Patent Publication Number: US-2022237563-A1

Title: System and method for appraising damage claims

Description:
FIELD OF THE INVENTION 
     The present invention pertains generally to methods and procedures for the in-house processing of insurance claims for property damage. More particularly, the present invention pertains to in-house processing procedures wherein employees of an insurance carrier are dispatched by the carrier to gather the information and documents needed to characterize the nature, extent, and probable cause of the property damage. The present invention is particularly, but not exclusively, useful as a method and procedure for processing insurance claims using exclusively in-house employees of the insurance carrier to appraise property damage. 
     BACKGROUND OF THE INVENTION 
     Heretofore, insurance claims for property damages have been processed, in part, using field and independent adjusters. From the perspective of the insurance carrier, the process has frequently been time consuming, and not always directed to the legitimate concerns of the carrier. Furthermore, control over a process where field and independent adjusters are involved has often been tenuous. This diminished control is all the more problematic when it is recognized that the evaluation and assessment of the data ultimately required to make an appraisal of the damages is directly dependent on the accurate, complete and timely collection of relevant data. 
     In recent years, data collection devices have been developed to the point where data that is pertinent to an evaluation of property damages can be effectively collected and evaluated very efficiently and accurately. Importantly, data collection and evaluation functions are not labor-intensive, and they can be performed using well known techniques and devices. For example, 3D cameras that can effectively visualize a property damages site are commercially available from manufacturers such as “Matterport”. Further, insurance claims estimating software is also available from commercial entities such as “Xactimate”. With such tools, a direct coordination of in-house adjustors with other in-house personnel who gather, collect and organize the physical, administrative and regulatory documentation needed to prepare a comprehensive appraisal of property damages, simplifies control and enhances efficiency. 
     In light of the above, it is an object of the present invention to process an insurance claim quickly and efficiently using only employees of the insurance carrier. Another object of the present invention is to maintain direct operational control over the gathering of all information that is needed to prepare a comprehensive appraisal for a damage claim. Yet another object of the present invention is to provide a methodology for efficiently winnowing and coalescing both cause and effect factors for an appraisal of actual property damages in a timely manner, that is comprehensive, accurate and fair for the claimant. Still another object of the present invention is to provide a methodology for preparing an appraisal for property damages that is easy to implement, is simple to use, and is cost effective. 
     SUMMARY OF THE INVENTION 
     In accordance with the present invention, a method is provided for use by an insurance carrier to process an insurance claim completely in-house. In response to a claim, the first step in the methodology of the present invention is to dispatch an investigator to the site where the property damages have allegedly occurred. Gathering information at the site that is pertinent for an evaluation of the damaged property requires making an initial estimate of the extent of property damage. Also, information that is helpful for identifying the relevant cause and effect factors needed to initially determine whether property damage at the site was an unexpected loss can be collected. 
     In detail, the information to be gathered during a field investigation will include a detailed property description, e.g. i) personal residence(s), ii) buildings and edifices, iii) vehicle(s), iv) conveyances, and v) infrastructures. Additionally, information gathering at the site will also require identifying the age, condition, extent, and relative location of the damaged property at the site. Also, information pertaining to the cause of the property damage, i.e. i) fire, ii) water, iii) explosion, iv) impulse forces, and v) other cause(s) with an appropriate description are needed. In general, the nature and extent of damage can be recorded by taking in-situ photos, preparing sketches and maps, and obtaining claimant and witness comments regarding incidents and recollections before and after the property damage. 
     Once on-site data has been collected, it is next necessary to establish a firm estimate of the extent of property damage at the site, and to evaluate the information to identify the relevant cause and effect factors for the property damage. This evaluation will typically also include i) reviewing police records and reports, ii) considering claimant and witness comments, iii) analyzing pertinent financial information, and iv) referencing relevant documentary evidence. 
     An important function in the methodology of the present invention is to factorize the collected data into cause and effect factors. The cause and effect factors are then respectively winnowed to discard nonessential factors and to focus on the pertinent factors that are necessary for determining a probable cause for the property damage (cause factors) and for determining the resultant effect(s) of the causation (effect factors). In this process, the cause factors are evaluated by considering the nature of actual damages to identify a most probable cause for the damages. Additionally, the effect factors are assessed by considering the nature of the actual damages to determine an origin of the actual damages during this process. Together the result is a cause and origin report which will be used to substantiate whether the property damage is an unexpected loss. 
     In the process of preparing an appraisal report for implementing a proposed course of action by the insurance carrier to settle the claim, it may be necessary to review previously archived reports that may be pertinent to the damaged property, client profile information, and causation and origin factors. The present invention envisions that a computer may be helpful for this purpose. Also, a computer may be helpful for coalescing data factors into cause and effect categories for evaluating the insurance claim in the appraising step. Once the appraisal has been completed it is preferable that a copy of the appraisal report be placed in an archives for future reference. 
    
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
       The novel features of this invention, as well as the invention itself, both as to its structure and its operation, will be best understood from the accompanying drawings, taken in conjunction with the accompanying description, in which similar reference characters refer to similar parts, and in which: 
         FIG. 1  is a flow chart showing the steps taken by an insurance carrier for an in-house processing of an insurance claim; and 
         FIG. 2  is a functional flow chart showing computerized tasks to be accomplished for converting field data into documentation for a subsequent property damage appraisal. 
     
    
    
     DESCRIPTION OF THE PREFERRED EMBODIMENTS 
     Referring initially to  FIG. 1  a method for the in-house processing of an insurance claim for property damage is shown and is generally designated  10 . As shown, the method  10  begins when a claim is submitted to the insurance carrier (see block  12 ). The first affirmative step for the insurance carrier is to then dispatch personnel to the field site where the alleged damage has occurred (see block  14 ). At the field site, an investigator(s) will gather information that is pertinent for an evaluation of the damage (see block  16 ). In detail, this information gathering step (block  16 ) will include identifying an age, condition, extent, and relative location of the damaged property at the site. It will also include recording the nature and extent of damage; taking in-situ photos; preparing sketches; and recording claimant and witness comments regarding incidents and recollections before and after the property damage. 
     Along with the information gathered at the field site (block  16 ), the method  10  further requires an off-site assessment/evaluation of the damage. Additional information for this purpose can be obtained from sources beyond the field, such as reviewing police records and reports, considering claimant and witness comments, analyzing pertinent financial information, and referencing relevant documentary evidence. Further, it may be necessary to review previously archived reports pertinent to the damaged property, client profile information, causation and origin factors, as well as specific information that may be deemed pertinent. 
     Once all of the acquired information has been assessed (see block  18 ) the inquiry block  20  requires a determination as to whether additional information is needed, i.e. return to block  16 . If not, inquiry block  22  requires a determination as to whether the damage was an unexpected loss. If the determination is that the loss was unexpected, there is a need for an adjuster appraisal (block  24 ) and a consequent report supporting the appraisal (see block  26 ). On the other hand, if the loss should have been expected or avoided by reasonable conduct by the claimant, the report  26  will provide reasons for denying the claim. In any event, all of the above tasks can be accomplished using in-house employees of the insurance carrier. Accordingly, action is taken (see block  28 ) and a report of the investigation is given which informs the claimant of the action being taken by the insurance carrier; to either pay or deny the claim. As a final action on the claim, the report should be archived for possible future use (see block  30 ). 
     As envisioned by the present invention, as shown in  FIG. 2 , a process  32  for evaluating and appraising a valid claim can be facilitated and simplified by employing a computer (not shown). Specifically, (block  16 ) for the information gathering step, (block  22 ) for the determination as to whether the damage was an unexpected loss, and (block  24 ) for portions of the adjuster appraisal itself, can all be aided by the use of a computerized process  32 . 
     In  FIG. 2  it is to be appreciated that damage information, together with other administrative and pertinent information, can all be uploaded for computerized processing (block  34 ). For example, an administrative input including claimant identification, property ownership rights, and property location may be required. Also, set-up input may be required such as the selection of a probable cause for the property damage, to include indicators of i) fire, ii) water, iii) explosion, iv) impulse forces, and v) other cause(s) with an appropriate description. Further, a property description input may be helpful which identifies i) personal residence(s), ii) buildings and edifices, iii) vehicle(s), iv) conveyances, v) infrastructures, vi) and other descriptions for structures of interest. Still further, it may be preferable to include field investigation information that was obtained during the gathering step regarding i) documentation, ii) photos, and iii) maps and sketches. 
     Once the pertinent information has been uploaded (block  34 ) the method/process  10 / 32  of the present invention envisions a winnowing of the information to discard nonessential and redundant factors, and to focus instead on the relevant and pertinent factors necessary for an appraisal. Specifically, the import here is to focus on information that is helpful for determining a probable cause for the property damage, and the resultant effect(s) of the causation. 
     In accordance with the method/process  10 / 32  of the present invention, all information to be considered is factorized (see block  36 ) into cause factors (block  38 ) and effect factors (block  40 ). These factors can then be respectively evaluated by the inquiry blocks  42  and  44  according to their relevance. As shown, the factors that are deemed irrelevant or redundant are discarded (block  46 ). On the other hand, relevant and non-redundant factors are further coalesced (see block  48 ) into determination of the cause and effect (see block  50 ) for use in an appraisal (block  52 ). The result then is a report  26  as shown in  FIG. 1 , and an archiving of the report  26 . 
     While the particular System and Method for Appraising Damage Claims as herein shown and disclosed in detail is fully capable of obtaining the objects and providing the advantages herein before stated, it is to be understood that it is merely illustrative of the presently preferred embodiments of the invention and that no limitations are intended to the details of construction or design herein shown other than as described in the appended claims.