|
Insurance Abstract
There is disclosed a system that enables an efficient and flexible
way to provide automated rating and underwriting based on a specific
set of rules. The system includes a software running on a centralized
or distributed computing system and accessing different databases.
The software system can be access by insurance carriers and their
agents located in one single location or distributed geographically.
Insurance Claims
1. A system for improving insurance quoting and underwriting, the
system interfacing with a remote server, the system comprising:
a policy administration module for implementing core policies and
client customization and outputting a client policy; a billing module
for generating a bill to each client according to the client policy;
a claims module for processing claims according to core claims features,
the claims module further being capable of customizing according
to each individual client policy; and an interface module for sending
and receiving information from the remote server.
2. The system of claim 1, further comprising a reinsurance module
for implementing reinsurance.
3. The system of claim 1, wherein the policy administration module
further being capable of providing automated rating.
4. The system of claim 3, wherein the policy administration module
further being capable of displaying rating information to a user.
5. The system of claim 1, wherein the billing module further being
capable of agency billing, direct billing, and account billing.
6. The system of claim 1, wherein the claims module further being
capable of litigation tracking.
7. A method for improving insurance quoting and underwriting, the
method comprising the steps of: receiving customer information;
customizing customer information according to core policies; outputting
a client policy; and generating a bill according to the client policy.
8. The method of claim 7, further comprising the steps of: Transmitting
customer information to a remote server; and retrieving a quote
information from the remote server.
9. The method of claim 7, further comprising the steps of: generating
a rating information; and displaying the rating information.
10. The method of claim 7, wherein the step of generating a bill
further comprising the steps of: generating an agency bill; generating
a direct bill; and generating an account bill.
Insurance Description
RELATED APPLICATION
[0001] This application claims benefits of the U.S. Provisional
Patent Application No. 60/776,020, titled "System For Automated
Insurance Underwriting," filed on Feb. 23, 2006; this application
is also a continuation-in-part of a U.S. patent application Ser.
No. 10/008,182, titled "System And Method For Interactively
Evaluation A commercial Risk Insurance," filed on Nov. 9, 2001,
which claims the benefit of the U.S. Provisional Patent Application,
60/247,364, filed on Nov. 9, 2000. The specifications of three prior
applications are incorporated herein in their entirety by this reference.
BACKGROUND OF THE INVENTION
[0002] 1. Field Of The Invention
[0003] The present invention generally relates to a computer system
implementing a process related to the issuance of insurance policies.
More specifically, the present invention is an automated system
and method for underwriting insurance policies.
[0004] 2. Description of The Related Arts
[0005] Due to changes in the insurance marketplace, it is advantageous
to employ an aggressive, competitive initiative in re-positioning
insurance products and the internal processing of those products
based on a specific set of rules for quoting, underwriting, printing,
and administering an insurance policy. Consequently, insurance carriers
and their agents must analyze data from various sources and react
appropriately. This data analysis from constantly increasing data
sources makes the insurance agent's job increasingly difficult and
costly.
[0006] Therefore, it is desirous to have a system capable of performing
automated rating and underwriting based on a specific set of rules
that streamlines the process for quoting, underwriting, printing
and administering a policy. Such system should access the appropriate
database and gather the optional data to improve the ability for
insurance carriers and agents to analyze data and react appropriately,
and it is to such system and method that this invention is primarily
directed.
SUMMARY OF THE INVENTION
[0007] In one embodiment, there is a system for streamlining insurance
quoting and underwriting process, the system interfacing with a
remote server. The system includes a policy administration module
for implementing core policies and client customization and outputting
a client policy, a billing module for generating a bill to each
client according to the client policy, a claims module for processing
claims according to core claims features, and an interface module
for sending and receiving information from the remote server. The
claims module is further capable of customization according to each
individual client policy.
[0008] In another embodiment, there is a method for improved insurance
quoting and underwriting. The method includes the steps of receiving
customer information, customizing customer information according
to core policies, outputting a client policy, and generating a bill
according to the client policy.
[0009] Other advantages and features of the present invention will
become apparent after review of the hereinafter set forth Brief
Description of the Drawings, Detailed Description of the Invention,
and the Claims.
BRIEF DESCRIPTION OF THE DRAWINGS
[0010] FIG. 1 is an architecture of a system according to one embodiment
of the invention.
[0011] FIG. 2 is an interface architecture between a main application
and a client application according to one embodiment of the invention.
[0012] FIG. 3 is a flow chart for a client process according to
one embodiment of the invention.
DETAIL DESCRIPTION OF THE INVENTION
[0013] In this description, the term "exemplary" means
that the disclosed element or embodiment is only an example, and
does not indicate any preference of user. Further, like numerals
refer to like elements throughout the several views, and the articles
"a" and "the" includes plural references, unless
otherwise specified in the description.
[0014] In overview, the system and method enables an efficient
and flexible way to provide automated rating and underwriting based
on a specific set of rules. The system includes a software running
on a centralized or distributed computing system and accessing different
databases. The software system can be access by insurance carriers
and their agents located in one single location or distributed geographically.
FIG. 1 illustrates a system architecture 100 supporting the present
invention. The system includes a software-based application interfacing
with different system players. The application takes inputs from
different databases (policy tables, billing information) and provides
outputs to different users in the insurance industry. The system
may be a single application or a centralized server application
interfacing with different distributed client applications. FIG.
2 illustrates a centralized server application 202 interfacing with
a client application 204. The centralized server application is
capable of interfacing with more than one client application at
the same time. The client application 204 is shown with five internal
modules: policy administration module, billing module, claims module,
reinsurance module, and interface module.
[0015] The server application 202 includes the following features:
[0016] 1. Tables [0017] System Tables--Both standard system-defined
and user-maintained [0018] Profiles [0019] Error Log [0020] Commission
Packages [0021] Custom Tables (such as Cause of Loss, Bank Account
and SURE related tables) [0022] 2. Settings [0023] Application Settings--System
settings that incorporate user-defined parameters. [0024] Number
Control--Settings to define the Policy numbering schema selected
by the Client [0025] 3. Security--User security to be set by function
or transaction for all employees entered into User Profile, including
agency designation for agency level security settings [0026] 4.
Direct access to the Policy, Billing, Claims and Cash Disbursement
modules [0027] 5. Name and Address Search--Ability to access information
by name or address [0028] 6. Account Reference View--Ability to
view Notes, Diary, Tasks, Policy Activity, Policy Action, Policy
Log and Suspended Transactions for all policies linked by a user
established Account Reference Number. [0029] 7. Locality Search
(Mapping Software)--Ability to view geographic location of a risk
based on address [0030] 8. View of Policy Activity, Policy Action,
Policy Log and System Action [0031] 9. Diary--Ability to enter and
view diary entries at an account, policy, claim or claimant level.
[0032] 10. Notes--Ability to enter and view Notes at an account,
policy, claim or claimant level. [0033] 11. Task Pad--Ability to
enter, display and maintain user tasks [0034] 12. Reports--On-demand
and scheduled report generation for all systems supplied reports
[0035] 13. Agency Transfer--Ability to transfer individual policies
or an Agency's book of business to another agency. [0036] 14. Bulk
Lien Holder Transfer--Ability to transfer policies from an existing
Additional Interest profile to a new profile. [0037] 15. Word Merge
(works with Microsoft Word)--Ability to merge pre-defined system
information into user created Word templates [0038] 16. SURE launch
pad and rule establishment [0039] 17. Auto Renewal/Non-renew rule
creation and editing--Ability for user to enter and maintain processing
rules regarding the generation of renewals and non-renewals [0040]
18. Prorata calculation tool--Calculates factor based on entered
effective and expiration dates. [0041] 19.Account Reference Link--Ability
for a user to set up an account to link policies in the system together
[0042] 20.View Rating Tables [0043] 21. Suspended Transaction Table
[0044] 22. Purge--Ability to purge both Quote and Diary entries
[0045] 23. XML View--Ability to view policy XML generated by the
system [0046] 24. On-line Help System
[0047] The Policy Administration Module (also known as policy rating
and issuance module) includes core policy features and client policy
customizations.
The core policy features include:
[0048] 1. Policy processing including the following policy transactions:
[0049] a. Quote Processing [0050] i. Incomplete Quote [0051] ii.
Issue Quote [0052] iii. Amend Quote [0053] iv. Quote As (iterative
quoting) [0054] v. Reject Quote [0055] b. Application Processing
[0056] i. Issue Application [0057] ii. Amend Application [0058]
iii. Decline Application [0059] iv. Application As (iterative applications)
[0060] c. Binder Issuance [0061] d. New Business Issuance [0062]
e. Amendment Processing [0063] i. Sequential amendments [0064] ii.
Out of Sequence Amendments [0065] iii. Cross Term Amendments [0066]
f. Cancellation Processing [0067] i. Flat [0068] ii. Pro rata [0069]
iii. Short rate [0070] iv. Equity based [0071] v. Cancellations
imported from ancillary source [0072] g. Reinstatement Processing
[0073] i. Flat [0074] ii. Pro rata [0075] iii. Short rate [0076]
iv. Reinstate with lapse [0077] h. Renewal Quote [0078] i. Amend
renewal quote [0079] ii. Issue renewal quote [0080] i. Renewal Issuance
[0081] i. Manual renewal [0082] ii. Automated renewal [0083] j.
Cancel/Rewrite Processing (i.e. policy is cancelled flat, new quote
is created, user updates quote and updated quote is re-issued with
original policy number) [0084] 2. Automated rating including the
following features: [0085] a. On screen viewing, printing, faxing
and exporting of Rating Worksheets showing summary, pro rata and
detail premium calculations. [0086] b. Automatic generation of quote,
application, binder and policy number according to client specifications.
[0087] c. "Soft" and "hard" underwriting edits
(as specified in Business Design Specifications) [0088] d. Drop
down menus for selections and default settings. [0089] e. "Required
field" edits by policy transaction [0090] f. Multi-location
quoting/rating (as specified in Detail Business Requirements) [0091]
g. Honoring of quotes restricted by date [0092] h. Calculation of
premium adjustments including taxes, acquisition fees, surcharges,
discounts and state pool assignments [0093] i. Ability to exclude
drivers on auto policies [0094] j. Ability to assign a pay plan
to a policy [0095] k. Ability to override agency commission on a
per policy and/or line of business basis [0096] 1. Ability to handle
various policy terms (as specified in the Detail Business Requirements)
[0097] m. Reinsurance indicators within the policy module to process
applicable reinsurance [0098] 3. Policy output declarations (as
specified in the Detail Business Requirements) [0099] 4. Policy
History (View, print or inquire against multiple historical versions
of the policy) [0100] 5. Policy Actions (non-amendment updates to
policies) [0101] a. Inspection Tracking [0102] b. Underwriter assignment/status
[0103] 6. SURE (System Underwriting Rules Enforcer) [0104] a. User
configured and maintained underwriting rule tables [0105] b. Manual
and automated application of rules [0106] c. Activity results and
reports The client policy customizations include: [0107] 1. Automated
application of multiple rate plans and program tiers (based on requirements
study) [0108] 2. Automated application of multiple rate revisions
(as specified in the Detailed Business Requirements) [0109] 3. Generation
of policy forms and notices [0110] 4. Customer Service Inquiry Screen
[0111] 5. Support for multiple underwriting companies.
[0112] The Billing Module includes the following baseline functionalities
and features.
Core Billing Features:
[0113] 1. Agency Billing Functionality [0114] a. Account Current
Statements (as specified in the detail client requirements) generated
according to client configuration [0115] b. Flexible Cash application
[0116] c. Unmatched Cash acceptance [0117] d. On-line view of agency
billed policies and cash applied [0118] e. Write Off capabilities
[0119] 2. Direct Billing Functionality [0120] a. Automatic assignment
of pay plan and application of fees [0121] b. Override pay plan
and due date utility [0122] c. Automatic generation of bills and
notices (output to be specified in detail client requirements) [0123]
d. Reprint Bills [0124] e. Manually generated bills [0125] f. Stand
alone billing for amendments [0126] g. Flexible cash input and application
[0127] h. Unmatched cash acceptance [0128] i. Payments Inquiry [0129]
j. Equity cancellation [0130] k. Billing Inquiry [0131] I. Automated
tolerance and manual write off [0132] m. Automatic non-payment cancellation
notification to policy administration system [0133] n. Agency Commission
Statements [0134] o. Non-Sufficient Funds (NSF) charge for returned
checks [0135] p. Late payment fees [0136] q. Balance Brought Forward
(BBF) at renewal [0137] 3. Account Billing Functionality [0138]
a. Generation of invoices by Account (output to be specified in
Business Design Specifications) [0139] b. Billing Inquiry by Account
[0140] 4. Interface with Cash Disbursement System (CDS) for creation
of checks [0141] a. Agency Commission Checks (output to be specified
in the detail client specifications) [0142] b. Return Premium Checks
(output to be specified in the detail client specifications) [0143]
5. Assignment of General Ledger Accounts at the Line of Business
level [0144] 6. Client configured option tables scoped by Company,
State, Product, Program and Bill Type where applicable [0145] 7.
User/administrator control of invoice and report generation Client
Billing Customizations: [0146] 1. Electronic Funds Transfer (EFT)
(See Interface Module) [0147] 2. Non Sufficient Funds (NSF) [0148]
a. Processing of NSF checks in accordance with Insurance Carrier
business rules [0149] 3. Lockbox Processing (See Interface Module)
[0150] 4. Additional flexibility in the application of installment
fees [0151] 6. Selection of repetitive monthly due date [0152] 7.
First installment surcharge [0153] 8. Application of cash in order
of fees, premium and surcharges (if any) [0154] 9. All date fields
must offer calendar date selection
[0155] The Claims Module includes the following baseline functionalities
and features.
Core Claims Features:
[0156] 1. New Claims processing [0157] a. Policy verification [0158]
b. Capture of: [0159] i. First notice of loss information [0160]
ii. Claimant information [0161] iii. Loss description including
location [0162] iv. Parties to Loss information [0163] c. Catastrophe
Tracking [0164] d. Service Provider selection [0165] e. Claims Professional
assignment [0166] f. Line of business and cause of loss assignment
[0167] g. Reserve assignment (including averaging and defaults according
to client configuration) [0168] h. "Record only" claims
[0169] 2. Loss Summary entry for bulk transaction recording [0170]
3. Payment processing including the following transactions [0171]
a. Scheduled recursive payments [0172] b. Deferred Payments--combine
payment transactions across multiple claims for a single payee [0173]
c. Consolidated Payments--consolidate payments within a claim into
a single payment [0174] d. Partial Payments (both reducing reserves
and not affecting reserves) [0175] e. First and Final Payments [0176]
f. Closing Payments [0177] g. Closing Without Payments [0178] h.
No payment (recording payment without creating an accounting transaction)
[0179] i. Void payment reserve reinstate [0180] j. Void payment
no reserve reinstate [0181] 4. Salvage and subrogation at LOB level
[0182] a. Description, total estimated value, estimated cost of
recovery, etc. [0183] b. Salvor information [0184] c. Salvage Item
schedule [0185] d. Salvage owner information [0186] e. Salvage reserve
entry for salvage expense reserving, salvage expense payments (e.g.:
fees), and salvage recoveries. [0187] f. Tortfeasors information
(subrogation only) [0188] g. Other insurance information (subrogation
only) [0189] 5. Litigation tracking [0190] a. Capture details including:
[0191] i. Litigation type, dates filed, served, hearing, etc. [0192]
ii. Litigation attorney information [0193] iii. Court information
[0194] iv. Litigation service providers [0195] v. Settlement offers
[0196] vi. Judgment information [0197] 6. Activity log at each level
of claim [0198] 7. Claims Inquiry [0199] 8. Display of Claims based
on various fields such as policy, insured, etc. [0200] 9. Claim
screen navigation via the Claim Center [0201] 10. Interface to Cash
Disbursement System (CDS) for manual and automated check writing
(as documented in the detail client specifications) [0202] 11. Client
configured authority access and authority amount permissions tables
[0203] 12. Capture of 1099 Information Client Claim Customizations:
[0204] 1. Modify the granting of authority override limits from
that of a claim level to that of a transaction level [0205] 2. Default
to "check" option for all entries where check/draft appear
[0206] 3. Remove the option for "record only" claims [0207]
4. Make "city" a mandatory field for accident and claimant
addresses [0208] 5. Report date, at all hierarchical levels, is
to default to the current date
[0209] The Reinsurance Module includes the following baseline functionalities
and features: [0210] 1. XML Based messaging for modularity. [0211]
2. User maintainable tables include: [0212] a. Reinsurance Companies
[0213] b. Broker/Reinsurance Intermediaries [0214] c. Treaty Reinsurance
Contracts [0215] d. Facultative Reinsurance Contracts [0216] e.
Treaty Participant Schedules [0217] f. Schedule of Approved Facultative
Reinsurers [0218] g. Broker/Reinsurance Commissions [0219] 3. Handles
ceded reinsurance contracts. [0220] 4. Facultative Reinsurance handling
system. [0221] 5. Facultative certificate information can be enforced
from Policy System. [0222] 6. Facultative and other forms of reinsurance
are evaluated for claims processing. [0223] 7. Automatically cedes
premium for Facultative, Quota Share, Surplus Share and other types
of pro-rata treaty reinsurance [0224] 8. Maintains the minimum and
deposit premium information for Excess of Loss and Catastrophe reinsurance
[0225] 9. Provides accounting reports for tracking the actual Excess
of Loss premium [0226] 10. Able to flexibly handle multiple levels
of reinsurance protection based on the contract criteria and processing
hierarchy. i.e. combinations of Facultative, Pro-rata and Excess
of Loss contracts protecting the same risk at different levels [0227]
11. Automatically cedes Loss Reserves and Paid Loss and LAE for
all types of reinsurance [0228] 12. Checks all claim transactions
for associated reinsurance [0229] 13. Generates periodic premium
and loss bordereaux reports (optional) [0230] 14. Generates Notice
of Loss, Proof of Loss and Ceded Reserve Change forms [0231] 15.
Maintains aged reinsurance balances at the participant level [0232]
16. Maintains all data necessary to produce Schedule "F"
[0233] 17. Portfolio Transfers feature (optional) [0234] 18. Processes
Run-offs [0235] 19. Facilitates Commutation activity support [0236]
20. Ceded transactions are maintained at the detail level for reporting
and auditing. [0237] 21. Balancing and edit controls. [0238] 22.
Allows for manual entry of reinsurance
[0239] The Interface Module includes the following client features:
[0240] 1. IVANS Download--Two stage process. First stage is getting
the legacy systems to feed the Download for Personal Auto (separate
Statement of Work) and then implement the download through once
PPA is in production. The next stage would include the downloading
of Property (HO, MH & DF) once these lines are in production
in the system. It would include certifications for Applied, AMS
AFW, AMS Prime, Doris and Agency Advantage. [0241] 2. Combined Printing
Interface--The ability to receive XML based files which contain
information from multiple sources and combine data onto a single
A/C Statement, Commission Statement or bill when there is specified
matched criteria. Phase I of this interface is being handled under
a separate Statement of Work and will combine multiple sources of
data within existing IH (insurance carrier) systems. Phase II will
include source data as part of combined printing. [0242] 3. Feed
to OSCAR--A monthly extract of name entity data from will be provided
that will be processed by the OSCAR System for the purpose of automated
verification of named entities against the current OFAC/SDN list.
[0243] 4. Imaging Interface--Multi-phase project. Phase I will be
the transmittal of Declarations for policy transactions to the Imaging
system with the appropriate indexes. (Billing and Claims imaging
requirements will be handled under a separate SOW or Change Request.)
[0244] 5. Web PPA Rating: IDP will provide a replacement for the
this product will be the acceptance of data input in the Accuauto
comparative rating product through a "bridge" that IDP
will provide.
[0245] The Web PPA product will allow agencies to rate and issue
policies fed directly into the system as well as provide MVR, Credit
Score, ADD, CLUE, and APLUS reporting capabilities. [0246] 6. ALIR
(Automobile Liability Insurance Reporting) (GA, NC, DC, VA &
SC)--Using the IVANS ALIR software, IDP shall translate insurance
transactions including new business, cancellation and error/verification
into the proprietary state format and transmit it via SFTP. Errors
reported by the DMV will be handled by insurance carrier personnel.
[0247] 7. ALIR Error Reporting to Agencies--ISP shall produce a
report to present the errors returned from the ALIR reporting [0248]
8. ChoicePoint (Scorecard)-- [0249] a. MVR (Motor Vehicle Reports):
order MVRs from ChoicePoint for policies upon request and upon renewal,
and store the rating data elements with the policy. The text of
all the data returned with the MVR shall be stored and available
for viewing in a text format. [0250] b. Credit Score: order Credit
Scores from ChoicePoint for policies upon request and upon renewal,
and store the rating data elements with the policy. The text of
all the data returned with the Credit Score will be stored and available
for viewing in a text format. [0251] c. ADD (Additional Driver Discovery):
order Additional Driver Discovery data from ChoicePoint for policies
upon request and upon renewal. The text of all the data returned
with the ADD will be stored and available for viewing in text format.
[0252] 9. CLUE (Comprehensive Loss Underwriting Exchange)--Monthly
feed of Claims data to CLUE [0253] 10. CLUE--Accessing CLUE reports
from within the Policy Tree during Auto and Property policy entry
[0254] 11. Aplus (Automobile-Property Loss Underwriting Service)--Monthly
feed of Claims data to Aplus [0255] 12. Aplus--Accessing APLUS reports
from within the Policy Tree during Auto and Property policy entry
[0256] 13. ISO (Insurance Services Organization) VinMaster--For
the supplemental files and years that Insurance Carrier has licensed
from ISO, IDP shall return Vehicle Series Rating symbol based upon
the VIN (Vehicle Identification Number) entered. A VIN/Symbol lookup
feature will also be available. [0257] 14. Sungard (GL Feed)--IDP
shall provide an XML to the Sungard General Ledger package which
will provide the information necessary to record financial transactions.
[0258] 15. Sungard AP--IDP will provide a feed from the CDS (Cash
Disbursement System) to the Sungard AP System for Billing and Claims
checks. [0259] 16. Agent Bank Account Sweeps (Two phase project)--Phase
I shall be creating an input file in the Cash Input XML format of
payments entered via the web rating application, and providing a
payment file to be processed through the IH cash sweeping mechanism.
[0260] 17. Feed to Datamart--An extract of standard policy and claims
XML will be provided to feed the insurance carrier datamart. [0261]
18. Do Not Insure file-A file containing Names and reasons for not
wanting to insure someone. Names will have effective/expiration
dates and a notes field. The names will be checked when name entities
are entered into the Policy system [0262] 19. NCMS (National Cash
Management Systems) ACH (Automatic Clearing Carrier)--Electronic
transfer of funds including credit card, check and debit processing,
for Account Current (A/C) and Direct Bill (DB) Bill Types. [0263]
20. Lockbox--Billing Module will accept the automated import of
cash from the designated IH payment processing facility. [0264]
21. Web Property Rating: IDP will provide a web product similar
to the PPA Rating product for the purpose of agency entry of HO,
MH and DF product lines. [0265] 22. Appraisals/Inspections (Reliable
Reports)--An interface that is provided through Reliable Reports,
Inc. They state the following "Reliable Reports, Inc. receives
orders from customers in a variety of ways. Many clients order directly
through our website. Larger customers send data files. We can support
almost any format of data file transfer." [0266] 23. FNOL (First
Notice of Loss)--shall accept an electronic import of the First
Notice of Loss for all lines of business. [0267] 24. ISO Index Bureau--Daily
feed of Claims data to bureau. [0268] 25. ISO Index Bureau--Accessing
Bureau information from within the Claims System [0269] 26. Diamond
Triumph (Glass loss assignment)--Diamond Triumph entry of all FNOL
for glass claims directly into the system with coverage verification.
[0270] 27. North Carolina Reinsurance Facility--The creation of
a daily flat file (80 character, fixed length) that contains Record
ID, State & Company Codes, Effective, Expiration & Cession
dates, Designated Indicator, Class, BI, PD, MED, UM BI, UM/UIM and
UM or UM/UIM PD Limits codes, Transaction Code, Policy number and
Insured name.
[0271] The Bureau Reporting Services will include full bureau reporting
including generation, balancing, edit and correction of required
bureau output for premium and loss data processed via the System.
[0272] The following optional functions can also be supported by
the system: [0273] 1. Insurance Carrier's definition of its Business
Requirements [0274] 2. Creation of Acceptance Test Cases and expected
results [0275] 3. Acceptance Testing [0276] 4. Incorporating changes
to the specifications, design, and coding that result from a change
in Insurance Carrier's Business Requirements once those Requirements
are received. [0277] 5. Support for error correction and debugging
as a result of Insurance Carrier providing data not in conformance
to specifications [0278] 6. Conversion of policy, billing, reinsurance
or claims data (to be handled under a separate SOW) [0279] 7. IVANS
Upload (uploading of data from agency management systems) [0280]
8. Work effort, resources, and/or costs of Third Party services
not specifically included in this document [0281] 9. Claims processing
associated with claims made policies
[0282] The following additional features and options can be made
to the present system: [0283] 1. Imaging Interface for workflow
for policy and claim triggers. [0284] 2. Web Portal Presentation
Layer that can be coded to be used as a single sign-on, single point
of entry for agents into the various systems provided by an insurance
carrier. [0285] 3. IVR (AGNES)--an extract of policy, billing and
claims data to the AGNES database for the purpose of IVR inquiries.
[0286] 4. Agent Bank Account Sweeps [0287] 5. Rules based assignment
to adjusters based on line, state and geography. [0288] 6. Premium
Finance Interface--Cancellation & Reinstatement processing.
[0289] 7. Claims (CCC Information Services, Inc.)--An interface
that is provided through CCC Information Services, Inc. whose headquarters
are in Chicago, Ill. They state the following "CCC Autoverse.TM.
provides an open environment enabling the efficient exchange of
data between insurers and appraisal sources for quicker claim resolution.
The CCC Pathways.RTM. Collision Estimating product has nearly 20,000
insurers and repair facilities installations in the U.S. CCC also
pioneered value added network communications between the industry
participants involved in claims settlement. The EZNet.RTM. network
handles an average of more than one million claims-related transactions
each business day." [0290] 8. Appraisals (RTS)--an interface
to RTS to order Commercial Lines inspections. [0291] 9. History
View--Additional customized feed of billing data to the datamart
[0292] The system must be able to process approximately 10,000
claims transactions per month (including opens, closures, adjustments,
stop-pays, other). To handle such volume of claim transactions the
system has the following input, output, and security requirements.
The input requirements, according to one embodiment of the invention,
are as follows. [0293] 1. Policy data for all lines of business
will be input via agency web users and IH data entry personnel for
new business, amendment and renewal processing. [0294] 2. Web PPA
rating system [0295] 3. Web Property rating system [0296] 4. Payment
upload from Agent Account Sweep, Lockbox and EFT Processing
[0297] The following output types, volumes and frequencies to be
supported. TABLE-US-00001 TABLE 2 Type of Output Volume Frequency
Billing Notices 51,000 Monthly Return Premium 100-200 Daily Checks
Commission Checks 600+ Monthly Claims Payments 100-200 Daily Policy
Output supporting the Annually Declarations/forms following transaction
activity: 70,720 new policies Approx. 70,000 renewals Approx. 4900
cancellations Approx. 66,000 amendments
[0298] The system should have security that provides the ability
for insurance carrier to control access to functionality by individual
user at an individual function level, e.g. quote or issue. The level
of access will be established and maintained by authorized personnel
through updates to the Main Application's security profiles.
[0299] One exemplary embodiment of the system is described below.
First certain terms are defined as follows: [0300] DBR--Detailed
Business Requirements [0301] BDS--Business Design Specifications
[0302] PPA--Private Passenger Automobile [0303] DG3--Delivery Group
3 [0304] IH--Insurance Carrier [0305] LOB--Line of Business [0306]
CLUE--Comprehensive Loss Underwriting Exchange [0307] ADD--Additional
Driver Disclosure
[0308] The exemplary embodiment provides processing and rating
of the Private Passenger Automobile (PPA) Line of Business, along
with interfaces to ancillary programs, within the Policy Module
of the Policy Management System. This exemplary system provides
automated rating and underwriting based on IH specific rules, streamline
the process for quoting, underwriting, printing and administering
a policy, and improve the ability of IH and their agents to analyze
data and react appropriately. This exemplary embodiment pertains
specifically to the PPA Line of Business.
[0309] The detailed business processing requirements of the exemplary
embodiment are listed below. [0310] 1. The scoping provided for
Insurance Carrier Georgia Private Passenger Auto within the Policy
Module is as follows: [0311] a. Company: Southern General Insurance
Company [0312] b. State: GA [0313] c. Product: PPA [0314] d. Program:
PPA [0315] 2. Data entry screens within the Policy Module for the
PPA Line of Business. [0316] 3. A unique Quote/Application and a
unique Policy Number are issued from within. These numbers will
be system generated by the system according to the following requirements:
[0317] a. Quote Number Assignment--Quotes and Applications will
have unique Symbols but will share number assignment. The beginning
quote should start with the automatic system assignment of Q00000001
and increment by one with each new quote. [0318] b. Application
Number Assignment--If the Application began as a Quote, change the
Q Symbol in the quote number to A and continue with the same number.
If the Application is new, the Symbol will be an A and the number
will be the next available number. [0319] c. Policy Number Assignment--The
IH policy number is comprised of a five position prefix identifying
the line, state and company, followed by a one position type indicator
and ending in a seven position sequential number. The system will
automatically generate this policy number. It is not necessary to
allow the manual input of a policy number by a system user. Whenever
the policy number is printed on a document, it should be displayed
with a space between the 5 digit prefix and the last 8 numbers.
[0320] 1. The system shall assign a 13 digit policy number formatted
as follows: [0321] First two (2) digits would represent the product
line: [0322] 15 Private Passenger Auto [0323] 22 Homeowners [0324]
35 Mobile Homeowners [0325] 45 Dwelling Fire [0326] 55 Commercial
Auto [0327] 65 Commercial Property [0328] Next two (2) digits would
represent the State/Region code: [0329] 01 Alabama [0330] 10 Georgia
[0331] 32 North Carolina [0332] 39 South Carolina [0333] 45 Virginia
[0334] 08 Washington DC [0335] The digit would represent the Company:
[0336] 9 Southern General Insurance Company (SGIC) [0337] 8 Southern
General Underwriters Insurance Company (SGUIC) [0338] 7 Southern
General Indemnity Insurance Company (SGIIC)
[0339] For PPA, the 8 digit policy specific number should begin
with a 1 if it is a renewal from the Legacy system and 2 if it is
new business on the system. The next seven digits should be sequentially
issued starting at 0050001. Once the policy number reaches 9999999,
the next number would be issued using a 3 as the first digit. [0340]
Example: The first new business SG GA PPA policy written in GA would
be 1510920050001: [0341] 15--Private Passenger Auto [0342] 10--Georgia
[0343] 9--Southern General Insurance Company [0344] 20050001 (Policy
Number 1)
[0345] The Legacy number schema will not be generated through ACIES
but will be generated through the renewal conversion process. [0346]
4. Automated rating according to IH requirements as specified in
the PPA Rating Specifications. [0347] 5. Insurance Carrier offers
various pay plan options dependent upon policy type. IH will be
provided the ability to enter applicable credit card and EFT account
information, although EFT and credit card processing will not be
available within the system until DG 4. Entry of an EFT or credit
card Payment Method will require the input of additional account
information to be used with future Installment EFT transactions.
Down Payment will be entered directly into either the Billing Module,
the agency Web PPA application or the agency Account Management
facility.
[0348] a. The Billing Options and Payment Method available for
new and renewal business are as follows: TABLE-US-00002 New Business
Billing Options: Payment Method: N1 Paid in Full Other N2 Two Pay
Other N5 Five Pay Other/EFT/Credit Card*
[0349] TABLE-US-00003 Renewal Business Billing Options: Payment
Method: R1 Paid in Full Other R2 Two Pay Other R5 Five Pay (Variable)
Other/EFT/Credit Card* R6 Six Pay (Variable also) Other/EFT/Credit
Card*
[0350] b. The selection of the Paid in Full Billing Option provides
the policy with a discount. It will be necessary for the user to
re-rate the policy after this selection in order to view the discounted
premium. [0351] C. If the N5 or R5 Billing Option is selected, the
user will also have the additional flexibility of entering a Bill
Due Date from day 1 to day 28.
[0352] This date will be used to specify the day of the month on
which each installment payment is due. This date can be up to 14
days prior to the system calculated due date and up to 14 days greater
than the system calculated due date. [0353] d. Each Billing Option
includes a down payment premium percentage.
[0354] The installment requirements shall be defined in the Create/Maintain
Pay Plan Table within the Billing Configuration Tables. Selection
of the N5 Billing Option provides for a variable down payment percentage
based on the existence of two elements of underwriting criteria--Credit
Score and Proof of Prior. [0355] The applicable rules used in determining
the Down Payment are as follows: For New Business: [0356] 1. If
Credit Score for the Named Insured is above 705, the Down Payment
is 20%, with the remaining 80% spread evenly across the remaining
four installments. [0357] Else [0358] 2. If Proof of Prior exists
with a lapse of less than or equal to 30 days, the Down Payment
is 22%, with the remaining 78% spread evenly across the remaining
four installments. [0359] Else [0360] 3. If none of the above applies,
the Down Payment is 25%, with the remaining 75% spread evenly across
the remaining four installments. [0361] All R5 pay plans shall provide
20% down, with the remaining 80% spread evenly across the remaining
four installments (unless the down payment is modified as a result
of the variable due date).
[0362] If the Bill Due Date entered is greater than the system
calculated second installment due date, the calculated Down Payment
shall be increased by 0.55% for each day the due date has been extended.
[0363] e. It is necessary to provide a view of the applicable installment
schedule within PPA via the View Installment button once the Billing
Option, Payment Method and Bill Due Date have been entered. The
user will need to validate the installment schedule as this is the
installment schedule that will be passed to the Billing Module as
part of the Policy to Billing XML and used for all installment billing.
[0364] 6. The system will supply rating worksheets at both the summary
and detail level including pro rata premium calculations for amendments.
It is the IH requirement that the worksheet shall contain the following
data elements: [0365] a. Quote Effective Date [0366] b. Policy Term
[0367] c. Insured Name [0368] d. Coverage Limits [0369] e. Agency
Information [0370] f. Drivers [0371] Age [0372] Sex [0373] Marital
Status [0374] Class [0375] Violation Points [0376] Excluded [0377]
SR-22 [0378] SR-22A [0379] Citizen [0380] Handicapped [0381] Inexperienced
[0382] U/W Tier [0383] Financial Responsibility Tier [0384] Market
Tier [0385] All applicable Discounts individually [0386] g. Vehicles
[0387] Age [0388] Description [0389] Territory [0390] ISO Symbol
[0391] LPMP Class [0392] Business Use [0393] Physical Damage Deductibles
for each vehicle. [0394] h. Driver/Vehicle Assignment [0395] i.
Punitive Damage exclusion [0396] j. Premium for each Vehicle and
Coverage type [0397] k. Coverage Base rates [0398] l. Payment methods
[0399] m. Disclaimers [0400] The rating worksheet should also show
all of the factors associated with each one of the rating variables
above.
[0401] 7. Premium generated by the Premium Module for PPA should
be mapped to the following Line of Business (LOB) coverage designations
as shown in Table 3. TABLE-US-00004 TABLE 3 LOB Company Product
Program Coverage elements Fee? Name State SGIC PPA PPA Bodily Injury
FALSE Liability SGIC PPA PPA Property Damage FALSE Liability SGIC
PPA PPA Medical Payments FALSE Medpay SGIC PPA PPA Family Financial
Help FALSE FFH GA SGIC PPA PPA Uninsured/Underinsured Motorists
FALSE UM Bodily Injury SGIC PPA PPA Uninsured Motorists Property
FALSE UM Damage SGIC PPA PPA Other Than Collision FALSE PhysDam
SGIC PPA PPA Collision FALSE PhysDam SGIC PPA PPA Towing and Labor
FALSE PhysDam SGIC PPA PPA Rental Reimbursement FALSE PhysDam SGIC
PPA PPA Customizations FALSE PhysDam SGIC PPA PPA SR-22 TRUE SR22
SGIC PPA PPA SR-22A TRUE SR22A SGIIC PPA PPA PIP FALSE PIP DC SGIC
PPA PPA PIP FALSE PIP SC, VA SGIC PPA PPA APIP - Medical Expense
FALSE PIP SC SGIC PPA PPA APIP - Extra Medical Expense FALSE PIP
VA SGIC PPA PPA PIP Work Loss Benefit FALSE PIP VA
[0402] 8. In addition to the worksheet, the system will supply
the required IH PPA documents as specified in the PPA Output BDS
document. [0403] 9. IH has contracted to use an underwriting tool
to provide the liability and physical damage symbols. In addition,
the underwriting tool provides the ability to update data regarding
vehicle descriptions and specifications in the underwriting of their
private passenger auto program. The system will validate whether
the VIN number entered is valid. If the VIN number entered is valid,
the system will populate the vehicle description, optional equipment
and symbol information in the appropriate fields. Should the system
return that the entered VIN number is not valid the User will be
notified and can select the ? button which follows the VIN number
field, this will allow the user to enter the Year and Make of the
vehicle for the look-up. If the VIN was not able to be validated
and the user wanted to accept the VIN, the system will track this
item and generate the appropriate memo. The models and body types
associated to the year and make will be displayed in drop down boxes
for selection. [0404] The following information will be retained
by the system even though there are no specific fields on the vehicle
screen: [0405] a. County Wide Performance [0406] b. Special Vehicle
Group [0407] c. Four Wheel Drive Indicator [0408] d. Engine Cylinders
[0409] e. Engine Type [0410] f. Engine Size [0411] g. Special Information
[0412] h. Model Series Information [0413] i. Body Information [0414]
j. Engine Information [0415] k. Restraint Information [0416] I.
Transmission Information [0417] m. Not Classified Info
[0418] The improved insurance quoting and underwriting process
described above can be summarized through an exemplary client process
of FIG. 3. When a customer needs an insurance service, the customer
approaches an insurance agent, step 302. The insurance agent takes
customer information and input it into the client application resident
on a client terminal at the insurance agent's office, step 304.
The customer information is used to retrieve a quote from a remote
server, step 306. The customer information may be customized according
to core policies, step 305, before being sent to the remote server
and used to generate a customized client policy, step 308. The customized
client policy is used to generate a customized bill, step 310. The
customized client policy is also used later to handle claims and
customizing the claims.
[0419] While there has been shown a preferred embodiment of the
present invention, it is to be appreciated that certain changes
can be made in the form and arrangement of the elements and steps
of the method without departing from the underlying spirit and scope
of the invention.
|