Patent Publication Number: US-2016239923-A1

Title: Insurance System and Method of Use

Description:
CROSS-REFERENCE TO RELATED APPLICATIONS 
     This application claims benefit to U.S. Patent Application No. 62/117,766 which was filed one year prior to this filing on 2015 Feb. 18, that application is hereby incorporated by reference. 
    
    
     STATEMENT REGARDING FEDERALLY SPONSORED RESEARCH OR DEVELOPMENT (IF APPLICABLE) 
     Not applicable. 
     REFERENCE TO SEQUENCE LISTING, A TABLE, OR A COMPUTER PROGRAM LISTING COMPACT DISC APPENDIX (IF APPLICABLE) 
     Not applicable. 
     BACKGROUND OF THE INVENTION 
     This disclosure relates generally to an Insurance System and Method of Use. Examples of similar disclosures can be found at US 20110131137 A1, U.S. Pat. No. 8,626,538 B1, US 20140143133 A1, WO 2012142347 A1, US 20140278573 A1, U.S. Pat. No. 7,966,200 B1, US 20090048877 A1, U.S. Pat. No. 8,442,847 B1, and U.S. Pat. No. 8,494,882 B1. However, none of the known inventions and patents, taken either singularly or in combination, is seen to describe the instant disclosure as claimed. Accordingly, an improved Insurance System and Method of Use would be advantageous. 
     One objective of the insurance product creation system is to provide customer and value-added service to said insured  602  as well as said agency  604  in the event of an insurance claim. In one embodiment, the agency  604  and its affiliated industries have has become limited in the “claim support” from the carriers&#39; standpoint. The carrier  606  has set a boundary between said agency  604  and said insured  602 . The carrier  606  wants to handle the claim in the best interest of the carrier  606 , not the policyholder or the agency  604 . The agent/agency  604  can sell an insurance policy, but when there is a claim, they cannot service it. The servicing of the claim is done at the discretion of the carrier  606  and their representative (said adjuster  608 ). If there is a dispute within the settlement, the policyholder (said insured  602 ) does not have anyone to advocate on their behalf. Unless the adjuster  608  carries the specific adjuster&#39;s license (required by various licensing agencies such as the Texas Department of Insurance), the adjuster  608  cannot lawfully negotiate, advocate, and/or settle a claim. This limits the adjuster  608 &#39;s involvement. The solution is that the insurance agency  604  use said insurance product creation system  100  to advocate on behalf of the agency  604  as well as the policyholder to fight for a fair and reasonable settlement. 
     Another problem is the “human factor” of settling coverage for a particular one among said insured  602 , being it business or personal insurance. In one embodiment, said insurance product creation system  100  allows the guessing work to be at a minimum, as the system can determine the type of coverage needed and the policy that will provide this coverage. 
     Said insurance product creation system  100  can provide the value-added services to independent insurance agencies: claims negotiations; claim settlements; verification of claim coverage; agency/agent education on the claims process; Insurance to Value evaluations; strategic evaluations for clientele business; risk training for avoidance of E&amp;O claims; legal issues; IAN certification given to agencies as well as management; agency adjusting firms. 
     Said insurance product creation system  100  can be used for separate claims tracking software to determine the needs, the particular coverage, the settlement, and the follow-up. This will allow the policyholder to move through the claims process with ease, knowing the timeframe will be met as required by the carrier  606 . 
     Coverage will be used as provided by the agency  604 , and the settlement will be made in accordance with the policy provisions. The follow-up will be set in a timely fashion for the agency  604  to not only have a “touch” but a possibility for up-sale. In one embodiment, said insurance product creation system  100  program allows the adjuster  608  and/or the advocate (said adjuster  608 ) to determine coverage by the insurance product creation system  100  stating where the cover is within the policy and if the insured  602  has this particular coverage. 
     The insurance product creation system  100 , however, does not determine the financial settlement, only the coverage. 
     As is known in the art, many insurance agencies do have a low paid employee that will turn in the claim and then will close the claim once the carrier  606  states their decision. 
     BRIEF SUMMARY OF THE INVENTION 
     An apparatus, comprising: at least one memory including computer program code. At least one processor, wherein the at least one memory and the computer program code are configured to, with the at least one processor, cause the apparatus at least to receive a claims event from an insured, calculating a one or more claim requirement recommendations based on the claims event and an E&amp;O index table stored in the at least one memory, and assessing the validity of the claims event based on the comparison of the claims event to the one or more claim requirement recommendations. 
     An apparatus, comprising: at least one memory including computer program code. At least one processor, wherein the at least one memory and the computer program code are configured to, with the at least one processor, cause the apparatus at least to analyzing a policy offering to a client at a time of policy initiation by: categorizing a client into a known and risk profiles and generating a policy quote. Comparing the policy quote to a one or more data sources to determine completeness of the policy quote. Comparing the policy quote with previous events to determine likelihood of risk to the client associated with the policy quote. 
     A computer program product embodied on a non-transitory computer readable storage medium, the computer program product being encoded with instructions to control a processor to perform a process, the process comprising: receive a claims event from an insured, calculating a one or more claim requirement recommendations based on the claims event and an E&amp;O index table stored in the at least one memory, and assessing the validity of the claims event based on the comparison of the claims event to the one or more claim requirement recommendations. 
    
    
     
       BRIEF DESCRIPTION OF THE SEVERAL VIEWS OF THE DRAWING 
         FIG. 1  illustrates a first network configuration  101  of an insurance product creation system  100 . 
         FIGS. 2A, 2B and 2C  illustrate a perspective overview of a mobile phone  201   a , a personal computer  201   b  and a tablet  201   c.    
         FIGS. 3A, 3B and 3C  illustrate an address space  302  within said one or more computers, an address space  302   a  and an address space  302   d.    
         FIGS. 4A and 4B  illustrate two embodiments for collecting and storing data with said insurance product creation system  100 ; a first embodiment with a flow diagram between said first computer  102   a  and said server  108 , and a second embodiment comprising of just said first computer  102   a.    
         FIGS. 5A and 5B  illustrate two examples of a flow diagram between said memory  306   a  and said memory  306   d.    
         FIG. 6  illustrates a flow chart  600 . 
         FIG. 7  illustrates a schematic  700  of said insurance product creation system  100 . 
         FIG. 8  illustrates a policy acquisition procedure  800 . 
         FIG. 9  illustrates a claim event procedure  900 . 
         FIG. 10  illustrates a claim analysis procedure  1000 . 
         FIG. 11  illustrates a policy offering review procedure  1100 . 
     
    
    
     DETAILED DESCRIPTION OF THE INVENTION 
     Described herein is an insurance system and method of use. The following description is presented to enable any person skilled in the art to make and use the invention as claimed and is provided in the context of the particular examples discussed below, variations of which will be readily apparent to those skilled in the art. In the interest of clarity, not all features of an actual implementation are described in this specification. It will be appreciated that in the development of any such actual implementation (as in any development project), design decisions must be made to achieve the designers&#39; specific goals (e.g., compliance with system- and business-related constraints), and that these goals will vary from one implementation to another. It will also be appreciated that such development effort might be complex and time-consuming, but would nevertheless be a routine undertaking for those of ordinary skill in the field of the appropriate art having the benefit of this disclosure. Accordingly, the claims appended hereto are not intended to be limited by the disclosed embodiments, but are to be accorded their widest scope consistent with the principles and features disclosed herein. 
       FIG. 1  illustrates a first network configuration  101  of an insurance product creation system  100 . 
     In one embodiment, said insurance product creation system  100  can comprise a one or more computers at a one or more locations. In one embodiment, said one or more computers can comprise a first computer  102   a , a second computer  102   b  and a third computer  102   c . In one embodiment, said one or more locations can comprise a first location  103   a , a second location  103   b  and a third location  103   c . In one embodiment, said first location can comprise a field location. In one embodiment, said one or more computers can communicate on a network  106 , which can connect to a one or more servers (such as a server  108 ). In one embodiment, a printer  104  can be hardwired to said first computer  102   a  (not illustrated here), or said printer  104  can connect to one of said one or more computers (such as said third computer  102   c , illustrated) via network  106 . 
     Said network  106  can be a local area network (LAN), a wide area network (WAN), a piconet, or a combination of LANs, WANs, or piconets. One illustrative LAN is a network within a single business. One illustrative WAN is the Internet. 
     In one embodiment, said server  108  represents at least one, but can be many servers, each connected to said network  106 . Said server  108  can connect to a data storage  110 . Said data storage  110  can connect directly to said server  108 , as shown in  FIG. 1 , or may exist remotely on said network  106 . In one embodiment, said data storage  110  can comprise any suitable long-term or persistent storage device and, further, may be separate devices or the same device and may be collocated or distributed (interconnected via any suitable communications network). 
       FIGS. 2A, 2B and 2C  illustrate a perspective overview of a mobile phone  201   a , a personal computer  201   b  and a tablet  201   c.    
     In the last several years, the useful definition of a computer has become more broadly understood to include mobile phones, tablet computers, laptops, desktops, and similar. For example, Microsoft®, have attempted to merge devices such as a tablet computer and a laptop computer with the release of “Windows® 8”. In one embodiment, said one or more computers each can include, but is not limited to, a laptop (such as said personal computer  201   b ), desktop, workstation, server, mainframe, terminal, a tablet (such as said tablet  201   c ), a phone (such as said mobile phone  201   a ), and/or similar. Despite different form-factors, said one or more computers can have similar basic hardware, such as a screen  202  and a one or more input devices (such as a keyboard  204   a , a trackball  204   b , a one or more cameras  204   c , a wireless—such as RFID—reader, a track pad  204   d , and/or a home button  220 ). In one embodiment, said screen  202  can comprise a touch screen. In one embodiment, said track pad  204   d  can function similarly to a computer mouse as is known in the art. In one embodiment, said tablet  201   c  and/or said personal computer  201   b  can comprise a Microsoft® Windows® branded device, an Apple® branded device, or similar. In one embodiment, said tablet  201   c  can be an X86 type processor or an ARM type processor, as is known in the art. 
     Said insurance product creation system  100  can comprise a data  206 . In one embodiment, said data  206  can comprise data related to financial transactions. 
     In one embodiment, said one or more computers can be used to input and view said data  206 . In one embodiment, said data  206  can be input into said one or more computers by taking pictures with one of said one or more camera  204   c , by typing in information with said keyboard  204   a , or by using gestures on said screen  202  (where said screen  202  is a touch screen). Many other data entry means for devices similar to said one or more computers are well known and herein also possible with data  206 . In one embodiment, said first computer  102   a  can comprise an iPhone®, a BlackBerry®, a smartphone, or similar. In one embodiment, one or more computers can comprise a laptop computer, a desktop computer, or similar. 
       FIGS. 3A, 3B and 3C  illustrate an address space  302  within said one or more computers, an address space  302   a  and an address space  302   d.    
     Each among said one or more computers and said server  108  can comprise an embodiment of address space  302 . In one embodiment, said address space  302  can comprise a processor  304 , a memory  306 , and a communication hardware  308 . In one embodiment, said processor  304  can comprise a plurality of processors, said memory  306  can comprise a plurality of memory modules, and said communication hardware  308  can comprise a plurality of communication hardware components. In one embodiment, said data  206  can be sent to said processor  304 ; wherein, said processor  304  can perform processes on said data  206  according to an application stored in said memory  306 , as discussed further below. Said processes can include storing said data  206  into said memory  306 , verifying said data  206  conforms to a one or more preset standards, or ensuring a required set among said required data  206  has been gathered for said data management system and method. In one embodiment, said data  206  can include data which said one or more computers can populate automatically, such as a date and a time, as well as data entered manually. Once a portion of gathering data has been performed said data  206  can be sent to said communication hardware  308  for communication over said network  106 . Said communication hardware  308  can include a network transport processor for packetizing data, communication ports for wired communication, or an antenna for wireless communication. In one embodiment, said data  206  can be collected in one or more computers and delivered to said server  108  through said network  106 . 
     In one embodiment, said first computer  102   a  can comprise said address space  302   a , a processor  304   a , a memory  306   a , and a communication hardware  308   a . Likewise, in one embodiment, said server  108  can comprise said address space  302   d , a processor  304   d , a memory  306   d , and a communication hardware  308   d.    
       FIGS. 4A and 4B  illustrate two embodiments for collecting and storing data with said insurance product creation system  100 ; a first embodiment with a flow diagram between said first computer  102   a  and said server  108 , and a second embodiment comprising of just said first computer  102   a.    
     In the first embodiment, said communication hardware  308   a  and said communication hardware  308   d  can send and receive data to and from one another and or can communicate with said data storage  110  across said network  106 . Likewise, in the second embodiment, data storage  110  can be embedded inside of said one or more computers as a data storage  110   a , which may speed up data communications by said insurance product creation system  100 . In another embodiment, said data can be stored temporarily on said data storage  110   a  and later moved to said data storage  110  for backup and sharing purposes. 
     As illustrated in  FIG. 4A , in one embodiment, said server  108  can comprise a third party data storage and hosting provider or privately managed as well. 
     As illustrated in  FIG. 4B , said data storage  110  can be located on said first computer  102   a , here labeled as said data storage  110   a . Thus, said first computer  102   a  can operate without a data connection out to said server  108  while performing said system and method for field capture of data. 
       FIGS. 5A and 5B  illustrate two examples of a flow diagram between said memory  306   a  and said memory  306   d.    
     As illustrated in  FIG. 5A , in one embodiment, said insurance product creation system  100  can process said data  206  on said first computer  102   a  and/or said server  108 . For example, in one embodiment, said memory  306   a  can comprise a device application  502  capable of generating a data records  504  from user inputs or, otherwise, processing said data records  504  delivered to said device application  502  from said data storage  110 . In one embodiment, said data records  504  can be transferred between said device application  502  on said memory  306   a  of said first computer  102   a  and a server application  506  in said memory  306   d  of said server  108 . In one embodiment, said server  108  can be useful for processing said data  206 , as is known in the art. As illustrated in  FIG. 5B , in another embodiment, said server  108  can be removed from the flow diagram entirely as said memory  306   a  is capable of processing said data records  504  and/or said data  206  without the assistance of said server  108 . 
       FIG. 6  illustrates a flow chart  600 . 
     In one embodiment, said insurance product creation system  100  negotiates rights between an insured  602 , an agency  604  and a carrier  606 . In one embodiment, said insured  602  can discuss an insurance acquisition  620  with said agency  604 . In one embodiment, said agency  604  can discuss a policy acquisition  622  with said carrier  606 . In one embodiment, said insured  602  can file a claim negotiation  624  with said carrier  606 . In one embodiment, said adjuster  608  can negotiate said claim negotiation  624  between said insured  602  and said carrier  606 . 
     The pain of any claim is that the insured  602  is at the mercy of the carrier  606  (insurance company) and the adjuster  608 . They rely on the carrier  606  to provide proper and fair settlement. In today&#39;s environment, policyholders or the insured  602  are extremely leery of insurance companies in general. The agency  604  that sold the policy to the insured  602  is at the mercy of the carrier  606  during a claim because, as is the case in certain US states, legislation requires a license to negotiate and settle any insurance-related claim. 
     Most agencies do not have an employee who holds such a license, so by default, they are reliant on the carrier  606  and their adjuster  608 . When there is an issue with a claim brought up by the agency  604 &#39;s insured  602 , the agency  604  has no other resource. 
     The insured  602  then has to turn to the expense of hiring attorneys to defend their case. The pain is that now the agency  604  is in fear of losing an account due to the lack of claims/customer service by the agency  604 , which is “hand tied” due to state regulations. 
     To leverage the negotiating powers from the carrier  606  and its advocate (the adjuster  608 ), back to the policyholder. In one embodiment, said insurance product creation system  100  is used to serve the agency  604  and the insured  602  for proper claim settlement and education with honesty, integrity and efficiency. 
     In one embodiment, said insurance product creation system  100  is configured to negotiate and settle claims before attorneys get involved. 
       FIG. 7  illustrates a schematic  700  of said insurance product creation system  100 . 
     In one embodiment, said insurance product creation system  100  can comprise an internal databases  701   a  and an external databases  701   b . In one embodiment, said internal databases  701   a  can comprise a user table  702 , a clients table  703 , an industries table  704 , a risk profiles table  706 , a history table  708 , an events table  710 , a claims table  712 , and an E&amp;O index table  714 . In one embodiment, said external databases  701   b  can comprise a public records  750  and a court records  752 . In one embodiment, said user table  702  can comprise a list of users in said insurance product creation system  100 . Said clients table  703  can comprise a list of clients for said agency  604  among said insured  602 . In one embodiment, said industries table  704  can comprise a list of industries for which data is stored in said E&amp;O index table  714 . In one embodiment, said risk profiles table  706  can comprise a profile of risks for businesses categorized in said risk profiles table  706  or a list of risk profiles for parties in said user table  702 . Said history table  708  can comprise a list of historical events relevant to said insurance product creation system  100 . Said claims table  712  can comprise a list of claims filed by users, such as said insured  602 , stored in said user table  702 . In one embodiment, said E&amp;O index table  714  can comprise an index of policy recommendations for different scenarios as characterized by the data in other tables in said internal databases  701   a . In one embodiment, said public records  750  can comprise data which said insurance product creation system  100  indexes to populate said E&amp;O index table  714 . In one embodiment, said court records  752  can comprise a list of records of court cases and dispositions relevant to said industries table  704  and said user table  702 . 
       FIG. 8  illustrates a policy acquisition procedure  800 . 
     In one embodiment, said policy acquisition procedure  800  can comprise a step one  802 , a step two  804 , a step three  806  and a step four  808 . In one embodiment, said step one  802  can comprise initiating an insurance offer  850  between said insured  602  and said agency  604 . Said step two  804  can comprise said agency  604  entering an insured profile  852  of said insured  602  into said insurance product creation system  100 . Said step three  806  can comprise calculating a one or more policy recommendations  854  based on said insured profile  852  and said E&amp;O index table  714 . Said step four  808  can comprise issuing said one or more policy recommendations  854  to said insured  602  and/or said agency  604 . 
       FIG. 9  illustrates a claim event procedure  900 . 
     In one embodiment, said policy acquisition procedure  900  can comprise a step one  902 , a step two  904 , a step three  906 , a step four  908  and a step five  910 . Said step one  902  can comprise initiating a claims event  950  between said insured  602  and said carrier  606 . Said step two  904  can comprise entering said claims event  950  into said insurance product creation system  100 . Said step three  906  can comprise calculating a one or more claim requirement recommendations  954  based on said claims event  950  and said E&amp;O index table  714 . Said step four  908  can comprise comparing said claims event  950  to said one or more claim requirement recommendations  954 . Said step five  910  can comprise assessing the validity of said claims event  950  based on the comparison of said step four  908 . 
       FIG. 10  illustrates a claim analysis procedure  1000 . 
     In one embodiment, said claim analysis procedure  1000  can comprise a call step  1002 , a determination step  1004 , an adverse renewal determination step  1006 , an educate insured step  1008 , and an up sell step  1010 . 
     The fundamental basis of claim analysis is to determine the coverage, the sequence of events, the pitfalls, the involved parties, and the questions that the carrier  606  will ask. Once this is determined and there is a meeting between the advocate and the insured  602 , a claim will be turned in, providing these crucial answers. This will give all the information to the carrier  606  to assess the claim properly. This will allow the insured  602  to have the upper hand in the claims process. 
     Conversely, said insurance product creation system  100  will be able to use its claims support software to determine the coverage for argumentative support against the carrier  606  and their adjuster  608 , or show this to the insured  602  and explain why it is not covered. 
     Most negotiations will be handled through the policyholder with the adjuster  608 . This will allow open communications between the policyholder and the adjuster  608 . The claims advocate associated with said insurance product creation system  100  will assess the initial offer, discuss this with the policyholder, and identify any other needs that need to be met. Once this determination is made, it will be addressed to the policyholder in a manner in which the policyholder is educated in the process and can speak the “insurance terms” to the adjuster  608  for matter of the settlement. The claims advocate in most cases will speak to the policyholder. Only in rare cases will the Insurance product creation system  100  claims advocate speak to the adjuster  608 , and when this does happen, it will be in a role of the agency  604 &#39;s representative and not as a third party. 
     Said educate insured step  1008  can comprise an important step. It is vitally important that the policyholder knows the claims process and what is about to be embarked upon. The initial meeting will lay out the normal claims process of the timeframe, questions asked, pitfalls to avoid, and settlement offers. This is important as the insured  602  is the one that has the contract with the carrier  606 , as administered through the agency  604 . The final settlement is between the policyholder and adjuster  608 . 
     Insurance to Value “ITV” evaluations: This allows the insurance agency  604  to place a value on a particular property for replacement cost. Providing the correct ITV will not only protect the policyholder from a penalty of not insuring it correctly, but will also provide additional income to the agency  604 . On average, agencies have an average ITV at 65%. Most carrier  606   s , requires ITVs to be at least 80%, so there is a difference, on average, of 15% that is not being billed correctly, therefore causing loss of income to the agency  604  and jeopardizing the insured  602 . 
     Preventative maintenance for Error and Omission (E&amp;O) claims: A program can be set up with the insurance agency  604  to review complex and/or any particular policies to make sure claim scenarios have been reviewed and coverage has been offered to the policyholder. By offering Insurance product creation system  100 &#39;s claims software to the agency  604 , they will be able to write coverage correctly based on the information given from the policyholder. 
       FIG. 11  illustrates a policy offering review procedure  1100 . 
     In one embodiment, said policy offering review procedure  1100  can comprise a step one  1102 , a step two  1104 , a step three  1106  and a step four  1108 . 
     In one embodiment, said policy offering review procedure  1100  can be used to analyze a policy offering to a client at a time of policy sign up. Said step one  1102  can comprise reviewing a new client (listed in said clients table  703 ) by categorizing that client into known industries (as listed in said industries table  704 ) and risk profiles (in said risk profiles table  706 ) and generating a policy quote  1120 . In one embodiment, said step two  1104  can comprise comparing said policy quote  1120  to a one or more data sources in said external databases  701   b  (such as said public records  750 , and/or said court records  752 ) to determine completeness of said policy quote  1120 . In one embodiment, said insurance product creation system  100  can compare said policy quote  1120  with previous events such as law suits to determine likelihood of risk to the user underlying said policy quote  1120 . 
     In one embodiment, said step three  1106  can comprise updating said E&amp;O index table  714  based on said policy quote  1120 ; recording said policy quote  1120  into said internal databases  701   a  (such as said history table  708 ). Accordingly, said insurance product creation system  100  can protect insurance carriers by recording offerings made and rejected by the insured  602  and protect said insured  602  by showing likely risks that he may face. 
     In one embodiment, said step four  1108  can comprise comparing said policy quote  1120  to previous claims by all users and weighing relevant records to produce a risk profile for said user. 
     Various changes in the details of the illustrated operational methods are possible without departing from the scope of the following claims. Some embodiments may combine the activities described herein as being separate steps. Similarly, one or more of the described steps may be omitted, depending upon the specific operational environment the method is being implemented in. It is to be understood that the above description is intended to be illustrative, and not restrictive. For example, the above-described embodiments may be used in combination with each other. Many other embodiments will be apparent to those of skill in the art upon reviewing the above description. The scope of the invention should, therefore, be determined with reference to the appended claims, along with the full scope of equivalents to which such claims are entitled. In the appended claims, the terms “including” and “in which” are used as the plain-English equivalents of the respective terms “comprising” and “wherein.”