WO2002084439A2 - Systems and methods for electronic claims processing - Google Patents
Systems and methods for electronic claims processing Download PDFInfo
- Publication number
- WO2002084439A2 WO2002084439A2 PCT/US2002/011594 US0211594W WO02084439A2 WO 2002084439 A2 WO2002084439 A2 WO 2002084439A2 US 0211594 W US0211594 W US 0211594W WO 02084439 A2 WO02084439 A2 WO 02084439A2
- Authority
- WO
- WIPO (PCT)
- Prior art keywords
- arbitrator
- receiving
- processing
- digital data
- information
- Prior art date
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Classifications
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- G—PHYSICS
- G06—COMPUTING; CALCULATING OR COUNTING
- G06Q—INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR ADMINISTRATIVE, COMMERCIAL, FINANCIAL, MANAGERIAL OR SUPERVISORY PURPOSES; SYSTEMS OR METHODS SPECIALLY ADAPTED FOR ADMINISTRATIVE, COMMERCIAL, FINANCIAL, MANAGERIAL OR SUPERVISORY PURPOSES, NOT OTHERWISE PROVIDED FOR
- G06Q10/00—Administration; Management
- G06Q10/10—Office automation; Time management
Definitions
- the present invention relates generally to systems and methods for claims processing. More particularly, this invention relates to systems and methods for electronic claims processing.
- the U.S. Postal Service (USPS), an independent establishment of the executive branch of the U.S. Government, provides many features through a variety of document and package delivery services.
- USPS like many other organizations, has extensive claims processing requirements.
- a parcel is damaged in transit, the receiver makes a claim.
- the claim is typically processed manually.
- the receiver fills out paperwork and brings the damaged parcel into a center.
- the center personnel look at the parcel and then forward the claim to a manual-processing center. If the processing center personnel wish to dispute a claim's validly, further investigation may be needed. However, often the damaged parcel is either unavailable or discarded by the time of the investigation.
- the personnel who originally looked at the damaged parcel may be unavailable due to relocation or retirement.
- the Internet fueled by the phenomenal popularity of the World Wide Web (WWW or the "web"), has also exhibited exponential growth over the past few years, giving many users access to an electronic network.
- WWW World Wide Web
- users need only standard computer equipment, such as a personal computer with a display and modem, and an Internet connection.
- ISPs Internet Service Providers
- To use an Internet connection from an ISP for example, the user causes the personal computer to connect electronically to a computer at the ISP's facility using the modem and a communication channel, such as a standard telephone line, DSL line, or a CATV cable.
- the ISP's computer in turn provides the user with access to the Internet.
- the user accesses information on the web using a computer program called a "web browser," such as the Netscape NavigatorTM from Netscape Communications Corporation or Internet Explorer from Microsoft Corporation.
- a web browser such as the Netscape NavigatorTM from Netscape Communications Corporation or Internet Explorer from Microsoft Corporation.
- the user inputs to the web browser a Uniform Resource Locator (URL) identifying an object on the Internet, for example, a document containing claims processing information.
- URL Uniform Resource Locator
- the web browser retrieves the web page and displays it for the user.
- the invention provides systems and methods for electronic claims processing.
- a method for electronic claims processing includes receiving information regarding a claim through an electronic form.
- the method further includes receiving digital data associated with the claim.
- the method further includes electronically transmitting the information and the digital data to an arbitrator.
- the method further includes electronically receiving a determination from the arbitrator.
- FIG. 1 shows a block diagram of an exemplary system in which methods and system consistent with the invention may be implemented.
- FIG. 2 shows an internal block diagram of an exemplary computer system in which methods and system consistent with the invention may be implemented.
- FIG. 3 shows a block diagram of a claim form that can be used with methods and systems consistent with the invention.
- FIG. 4 shows a flowchart of an exemplary method for performing electronic claims processing.
- FIG. 5 shows a flowchart of another exemplary method for performing electronic claims processing.
- FIG. 1 is block diagram of an exemplary system 100 in which methods and apparatus consistent with the invention may be implemented.
- System 100 includes a user 110 and an arbitrator 130 connected by a claims processing center 120.
- a third party 160 may be connected to the claims processing center 120.
- Claims processing center 120 includes an image center 140 and a claim processing system 150.
- User 110 can be a receiver of merchandise who experiences an incident, such as a damaged parcel.
- User 110 may be an individual or a business.
- Arbitrator 130 maybe a neutral third party, such as an arbitrator, adjuster, or adjudicator that can facilitate the response to the incident.
- Third party 160 may be the sender of the parcel.
- Third party 160 may also be the shipper of the parcel, such as USPS, United Parcel Service of America, Inc., or Federal Express®.
- the incident may be damage to the parcel, which leads to a claim by the user for compensation for the damage, such as monetary compensation or the replacement of merchandise.
- User 110, arbitrator 130, and third party 160 may use a personal computer, such as Apple PowerMacintoshes or Pentium-based personal computers running a version of the Windows operating system, workstation, or other appropriate types of computers.
- the connection between claims processing center 120 and the computers used by user 110, arbitrator 130, and third party 160 may be through a network which is TCP/IP based, wireless, or any kind of digital network connection, such as the Internet, a wide area network (WAN), a local area network (LAN) or a proprietary network.
- the communication can be conducted through a web-based environment in which the communications are transmitted via HTTP protocol.
- claims processing center 120 may have two parts: image center 140 and claim processing system 150.
- claims processing center 120 is a computer-based system that facilitates claim processing.
- claims processing center 120 uses physical locations to facilitate claim processing.
- Image center 140 and claim processing system 150 could be separate systems or part of one integrated center.
- Image center 140 may be a physical site that is constructed to generate digital data. The digital data may be still images of a damaged parcel taken from different viewpoints, audio recordings, digital video recordings, computer simulations of events, or any other type of digital data related to a claim.
- Image center 140 may include devices for generating digital data, such as digital cameras, video recorders, audio recorders, and computers running software that enables the generation of computer simulations.
- Image center 140 could be found in trusted locations such as post offices, banks, or other locations.
- the physical site may also include personnel to help user 110 generate the digital data.
- image center 140 is an image-processing center that is capable of receiving digital data from user 110.
- the digital data may be an image taken by a digital camera connected to a computer used by user 110 and sent to image center 140.
- Image center 140 may include a processing system for verifying the image and to insure that improper manipulations have not been made to the digital data.
- Claim processing system 150 may be a computer system. Claims processing system 150 generates claim forms, receives claim data from user 110, stores claim data, links claim data to digital data, creates claim reports, forwards claim reports to arbitrators, receives determination reports from arbitrators, and publishes claim results. Claim processing system 150 handles all the processing necessary to allow for the determination of responses to a claim made by user 110. Claims processing center 150 may be implemented as a web site which displays web-based forms for which information can be entered on-line, a computer program running on a computer at a physical site that allows for personal to enter information for non- computer savvy people, or a physical location that allows users to enter the information for themselves at the locations. Claim processing system 150 may be one computer or a number of computers connected together to form a system. Each computer can control specific tasks or they can all function independently.
- claims processing center 120 comprises a postal kiosk locate, for example, in a post office, a shopping mall, an office-building lobby, or other mutable locations. Attached to the postal kiosk is a digital camera performing the function of image center 140, describe above. Inside the postal kiosk is a computer system performing the function of claims processing system 150. Claims processing system 150 generates electronic forms for a user to fill out, links the images captured from the digital camera to the form, and facilitates communication with arbitrator 130 through a network connection.
- FIG. 2 is an internal block diagram of an exemplary computer system 200 in which methods and system consistent with the invention may be implemented.
- Computer system 200 may represent the internal components of claim processing system 150, image center 140, claims processing center 120 or the computers that may be used by user 110, arbitrator 130, or third party 160 in FIG. 1.
- Computer system 200 includes several components all interconnected via a system bus 260.
- Bus 260 may be, for example, a bi-directional system bus that connects the components of computer system 200.
- bus 260 may contain thirty-two address lines for addressing a memory 265 and thirty-two bit data lines for transferring data among the components.
- multiplex data/address lines may be used instead of separate data and address lines.
- Computer system 200 may communicate with other computing systems via network interface 285, examples of which include Ethernet or dial-up telephone connections.
- Computer system 200 contains a central processing unit (CPU) 255 connected to a memory 265.
- CPU 255 may be a microprocessor such as the
- Memory 265 and cache memory 290 may include a random access memory (RAM), a read-only memory (ROM), a video memory, or mass storage.
- RAM random access memory
- ROM read-only memory
- Memory 265 may contain a program, an application programming interface (API), and other instructions for performing the methods consistent with the invention.
- API application programming interface
- FIG. 3 is a block diagram of an exemplary claim form 300.
- Claim form 300 allows for the entry of information necessary for user 110 to make a claim request.
- Claim form 300 may include entry boxes for Claimant Details, such as the name of Person Reporting Claim 310, Telephone number (including dialing code) 320, E-mail address 330, Postal Address 340, Transit Detail 350, and Description of Claim 360.
- Claim form 300 may include other entry boxes that are not shown for gathering any other details necessary for processing a claim.
- Claim form 300 may be an electronic form that appears as a web page on a web browser.
- claim form may be an electronic form that appears on a computer in claims processing center 120.
- Claim form 300 may be a standard claim form used by claims processing center 120 or it may be a form generated specifically for each claimant based on the specifics of the claim.
- FIG. 4 shows a flowchart of an exemplary method for performing electronic claims processing.
- the claim processing center receives claim information from user 110 (step 410).
- the claim information can be received through user 110 entering data into an electronic claim form 300.
- Digital data related to the claim is received (step 420).
- the digital data may be an image file, a video file, a computer based simulation, an audio file or any other type of digital data that may be helpful for to the arbitrator in processing the claim.
- the digital data and the claim information are then associated, or linked, to form a complete claim request (step 430).
- the claim request is then forwarded to an arbitrator (step 440).
- the claim request can be forwarded to arbitrator 130 by electronically transmitting to the arbitration an email message that includes a hyperlink to a claim complete claim request page, which includes an area for arbitrator to enter a determination.
- the claim request can be a "live" claim request and the arbitrator can view the claim information being entered and the linked digital data and forwarding the claim request to the arbitrator involves informing the arbitrator of the need to view the claim information.
- the determination from the arbitrator can be in the form of an electronic written report or a simple check of YES or NO in a check box viewable by the arbitrator.
- the determination from the arbitrator completes the claim process.
- the user can be informed of the result by, for example, electronic publication.
- FIG. 5 shows a flowchart of an alternate exemplary method for performing electronic claims processing.
- a third party such as a sender, is part of the claim process.
- the claim processing center receives a claim from user 110 (step 510).
- the claim may be for a shipment of glassware that arrived damaged.
- An image file is received (step 520).
- the image file may include an image of the box containing the glassware and an image of the damaged glassware.
- the damaged package may be imaged it before the package is delivered.
- a record may be created to be used in the arbitration process.
- the carrier could image all packages when they are picked up and when they are delivered, and this information may be stored for a set period of time.
- Electronic notification is sent to third party 160 (step 530).
- the claim processing system may send a copy of the claim from user 110 to the sender of the glassware, third party 160.
- Information is then received from the third party 160 (step 540).
- Third party 160 information may include the sender's shipping information, the sender's insurance information, the value of the merchandise, and/or the sender's standard shipping procedure.
- the claim report is then sent for arbitration (step 550).
- the claim report may include the original claim request from the user, images of the damaged glassware and shipping material, and the third party sender's information. The arbitrator may use this information to come to a determination of how to respond to the claim.
- the arbitrator may determine that the glassware was damaged in transit, the receiver damaged the glassware, the glassware was not properly packaged according to sender procedure, or any other type of claim determination, including value of loss and how to respond to the loss. [036]
- the arbitrator creates a determination report based on their findings, which is received by claims processing center 120 (step 560). Once received, the parties can view the results, along with all the factual inputs on-line.
- the method may be applied to the auto insurance industry.
- Insurance companies may equip remote sites or garages with online video devices or still cameras, forming their own system of image centers 140.
- a user may fill out an on-line form, then may be directed to take the damaged car to claims processing center 120, which is located in a pre-selected garage.
- the car may be imaged from all angles and even underneath.
- the images and form may be sent to the arbitrator 130.
- authorization to perform the work may be granted. This process may reduce the cost of having claims adjustors at multiple remote sites.
- every U.S. Post Office may be equipped with an inexpensive digital camera.
- the customer may complete the claims process before leaving left the Post Office, by having the packaged imaged, the form filled out and arbitration happen by use of a postal kiosk or the help of postal employees.
Abstract
Description
Claims
Priority Applications (2)
Application Number | Priority Date | Filing Date | Title |
---|---|---|---|
AU2002256199A AU2002256199A1 (en) | 2001-04-13 | 2002-04-15 | Systems and methods for electronic claims processing |
US10/474,722 US20040117329A1 (en) | 2002-04-15 | 2002-04-15 | Systems and methods for electronic claims processing |
Applications Claiming Priority (2)
Application Number | Priority Date | Filing Date | Title |
---|---|---|---|
US28336001P | 2001-04-13 | 2001-04-13 | |
US60/283,360 | 2001-04-13 |
Publications (2)
Publication Number | Publication Date |
---|---|
WO2002084439A2 true WO2002084439A2 (en) | 2002-10-24 |
WO2002084439A3 WO2002084439A3 (en) | 2003-11-06 |
Family
ID=23085671
Family Applications (1)
Application Number | Title | Priority Date | Filing Date |
---|---|---|---|
PCT/US2002/011594 WO2002084439A2 (en) | 2001-04-13 | 2002-04-15 | Systems and methods for electronic claims processing |
Country Status (2)
Country | Link |
---|---|
AU (1) | AU2002256199A1 (en) |
WO (1) | WO2002084439A2 (en) |
Citations (5)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US20020002475A1 (en) * | 2000-04-13 | 2002-01-03 | Joel Freedman | Automated insurance system and method |
US20020035488A1 (en) * | 2000-04-03 | 2002-03-21 | Anthony Aquila | System and method of administering, tracking and managing of claims processing |
JP2002092154A (en) * | 2000-09-12 | 2002-03-29 | Nri & Ncc Co Ltd | Medical bill exchange system |
US20020040351A1 (en) * | 2000-09-29 | 2002-04-04 | Masaaki Nishikiori | Mediation negotiating method, negotiation responding method, and computer-readable recording medium storing program for the same therein |
US20020120588A1 (en) * | 2000-11-03 | 2002-08-29 | Preist Christopher William | Method and apparatus for negotiation |
-
2002
- 2002-04-15 AU AU2002256199A patent/AU2002256199A1/en not_active Abandoned
- 2002-04-15 WO PCT/US2002/011594 patent/WO2002084439A2/en not_active Application Discontinuation
Patent Citations (5)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US20020035488A1 (en) * | 2000-04-03 | 2002-03-21 | Anthony Aquila | System and method of administering, tracking and managing of claims processing |
US20020002475A1 (en) * | 2000-04-13 | 2002-01-03 | Joel Freedman | Automated insurance system and method |
JP2002092154A (en) * | 2000-09-12 | 2002-03-29 | Nri & Ncc Co Ltd | Medical bill exchange system |
US20020040351A1 (en) * | 2000-09-29 | 2002-04-04 | Masaaki Nishikiori | Mediation negotiating method, negotiation responding method, and computer-readable recording medium storing program for the same therein |
US20020120588A1 (en) * | 2000-11-03 | 2002-08-29 | Preist Christopher William | Method and apparatus for negotiation |
Also Published As
Publication number | Publication date |
---|---|
WO2002084439A3 (en) | 2003-11-06 |
AU2002256199A1 (en) | 2002-10-28 |
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