Abstract:
A system and method are provided for interactively managing information using a web site with submitter and receiver sides. A submitter provides information in connection with a transaction, such as processing an insurance claim. The information can be grouped in predetermined categories. The information recipient, such as a claims adjuster in the case of an insurance claim, can access the information via the receiver side of the web site. The information can be processed, e.g. adjusted, in connection with concluding the transaction. The web site can link to various other resources, which can provide additional information for use in connection with concluding the transaction.

Description:
BACKGROUND OF THE INVENTION  
       [0001]     1. Field of the Invention  
         [0002]     The present invention relates generally to interactive information management, and in particular to a system and method for submitting, verifying and processing insurance property loss claims via a web site selectively accessible by insureds/claimants and insurers, including carriers and claims adjusters.  
         [0003]     2. Description of the Related Art  
         [0004]     Various commercial transactions involve submitting and managing information. Commercial transactions generally involve two or more participants, each of whom performs a particular role in concluding the transaction. For example, in the insurance field the participants include: insurers, which provide loss indemnification insurance services; claims adjusters who review submitted claims; insureds; and others. When covered losses occur, insureds/claimants commonly submit claims to adjusters for processing and compensation for their losses.  
         [0005]     An insurance claim processing transaction generally includes the insured submitting information concerning the loss to the insurer, which may utilize the services of an independent claims adjuster. A large property loss claim can involve a significant amount of loss-related information, which must be collected, submitted, tabulated, verified and adjusted in order to conclude the adjustment process and saidtle the claim. For example, a claim involving damage to or the destruction of a structure and its contents tends to be a relatively time-consuming and labor-intensive claim to process. Such claims often arise under homeowners&#39; policies, which provide coverage for dwellings and their contents. A major loss resulting from a catastrophe such as a fire, a burglary or a natural occurrence can involve a large number of lost or damaged property items. Identifying and valuing those items previously consumed large amounts of time on the part of the adjusters and the insureds/claimants. Automating such procedures and providing convenient, interactive, on-line systems for exchanging and managing claims-related information could expedite and otherwise improve the process for both the insurers and the insureds/claimants.  
         [0006]     The prior art includes systems and methods for handling insurance claims with computer networks automating many of the information-processing procedures. For example, Chen et al. U.S. Pat. No. 5,504,674 disclose an insurance claims estimate, text and graphics network and method. Borghesi et al. U.S. Pat. No. 5,950,169 disclose a system and method for managing insurance claim processing. However, heretofore there has not been available a system and method for interactively managing information with the advantages and features of the present invention.  
         [0007]     The present invention addresses some of the time-consuming and labor-intensive aspects of information management, such as the processing of property loss claims under insurance policies.  
       SUMMARY OF THE INVENTION  
       [0008]     In the practice of the present invention, a system is provided for interactively managing information using a web site with submitter and receiver sides. A submitter provides information in connection with a transaction, such as processing an insurance claim. The information can be grouped in predetermined categories. The information recipient, such as a claims adjuster in the case of an insurance claim, can access the information via the receiver side of the web site. The information can be processed, e.g. adjusted, in connection with concluding the transaction. The web site can link to various other resources, which can provide additional information for use in connection with concluding the transaction. 
     
    
     BRIEF DESCRIPTION OF THE DRAWINGS  
       [0009]      FIG. 1  is a schematic block diagram of the major participants in an insurance claim processing transaction according to the method of the present invention.  
         [0010]      FIG. 2  is a flowchart of an initiation and set up phase of the method of the present invention.  
         [0011]      FIG. 3  is a flowchart of the insured side of an inventory portion of the method of the present invention.  
         [0012]      FIG. 4  is a flowchart of the insurer side of the inventory portion of the method of the present invention.  
         [0013]      FIG. 5  shows a login screen on the insured side of the web site.  
         [0014]      FIG. 6  shows a personal information screen on the insured side of the web site.  
         [0015]      FIG. 7  shows a screen for editing personal information on the insured side of the web site.  
         [0016]      FIG. 8  shows a screen for editing claim-related information from the insured side of the web site.  
         [0017]      FIG. 9  shows portions of screens displaying a categorized lost property listing, which can be accessed from the insured and insurer sides of the web site.  
         [0018]      FIG. 10  shows a screen on the insurer side of the web site for use in connection with adjusting a property loss claim.  
         [0019]      FIG. 11  shows a screen on the insurer side of the web site for providing an adjuster with a list of insured clients with open claim files. 
     
    
     DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS  
       [0000]     I. Introduction and Environment  
         [0020]     As required, detailed embodiments of the present invention are disclosed herein; however, it is to be understood that the disclosed embodiments are merely exemplary of the invention, which may be embodied in various forms. Therefore, specific structural and functional details disclosed herein are not to be interpreted as limiting, but merely as a basis for the claims and as a representative basis for teaching one skilled in the art to variously employ the present invention in virtually any appropriately detailed system or method.  
         [0021]     Referring to the drawings in more detail, the reference numeral  2  generally designates a claims management system (CMS) embodying the present invention. Without limitation on the generality of useful applications of the present invention, the disclosed embodiment comprises a system for managing information in connection with processing property loss insurance claims. Other types of systems and relationships among parties involving the exchange of information and commercial transactions based on same could utilize the system  2  of the present invention. For example, the system of the present invention can be utilized in connection with handling other types of insurance claims, such as life, health and disability. The system  2  includes a web site  4 , which can be subdivided into different parts for access by respective participants in the system  2 .  
         [0022]     The major participants in the system  2  and their interrelationships are schematically depicted in  FIG. 1 . An insurer  6  includes an insurance company or carrier  8  and an adjuster  10 . The carrier  8  and the adjuster  10  can be a single entity or separate entities. Within the insurance industry many carriers utilize the services of independent adjusters. The insurer  6  is linked to the claims management system  2  and the insurer side of the website  10 , e.g. via the Internet worldwide network or otherwise. An insured  12  can possess property  14 , which can be covered by an insurance policy provided by the insurer  6 .  
         [0023]     An optional property and casualty (P &amp; C) industry database  16  can be linked to the CMS  2  for access by the insurers  6 . The database  16  can receive, store, process and make available, under appropriate conditions, information relating to claims for use by insurers, who can subscribe to such services. Vendors  18  can link to both the CMS  2  and the insureds  12  for expediting the replacement of lost property with replacement items  20 . For example, vendors  18  can compensate the administrator of the CMS  2  for being linked thereto and for the referrals of insureds with property losses, which referrals can generate sales of replacement items  20 .  
         [0024]      FIG. 2  shows the process for initializing the CMS  2  and a claim, for example but without limitation a property loss claim. From a start at  22 , the process proceeds to an enroll clients/insurers step  24 , whereat insurance carriers are solicited to participate in the CMS  2 . Other types of clients could also enroll in and utilize the CMS  2 , such as insurance adjusters who could promote the superior service aspects of the CMS  2  in conjunction with marketing their claims adjustment services. The clients/insurers  6  are provided with unique identification codes at step  26 , which permit them to access an insurer side of the web site  4 . The web site can be customized for the clients/insurers  6  at  28 , for example by incorporating the logo and other identifying information for the insurance carriers  8 , the adjusters  10  or other entities utilizing the CMS  2 . The web site  4  can thus be customized to the specific requirements of the clients/insurers  6  and promote their respective products and services.  
         [0025]     Step  30  represents a loss by an insured  12 , which can result from various events, including major catastrophes such as fires, burglaries, natural occurrences, etc. The process then proceeds to step  32  whereat the insured/claimant  12  submits a claim to the insurer/carrier  6 , which refers the claim to an adjuster  10  at step  34 . The adjuster  10  can be an employee of the insurer  6 , or an independent adjuster who adjusts claims for one or more insurance carriers. If an independent adjuster is utilized (affirmative decision at  36 ) the process proceeds to  38  whereat the CMS  2  provides the insured  12  with a unique identification and password. A negative determination at  36  can proceed to  40  whereat a company&#39;s adjuster provides the insured  12  with a unique identification and password. It will be appreciated that various procedures and security measures can be implemented in connection with the issuance of user names and passwords for claims processing purposes. The CMS  2  automatically bills the insurer  6  a service charge at  42 , which can be based on ongoing periodic service fees, event-specific charges, licensing fees or other suitable compensation arrangements. The method proceeds to the loss inventory procedure at  44 .  
         [0026]      FIG. 3  shows the inventory loss procedure from the insured side of the web site  4 . The inventory procedure is shown at  46 . Without limitation on the various types of claim-related information that can be submitted by the insured  12  to the CMS  2 , the claim-related information can include categories (e.g., dwelling contents categorized by room, etc.), item descriptions, quantities, purchase location, purchase date, item age, original cost, payment method and an indication of whether or not the insured  12  has the original purchase receipt. The inventory procedure  46  can optionally include a procedure for checking pricing, e.g. by linking to vendors  18  of replacement items  20 . For example, a shopping cart type of replacement item pricing procedure can be utilized whereby replacement items are placed in a virtual shopping cart, which is “full” at the end of the inventory procedure. The inventory procedure  46  repeats if another item is to be submitted with the claim (affirmative branch from decision box  48 ). The negative branch from the decision box  48  leads to an optional CMS  2  link to vendors  18  at  50 , whereby the insured  12  can be referred to appropriate vendors  18  of replacement items for those lost.  
         [0027]      FIG. 4  shows the inventory loss procedure from the insurer side of the web site  4 . The completed loss inventory is automatically submitted to the adjuster  10  on the insurer side of the web site  4  at  52 . The CMS  2  can optionally automatically apply depreciation to the lost property inventory according to policy depreciation guidelines at  54 . The total claim is tabulated at  56 , based on, for example, actual cash value (ACV), replacement cost (RC), claims reserves, etc. Unusually high values for individual items can be flagged at  58 . For example, all items with replacement costs exceeding a predetermined amount can be automatically flagged for verification. Moreover, categories of items can be examined for total purchases during predetermined time periods, such as all clothing purchases on a yearly basis. Total purchase amounts which are unusually high or exceed guidelines could automatically caused the category to be flagged for further inquiry, verification and possible adjustment. The CMS  2  can automatically apply predetermined guidelines based on reasonable expectations of purchases on a categorical and yearly basis. The CMS  2  can thus provide a control function in connection with adjusting insurance claims and preventing excessive claim settlements. The adjuster  10  edits the claim and verifies pricing at  60  and makes an actual cash value determination at  62 . Based on the adjustment, payment can be provided to the insured at  64  and the lost items replaced at  66 . Item replacement can be accomplished through an optional on-line electronic shopping function via links to vendors  18  of replacement items  20 . According to the claims adjustment procedures followed by the insurer  6 , receipts may be submitted to the adjuster at  68 , who can provide an update of the replacement cost (RC) to the CMS  2  at  70 . The CMS  2  can provide reminders to the insured  12  at  72 , for example if requested information has not been received for a predetermined period of time, whereby the CMS  2  generates appropriate reminders. Reports of the claim saidtlement can be generated at  74  according to the procedures of the insurer  6 , which can require such reports at predetermined intervals. Appropriate letters, reports, reminders and other types of information can optionally be automatically generated and submitted to the appropriate recipients by the CMS  2 . For example, the insured  12  can receive periodic reminders advising him or her that the claim file is still open and identifying the number of items pending, paid, etc. Optionally, information pertaining to the claim can be submitted to the P &amp; C industry database  16  at  76 , whereafter the procedure proceeds to close the file at  78 , ending the claim management process.  
         [0028]      FIG. 5  shows a screen display from the insured side of the web site  4 . Insured login information, including username and password, can be submitted to the CMS  2  via this screen. Other menu options can be provided for obtaining and submitting other types of information, as shown. Also, the screen display of  FIG. 5 , like the other screen displays accessible through the CMS web site  4 , can be provided with text and graphics identifying one or more of the insurer  6 , the insurance company  8  and/or the adjuster  10 , including appropriate links, contact options, etc.  FIG. 6  shows a display screen for the insured side, which displays a profile including his or her personal information.  FIG. 7  shows a screen for editing the insured&#39;s profile, e.g. with updated personal information. Such information is typically obtained and recorded by the insurers  6 , which could enter same on the insurer side of the web site  4 . Alternatively, such personal profile information could be submitted and/or edited by the insureds  12 .  
         [0029]      FIG. 8  shows a screen display for interactively adding a lost or damaged item of insured property to a claim from the insured side of the web site  4 . The display shown therein is an example of a type of screen display that can be used for interactively submitting claim information for a personal property item under a homeowner&#39;s policy. Various other types of information could be submitted in various other formats within the scope of the present invention. A product category is first chosen from a list of categories of household items. Submitted items are thus categorized. Item-specific information is then submitted, including description, quantity, where purchased, when purchased, age when purchased, original cost, estimated replacement cost, payment method and an indication of the availability of a receipt. When the insured finishes submitting the categorized lists of damaged or lost items, a comprehensive insurance claim inventory report is generated, as shown in  FIG. 9 . Various information can be tabulated and displayed, including item number, description, quantity, unit cost, total original cost and replacement cost. The insurance claim inventory is submitted to the adjuster  10  for review, verification, adjustment and claim payment. The inventory thus also becomes accessible via the insurer&#39;s side of the web site  4 . The inventory can assume various formats and information displays as required. The procedure for submitting lost property claims can interactively utilize the Internet worldwide network. Other interaction methodologies can also be utilized, such as telephonic, etc.  
         [0030]      FIG. 10  shows a screen on the insurer side of the web site  4 , which can be utilized by the adjuster  10  in connection with adjusting a property loss claim. Without limitation, the information entered can include: item number; description; quantity; original cost (unit cost); replacement cost (unit cost); depreciation percentage, depreciation total; ACV total; and ACV paid. All such information can be submitted and processed prior to the damaged or lost items being replaced. After replacement, additional information can be submitted, which can include: actual RC; replacement due; RC paid; and comments. The CMS  2  can provide control over the inventory and claim adjustment process whereby claim limits, reserves, depreciation schedules and guidelines are automatically imposed. However, the CMS  2  can enable the adjuster  10  to override such controls with manual entries and to provide comments in the comment column explaining such manual overrides. Thus, the insurer  6  can establish claim adjustment procedures with the ability to override same when necessary. The comments of the adjuster  10  can provide documentation and justification for such overrides. The CMS  2  thus provides security for its administrator, particularly in the event claims are settled for amounts in excess of the predetermined guidelines (e.g., in certain categories) of the insurer  6 , because a record is made of the adjuster&#39;s comments justifying such manual overrides. The screen shown in  FIG. 10  can provide the adjuster  10  with a number of other functions, such as retrieving claim-related information by history, date, reserve, item (e.g., go to item), etc.  
         [0031]      FIG. 11  shows a screen on the insurer side of the web site  4 , which can provide the adjuster  10  with lists and status information pertaining to insureds that he or she is working with, and status information concerning their open claim files. The CMS  2  can provide an archive function via the screen shown in  FIG. 11  whereby the insureds/claimants files can be archived, e.g., if they are inactive or closed.  
         [0032]     It is to be understood that the invention can be embodied in various forms, and is not to be limited to the examples discussed above. Other components and configurations can be utilized in the practice of the present invention.