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 externalization of rules for assessing bodily injury general damages.
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 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 involving 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 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 quality 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 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 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 prior art knowledge-based system. For example, the business rules used in the prior art often lacked flexibility. The business rules were often hard-coded in the insurance claim processing software. Every time there was a new business requirement, it was necessary to change the source code. In some cases, this inflexibility resulted in delaying the incorporation of the new business rules until the next system release date. Thus the insurance claim processing software was unable to adapt quickly to changing business conditions. This reduced the users' and therefore the insurance companies' flexibility to respond to changing business conditions in assessing bodily injury claims.
Very often, the user may have special or unique requirement, which may need the standard business rules to be modified (i.e., customized) to meet a specific application. The hard-coding method used in the prior art would not easily permit the customization of the business rules in a cost and time effective manner.
It is, therefore, desirable to develop a new system and method for externalization of rules for assessing bodily injury general damages. It is desirable for the rules to be easily updateable based on external business conditions. It is also desirable for the rules to be customizable to meet specific user requirements. Thus, the new system and method for externalization of rules should be of a flexible design, to meet user requirements.
USPTO Backgrounds
USPTO Backgrounds