance on a paper file. This requires
a claims handler to write proper file notes and to record transactions
and agreements. Unfortunately this reliance can sometimes be misplaced
and claims handlers can either fail to record details making it
difficult for other claims handlers to continue work on the file
to complete a subsequent step if the previous person has retained
information in their memory rather than recorded details.
[0004] Further, client histories in paper form can be difficult
to access when held in one branch location and a claim making a
subsequent claim has moved location and is claiming via a different
branch. Standardisation of processing steps can also be difficult
to achieve between various offices in an organisation where various
business units operate business processes in different ways.
[0005] It is one non-limiting object of the invention to provide
a method of and system for handling or managing claims that overcomes
at least some of the abovementioned problems, or at least to provide
the public with a useful choice.
SUMMARY OF THE INVENTION
[0006] According to a first broad aspect of the invention there
is provided a method of managing an insurance claim, the method
including the steps of: [0007] a) obtaining information on a claim,
including items of property relating to said claim, such information
forming a claim datafile; [0008] b) selecting items of property
being claimed by consulting a property register configured and arranged
to store items of property owned by the person or entity making
a claim; [0009] c) obtaining information to establish a replacement
value for each of the items of property relating to the claim; and
[0010] d) selecting a method of settlement of the claim and calculating
the replacement values for each of the items of property to determine
a settlement value.
[0011] Preferably in step b) a further process is undertaken whereby
an historical claims database is consulted to check the claims history
of the claimant.
[0012] Desirably in step b) if any items being claimed match previous
items claimed by consulting the historical claims database, a flag
is generated to provide an indication to a user that further investigation
may be warranted.
[0013] Advantageously the property register is periodically updated
to ensure accuracy of the items of property. Preferably the property
register is configured and arranged to be accessible by authorised
third parties over a communications network. Desirably the steps
of the method are carried out by a website server configured and
arranged to allow access by authorised users.
[0014] Preferably the method further includes an archiving step
wherein the datafile associated with a settled claim is moved to
an archiving database wherein further changes to the datafile are
not permitted.
[0015] Preferably the method further includes a post archiving
revision step wherein the datafile associated with a settled claim
is accessed from an archive location and reviewed and altered as
required, and wherein an audit trail of the process is recorded.
[0016] According to a second broad aspect of the invention there
is provided a computer controlled method for managing an insurance
claim, the computer being programmed to carry out the steps of:
[0017] A. generating a claim datafile by receiving information relating
to a claim, including items of property relating to the claim; [0018]
B. selecting items of property being claimed by consulting a property
register configured and arranged to store items of property owned
by the person or entity making a claim; [0019] C. obtaining information
to establish a replacement value for each of the items of property
relating to the claim; and [0020] D. selecting a method of settlement
of the claim and calculating the replacement values for each of
the items of property to determine a settlement value.
[0021] Desirably in step B. an historical claims database is consulted
to check the claims history of the claimant, and if any items being
claimed match previous items claimed the claimant, a flag is generated
to provide an indication to a user that further investigation may
be warranted.
[0022] According to a third broad aspect of the invention there
is provided a system of managing an insurance claim, the system
including a property register configured and arranged to store items
of property, the property register being configured and arranged
to be updatable with current schedules of items of property, the
database having means to accept a request to add or delete or update
an item of property, and to allow access by authorised users to
consult the items of property.
BRIEF DESCRIPTION OF THE DRAWINGS
[0023] Preferred embodiments of the invention will now be illustrated,
by way of example only, with reference to the accompanying drawings
in which:
[0024] FIG. 1: Shows a system and method for processing a claim;
[0025] FIG. 2: Shows a flow chart of processing steps in the settlement
of a claim; and
[0026] FIG. 3: Shows data flows between databases, registers and
organisations in a system according to a preferred embodiment of
the invention.
DETAILED DESCRIPTION OF THE DRAWINGS
[0027] Referring to FIG. 1, a system for processing an insurance
claim, generally referred to as 50, according to a broad aspect
of the invention, is illustrated.
[0028] The embodiments of the invention described herein are with
reference to insurance claims and for the management of items of
property owned by respective persons or entities, although it will
be appreciated that the various methods and systems employed are,
inter alia, for determining the current value of an item of property,
and for facilitating the settlement of claims. A description of
systems and methods for the management of insurance claims is as
expressed in Australian Patent Serial No. 769642 titled "Methods
and Systems for Managing Insurance Claims" and such description
is wholly incorporated herein as part of this description.
[0029] The claims that may be processed in accordance with any
one or more aspects of the invention can include damage or loss
to personal property, medical, travel, accident, income, life or
house contents insurance or any other item of property or thing
or person that can be covered by an insurance policy and later be
made the subject of a claim under an insurance contract.
[0030] This method 50 involves at least one claims operator associated
with an insurance company or organisation 52 who can receive details
of the lodged claim 51 and create or load a new claim datafile by
using a CAPS program 53. A new datafile can be created by allocating
a reference number. Loadable information can include all relevant
data such as, for example, the claimant's name and contact details,
type of claim (i.e. loss through theft or burglary, or damage by
accident), an event date being the date of the loss or damage to
the item of property, insurance organisation and branch in the arrangement
whereby outside parties may be reviewing and processing the claim
datafile, policy type, policy excess if applicable, claim processing
operator's name and title, and any other relevant information that
may be useful or required with processing a claim.
[0031] When the data has been loaded into appropriate fields, the
datafile is saved and stored in a claims database 54. It will be
appreciated that further information on the items of property being
claimed can be included in the data entered previously or as a separate
step in the claim settling process. The claims data is desirably
associated with a search engine that can allow users of the CAPS
program 53 to search for a datafile by any field, or more desirably
by the name of a claimant, claim reference number, and/or by policy
number.
[0032] It will be appreciated that an operator or insurance agent
can load information or data relating to a claim in a variety of
ways. One common way is by inserting the appropriate data by keyboard
into fields on a loading screen displayed on a computer monitor.
The display screen can be windows-based to conveniently display
the data entered before the data is saved.
[0033] The operator loads data on the item(s) of property being
claimed. The item(s) description, date of purchase and purchase
price, in an appropriate currency, is entered. A group code for
a category of property may be selected. This is useful when large
numbers of items are being claimed and sub totals of the groupings
can be provided to claimants on settlement rather than a large itemisation
of property. This information or data is also saved to a database
54.
[0034] Desirably the replacement value of any item is obtainable
by sending a computer request command to a second database in the
form of a replacement quote or price enquiry database 55 ("PED").
The PED 55 is consulted with a request and will respond by providing
a value of the item requested. It will be appreciated various coding
can be used to allow the CAPS 53 and PED 55 programs to communicate,
and that standard suitable communication systems can be employed
to allow the programs to exchange data. Common communications systems
include local area networks, wide area networks, internet and cable
links, radio frequency, telephone lines via modems, and/or a computer
server hosting various databases and/or slave servers and the like,
and communicating with client terminals by cable or abovementioned
networks.
[0035] Information relating to some items can be obtained by a
consultant 58 or third party such as an investigator, assessor or
claims consultant. Details of the claim are viewable by the consultant
58 who determines the item value and provides such a value to the
insurance organisation 52 or a separate claims management organisation
56 ("CMO"), as required. Such third parties can be provided
with a CAPS computer program 53 or associated program to enable
such parties to communicate directly by data exchange over the internet,
a wide or local area network, or otherwise.
[0036] An item or items in a claim can then be settled by a variety
of methods. These methods may include cash settlement, supply settlement,
voucher settlement and market value settlement. Each item in a claim
can be settled individually. It is envisaged that in some instances
items can be settled in groups or categories.
[0037] It may well be that the adjustment made to the initial value
of an item does not include a depreciation ratio if the item in
a claim is settled by supply settlement or voucher settlement. This
may be because the item is being replaced rather than a monetary
figure paid. The CAPS program 53 can be customised to comply with
a particular insurance organisation's settlement policies, and the
particular obligations an insurance organisation is contracted under
a policy to meet
[0038] With a cash settlement, the cash value is calculated for
each item and the settlement amount is minus any excess that may
apply to the final amount reimbursed. A print function 59 can be
activated to print a settlement cheque or payment made directly
into claimant's bank account.
[0039] With a supply settlement, a user can settle a claim by selecting
a retailer or supplier of an item being claimed to supply a replacement
item to the claimant. To select a supplier the CAPS program 53 may
include a drop down box having a table to select a preferred supplier.
It will be appreciated that different insurance organisations may
have a preference for some suppliers over others and such tables
can be customised. The CAPS program 53 may allow a user to update
a list of suppliers by adding or deleting suppliers.
[0040] The CAPS program 53 may include a quote option for items
being claimed. With this option an operator can select a supplier
and the appropriate information on the claim can be exported to
a word processing program or sub program of the CAPS program 53
and printed in a pre-formatted letter.
[0041] With the voucher settlement, items in a claim where the
settlement amount may have been determined at the adjustment stage
to derive a settlement amount or value on the item can then settle
the claim by generating and sending a voucher to the claimant. The
voucher may be redeemable at any suitable supplier or retailer selected
by the insurance organisation or otherwise. The claimant can then
take the voucher to suppliers that will accept the vouchers for
items of property. Further, the documents relating to a voucher
settlement can be generated and sent directly to a supplier without
having to print such documents. It is envisaged that all transactions
conducted according to the invention can be conducted electronically,
with any forms and documents prepared in electronic form and communicated
to various parties, as required.
[0042] The voucher is optionally derived by a user selecting the
voucher option in the appropriate display screen. The user can then
select a supplier and the appropriate information on the claim can
be exported to a word processing program or sub program of the CAPS
program 53 and printed in a pre-formatted letter. The letter will
record all the appropriate details of the claim including the item(s)
settlement amount(s) and the supplier(s) the claimant can approach
with the voucher.
[0043] With market value settlement, the market value is what one
would expect to pay for a similar item on the open market based
on factors such as the age, condition and market demand of the item.
That final figure may become the settlement amount or may be passed
through another variable as required.
[0044] The next stage of the process can involve a claim adjustment
step. This step in the claims settlement process is with adjusting
the initial assessed replacement value of the item depending on
factors, for example, as the type of policy covering the item being
claimed, the age of the item and any applicable depreciation rates,
and any other policy factors that determine the output value of
this step in the process. The output value can be seen as the settlement
value or amount of the item being claimed.
[0045] An operator at an insurance company or organisation 52 may
handle this processing step or may desirably refer this processing
step onto a CMO 56. If the CMO 56, a claims datafile can be exported
via link 57 to the CMO 56.
[0046] The CMO 56 can then make an appropriate adjustment to a
claim or item in a claim to determine the settlement value. The
settlement value can be determined by a mathematical calculation.
This mathematical calculation can desirably include a depreciation
ratio that is supplied by the particular insurance organisation
52 responsible for setting a client's policy claim. The expected
life expectancy of an item is a factor that may be included in the
claim adjustment. The CAPS program 53 may allow a computer operator
to adjust the depreciation ratio as required. Once the final figure
is derived a print function can be used to provide the claimant
with details of the item(s) being claimed and the settlement amount(s).
[0047] Advantageously the CAPS program 53 can include an interactive
report function relied on to track progress with the claim and to
record details of telephone calls and other correspondence and instructions
relating to a datafile. It will be appreciated that in any organisation
many operators may work in a claim at various stages, and it may
well be the claim may be audited at any one stage of the claim settlement
process or simply a supervisor desiring to check that the file is
in order before it is further processed or is archived.
[0048] The interactive report function can operate with a separate
display screen or window having fields to record details. The fields
may include the claim reference, insurance organisation, operator's
identifier, claimant's name, and type of claim, with a large field
for inserting text. Once the details are inserted the report is
saved, and can later be retrieved from the datafile by executing
a function to open the display window showing inputted details.
[0049] An advantage with the interactive report function is that
an operator or user of the CAPS program, being able to obtain the
claim datafile, can see everything on datafile at any location without
requiring a paper file. This is a very desirable feature as it can
save time and effort by not needing to request a file, and having
to delay or wait to receive it, before further work can be progressed
on the file. It also is convenient if a claimant contacts an insurance
organisation wishing to discuss a claim or to query a claim, and
a claims handler or other staff member may be able to assist with
details on the file as it is readily retrievable or available.
[0050] The CAPS program 53 can incorporate a reinstatement function
that allows for a re-evaluation of reinstatement costs, after loss
valuations for reinstatement claims either at full replacement or
indemnity costs.
[0051] The datafile on a claim can be easily transferred or exported/imported
to the CAPS program 53 as required. Further, the status of a datafile
can be changed, for example, from open to closed, depending on an
insurance organisation's archive policy. It may be desirable to
move datafiles on closed claims from an active and current database
to an archived database for convenience purposes.
[0052] A copy of an archived file may be subsequently retrieved,
reviewed and altered as required, Any further alterations can be
desirably tracked and recorded to provide an audit trail.
[0053] Referring to FIG. 2, a flow chart of processing steps in
the settlement of a claim, is illustrated.
[0054] The CAPS program 53 functions to manage the various processing
stages of handling or managing a claim to increase the likelihood
of settlement of the claim reasonable quickly and efficiently, and
with leaving an audit trail of transactions and correspondence at
each stage of the workflow process.
[0055] A client lodges an insurance claim with an insurance organisation
52 and a claims handler will create a new claim datafile 70. Such
lodgment can be via a website on the internet. The website can be
configured to create the datafile 70 from the information supplied
by the claimant and as prompted by the website. The program 53 may
function such that the datafile 70 can not be saved to a current
claims database until all the necessary data or information is entered
in the various fields in the claim loading display screen. The program
53 can include prompts and help files to assist a claims handler
or claimant to obtain and enter all the required data or information.
[0056] The claim datafile 70 is also generally associated with
a current policy and policy details, relating to the items of property
being claimed, can be imported or copied from a policy database
71 into the claims datafile 70, or a database reference or link
can be saved as part of the database file.
[0057] If gaps in the information required for settling a claim
is evident, such as the current replacement value of an item, then
the program step 72 of obtaining such information is actioned. The
action can be by way of querying a PED database 73 to obtain a value
or quote of an item being claimed. The database 73, upon receiving
the request, can process the request and provide a value to the
program 53 of the item of property in question. When that item value
is received, it can be loaded into the appropriate field in the
datafile 70.
[0058] The program 53 allows for manual inputting of the value
sought. This may be for a claim involving vehicle damage whereby
a claims assessor must inspect the damage caused and to obtain a
value of the damage to the vehicle and pass that onto the claims
handler. It is envisaged that any outside third party may be provided
with part or all of the CAPS program 53 to enable those parties
to manage part of the claim electronically rather than via telephone
calls and further manual input by a claims handler at the insurance
organisation. That is, the claims handler can send a data request
for information or values from, say, an assessor, sent by email
or via a computer network to another computer loaded with the program
53 and allowing full access to the datafile 70, and the assessor
will receive and action the request, and provide the information
to the claims handler for inclusion in the datafile 70.
[0059] Once the required information on a claim is received, the
next processing step is with adjusting the item value. A method
of settling the claim or items in a claim is selected. It could
be by cash settlement 74, supply settlement 75, voucher settlement
76 and/or market value settlement 77 or a combination of these methods,
or otherwise, such as, for example, an agreed value between claimant
and insurance organisation. Details of these methods of settlement
are as described with reference to FIG. 1. Each item in a claim
can be settled individually by any suitable method. It is envisaged
that in some instances groups or categories of items can be settled
together.
[0060] Once the settlement figure is determined, the next processing
step can desirably include a printing processing step 78. This step
is to assist with the final stage of the claims process and is convenient
as all the relevant data relating to a claim can be easily exported
to pre-formatted letters and reports and memorandums or otherwise
rather than a claims handler re-entering such data in a word processing
program.
[0061] With supply settlement 75, a user can activate a pop up
window of a table and select, or enter details of, a retailer or
supplier of an item being claimed to supply a replacement item to
the claimant and/or services. The services may include an authorisation
of a reinstatement company or repairer proceeding with work in order
to properly indemnify the claimant. It will be appreciated that
different insurance organisations, or even different branches of
an organisation, may have preferences for some suppliers over others
and such tables can be customised. The CAPS program 53 may allow
a claims handler or any authorised person, to update a list of suppliers
by, for example, adding or deleting suppliers.
[0062] The CAPS program 53 can include a quote option for items
being claimed. With this option an operator can select a supplier
and the appropriate information on the claim can be exported to
a word processing program or sub program of the CAPS program 53
and printed in a pre-formatted letter in accordance with the supply
settlement printing step 79. Suppliers include authorised repairers
and reinstatement companies.
[0063] Alternatively the claims operator may choose to activate
a sub-routine in the program 53 to directly order a replacement
item to be delivered to the claimant from the supplier. Advantageously
this order is placed digitally and may be communicated to the supplier
having a CAPS program 53 or a part thereof of the program tailored
to meet this direct ordering processing step. An advantage with
this method is that it avoids printing an order form and sending
by postal mail.
[0064] With the voucher settlement 76, items in a claim where the
settlement amount may be determined by the purchase price of the
item in the case where the item is covered by a replacement value
in the relevant policy. The program 53 can then be used to settle
the claim by generating and printing a voucher for the claimant
in accordance with a printing step 80. The claimant can then take
the voucher to specified suppliers that will accept the vouchers
for items of property.
[0065] The voucher can be generated by a program user selecting
the voucher option in the appropriate display screen. The user can
then select a supplier and the appropriate information on the claim
can be exported to a word processing program or sub program of the
CAPS program 53 and printed in a pre-formatted letter. The letter
will record all the appropriate details of the claim including the
item(s) settlement amount(s) and the supplier(s) the claimant can
approach with the voucher.
[0066] With market value settlement 77, the market value is what
one would expect to pay for a similar item on the open market based
on factors such as, including age, condition and market demand of
the item. Such a value may be obtained by consulting the PED 73.
That final figure may become the settlement amount or may be passed
through another variable as required. Further details are as applied
to market value settlement as described with reference to FIG. 1.
Other mathematical calculations may be applied and values and figures
insertable in fields on the display screen can be adjusted as required.
That final figure may become the settlement amount or can be manually
changed, if required.
[0067] Once the final settlement amount of the item is derived
a printing step 81 function can be used to provide the claimant
with details of the item(s) being claimed and the settlement amount(s)
in a pre-formatted letter or table.
[0068] A print function 82 may be activated after any one of steps
78 to 81 are completed to print a settlement cheque. It is envisaged
that if the claimant's bank account details are available a direct
debit facility may be set up for payment.
[0069] When the claim has been completely actioned and any auditing
of the datafile has been made, then the insurance organisation may
direct that the claim be closed. At this stage the archive step
can be actioned by the program by moving the current claims datafile
from the database 73 to an archive database 83.
[0070] The archive processing step involves freezing the datafile
70 and therefore no changes to any data can be subsequently made.
Additionally, at any stage of the claim management process, an operator
can activate a pop up display window and enter a report 84. This
is to allow tracking of activities on a datafile 70 and recording
of correspondences.
[0071] The CAPS program 53 can function to allow for a multitude
of variables reflecting the myriad of claims management and settlement
options available. That is why, for example, the settlement amounts
or figures can be manually over ridden by an authorised claims handler
who must exercise an appropriate level of judgement when settling
claims.
[0072] It is envisaged that the program 53 can be easily adapted
to include search and report functions, with printing options, involving
a current working database and/or the closed archive database 84.
The statistical analysis may desirably include reports such as the
number of claims from a geographical location or certain demographic
factor, claimant, claim types and yearly claim figures. Such reports
are only limited by the fields in the program and the amount of
information obtained from claimants or otherwise, and entered into
datafiles.
[0073] An advantage with the CAPS program 53 is that it is configured
and functions to allow a particular insurance organisation to easily
and conveniently export and import claim datafiles and interact
with third parties outside the organisation or staff located at
another branch of the organisation. The reliance on paper files
can be avoided as all the file documentation or information can
be readily available from a datafile viewable at any terminal or
computer programmed with the CAPS program 53. Datafiles can be conveniently
compressed and exported as an email attachment via the internet
or by any other form of communication means, or simply transferred
physically via suitable media
[0074] It is envisaged that when international currencies are involved
with determining insurance claims, for example with a claim under
travel insurance, the CAPS program 53 may include a feature having
direct access to currency conversions, whether current or historic
currency data, and may also include replacement quote values for
foreign countries.
[0075] The CAPS program 53 can include a user's operating manual
in the form of help files that can be dropped from the tool bar
of a display window.
[0076] Referring particularly to FIGS. 1 and 2, it is seen that
in various embodiments of the invention a replacement quote database,
or more accurately termed, a Price Enquiry Database ("PED")
has been consulted in the claim settlement process.
[0077] The PED includes current replacement values, market values
and historic values of items. The PED has the advantage of being
programmed and configured to provide current values for items of
property being claimed. As PED can desirably be used in association
with the CAPS program 53, and as PED can be consulted digitally,
it is seen that a claims handler using the CAPS program 53 can settle
a claim reasonably quickly by obtaining a reply to a request within
a short time period.
[0078] The PED can be kept current with item values by an associated
program set up to get information from various sources as required.
The PED can be configured with a linked network of third parties
that are consulted in the case of an unusual item not being present
in the PED database. In this situation an assessor or valuer at
a remote location can be provided with a program (not shown) that
interacts and communicates with the PED and/or PED software program.
[0079] The assessor or valuer can obtain the replacement value
of the item requested and sends it, desirably electronically, to
the PED that immediately updates its database and actions a reply
to the initial request for the replacement value. If the replacement
value of that item is again requested at a later date by any insurance
organisation or operator using a CAPS program 53, the PED can send
the value immediately after locating it in its database.
[0080] The information that may be detailed in the PED include
a category of item, a description of the item, the replacement value,
a supplier of the item, and the date the database was updated with
the replacement value of the item. It will be appreciated that the
computer program associated with the PED may include a searching
function for items, a log of activities with time stamps, and any
other known associated feature with a software program that can
enhance its capabilities.
[0081] It is envisaged that the CAPS program 53 can function in
conjunction with the PED to form a complete package. This package
can optionally be operational at any one location, particularly
in the case of smaller applications of the program.
[0082] Referring now to FIG. 3, a block diagram of data flows between
databases, registers and a selection of some relevant organisations,
is illustrated.
[0083] The processing steps of a CAPS program 100 is similar as
already described with the CAPS program with reference to FIGS.
1 and 2 and need not be repeated in detail. However, a broad summary
of the processing steps as seen by steps a. to e. in FIG. 3 are
described as follows. The first step a. is with generating a claim
datafile by receiving information relating to a claim, including
items of property relating to the claim; then step b. is proceeded
with by selecting items of property being claimed by consulting
a property register configured and arranged to store items of property
owned by the person or entity making a claim; then step c. is commenced
with obtaining information to establish a replacement value for
each of the items of property relating to the claim; and finally
step d. is with selecting a method of settlement of the claim and
calculating the replacement values for each of the items of property
to determine a settlement value. The optional and non-essential
final step e. in the process with settlement of the claim with the
claimant by the step of actioning settlement, electronic means and/or
manually, by printing out vouchers or a settlement cheque or otherwise,
and optionally generating the documents for confirming settlement.
[0084] It is considered that when a claim is being processed according
to the CAPS program 100, one of the steps will include consulting
an historical claims database 101 to check the claims history of
the claimant. The check may include determining whether the claimant
has made a previous claim with any insurance organisation and/or
to determine whether any one or more items being claimed have been
previously claimed. This check has the advantage of assisting an
investigation into whether a claimant may be fraudulently making
a claim, or at least can raise a flag or sign to direct further
investigation of the claim and the claimant should that be considered
prudent.
[0085] The process may be carried out by forming a link via an
insurance organisation 103 to an insurance claims register 104.
The insurance claims register 104 may be a commonly linked register
104 from a plurality of insurance organisations (not shown) and/or
including any other users of the CAPS program 100 that manages insurance
claims or any other interested party such as an agent for any insurance
organisation or claims management organisation 112.
[0086] Alternatively, it is envisaged that the insurance claims
register 104 may be incorporated in the processing steps of the
CAPS program 100 and can be located on a server within one organisation
rather than being located externally via an external link or wide
area network to a claims register 104. Further, the insurance claims
register 104 may be consulted by other parties, as required and
subject to any applicable laws regarding the handling of personal
information.
[0087] A Price Enquiry Database 102 (referred to hereinafter as
"PED") may desirably be consulted in a claim settlement
process. As detailed with reference to FIGS. 1 and 2, the PED 102
can include current replacement values, market values and historic
values of items of property. The PED 102 has the advantage of being
programmed and configured to provide current values for items of
property being claimed. As the PED 102 can desirably be used in
association with the CAPS program 100, the PED 102 can be consulted
as required.
[0088] The PED 102 can advantageously be kept current with item
values by an associated program set up to get information from suitable
sources to ensure the accuracy of listed values of items of property.
The PED 102 can be configured with a linked network of third parties
that are consulted in the case of an unusual item not being present
in the PED 102. In this situation an assessor or valuer at a remote
location can be provided with a program (not shown) that communicates
with the PED 102 and/or PED software program and associated server.
[0089] The claims management method and system can also preferably
include the creation, update and consultation of a personal property
register or database 105 configured and arranged to store a plurality
of details of personal property. That is, for each client and potential
claimant, all the personal property that may be covered by a possible
claim at a future date, or for any other desirable reason such as,
for example, property the subject of a deceased client's estate,
may be stored electronically in any suitable format.
[0090] The date or information being held by the personal property
register or database 105 may be in any form, and can desirably include
images in any format such as, for example, JPEG or TIF or otherwise.
Such images of items of property or of any item of value to a client
107 can be stored in a secondary database 106 or be incorporated
in the personal property database 105. Such images can be uploadable
to the personal property database 105 by the client 107 or the client's
agent 108 from time to time, and be downloadable or viewable by
an insurance organisation at the time of a claim or for any other
purpose.
[0091] The personal property database 105 may also include a facility
to store scanned documents proving ownership of property, and other
documents such as valuations, guarantees, serial number cards, and
legal documents being stored elsewhere. It will be appreciated that
the secondary database 106 can store some of these further details.
[0092] To obtain such photos or digital images a client 107 or
agent 108 may initially set up an inventory of images, and then
periodically update the inventory. A client 107 or agent 108 may
make an inventory of all items of property. This form of inventory
can desirably include private collections of any property of worth
and value the subject of an insurance cover such as, for example
only, stamps, coins, artworks, jewellery, antiques, and the like.
By documenting such collections and loading lists of such collections,
a client, and any relevant authorities, would have easy and quick
access to such inventories and collections for purposes other than
settling an insurance claim, such as, for example, a revision of
values, re-appraising the worth of collections, for sales purposes
at auctions, or otherwise. However, the main purpose may be for
the reason of making an insurance claim quickly and easily when
a collection or property has been lost or stolen and is the subject
of an insurance claim.
[0093] Only authorised access to the inventories and the personal
property database 105 may be applied, and access is also envisaged
as being allowable remotely via the internet or by any suitable
communication means. A client 107, or a client's agent 108, can
have access to the personal property database 105 to update the
inventory of property, and such updates are envisaged as being useful
to ensure accuracy of the inventories should a claim or related
consultation be made.
[0094] The formatting of the inventories may be in any suitable
form, and may desirably be in a form to allow for ease of additions
and deletions, and general updates. Further, the format may preferably
be such that importing and exporting functionality is achieved.
Further, the categories applied to the inventories of clients may
be by type or value, by collection, by policy benefit, chronologically
by age of each item, or by any other desirable type.
[0095] One advantage of the personal property database 105 is that
it should increase the promptness of settlement of a claim.
[0096] It is envisaged that clients may customise their personal
register by selecting the insurance organisation 103 they are insured
with, enter an appropriate customer identification number, and provide
information relating to a particular insurance policy, thus shifting
items into appropriate insurance policies as required.
[0097] The personal property database 105 may be configured and
arranged to automatically update the sum insured of the items of
property being covered by a policy, and such update could be exported
to the relevant insurance company covering the property. The client
and any other interested parties may also be automatically notified
electronically via the internet or the like, of any changes of policy
or with information affecting a policy covering property being listed
on the personal property register or database 105. Any premium changes,
including regular policies, can be desirably sent electronically
to the client 107.
[0098] It is seen that the personal property database 105 may be
utilised for moving or storage quotation purposes. Downloaded items
of property can be viewable when running the CAPS program 100 that
may be, for example, on an agent's laptop computer or by a shipping
company 109 computer. It is envisaged that information flows between
various organisations in FIG. 4 can be achieved for any desirable
purpose with the inventories loaded on the personal property database
105.
[0099] The personal property database 105 can be consulted by government
agencies 110 such as the Police and/or Public Trust. In the case
of the Police, items of property claimed as stolen can be forwarded
to the Police as required. The Public Trust organisation or other
such estate management organisation can desirably use the inventories
to assist in the assessment and valuation of estate property. This
consultation process may advantageously save time by the creation
of an accurate inventory that indicates when property was owned
or in trust by the client 107.
[0100] Additionally, a retailer 111 may, at the point of sale with
a client 107 present, or at any other suitable or convenient time,
could ask the client 107 if they have a personal property inventory
in the system as being described, and if so, the retailer 111 could
forward information on a sale and/or update the client's property
register or inventory with the item or items of property being purchased.
This transaction could be in the form of a datafile update request
being forwarded to the personal property database 105, and actioned
accordingly. A copy of the update of the client's property inventory
can then be sent to the client 107 and/or the insurance organisation
103.
[0101] The personal property database 105 may further include a
response unit (not shown) that enables a client 107 to communicate
with the insurance organisation 103 at the time the client 107 enters
information into the system. In this respect, the insurance organisation
103 or a group of member organisations 103 can potentially be in
contact with the client 107 and service various insurance requirements
of the client 107.
[0102] It is envisaged that the personal property database 105
can be utilised at any time by any client 107 for a variety of purposes,
not just to update the personal property inventory. The easy flow
of information and communications between all parties involved in
either a claim settlement transaction, or in the insurance business,
can be networked, and provided with suitable computer software programs
so as to participate in the systems and methods of the invention.
[0103] The use of a website or series of linked websites, and the
current use of the internet make this system not only viable but
very practicable and efficient to all parties involved in the settlement
of insurance claims, and other business activities associated with
insurance contracts, policies and the like. It is considered within
the scope of the invention to provide the CAPS program 100 and associated
registers and databases on a computer server or suitably networked
servers configured and arranged to allow access by users who do
not require any software for consulting purposes, but simply authorised
access to the computer server via any known communications means
including a local or wide area network or via the internet.
[0104] Wherein the aforegoing reference has been made to integers
or components having known equivalents, then such equivalents are
herein incorporated as if individually set forth. Accordingly, it
will be appreciated that changes may be made to the above described
embodiments of the invention without departing from the principles
taught herein.
[0105] Additional advantages of the present invention will become
apparent for those skilled in the art after considering the principles
in particular form as discussed and illustrated. Thus, it will be
understood that the invention is not limited to the particular embodiments
described or illustrated, but is intended to cover all alterations
or modifications which are within the scope of the appended claims.
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