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Insurance Abstract
A method, system and computer program product for evaluating a subrogation
potential of a target insurance claim is disclosed. A peer group
of claims that are expected to include similar behaviors as the
target claim and have been successfully subrogated is established
to determine a normal behavior that the target claim is supposed
to include. A behavior of the target claim is compared to the normal
behavior to evaluate a subrogation potential of the target claim.
Proper subrogation solutions are prospectively chosen based on the
determined normal behavior to increase efficiency.
Insurance Claims
1. A method for evaluating a subrogation potential of a target claim
for insurance payment, the method comprising steps of: selecting
a peer group of claims that are expected to include a similar behavior
as the target claim and have been successfully subrogated; identifying
a set of behavioral attributes of the peer group; determining a
normal behavior of the peer group regarding the identified set of
behavioral attributes; and comparing a behavior of the target claim
to the normal behavior regarding the identified set of behavior
attributes to evaluate the subrogation potential of the target claim.
2. The method of claim 1, wherein the normal behavior determining
step includes collecting behaviors of the peer group and analyzing
the collected behaviors of the peer group regarding the identified
set of behavioral attributes.
3. The method of claim 1, wherein the comparing step includes steps
of: comparing the behavior of the target claim with the normal behavior
with respect to each of the identified set of behavioral attributes;
and combining a result of the comparison with respect to each of
the identified set of behavioral attributes to generate an overall
comparison result.
4. The method of claim 1, wherein the peer group selecting step
includes a step of determining a similarity between and among the
target claim and other claims for insurance payment with respect
to claim attributes other than the set of behavioral attributes.
5. The method of claim 1, further including a step of prospectively
investigating the subrogation potential based on a result of the
comparing step.
6. A system for evaluating a subrogation potential of a target
claim for insurance payment, the system comprising: means for selecting
a peer group of claims that are expected to include a similar behavior
as the target claim and have been successfully subrogated; means
for identifying a set of behavioral attributes of the peer group;
means for determining a normal behavior of the peer group regarding
the identified set of behavioral attributes; and means for comparing
a behavior of the target claim to the normal behavior regarding
the identified set of behavior attributes to evaluate the subrogation
potential of the target claim.
7. The system of claim 6, further including: means for collecting
behaviors of the peer group; and means for analyzing the collected
behaviors of the peer group regarding the identified set of behavioral
attributes.
8. The system of claim 6, further including: means for comparing
the behavior of the target claim with the normal behavior with respect
to each of the identified set of behavioral attributes; and means
for combining a result of the comparison with respect to each of
the identified set of behavioral attributes to generate an overall
comparison result.
9. The system of claim 6, wherein the peer group selecting includes
determining a similarity between and among the target claim and
other claims for insurance payment with respect to claim attributes
other than the set of behavioral attributes.
10. The system of claim 6, further including means for prospectively
instructing an investigation the subrogation potential based on
a result of the behavior comparing.
11. A computer program product for evaluating a subrogation potential
of a target claim for insurance payment, the computer program product
comprising: computer usable program code configured to: select a
peer group of claims that are expected to include a similar behavior
as the target claim and have been successfully subrogated; identify
a set of behavioral attributes of the peer group; determine a normal
behavior of the peer group regarding the identified set of behavioral
attributes; and compare a behavior of the target claim to the normal
behavior regarding the identified set of behavior attributes to
evaluate the subrogation potential of the target claim.
12. The program product of claim 11, wherein the program code is
further configured to collect data of behaviors of the peer group
and analyze the collected behavior data of the peer group regarding
the identified set of behavioral attributes.
13. The program product of claim 11, wherein the program code is
further configured to: compare the behavior of the target claim
with the normal behavior with respect to each of the identified
set of behavioral attributes; and combine a result of the comparison
with respect to each of the identified set of behavioral attributes
to generate an overall comparison result.
14. The program product of claim 11, wherein the program code is
further configured to determine a similarity between and among the
target claim and other claims for insurance payment with respect
to claim attributes other than the set of behavioral attributes.
15. The program product of claim 11, wherein the program code is
further configured to prospectively instruct an investigation of
the subrogation potential based on a result of the behavior comparison.
16. A method of generating a system for evaluating a subrogation
potential of a target claim for insurance payment, the method comprising:
providing a computer infrastructure operable to: select a peer group
of claims that are expected to include a similar behavior as the
target claim and have been successfully subrogated; identify a set
of behavioral attributes of the peer group; determine a normal behavior
of the peer group regarding the identified set of behavioral attributes;
compare a behavior of the target claim to the normal behavior regarding
the identified set of behavior attributes to evaluate the subrogation
potential of the target claim; and communicate a result of the evaluation
to a customer insurance company.
17. The method of claim 16, wherein computer infrastructure is
further operable to collect data of behaviors of the peer group
and analyze the collected behavior data of the peer group regarding
the identified set of behavioral attributes.
18. The method of claim 16, wherein computer infrastructure is
further operable to: compare the behavior of the target claim with
the normal behavior with respect to each of the identified set of
behavioral attributes; and combine a result of the comparison with
respect to each of the identified set of behavioral attributes to
generate an overall comparison result.
19. The method of claim 16, wherein computer infrastructure is
further operable to determine a similarity between and among the
target claim and other claims for insurance payment with respect
to claim attributes other than the set of behavioral attributes.
20. The method of claim 16, wherein computer infrastructure is
further operable to prospectively instruct an investigation of the
subrogation potential based on a result of the behavior comparison.
Insurance Description
FIELD OF THE INVENTION
[0001] The invention relates generally to a subrogation of an insurance
claim, and more particularly to an evaluation of a subrogation potential
of an insurance claim.
BACKGROUND OF THE INVENTION
[0002] In the operation of an insurance business, the processing
of claim function is a key to the financial performance and the
customer satisfaction of the business. For example, in the case
of home insurance, the claim function provides payment to an insured
homeowner if a loss is incurred to the homer. As is understandable,
a quick, reasonable payment will make the insured homeowner satisfactory,
which may increase credibility and reliability of the insurance
business. On the other hand, avoidance of an unreasonable or unwarranted
payment to the insured homeowner will increase the financial solidity
of the insurance business.
[0003] A common process of an insurance company to avoid unreasonable
or unwarranted claim payments is referred to as subrogation, which
identifies situations where a third party may share in the responsibility
for an insured loss. For example, if a hot water heater leaks and
floods an insured real estate, the insurance company needs to pay
for the damage. However, if the insurance company identifies through,
e.g., subrogation, that the hot water heater leakage is caused by
manufacturing defects, the manufacturer may also be liable for the
loss, which reduces the claim cost of the insurance company and
also keeps the insurance cost of the homeowner from rising.
[0004] Regarding subrogation, an insurance company often finds
itself in a dilemma. Attempting to subrogate all claims would be
excessively expensive and time consuming, whereas missing an opportunity
of sharing responsibility would unduly increase claim cost. For
most insurance companies, claim costs constitute approximately 80
percent of the costs incurred in the operation, which has a significant
impact to the insurance companies.
[0005] Based on the above, it is preferable that an insurance company
can identify claims that have a high potential for subrogation to
conduct subrogation selectively. The existing technology does not
provide a successful solution to this question. As such, there is
need for evaluating a subrogation potential of an insurance claim.
BRIEF SUMMARY OF THE INVENTION
[0006] A method, system and computer program product for evaluating
a subrogation potential of a target insurance claim is disclosed.
A peer group of claims that are expected to include similar behaviors
as the target claim and have been successfully subrogated is established
to determine a normal behavior that the target claim is supposed
to include. A behavior of the target claim is compared to the normal
behavior to evaluate a subrogation potential of the target claim.
Proper subrogation solutions are prospectively chosen based on the
determined normal behavior to increase efficiency.
[0007] A first aspect of the invention is directed to a method
for evaluating a subrogation potential of a target claim for insurance
payment, the method comprising steps of: selecting a peer group
of claims that are expected to include a similar behavior as the
target claim and have been successfully subrogated; identifying
a set of behavioral attributes of the peer group; determining a
normal behavior of the peer group regarding the identified set of
behavioral attributes; and comparing a behavior of the target claim
to the normal behavior regarding the identified set of behavior
attributes to evaluate the subrogation potential of the target claim.
[0008] A second aspect of the invention is directed to a system
for evaluating a subrogation potential of a target claim for insurance
payment, the system comprising: means for selecting a peer group
of claims that are expected to include a similar behavior as the
target claim and have been successfully subrogated; means for identifying
a set of behavioral attributes of the peer group; means for determining
a normal behavior of the peer group regarding the identified set
of behavioral attributes; and means for comparing a behavior of
the target claim to the normal behavior regarding the identified
set of behavior attributes to evaluate the subrogation potential
of the target claim.
[0009] A third aspect of the invention is directed to a computer
program product for evaluating a subrogation potential of a target
claim for insurance payment, the computer program product comprising:
computer usable program code configured to: select a peer group
of claims that are expected to include a similar behavior as the
target claim and have been successfully subrogated; identify a set
of behavioral attributes of the peer group; determine a normal behavior
of the peer group regarding the identified set of behavioral attributes;
and compare a behavior of the target claim to the normal behavior
regarding the identified set of behavior attributes to evaluate
the subrogation potential of the target claim.
[0010] A fourth aspect of the invention is directed to a method
of generating a system for evaluating a subrogation potential of
a target claim for insurance payment, the method comprising: providing
a computer infrastructure operable to: select a peer group of claims
that are expected to include a similar behavior as the target claim
and have been successfully subrogated; identify a set of behavioral
attributes of the peer group; determine a normal behavior of the
peer group regarding the identified set of behavioral attributes;
compare a behavior of the target claim to the normal behavior regarding
the identified set of behavior attributes to evaluate the subrogation
potential of the target claim; and communicate a result of the evaluation
to a customer insurance company.
[0011] Other aspects and features of the present invention, as
defined solely by the claims, will become apparent to those ordinarily
skilled in the art upon review of the following non-limited detailed
description of the invention in conjunction with the accompanying
figures.
BRIEF DESCRIPTION OF THE SEVERAL VIEWS OF THE DRAWINGS
[0012] The embodiments of this invention will be described in detail,
with reference to the following figures, wherein like designations
denote like elements, and wherein:
[0013] FIG. 1 shows a schematic view of an illustrative insurance
claim subrogating system according to one embodiment of the invention.
[0014] FIG. 2 shows a block diagram of an illustrative computer
system according to one embodiment of the invention
[0015] FIG. 3 shows a flow diagram of one embodiment of the operation
of a claim subrogation potential evaluating system according to
the invention.
[0016] FIG. 4 shows an illustrative example of a hierarchical structure
of claim attributes according to the invention.
[0017] FIG. 5 shows an illustrative example of a data table of
behavioral attributes and subrogation solutions according to one
embodiment of the invention.
DETAILED DESCRIPTION OF THE INVENTION
[0018] The following detailed description of embodiments refers
to the accompanying drawings, which illustrate specific embodiments
of the invention. Other embodiments having different structures
and operations do not depart from the scope of the present invention.
1. System Overview
[0019] Referring to FIG. 1, a schematic view of an illustrative
insurance claim subrogating system 10 is shown. According to one
embodiment, subrogating system 10 includes a claim subrogation processing
center 12 including a computer system 100 and a claim subrogation
implementation unit 200; and multiple investigating units 14 (two
are shown). Investigating units 14 collect information regarding
claim 16, including, for example, time of loss, time of report,
type of loss, type of claim, actions taken by claimant 16, etc.
Investigating units 14 may include any persons or devices employed
by an insurance company for investigating an insurance claim regarding
issues that are related to the processing of the claim by the insurance
company. For example, investigating units 14 may be an investigator
who is employed by an insurance company and works to investigate
issue related to the processing of a claim. A claim appraiser may
also be a convenient candidate to perform the functions of investigating
units 14. According to one embodiment, investigating units 14 may
also conduct a claim subrogation process according to the instructions
of claim subrogation implementation unit 200 and may feedback the
outcomes of the subrogation process to computer system 100. For
example, investigating units 14 may communicate to computer system
100 whether they successfully find a third party to share responsibility
through the claim subrogation process.
[0020] Claim/claimant 16 may communicate with processing center
12 regarding, for example, loss and claim information, for example,
time of loss, type of loss, any measures taken to reduce loss, amount
of loss, and the context of the loss. Claimant 16 may also communicate
with investigating units 14 in the process of data collecting. For
example, claimant 16 may be interviewed by investigating unit 14
regarding the context of the loss and measures taken to reduce loss,
and may be requested to provide police reports, product warranty
documents, or other information that can be used in the investigation.
[0021] According to one embodiment, in the following description
of subrogation system 10, a claim and a claimant are taken as matching
one-to-one to each other. Specifically, in subrogation system 10,
a claim is always a claimant's claim, and a claimant is always a
claim's claimant. If an individual submits two claims, the individual
is treated as two claimants regarding the two claims. If a claim
has more than one beneficiaries, e.g., joint beneficiaries, the
more than one beneficiaries are treated as one claimant for simplicity
purpose. As such, in FIG. 1, a claim and a claimant are similarly
marked as 16. In subrogating system 10, a target claim 16 is generally
a claim 16. However, for illustrative purpose, in the following
description, a claim 16 is referred to as a target claim 16 when
this claim 16 is processed by claim subrogation processing center
12, i.e., when this specific claim 16 is evaluated regarding a subrogation
potential. Similarly, the claimant of target claim 16 is referred
to as target claimant 16, for illustrative purpose only. It should
be noted that in subrogating system 10, regardless of whether a
claim 16 is a target claim 16, data regarding the claim 16 will
be collected because: (a) any claim may potentially become a target
claim, and (b) any claim may potentially be selected into a peer
group as described later.
[0022] In operation, claim 16 submitted from claimant 16 may be
communicated to computer system 100 of processing center 12 to evaluate
whether the claim has potential of subrogation. If computer system
100 obtains a positive evaluation result, i.e., the claim has potential
of subrogation, the evaluation result will be communicated to claim
subrogation implementation unit 200 to implement a subrogation process.
Details of computer system 100 of processing center 12 will be described
below.
2. Computer System
[0023] Referring to FIG. 2, a block diagram of an illustrative
computer system 100 according to the present invention is shown.
In one embodiment, computer system 100 includes a memory 120, a
processing unit (PU) 122, input/output devices (I/0) 124 and a bus
126. A database 128 may also be provided for storage of data relative
to processing tasks. Memory 120 includes a program product 130 that,
when executed by PU 122, comprises various functional capabilities
described in further detail below. Memory 120 (and database 128)
may comprise any known type of data storage system and/or transmission
media, including magnetic media, optical media, random access memory
(RAM), read only memory (ROM), a data target, etc. Moreover, memory
120 (and database 128) may reside at a single physical location
comprising one or more types of data storage, or be distributed
across a plurality of physical systems. PU 122 may likewise comprise
a single processing unit, or a plurality of processing units distributed
across one or more locations. I/O 124 may comprise any known type
of input/output device including a network system, modem, keyboard,
mouse, scanner, voice recognition system, CRT, printer, disc drives,
etc. Additional components, such as cache memory, communication
systems, system software, etc., may also be incorporated into computer
system 100.
[0024] As shown in FIG. 2, program product 130 may include a claim
subrogation potential evaluating system 132 that includes a data
collector 140; a normal behavior determinator 142 including a sampler
144, a behavioral attribute identifier 145 and an analyzer 146;
a subrogation potential evaluator 148 including a comparator 150
and a combiner 152; a suspect behavior detector 154; a prospective
subrogation potential investigator 156; and other system components
158. Other system components 158 may include any now known or later
developed parts of a computer system 100 not individually delineated
herein, but understood by those skilled in the art.
[0025] Inputs to computer system 100 include investigating inputs
160, operator inputs 162 and claimant inputs 164. Investigating
inputs 160 include the data collected by investigating units 14
(FIG. 1). Operator inputs 162 include instructions of an operator
of computer system 100 regarding the operation of, inter alia, claim
subrogation potential evaluating system 132, as will be described
in detail below. Claimant inputs 164 include information regarding
claim 16 that is reported by claimant 16 (FIG. 1). Those inputs
may be communicated to computer system 100 through I/O 124 and may
be stored in database 128. Outputs of computer system 100 include
evaluating result outputs 166 that are communicated to, inter alia,
claim subrogation implementation unit 200 for it to act accordingly.
The information provided by investigating units 14 through investigating
inputs 160 and by claimants 16 through claimant inputs 164 might
overlap and the contradict. In this situation, the information from
investigating units 14 is relied by claim subrogation potential
evaluating system 132 in evaluating a subrogation potential of target
claim 16 because investigating units 14 are supposed to be more
reliable than claimants 16 regarding a claim submitted. In addition,
a divergence between the information provided by investigating units
14 and claimant 16 may be used to detect an abnormal behavior of
the claim submitted by claimant 16 in a prospective analysis of
claim subrogation potential evaluating system 132, as will be described
later. The operation of claim subrogation potential evaluating system
132 will be described in details below.
3. Claim Subrogation Potential Evaluating System
[0026] Claim subrogation potential evaluating system 132 functions
generally to evaluate whether a claim has the potential of subrogation,
i.e., a process to identify whether a third party may share the
responsibility for the claimed loss. One embodiment of the operation
of claim subrogation potential evaluating system 132 is shown in
the flow diagram of FIG. 3.
[0027] According to one embodiment, the operation of claim subrogation
potential evaluating system 132 includes a historic analysis and
a prospective analysis. Referring also to FIG. 1, the historic analysis
operation occurs usually after investigating units 14 have finished
an investigation of target claim 16 and obtained all the information
needed for evaluating the subrogation potential of target claim
16. The prospective analysis operation usually occurs after target
claim 16 is submitted, but before investigating units 14 finish
an investigation of target claim 16. One objective of the prospective
analysis operation is to prospectively detect an abnormality of
target claim 16 so that investigating units 14 and/or claim subrogation
implementation unit 200 may respond accordingly before unnecessary
investigations have been performed. For example, investigating units
14 may pay more attention to the information related to the detected
abnormality and/or possible subrogation solutions related to the
abnormality to increase efficiency. An embodiment of the operation
of claim subrogation potential evaluating system 132 regarding the
historical analysis and the prospective analysis will be shown in
the flow diagram of FIG. 3.
[0028] Referring now to FIG. 3, with reference also to FIG. 2,
according to one embodiment, the historic analysis is represented
by step S200 including steps S201 to S203; and the prospective analysis
is represented by step S300 including steps S301 to S302. Specifically,
with respect to step 200, first in step S201, data collector 140
collects data and organizes the data to facilitate a further statistical
analysis of the data. The data collected include those of investigating
inputs 160 and claimant inputs 164. Data collector 140 collects
data of all claims submitted to an insurance company that employs
processing center 12 (FIG. 1). As is described above, investigating
units 14 may also conduct subrogation process and communicate the
results of the subrogation process, e.g., whether a third party
is identified through the subrogation process, to computer system
100 through investigating inputs 160. As such, the data collected
may also include subrogation results of claims 16, if a subrogation
process had been done with claims 16. Please note, as is understandable,
there will not be subrogation results information regarding target
claim 16, because target claim 16 has not been subrogated. According
to one embodiment, the data collected include all the data regarding
claim 16 for processing an insurance payment and the additional
data for processing a claim subrogation. For example, the data may
include information regarding the loss of the property, actions
taken after the loss including those taken to reduce further loss,
claiming process, and other details of the claim. In the following
description, the information collected by data collector 140 will
be referred to as claim attributes, for illustrative purpose only.
The claim attributes may have continuous data value or categorized
data value such as "yes/no" or "1/0". The data
value of a claim attribute is referred to as a behavior regarding
the claim attribute in the following description, for illustrative
purpose only.
[0029] For each specific claim 16 (FIG. 1), claim attribute data
might have some problems such as missing data or obviously strange
data. Those problems need to be resolved by data collector 140 in
step S201 before the problematic data is used for further analysis.
Claim attribute data may also need to be treated in step S201 to
fit an analysis purpose. For example, in some situations, a categorized
type of data might be more suitable than a data of continuous value,
so continuous claim attribute data may need to be converted to categorized
data in step S201.
[0030] Next in step S202, normal behavior determinator 142 determines
a normal behavior of a peer group of claims 16 that are expected
to include similar behaviors regarding a certain claim attributes
as target claim 16 (FIG. 1) and have been successfully subrogated.
Specifically, in step S202a, sampler 144 establishes/selects a peer
group of claims 16, which are expected to include the same (or similar)
behaviors regarding a certain claim attributes and have been successfully
subrogated. Generally speaking, definition of a peer group for a
specific target claim 16 is based on homogeneous or similar behaviors
regarding claim attributes among target claim 16 and other claims
16 that have been successfully subrogated. For example, if target
claim 16 claims loss of household property due to hot water heater
explosion, other claims (16) of loss of household property due to
hot water heater explosion and have been successfully subrogated
may be selected to constitute the peer group.
[0031] Any claim attribute may be used as the basis to define a
peer group if the homogeneity in this claim attribute may predict
similarity in other claim attributes. However, claim attributes
that are related to (or affect) subrogation potential are usually
not preferable to define peer group because behaviors regarding
those claim attributes will be analyzed in the evaluation of subrogation
potential of target claim 16. As is understandable, any claim attribute
that is used to define a peer group will not be analyzed among the
peer group, because the homogeneity regarding this claim attribute
is given. According to one embodiment, a classification of claims
in the insurance company that claim 16 is submitted to maybe used
to define a peer group to facilitate the administration of the claim
processing.
[0032] Please note, claim attribute data may be described as a
hierarchical structure like the illustrative example shown in FIG.
4. As is understandable, the more claim attributes are used for
defining a peer group, the more homogeneous the peer group is and
the more specific an analysis is based on the peer group. Referring
to the example of FIG. 4, please note, however, the operation of
claim subrogation potential evaluating system 132 can be operated
in any tiers of peer groups. For example, if a peer group in established
in tier 1, i.e., all claims, whether a real estate related claim
or a vehicle related claim have more potential of subrogation may
be determined according to the operation described below; if a peer
group is established in tier 2 level, e.g., all real estate claim,
whether a fire related real estate damage or a flooding related
real estate damage has more potential of subrogation may be determined.
In the following description, claim attributes that are used to
define a peer group are referred to as sampling attributes, for
descriptive purpose only.
[0033] It should also be noted that the selection of a peer group
is conducted by evaluating system 132, specifically sampler 144,
independent of interventions of claimants 16 (FIG. 1). According
to one embodiment, no information regarding the peer group selection,
for example, standard, procedure, and/or results, will be communicated
to claimant 16. This is to ensure that target claimant 16 and other
claimants 16 of claims 16 that have the possibility of being selected
into a peer group will not coordinate in a fraudulent type of actions,
which will be more difficult to detect.
[0034] According to one embodiment, in step S202a, sampler 144
first identifies a pool of all the claims 16 based on their homogeneity
in the sampling attributes as target claim 16. Next, sampler 144
selects among the pool those claims 16 that have already successfully
gone through subrogation processes (e.g., identified at least one
third party that is responsible for the claimed loss) to generate
a modified pool. According to one embodiment, sampler 144 only selects
claims 16 that were randomly selected to be subrogated to establish
the modified pool, to reduce systematic sampling errors, as is understandable.
Next, sampler 144 samples a peer group from the modified pool. One
reason for sampling a peer group from the modified pool is to save
system resources of computer system 100 (FIG. 2), for example, the
memory space required for further calculation. It should be understood
that in some situations, sampling may not be necessary or may not
be desirable. For example, if the modified pool itself is not big
or if the potential sampling errors are not acceptable, the modified
pool itself may be used as the peer group. The sampling may use
any now known or future developed methods of sampling, for example,
random sampling or representative sampling.
[0035] Next in step S202b, behavioral attribute identifier 145
identifies a set of claim attributes regarding which target claim
16, if it has subrogation potential, is expected to include similar
behavior as the peer group identified in step S202a. The identified
set of claim attributes is referred to as behavioral attributes,
for illustrative purpose only. For a specific target claim 16, it
may not be expected that it includes similar behaviors regarding
all claim attributes as the peer group, if it has subrogation potential,
instead it may be expected that target claim 16 includes similar
behaviors regarding some claim attributes as the peer group. In
addition, even if target claim 16 is expected to include similar
behaviors regarding all claim attributes, not all claim attributes
are of concern for target claim 16 in a specific evaluation.
[0036] According to one embodiment, the selection of behavioral
attributes may be based on statistical analysis of the peer group
behaviors regarding claim attributes. For example, a standard deviation
of the peer group behaviors regarding a specific claim attribute
may be compared to a threshold, for example, standard deviation
being less than 10 percent of mean. If the standard deviation of
the peer group behaviors regarding a specific claim attribute meets
the threshold, that specific claim attribute may be selected as
a behavioral attribute.
[0037] According to an alternative embodiment, the selection of
behavioral attributes may be based on identified "contributing"
claim attributes that are related to claim subrogation potential.
For example, if based on past records, it is established that a
set of claim attributes, for example, in the case of fire damage
in a house, time between loss and submission of claim and actions
taken after accident to reduce further loss are related to (contributing
to) the outcomes of claim subrogation processes, this set of claim
attributes may be selected, among others, as the behavioral attributes.
For another example, in the case of car accident, location of accident,
time between accident and report to insurer, amount of loss, whether
a third part was involved, whether a police report was filed, whether
claimant 16 was at fault, and number of parties involved may be
selected, among others, as the behavioral attributes. It should
be noted that any now known or later developed methods of selecting
behavior attributes are also included in the current invention and
may be used independently, or in combination, in selecting behavioral
attributes.
[0038] Please note, step S202b is not necessarily conducted after
step S202a. According to an alternative embodiment, claim subrogation
potential evaluating system 132 may identifies the behavioral attributes
before selecting a peer group. In this situation, the selection
of peer group may be based on a similarity between and among target
claim 16 and other claims 16 with respect to claim attributes other
than the set of behavioral attributes.
[0039] According to one embodiment, behavioral attribute data and
the subrogation result data may be arranged in a table. FIG. 5 shows
an illustrative example of the data table of an illustrative peer
group of car accident claims. Referring now to FIG. 5, as is understandable,
in a subrogation process, more than one subrogation solution may
be tried. For example, for a car accident claim (16), investigating
units 14 (FIG. 1) may attempt to identify the manufacturer of the
cars involved as responsible for the claimed loss (SUB_Manu), or
may attempt to identify another driver as negligence in causing
the accident (SUB_Driver). If a responsible third party is identified
through at least one of the subrogation solutions, claim 16 is considered
successfully subrogated. Subrogation results may be indicated by
binary codes. For example, as shown in FIG. 5, value "1"
may be used to indicate a positive subrogation result, e.g., successfully
identifies a responsible third party, and value "0" may
be used to indicate a negative subrogation result, e.g., no third
party is identified as responsible.
[0040] Next in step S202c, analyzer 146 determines a normal behavior
of the peer group selected in step S202a, regarding the set of behavioral
attributes identified in step S202b. In step S202c, analyzer 146
may also determines a relationship between the identified behavioral
attributes to the outcomes of subrogation.
[0041] Various methods may be used to determine the normal behavior.
According to one embodiment, the average of the behaviors of the
peer group regarding a behavioral attribute may be selected as the
normal behavior regarding this behavioral attribute. The average
of the peer group may be either the mean or the median depending
on a specific target claim 16 and a specific evaluation. According
to one embodiment, the mean of the behaviors of the peer group of
claims 16 is a better choice to be used as the normal behavior because
a standard deviation is calculated based on the mean, instead of
the median. As will be described below, a standard deviation may
be used in further analysis, such as a score normalization procedure.
It should be noted that any now existing and later developed methods
of determining a normal behavior are included in the scope of the
present invention.
[0042] According to one embodiment, the relationship between a
behavioral attribute and an outcome of subrogation may be determined
by determining a statistical relationship between a specific subrogation
solution and the behavioral attribute, such as a correlation or
a regression equation. For example, using the example of data table
shown in FIG. 5, the relationship between behavioral attribute "time
from accident to report" to subrogation outcomes may be determined
by determine a correlation between "time from accident to report"
and "Sub_Manu" and between "time from accident to
report" to "Sub_Driver". It should be noted that
any now known and later developed methods of determining a relationship
between a behavioral attribute and subrogation solutions are all
included in the present invention.
[0043] Please be noted, step S202 does not need to be conducted
after computer system 100 receives/collects all the data regarding
target claim 16. Instead, step S202 may be conducted any time before.
For example, an insurance company employing processing center 12
may established a peer group based on its own classification of
claims and obtain the normal behavior and the relationship between
behavior attributes and subrogation solutions before claim subrogation
potential evaluating system 132 is operated to evaluate the subrogation
potential of target claim 16. For example, the peer group and normal
behavior may be established during system setup, and may be saved
in database 128 for future reference.
[0044] It should be also noted, the procedure of the determination
of the relationship between a behavioral attribute and a subrogation
solution may also be used to select a behavioral attribute. For
example, a relationship between a claim attribute and a subrogation
solution may be used to determine whether the claim attribute can
be selected as a behavioral attribute. If it is determined that
the claim attribute is related to the outcome of the subrogation
solution, e.g., a correlation exists, the behavioral attribute can
be selected as a behavioral attribute.
[0045] Next in step S203, subrogation potential evaluator 148 evaluates
a subrogation potential of target claim 16. Specifically, in step
S203a, comparator 150 compares the behavior of target claim 16 with
the normal behavior determined in step S202 regarding each of the
identified set of behavioral attributes. The specific procedure
of the comparison depends on how the normal behavior is determined
in step S202c. According to one embodiment, if the normal behavior
is determined using the mean of the peer group behaviors regarding
each identified behavioral attribute, comparator 150 compares the
behavior of target claim 16 with the normal behavior with respect
to each of the identified set of behavioral attributes. The difference
between the behavior of target claim 16 and the normal behavior
with respect to each behavioral attribute may be converted into
a 0 to 1000 score, in a manner that a bigger difference is converted
to a higher score. It should be noted that any score normalization
procedures (methods) may be used in the conversion and is included
in the current invention. Because the details regarding the conversion
are not necessary for an understanding of the current invention,
no further details will be provided.
[0046] Next in step S203b, combiner 152 combines the comparison
results, i.e., the scores, with respect to each behavioral attribute
to generate an overall comparison result, i.e., a combined score.
A low combined score indicates that target claim 16 conforms to
the norm, which predicts that target claim 16 has the potential
of subrogation. Please note, the peer group is selected from claims
16 that have been successfully subrogated and the normal behavior
is the norm of claims that have subrogation potential. The combined
score may be compared to a threshold to determine whether target
claim 16 has the potential to be subrogated. If the combined score
is lower than the threshold, i.e., meets the threshold, target 16
is considered having subrogation potential and computer system 100
will communicate the result to claim subrogation implementation
unit 200 to implement a subrogation process (FIG. 1).
[0047] According to one embodiment, the combined scores of more
than one target claims 16 may be ranked in a list of claims waiting
for subrogation. Claim 16 with lowest combined score, i.e., highest
subrogation potential, is put on the top of the list. Due to limited
resources, an insurance company may not subrogate all of the target
claims 16, but will select claims 16 to be subrogated from the top
of the list.
[0048] According to one embodiment, the combined score is obtained
by averaging the scores obtained regarding each individual behavioral
attributes. According to an alternative embodiment, the score with
respect to a behavioral attribute is first weighed according to
the behavioral attribute's relative importance in evaluating subrogation
potential before the score is combined with others to obtain a combined
score.
[0049] In addition, an individual score regarding an individual
behavioral attribute may also be used to evaluate whether target
claim 16 has the potential to be subrogated for a specific subrogation
solution, if the behavioral attribute has been determined as related
to the specific subrogation solution, in step S202c.
[0050] The results of the evaluation, e.g., the combined scores
and the individual scores may be communicated to, for example, claim
subrogation implementation unit 200 (FIG. 1) though, for example,
evaluation results outputs 166. In addition, if the operation of
claim subrogation potential evaluating system 132 is provided as
a service to a customer insurance company, the results of the evaluation,
e.g., the individual and the combined scores, may be communicated
to the customer insurance company through, e.g., evaluation results
outputs 166.
[0051] With respect to the prospective analysis, according to the
embodiment shown in FIG. 3, step S300 includes two steps S301 and
S302. Please note, step S300 occurs before all claim attribute data
of target claim 16 have been collected. As such, according to one
embodiment, the prospective analysis operation only evaluates target
claim 16 regarding individual behavioral attributes, but not their
combination. In addition, results of the historic analysis, e.g.,
the peer group and the normal behaviors, may be used as a basis
for the prospective analysis.
[0052] Specifically, in step S301, suspect behavior detector 154
detects a suspect behavior of a target claim 16. According to one
embodiment, suspect behavior detector 154 compares the behavior
of target claim 16 to the normal behavior regarding the behavioral
attributes identified in step S202, using the available data of
target claim 16. If the comparison shows that target claim 16 includes
an suspect behavior, i.e., a behavior similar to the normal behavior,
regarding at least one behavioral attribute, which predicts subrogation
potential, the prospective analysis will proceed to step S302. If
the comparison shows that target claim 16 does not include a suspect
behavior regarding any of the behavioral attributes, based on the
available information, prospective analysis will pause to wait for
more information regarding target claim 16.
[0053] Next in step S302, prospective subrogation potential investigator
156 instructs investigating units 14 (FIG. 1) to investigate target
claim 16 purposefully regarding subrogation potential. For example,
if in step S301, target claim 16 is determined to include a suspect
behavior regarding a specific behavioral attribute that has been
determined in step S202c of the historic analysis to be related
to a specific subrogation solution, prospective subrogation potential
investigator 156 may instruct investigating units 14 to pay more
attention to investigate the potential of the specific subrogation
solution. For another example, if in step S301, target claim 16
is determined to include a suspect behavior regarding a specific
behavioral attribute that has not been determined in step S202c
of the historic analysis to be related to any specific subrogation
solution, prospective subrogation potential investigator 156 may
instruct investigating units 14 to pay generally more attention
to investigate subrogation potential.
[0054] Please note, in the description of the operation of claim
subrogation potential evaluating system 132, the historic analysis
(step S200) is discussed before the prospective analysis (step S300).
This order of description is used only for illustrative purpose
because the prospective analysis is based on the peer group and
the normal behavior determined in the historic analysis. However,
for the processing of a specific target claim 16 (FIG. 1), the prospective
analysis may occur before the historic analysis. For example, in
a computer system 100, the peer group and the normal behavior of
the historic analysis may have already been established (through,
e.g., a previous historic analysis operations or a system setup)
and are saved in database 128 (FIG. 2). Regarding a specific target
claim 16, claim subrogation potential evaluating system 132 may
first begin a prospective analysis using available information regarding
target claim 16 and may iterate the prospective analysis as more
information is collected until all the information required for
a historic analysis is collected, when evaluating system 132 may
begin and complete the historic analysis.
4. Conclusion
[0055] While shown and described herein as a method and system
for evaluating a subrogation potential of an insurance claim, it
is understood that the invention further provides various alternative
embodiments. For example, in one embodiment, the invention provides
a program product stored on a computer-readable medium, which when
executed, enables a computer infrastructure to evaluate a subrogation
potential of an insurance claim. To this extent, the computer-readable
medium includes program code, such as claim subrogation potential
evaluating system 132 (FIG. 2), which implements the process described
herein. It is understood that the term "computer-readable medium"
comprises one or more of any type of physical embodiment of the
program code. In particular, the computer-readable medium can comprise
program code embodied on one or more portable storage articles of
manufacture (e.g., a compact disc, a magnetic disk, a tape, etc.),
on one or more data storage portions of a computing device, such
as memory 120 (FIG. 2) and/or database 128 (FIG. 2), and/or as a
data signal traveling over a network (e.g., during a wired/wireless
electronic distribution of the program product).
[0056] In another embodiment, the invention provides a method of
generating a system for evaluating a subrogation potential of an
insurance claim. In this case, a computer infrastructure, such as
computer system 100 (FIG. 2), can be obtained (e.g., created, maintained,
having made available to, etc.) and one or more systems for performing
the process described herein can be obtained (e.g., created, purchased,
used, modified, etc.) and deployed to the computer infrastructure.
To this extent, the deployment of each system can comprise one or
more of: (1) installing program code on a computing device, such
as computing system 100 (FIG. 2), from a computer-readable medium;
(2) adding one or more computing devices to the computer infrastructure;
and (3) incorporating and/or modifying one or more existing systems
of the computer infrastructure, to enable the computer infrastructure
to perform the process steps of the invention.
[0057] In still another embodiment, the invention provides a business
method that performs the process described herein on a subscription,
advertising supported, and/or fee basis. That is, a service provider
could offer to evaluate a subrogation potential of an insurance
claim as described herein. In this case, the service provider can
manage (e.g., create, maintain, support, etc.) a computer infrastructure,
such as computer system 100 (FIG. 2), that performs the process
described herein for one or more customers and communicates the
results of the evaluation to the one or more customers. In return,
the service provider can receive payment from the customer(s) under
a subscription and/or fee agreement and/or the service provider
can receive payment from the sale of advertising to one or more
third parties.
[0058] As used herein, it is understood that the terms "program
code" and "computer program code" are synonymous
and mean any expression, in any language, code or notation, of a
set of instructions that cause a computing device having an information
processing capability to perform a particular function either directly
or after any combination of the following: (a) conversion to another
language, code or notation; (b) reproduction in a different material
form; and/or (c) decompression. To this extent, program code can
be embodied as one or more types of program products, such as an
application/software program, component software/a library of functions,
an operating system, a basic I/O system/driver for a particular
computing and/or I/O device, and the like. Further, it is understood
that the terms "component" and "system" are
synonymous as used herein and represent any combination of hardware
and/or software capable of performing some function(s).
[0059] The flowcharts and block diagrams in the Figures illustrate
the architecture, functionality, and operation of possible implementations
of systems, methods and computer program products according to various
embodiments of the present invention. In this regard, each block
in the flowchart or block diagrams may represent a module, segment,
or portion of code, which comprises one or more executable instructions
for implementing the specified logical function(s). It should also
be noted that, in some alternative implementations, the functions
noted in the blocks may occur out of the order noted in the figures.
For example, two blocks shown in succession may, in fact, be executed
substantially concurrently, or the blocks may sometimes be executed
in the reverse order, depending upon the functionality involved.
It will also be noted that each block of the block diagrams and/or
flowchart illustration, and combinations of blocks in the block
diagrams and/or flowchart illustration, can be implemented by special
purpose hardware-based systems which perform the specified functions
or acts, or combinations of special purpose hardware and computer
instructions.
[0060] The terminology used herein is for the purpose of describing
particular embodiments only and is not intended to be limiting of
the invention. As used herein, the singular forms "a",
"an" and "the" are intended to include the plural
forms as well, unless the context clearly indicates otherwise. It
will be further understood that the terms "comprises"
and/or "comprising," when used in this specification,
specify the presence of stated features, integers, steps, operations,
elements, and/or components, but do not preclude the presence or
addition of one or more other features, integers, steps, operations,
elements, components, and/or groups thereof.
[0061] Although specific embodiments have been illustrated and
described herein, those of ordinary skill in the art appreciate
that any arrangement which is calculated to achieve the same purpose
may be substituted for the specific embodiments shown and that the
invention has other applications in other environments. This application
is intended to cover any adaptations or variations of the present
invention. The following claims are in no way intended to limit
the scope of the invention to the specific embodiments described
herein. |