WO2003034306A1

WO2003034306A1 - Interactive web site for insurance claims loss adjusting and management

Info

Publication number: WO2003034306A1
Application number: PCT/NZ2001/000250
Authority: WO
Inventors: Peter John Webb
Original assignee: On Line Adjusters Limited
Priority date: 2001-10-10
Filing date: 2001-11-07
Publication date: 2003-04-24
Also published as: NZ514688A

Abstract

The invention relates to an interactive web site specific to the insurance and loss adjusting industry. The web site allows parties from different insurance companies to lodge and view claims under a secure environment, with their files viewed only by personnel authorised by them, and by the sire's administrators. The data entered is stored in a database. Thus this data is kept off the companies' servers, but is still fully accessible by them for downloading when required. The site also allows for loss adjuster reports and further advice of actions taken to be added to the database within the same secure environment. This creates a paperless and concise history of the claim irrespective of the location of the various parties or the systems they are running.

Description

INTERACTIVE WEB SITE FOR INSURANCE CLAIMS LOSS ADJUSTING AND MANAGEMENT

Primary Objectives of the Web site

The main objective of the web site is to essentially provide a communication interface between

Loss Adjuster and insurance firms in a secure and private environment.

Overall Structure of web site

The overall structure of the web site reflects the business needs of OLA to capture information from (a) the insurance companies (like claims and underwriting requests) and (b) to add and update to this information as work in progress until completion.

Structure of Web site (User Perspective)

Based on your proposal the initial structure of the web site will be as follows:

excepton to -ma s t ese eve pages conta n "read on y n ormaton, about insurance adjusting, OLA's goals, qualifications, expertise and what they require from insurance companies.

Forms

"E-mail Us" branches off into 7 forms for the purposes of lodging claims, updating requests, requesting underwriting and claim property reports, negotiate settlement and to report on general but related claim issues.

At form submission stage the server does the following:

1. Validates User Profile Information

If the user is already registered they will be required to enter a valid user name and password (see Registration below).

2. Validates "mandatory" form fields

To ensure the integrity of the information submitted by the user, each form will have a set of mandatory fields that must be completed. These have been detailed in the OLA proposal. Scripting will be used to ensure these fields contain information in the first instance and that they are of the valid data type etc.

3. Confirms the data to be processed (confirmation page level)

As a second chance users can view the information they will be submitting before confirming the submission. Users have the option at this stage to edit and make corrections. If they satisfied with the information then users click on a "confirm submission" button to send the data to OLA.

4. Registers abridged Claims Details in Database

At this stage the server will add a new claims transaction record into the transaction database (see structure of database below). Each form will record both visible and hidden fields that will be processed to and stored in a "Transaction database".

These would include:

The submission date,

Transaction type (i.e. "claim", or "underwriting")

Insurer's reference number (i.e. claim number or underwriting proposal reference)

Summary of Request

Policy holders name and address details

Insurance company registration number/code

Transaction Status (i.e. "initiated").

5. Submits full form data to OLA via e-mail

A full copy of the submission can be e-mailed directly to Peter.

To facilitate security and privacy requirements, all forms will be contained and processed in a Secure Server (SSL) environment.

Database and Scripting

In order to meet Peter's needs the database would require two tables to record: • Insurance User Profile

• Insurance Transactions

1. Insurance User Profile

Depending again on Peter's requirements. Insurance companies can register at the insurance company level (in which case there would be one universal user name and password) or at the branch management/supervisor level (in which case there can many hundreds of different user names and passwords). For security reasons the latter option is preferable, however it will require more processing and validation.

To get the insurance company users to register, they could complete an on-line registration form. The details of their profile would include:

Insurance Company

Insurance Type Commercial, Residential

User Name Generic or branch specific (see above)

User Password This can be randomly selected by the server, or chosen by the user.

Address Details The physical and Postal address for correspondence and billing.

Contact Details Phone Numbers, Fax and email details Record Number Unique Index Number for database purposes

Insurance users should also have the option to access the web site in order to read and or make modifications to their profile. If this option is taken then the following pages and processes would be required:

These pages would be secured and perhaps added to the web site structure shown on page 3.

If users have forgotten their user name/password then they will have recourse to an e-mail hyperlink that submits an urgent request for Peter to e-mail them the correct details.

It is advisable that whatever backend database system Peter chooses for his business that the database type is the same as the one used on the web site or perhaps exportable/importable in either format.

2. Insurance Transactions

The second table contains records relating to the status of each claim or underwriting transaction. Essentially this table would comprise the following fields: Insurance Company User Index/code identifier (from Insurance Company Table - this provides a short link between each transaction and the insurer).

Date - Date Transaction was processed

Reference (claim or underwriting reference number)

Transaction Type: Claim or Underwriting

OLA's own sequentially generated reference number

Index Number/code of this transaction record

General Description field (a memo field that holds 256 or more characters)

Status Field (The status of the Transaction, these include, "initiated", "Work in Progress", "Completed", "Invoiced", "Paid/Completed" etc).

Priority: Urgent/non-urgent/as soon as possible etc.

Note the transaction table is initially accessed and a transaction record added/initiated via the pages shown on page 3 (i.e. "Request Update").

The records are added to the database, after the user has been validated, and via submission of data at the Form level shown on Page 3.

From this point on only Peter can access the transaction table via a separate set of pages. These pages effectively allows for the addition and modification of records:

I have included the "Delete" option as it is possible that user's will make errors.

Whenever a new record is created the server will both update the record to the database as well send an e-mail to the insurance company user, with the: date, status and general description of the transaction entry. This serves an automatic update mechanism for the insurance company.

The Read/Export option should allow the database records to extracted or output to CSV, delimited text, or dbase file format so that OLA can import/append these records to an backend database for offline or and backup purposes.

User Registration

New users will not be able to access the secure parts of the web site (i.e. transactions) if they are not registered or recorded in the User database.

To be registered the following process is recommended: Registration Process

User registers User contacted Unique User Name User accesses the Online and validated by and Password web site using the

OLA manually or Allocated subject to user name and automatically validation password

The time frame between the user's online registration and when they can access the web site will vary depending on Peter's own validation criteria. The underlying consideration here is that the user must belong to a valid insurance company, etc.

To expedite the submission of a new transaction from an unregistered user could be allocated a temporary user name and password that is subject to confirmation after the validation process. In the meantime they would only be able to add new transactions (as shown on page (3)).

If the user is not the genuine article then the user profile can be locked and the transaction cancelled.

Scripting

The dynamics of the web site requires scripting that:

(1) Handles and processes the validation processes

(2) enable database interaction

(3) is session based

There are various scripting options but they are Database and Server dependent. ASP or CFML for example work on NT/SQL Servers that may host an Access database whereas there is also PHP or CGI on an Apache server that hosts a MYSQL database.

ISPs offering web hosting will generally use one or two different servers. In general NT servers are more expensive to rent compared to Unix based Apache servers. Tentative prices are provided at the back of this document.

Security

Again ISPs offer varying security levels. SSL (Secure Servers) can be rented as part of the overall web-hosting package or linked to and rented separately from another party. Home Page

Main Menu Welcome to Online Adjusters Limited

Specialist in providing the following services for the aiBuiOM New Zealand Insurance Industry ϊιSftβ!to3ϊi%

Loss Adjusting

Claims Negotiation

Property Reports for replacement Policies

Click Here for Property Reports for Private Purchasers

Loss Adjusting Claims Negotiation Property Reports for replacement Policies Property Reports for Private Purchasers

Online Adjustments Limited

Contains address and URL's

Acknowledgements to:

Contains company names and URL's of companies who are related to the site building

This page gained from enter site on home page

On Line Adjusters Limited

Main Menu Please enter your registration details and click Login

Contains Contact address and URL of company

I Enter Site 11 In House Adiustino 1 f Why Choose Us? 1 [ Our Goals 1 I What we need from vou 1 [ Expertise & Service 1 1 Fee Charges 1 j Contact Us 1 1 Howe

Once user name and password entered this page is displayed

Transactions

Menu Transaction Menu

Transactions Date: Fri 16-Nov-2001 User Name: Menu

Loα Off

Contact Us Welcome back name of user, please select from one of the following options:

Lodge a Claim

C Get Status on an existing claim/report Request a Property report for replacement policy _r Request a Property report for private house purchase Negotiate a claims settlement

C Report on other issues

C Edit transaction

C User Administration Menu

I Transaction Menu l f Home 1 Pages 10 & 11 show the lodge a claim page accessed from transactions page

Transactions

LODGE A CLAIM

Menu * Please note all fields marked with an asterisk are mandatory fields and require input.

Transactions Menu

Loα Off Date: Fri 16-Nov-2001 Company: online Claims Handler Details

Contact Us

Claims Handler: Contact Phone No: Contact Email:

This is the default address to which correspondence will be sent regarding this transaction

Claim Number:

Policy Type:

Time Insured: (dd-mm-yyyy)

Details of the Insured:

Policy Holder Name Contact Phone

Street

Name/Number

Suburb

City I Please Select gL

Note if no other contact required simply state no in each section Contact if different from above:

Contact Name Contact Phone:

Site of Risk:

Street

Number/Number.

Suburb:

City/Region: Please Select a_*

Brief description of damage, further instructions, cover from schedule, renewal date and length of time insured with company:

[ Transaction Menu 1 [ Home 1

Page 12 shows get status on existing claim from transactions page

r G>n Line Adjusters Limited!

Transactions

Request a Transaction Update

Menu

Transactions Date: Fri 16-Nov-2001 Company: online

Menu

Handler Details

Loo Off

Claims Handler: Contact Us Reference I * Number: (i.e. Claim ' or Policy No.)

UBS

I Transaction Menu 1 1 Home 1

Pages 13 & 14 show replacement policy survey accessed from Transactions page

Transactions

Replacement Policy Survey

Menu

* Please note all fields marked with an asterisk are mandatory fields and require input.

Transactions Menu

Lo Qff Date: Fri 16-Nov-2001 Company: online Underwriter Details

Contact Us

Handler:

Contact Phone No:

Contact Email:

Policy/Temporary Cover Reference:

Customer's Details:

Policy Holder Name

Contact Phone *

Street Name/Number

Suburb

City Please Select Ξ,

Contact if different 1 From above:

Contact Name

Contact Phone:

Address of Survey:

Street Number/Number: Suburb: City/Region: Please Select

I Transaction Menu 1 [ Home 1

Pages 15 & 16 show the private property survey accessed from Transactions page

Transactions

Private Property Survey

Menu

' Please note all fields marked with an asterisk are mandatory fields and require input.

Transactions Menu

Log Qff

Fri 16-Nov-2001 Company: online

Contact Us Customer's Details

Name

Contact Phone Contact Email:

Street Name/Number

Suburb

City Rease Select

Type of Survey:

Fault Finding Fault and maintenance ^■

Address of Survey:

Street Number/Number: Suburb:

City/Region: I Please Select

Detailed Instructions or description for Adjuster:

[ Transaction Menu ! f Home 1

Pages 17 & 18 show negotiate settlement page accessed from Transactions page

Transactions

Negotiate a Settlement

Menu ' Please note all fields marked with an asterisk are mandatory fields and require input.

Transactions

Menu

Loo Off Date: Fri 16-Nov-2001 Company: online

Contact Us Claims Handler Details

Handler:

Contact Phone No: *

Contact Email:

Claim Number:

Insured Details:

Policy Holder Name Contact Phone

Street

Name/Number

Suburb

City Please Select

Detailed Instructions/Comments for consideration:

I Transaction Menu 1 [ Home 1

Pages 19 & 20 Shows report on other issues page which is the same as the contact us page accessed via both the transactions page and the home page.

Transactions

Contact Us

Menu Our contact details for postal and phone purposes are:

Transactions PO Box 13445 Menu Johnsonville

Wellington

Log Qff

Telephone: (04) 478 6202

Contact Us Facsimile: (04) 4786202 Mobile'

Online Form

Alternatively you can complete the form below. Please enter your contact details and a reference number if this request relates to a claim etc. Upon receipt we will contact you as soon as possible...

Your Contact Details

Your Name

Company

Telephone Number Fax Number

I Select a Message Type

Reference Number

Notice of Confidentiality:

Please note, we will only be using the information you submit above for contact and reference purposes. Under no circumstance will we provide any of this information to another party other than for the purposes of fulfilling your service request. In which case approval to use this information will be sought from the person or organisation who has submitted the data above.

f Transaction Menu 1 f Home 1

Page 21 is the admin query page which is only available from the admin side of the web page.

Transactions

ADMIN QUERY FORM

Menu 1. At what level do you want to query the transaction database?

Contact Us • User Name I

OR

• Transaction Reference | 2. Do you want transactions that are active or closed status?

Open Completed and Paid

f Transaction Menu I \ Home 1

Page 22 user administration page available on the admin side of the page from transactions

Transactions

User Administration Menu

Menu

Transactions A: Add a user Menu Create a new record directly into Online Adjuster's User

B: Import a new user record

Enter user's temporary reference number to call up temporary record for validation and addition to the User database.

C: Edit an User

Enter User Name

f Transaction Menu 1 [ Home ] Pages 22 to 27 contain all static pages from web site used for marketing purposes.

Main Menu In House Adjusting

During the past decade Insurers have employed and trained personnel to perform as loss adjusters to:

D Minimise the cost of adjusting fees D Obtain tighter control of policy interpretation D Better reinstatement, replacement costs D Improve the quality of customer service

The need to improve service has been a dominant factor, linked with market forces and customer expectations have, in many cases created rises in the costs of administration.

If a company employs internal adjusters with the following average costs and performance:

D salary of $47500-00

D adjusting an average of 430 claims per annum

Taking into account

□ General employment costs (hr etc.)

D Support and managerial staff D Training

D Office and personal equipment

Contains address of company and URL D Vehicle

The average adjustment costs approximately $228-00 per claim this does not take into account any extra costs incurred by overtime payments above the normal salary.

Understandably the argument for In-house adjusters is that salary costs are known and companies have complete control but to what standard and are hidden costs being ignored. Customer care and service are often misunderstood as a reason to make payments outside of policy cover. There appears in some cases a misconception that this type of approach secures customers loyalty and proves the in-house adjustment/claims process is unbiased and fair.

We want to prove an external company can become a valid unbiased member of any internal team. Competing in cost and performance

r Enter Site 1 f In House Adiustinα 1 1 Why Choose Us? 1 1 Our Goals 1 t What we need from vou 11 Expertise & Service 1 r Fee Charges 11 Contact Us 1 [Home ]

1 Why Choose Us? J>

company an customers value the service they receive.

As the company grows we will endeavour to train and supervise our staff ensuring to the best of our ability the service you receive is of the highest possible quality. Our staff will be encouraged to become members of the institute of insurance and or loss adjusting in an attempt to procure the education, experience and understanding required, to satisfy all service requirements

The intention is to become renowned throughout the industry as a valid and preferred company for claims adjustment.

f Enter Site 1 Mn House Adiustiπo 1 f Whv Choose Us? 1 f Our Goals 1 r What we need from vou 1 [ Expertise & Service 1 f Fee Charges 1 j Contact Us 1 [ Home 1

) Our Goals J

Main Menu Our goals

To become one of your preferred service suppliers who understand the need for and ensure:

• Insurers and the insured are kept informed

• Open and honest discussions between ourselves and insurers

• Supply a quality service that refers to the insurers technical teams when required

• Have the ability to recognise and utilise areas of possible savings

• Create relationships to enhance settlement costs And supply:

• Known competitive costs for the adjustment

• A fast, efficient customer focused adjusting service

Contains address of company and URL • Concise quality reports and photographs sent electronically

• Direct secure access to claims data

• A reasonable 24 hour emergency call out service

• All losses quantified

• Replacements listed and indemnity agreed on a without prejudice basis

• Direct contact to discuss difficult or unknown policy details

• Agreed performance standards

• A commitment to best price and practice Performance criteria

• Customer contact attempted and noted within two hours of receiving the call by phone and four hours by email (within normal working hours)

• An initial report giving details of contact within 8 hours or the first report within three days of viewing the claim

• Photographs set to each report as required

• All claims Quantified or the loss listed ready for replacements to be carried out

• Indemnity calculations agreed on a without prejudice basis

• Settlement process agreed on the first meeting or

• The customer advised what else is required to forward the claim

• Quotations obtained for repairs and replacements as required

• Declined claims quantified and a full report sent to your claims department for any consideration of exgratia or commercial payments

• Once costs are known or the basis of settlement agreed the claim will be handed back to your own claims people for final settlement, acceptance of quotations and payment of accounts.

• Any hard file material forwarded for adding to the claims file or scanning onto your own data bank.

f Enter Site 1 f In House Adjusting 1 f Whv Choose Us? 1 [Our Goals 1 [ What we need from vou 1 [ Expertise & Service 1 r Fee Charges 1 j Contact Us [ I Home 1

\ Requirements \ J for Services J

Main Menu What we need from vou

• Copies of all relevant policies

■ RWRM. • Contact phone and email addresses of claims staff finer

uster

• Name of the claims handler their contact email

Contains address of address and phone number company and URL

• Damage in brief with any other relevant information i.e.

• Known third party

• Cleaners appointed

• Contents of schedule (commercial claims)

f Enter Site 1 1 In House Adiusting 1 [ Whv Choose Us? 1 f Our Goals 1 [ What we need from vou 1 1 Expertise & Service 1 \ Fee Charges 1 [ Contact Us 1 [ Home 1

Claims

CLAIMS DEFINING INVENTION ARE

The objective and concept of the website is unique in that it allows parties from different companies to lodge and view claims under a secure environment with their files viewed only by personnel authorised by them with the acceptance of the website administrators. The site also allows for loss adjusters reports and further advice of actions taken to be added to the data within the same secure environment, creating a paperless and concise history of the claim irrespective of their location or what type of system they are running. This allows all of the information relating to the claim to be kept off the individual company servers but still fully accessible for downloading onto their system as required by all personnel with the correct password and user names. These are agreed by the administrator of the website. The web site can be used by more than one adjusting company and or insurer/broker .

The web site consists of a number of pages all relating to each other and interlinking via task buttons the pages contain either static infoπnation or carry out specific tasks and are accessed from the home page. These pages allow requests for loss adjusting of a claim, claims settlements to be negotiated, property reports for replacement policies and property reports for private purchasers. The secure areas of the website have text box formats to standardise the information received. Existing transactions can be edited and the administrator of the web site can be contacted directly from this area. Once changes are made to the data the website sends an automated email to the claims handler or adjuster which contains a record of the new information added to the file, saving further work or duplication to forward data or updates. Users police their own user names and passwords allowing security to be continually up dated this also informs the administrator of the web site who confirms and accepts the changes made.

These automated actions and hosting of the system on a webpage allows information to be interacted on without the need to give access to the users existing computer systems and the fact that updates or notification of changes to the data is made automatically saves time for personnel in both the insurance and adjusting industry it also saves duplication and allows a concise paperless system that also allows actions taken by members of different companies to be recorded in the same area.