SYSTEM AND METHOD FOR PROCESSING
INSURANCE CLAIMS USING A TABLE OF
BACKGROUND OF THE INVENTION
1. Field of the Invention The present invention generally relates to the field of insurance claims. More particularly, the present invention relates
to a system and method for processing insurance claims using 10 a graphical user interface with structured data collection.
2. Description of the Related Art
Insurance companies have been processing and settling claims associated with bodily injury for a long time. The task of evaluating, analyzing or estimating the amount of damage 15 associated with one or more types of bodily injuries, especially trauma-induced bodily injuries, can be very complex. Complexity in the evaluation process often arises out of the fact that concurrent expertise in legal, medical and insurance fields is often required to arrive at a particular decision involv- 20 ing a bodily injury claim.
Several factors can affect the estimated amount of the claim associated with a bodily injury. Every accident is different and every injury is unique. Arriving at a customized evaluation of a bodily injury claim, which is unique for a specific 25 accident, injury, etc. is desirable. Applying across-the-board standards may tend to result in an inequitable solution for one or more parties involved. External environmental factors, such as the experience level of a claims adjuster, record of accomplishment of the legal professionals, post-injury qual- 30 ity of life for the injured party, etc., all can affect the valuation of a claim.
During the past several years, many insurance companies have been using computer-based and knowledge-based claim-processing systems to process, evaluate, analyze and 35 estimate thousands of claims in a fair and consistent manner. A knowledge-based claim-processing system includes an expert system which utilizes and builds a knowledge base to assist the user in decision making. It may allow the insurance companies to define new rules and/or use previously defined 40 rules, in real-time. The business rules are generally written by industry experts to evaluate legal, medical, insurance conditions before arriving at a valuation of a claim.
There were several drawbacks with the earlier knowledgebased system. For example, the user interface (such as a 45 graphical user interface, or GUI) lacked flexibility and was inefficient. In estimating a claim for bodily injury, the user typically had to enter inputs on a display screen and step through a series of displays or screens in a predefined sequence to complete the data input process. The knowledge- 50 based prior art claim processing system would then utilize the user provided inputs, i.e., collect data from the user to generate a claim report. This reduced the user's flexibility and usability. For example, the user was required to enter the requested/required information for each display, before being 55 permitted to proceed to the next display. In addition, the user interface used in the prior art would not permit the user to easily go back to edit data that was entered in a previous display orto go forward to another display. In orderto go back to a desired previous display, the application would automati- 60 cally exit, re-launch, and then go through all the previous displays in sequence to arrive at the desired previous display.
It is, therefore, desirable to develop a new graphical user interface to improve usability and flexibility of a knowledgebased claims processing system. It is desirable for the GUI to 65 provide the user with a road map of all the steps involved with the data collection process. It is also desirable for the GUI to
provide full control to the user to select any display screen to enter required data. Thus, the GUI should be of a flexible design to allow the user to select display screens freely, based on user requirements. Furthermore, it is also desirable for the user to be able to edit inputs which were previously entered on previous display screens.
SUMMARY OF THE INVENTION
The present invention provides various embodiments of a system and method for processing and estimating a value of an insurance claim using a table of contents. In one embodiment, the processing of the insurance claim my be initiated by initiating a first step, wherein the processing of the insurance claim includes a plurality of steps. The steps may include screens displayed on a display device coupled to a computer system. The insurance claim may include a bodily injury claim, and processing the insurance claim to estimate the value of the insurance claim may include processing the bodily injury claim to estimate a bodily injury general damages value. The steps may include steps for entry of information relevant to the estimate of the value of the insurance claim. The information may include, for example, bodily injury treatment information and/or bodily injury damages information.
One or more of the steps in the processing of the insurance claim may be proceeded through to arrive at an intermediary step. As used herein, the intermediary step is any step between the first and final steps in the plurality of steps of processing the insurance claim. Proceeding through the one or more of the steps in the processing of the insurance claim may include entering information relevant to the estimate of the value of the insurance claim in the one or more of the steps. The entered information may be stored in a memory. The intermediary step may then be displayed. A table of contents may be displayed upon the entry of an appropriate command by the user, wherein the table of contents includes an ordered list of the steps associated with the processing of the insurance claim, and wherein the ordered list of steps comprises the first step, the intermediary step, and any steps in between the first step and the intermediary step. The ordered list of steps may be dynamically modifiable in response to the entry of information in a step. In other words, steps may be added to or deleted from said dynamically modifiable ordered list of steps in response to the entry of information. The user may be permitted to select one of the steps from the ordered list of steps associated with the processing of the insurance claim in the table of contents. The selected step may then be displayed in response to the user selecting the selected step in the table of contents. In one embodiment, the entered information in the selected step may be modified after selecting the step in the table of contents. The modified information may be stored.
After displaying the selected step, the intermediary step may be redisplayed upon entry of an appropriate command by the user. In one embodiment, in other words, the user may go back to the previously displayed step, either through the table of contents or through entry of a suitable "back" command. The processing of the insurance claim may be continued after redisplaying the intermediary step by permitting the user to enter additional information relevant to the estimate of the value of the insurance claim.
The ordered list of steps in the table of contents may include a final step. In one embodiment, the final step may be selected at any time from the table of contents. The final step may include a consultation report concerning an estimate of the value of the insurance claim. The consultation report may