CA2502336A1 - A method and system for estimating reserves for personal injury insurance claims - Google Patents
A method and system for estimating reserves for personal injury insurance claims Download PDFInfo
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- CA2502336A1 CA2502336A1 CA 2502336 CA2502336A CA2502336A1 CA 2502336 A1 CA2502336 A1 CA 2502336A1 CA 2502336 CA2502336 CA 2502336 CA 2502336 A CA2502336 A CA 2502336A CA 2502336 A1 CA2502336 A1 CA 2502336A1
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- G—PHYSICS
- G06—COMPUTING; CALCULATING OR COUNTING
- G06Q—INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR ADMINISTRATIVE, COMMERCIAL, FINANCIAL, MANAGERIAL OR SUPERVISORY PURPOSES; SYSTEMS OR METHODS SPECIALLY ADAPTED FOR ADMINISTRATIVE, COMMERCIAL, FINANCIAL, MANAGERIAL OR SUPERVISORY PURPOSES, NOT OTHERWISE PROVIDED FOR
- G06Q40/00—Finance; Insurance; Tax strategies; Processing of corporate or income taxes
- G06Q40/08—Insurance
Abstract
A computer-implemented method and system for estimating reserve for personal injury claims is disclosed. The method and system provide a standard platform for predicting reserve of personal injury claims.
Description
A METHOD AND SYSTEM FOR ESTIMATING RESERVES FOR
PERSONAL INJURY INSURANCE CLAIMS
FIELD OF THE INVENTION
The present invention relates to a method and system for estimating reserve for personal injury insurance claims.
BACKGROUND OF THE INVENTION
Insurance companies are required to set reserves when the insurer becomes aware of a loss in all jurisdictions. In Canada, the adequacy of the reserves set by insurers is monitored by the Office of the Superintendent of Financial Institutions of Canada if the insurer is federally incorporated and a comparable provincial authority if the insurer is provincially incorporated.
If the insurer has not established adequate reserves then the insurer may not be able to meet its financial obligations to its own insured or to third parties.
If insurers over reserve then the insurer's financial performance may appear poor, which will affect share value. It is therefore critical that insurers set reserves that are as accurate as possible when the insurer is made aware of a potential claim.
However, the setting of reserves is complex because there are many variables to consider and calculations to perform when determining a reserve for a personal injury claim. The determination of the reserve amount depends heavily on the experiences, judgments, interpretation of case laws and applicable legislation by insurance professionals.
Insurance professionals have been calculating reserves for personal injury claims manually for many years, causing the methods of reserve calculation to vary significantly depending on the knowledge, experience and judgment of the insurance professional.
Automation of such a process has merely been materialized. For example, US
Patent No. 5,613,072 issued March 18, 1997 to Hammond (the Hammond System) teaches a method for funding future workers compensation losses in California.
This is a statutory based system by utilizing statistical models for estimating /
calculating indemnity, vocational rehabilitation, medical and allocated costs based on injury type, severity and other factors that the statisticians may find; however, due to the high cost in implementing such statistical models which requires deploying professional statisticians) in terms of time and money, it is not a practical solution for many insurance professionals who requires such estimation. Moreover, since the Hammond System is based on statutory requirement of workers' compensation insurance claims, it cannot be applied or easily modified for personal injury reserve estimation, since most of the decisions in this area are based on the common law of tort.
Therefore, it is necessary to develop a standard method, which does not rely on statistical models that require professional manual refinement, but still provides an accurate result for estimating insurance reserve for personal injury cases based on case law. The present invention addresses these issues by providing simplified estimation models based on case law.
SUMMARY OF THE INVENTION
The present invention provides a method and system for estimating reserve for personal injury insurance claims.
According to one aspect of the invention, it provides a computer-implemented method of estimating reserve for a personal injury claim comprising the steps of: (i) displaying a user interface on a display means to guide a user to enter information associated with the personal injury claim; (ii) storing entered information in a storage means; (iii) calculating a reserve amount using an Automatic Estimation method based on case law; (iv) storing the reserve amount in the storage means; and (v) displaying the reserve amount in the display for user verification.
According to another aspect of the invention, it provides a computer-implemented method of estimating reserve for personal injury claim via a communication network comprising the steps of: (i) establishing a communication from a remote site where a user resides to a computing means; (ii) authenticating the user at the remote site for granting an access; (iii) displaying a user interface on a display to guide the user to enter information regarding the personal injury claim; (iv) storing entered information in a storage means; (v) calculating a reserve amount using automatic estimation method based on case law; (vi) storing the reserve amount in the storage means; and displaying the reserve amount on the display for user verification..
BRIEF DESCRIPTION OF THE DRAWINGS
The invention will now be described in more detail with reference to the accompanying drawings, in which:
Figure 1 illustrates the primary elements in one embodiment of the present invention;
Figures 2 & 3 illustrate user interface navigation of user in the embodiment of the present invention;
Figure 4 is a flow chart of basic steps implemented in the embodiment of the present invention;
Figure 5 is a flow chart of basic steps for automatic reserve estimation;
Figure 6 is a flow chart of basic steps for obtaining Net General Damages;
Figure 7 is a flow chart of basic steps for obtaining Net Damages for Family Law Acts (or FLA) Claimants;
Figure $ is a flow chart of basic steps for obtaining Net Past and Future Loss of Care;
Figure 9 is a flow chart of basic steps for obtaining Loss of Past Income;
Figure 10 is a flow chart of basic steps for obtaining Collateral Benefit /
Other Income to Date;
Figure 11 is a flow chart of basic steps for obtaining Loss of Future Income;
and Figure 12 is a flow chart of basic steps for obtaining Future Collateral Benefit / Other Income.
DETAILED DESCRIPTION OF THE INVENTION
The present invention teaches a computer-implemented method and a system for providing an innovative platform for predicting reserves for a personal injury claims. The description of the following embodiment of the invention illustrates a system and method adapted for Canadian jurisdiction.
A system as illustrated in Figure 1 consists of a user terminal 10 having a display 11 to enable a user to enter User ID 12 for authenticating an access to a computing means, such as a server 14 over a communication network 13. Once authentication is granted, server engine 15 provides the user access to computer-implemented method for Automatic Estimation 16 and the method for Manual Estimation 17. The server 14 has access to Claim Database 18. The Automatic Estimation method 16 has an access to Claim Database 18 and Model Data 19. The Claim Database 18 maintains relevant information regarding personal injury insurance claims. The Model Data 19 maintains estimation models and data including coefficients for calculation, list of typical gross earnings per year for occupations, levels and corresponding financial figures for estimating particular parts or steps of reserve estimation. The user may enter claim data from the user terminal 10 and may store data in Claim Database 18. The Model Data 19 may be embedded inside or reside remotely from Automatic Estimation method 16. In this embodiment of the present invention, the Model Data 19 is remotely located outside of Automatic Estimation method 16 and is maintained by a system administrator. The user may not be able to alter the content of the Model Data 19. The user may enter data from user terminal 10 to the Claim Database 18. Automatic Estimation method 16 and Manual Estimation method 17 utilizes data entered and stored in the Claim Database 18 to estimate reserve automatically and manually, respectively. User terminal 10 may be remotely located from server 14. The display 11 may be a display of personal computer, or the LCD of a PDA, or of a cellular phone, which may be connected through communication network 13, including wired or wireless communication.
Transferring data across communication network 13 may be secured by encryption algorithm, which are widely and publicly available.
Figures 2 and 3 illustrate a user interface, which guides the user to enter required data to estimate the reserve automatically. Figure 2 shows the first half of the display of a user interface describing the types of information required from the user. The user interface in this embodiment of the present invention was sent from the server to the user terminal, contains Client Information 101, Preliminary Information 102, Injuries information 103, FLA Claimants information 104, and Net Past and Future Loss of Care 105. Client Information 101 directs the user to enter administrative information, including the name of claimant, policy number, claim number, and file number; however, most important information necessary for the user to supply for calculating estimation of reserve are gender, date of loss, date of birth, and expected mediation or trial date, to determine and to calculate various aspects and parts of the reserve estimation method. Preliminary Information 102 is for obtaining information regarding general financial situation, including estimated employment starting date, occupation, gross earnings per year, percent of full time work and injuries. These information are used to assess General Damages, Past and Future Loss of Income, etc. Injuries Information 103 is to refine injuries of Preliminary Information 102. The user enters categories, types and severities of injuries to assess General Damage, and to decide degree of disability. FLA Claimants information is provided for the user to assess net damages of FLA Claimants by specifying number of claimants and amount per FLA category, and Deduction selection. Net Past and Future Loss of Care 105 consists of Net Past Loss of Care, Future Loss of Care and Collateral Benefits. Net Past Loss of Care, Future Loss of Care and Collateral Benefits can be modeled by a plurality of levels and can be estimated by the user selecting these levels, where these levels are predefined based on case law.
In this embodiment of the invention, Net past Loss of Care defines three levels;
Future Loss of Care defines five levels; and Collateral Benefits defines five levels.
The user may select a level for each of these three contents in Net Past and Future Loss of Care 105.
Figure 3 illustrates the second half of the display of a user interface describing further information required from the user. Loss of Past Income 106 guides the user to enter information related to obtaining Increase in Salary Loss, Collateral Benefits/Other Income to Date and Pre judgment Interest. Net earnings per year, including income tax, CPP and EI are automatically calculated based on the gross earnings per year entered in interface step 102, and may be displayed to confirm the calculation. Collateral Benefits / Other Income to Date information is obtained from Collateral Benefits / Other Income to Date 201. Pre judgment interest is obtained based on predetermined interest for a particular year of interest. Loss of Future Income 107 leads to one of three interfaces, including Disability 202, Change of Occupation 203, and Risk of Loss of Earning Capacity 204. Future Collateral Benefit / Other Income 205 is another interface called from Loss of Future Income 107, and is to specify Amount per Annum, Discount Rate and Contingency.
Figure 4 is a flow chart of basic steps implemented in the embodiment of the present invention. The user interface is provided in step 300 to obtain all the claim information required for Automatic Estimation method step 301 and most of the information required for Manual Estimation method step 302. After going through both Automatic Estimation method step 301 and Manual Estimation method step 302, results may be compared to confirm validity of computations from both estimations.
Automated Reserve Estimation for personal injury insurance claims consists a number of sub-steps. Each step is modeling selected elements / decision factors for the reserve estimation based on case law, to calculate the amount based on the information supplied by the user through the user interface guidance described earlier.
The processing means, such as a server, implements these case law models for personal injury insurance claim to estimate reserve. Figure 5 illustrates a flow chart of basic steps for Automatic Reserve Estimation, comprising the steps to Calculate Net General Damage 400, to Calculate Net Damage for FLA Claimants 401, to Calculate Net Past and Future Loss of Care 402, to Calculate Net Loss of Past Income 403, to Calculate Net Loss of Future Income 404, to Apply Contributory Negligence 405, to Apply Contribution to Plaintiff on Legal Cost 406, and to Apply Defense Cost and Expense 407. To optimize the computation, two or more of the steps 400 to can be processed in parallel depending on the dependency of the parameters and results of each of these steps.
Calculation of Net General Damages further comprises steps described in Figure 6. Net General Damage estimates damages for pain and suffering for personal injuries. Injury amounts are predetermined based on case law accordingly to category, type and severity of the injury. In this embodiment of the invention, severity of injury is generalized into three levels, including mild, moderate and severe. The user may choose multiple injury types, and may indicate degree of severity associated with the selection. Based on the user's choices, Automatic Estimation method retrieves injury amounts based on selected categories, types and seventies 420, then sorts the amounts by ascending order 421. Generally, it is highly unlikely that full amount of the total of all the injuries that sustained by the claimant would be compensated, but carefully considered portion of each injury amount may be summed up to decide the net general damage. For this reason, an estimation method shall simulate such process. In this embodiment of the present invention, based on those selections, Net General Damages are calculated by applying weighting coefficients 422 and then summing weighted injury amounts 423. The weighting coefficients are predetermined based on case law. In the preferred embodiment of the present invention, weighting coefficients are 100% for the highest injury amount, 50% for the second highest injury amount, and 0% for the rest of injury amounts the user entered. The value of the weighted coefficients may be modified by changing the Model Data 19.
Figure 7 is a flow chart of basic steps for obtaining Net Damages for FLA
Claimants. Net Damages for FLA Claimants is calculated based on the family members) involved in the personal injury case, and is categorized into: (i) Spouse, (ii) Parent(s), (iii) Child(ren), (iv) Grandparent(s), (v) Grandchild(ren), and (vi) sibling(s). Damages amount per claimant are predetermined or can be modified for each category of claimants. The user may also apply a certain deduction to this computation. In this embodiment of the present invention, Bill 59 or Bill 198 deduction (or no deduction) may apply to estimate Net Damages of FLA Claimants 430. If Bill 198 were selected, deduction would be 15000; if Bill 59 were selected, then it would be 7500; and if both of them or none of them were selected, deduction would be 0 as shown in step 431, 432 and 433 respectively. In a case of non-automobile related personal injury, deduction would always be 0. Then, at step 434, each of damage amount per claimant is examined against the deduction amount determined in the previous step; if the amount is less than the deduction amount, damage amount per claimant on that category is considered to be 0. Subtotal for each category is calculated at step 435, and the sum of subtotals is Net Damages for FLA
claimants at step 436.
Figure 8 is a flow chart of basic steps for obtaining Net Past and Future Loss of Care. Net Past and Future Loss of Care calculation comprises the steps of calculating (i) Net Past Loss of Care in step 440, (ii) Future Loss of Care in step 441, and (iii) Collateral Benefits in step 442. These are modeled in levels, i.e.
the amounts are calculated based on the user selecting the appropriate levels of losses and benefits.
Each level has an associated financial figure. The number of levels and financial figure associated with each level for these three steps are predetermined based on case law. In this embodiment of the present invention, there are three levels in Net Past Loss of Care, ranging from $5,000 to $25,000; five levels predefined in Future Loss of Care, ranging from $100,000 to $3,000,000; five levels predefined in Collateral Benefits, ranging from $250,000 to $2,000,000. The number of levels and ranges may be modified by changing the Model Data 19 (not shown). Net Future Loss of Care is obtained by subtracting Collateral Benefits amount from Future Loss of Care amount (if the result is less than 0, treat the result as 0), and then, Net Past and Future Loss of Care is obtained by adding Net Past Loss of Care and Net Future Loss of Care in step 443.
Figure 9 illustrates a flow chart of basic steps for obtaining Loss of Past Income. Net Loss of Past Income is a financial figure to estimate damages caused by the personal injury from the date of loss (injury) till the settlement date.
In this embodiment of the present invention, Net Earnings per Year, Increase in Salary Loss, Collateral Benefits and Pre judgment Interest are considered for obtaining Net Loss of Past Income. Net Earnings per Year is obtained from Gross Earnings per Year, Income Tax, CPP and EI in step 450. If the case is automobile related personal injury at 451, then coefficient of 80% is applied to the Net Earnings per Year in step 452;
otherwise, step 452 will be skipped. Loss of Past Income from date of loss till the settlement is estimated based on Net Earnings per Year, date of loss and date of settlement calculated in step 453; then, Net Loss of Past Income is calculated by applying Increase of Salary Loss at step 454, subtracting Collateral Benefits to Loss of Past Income at step 455 and applying Pre judgment Interest by looking up appropriate rate for the year of interest at step 456.
Figure 10 illustrates a flow chart of these basic steps for obtaining Collateral Benefit / Other Income To Date in this embodiment of the present invention. In the step 480, Canadian Pension Plan (CPP) received to date is calculated based on the starting date of the payment, the end date of the payment, frequency of payment and the amount of the payment. The user supplies data related these through step 201 (not shown). Employment Insurance (EI) in step 481, Income Replacement Benefit (IRB) in step 483 in the case of automobile related personal injury claim confirmed at step 482, Disability in step 484 and Other Benefit in step 485 are all calculated in the similar manner to the way to calculate CPP, based on the user supplied starting date, end date, payment frequency and the amount of payment for each of them. After CPP, EI, IRB, Disability and Other Benefits received to date are calculated, all these amounts are summed up at step 486 to obtain Collateral Benefit / Other Income To Date amount.
Figure 11 illustrates a flow chart of these basic steps for obtaining Loss of Past Income. Net Loss of Future Income estimates how much loss the injury affected based on Disability (temporary or permanent), Change of Occupation, and Risk of Loss of Earning Capacity. In the preferred embodiment of the present invention, one of these three categories is selected to represent Net Loss of Future Income at step 460.
Disability is calculated based on Gross Earnings per Year, by applying percentage of disability (one hundred percent being completely disabled) at step 461;
based on the number of years left from the date of loss till the age of sixty-five (retirement), and discount rate (or interest rate), and then, calculate present value at the time of trial or mediation date of total gross earnings the claimant would earn till the age of sixty-five at step 462. In the case of student, including university, college or high school, Expected Graduation Age would be used as in the calculation of present value, thus Disability amount, i.e. a present value of total gross earnings from the Expected Graduation Age till the age of sixty-five.
Change of Occupation is the second way of estimating Loss of Future Income if the gross earning from new occupation is less than before the date of loss in the case where the claimants is not able to continue the current occupation, but is forced to change his/her occupation. By selecting new occupation code, it estimates current average gross earning by looking up typical gross earnings per year for the selected occupation (at step 463), and then applies percentage of full-time work to new gross earnings per year estimated at step 464. Comparing it with the gross earning that the claimant had before the date of loss (for obtaining difference), and to determine the present value of total difference from the date of trial or mediation date till the age of sixty-five is calculated using user supplied discount rate (or interest rate) at step 465.
Risk of Loss of Earning is the third way of estimating Loss of Future Income.
In this embodiment of the present invention, there are four different levels predetermined based on case law, the associated amount ranging from $25,000 to $100,000. The user selects a level according to the claimant's situation at step 466.
If there is no Loss of Future Income, no selection is made, thus the value would be 0 for Loss of Future Income (at step 467).
Figure 12 is a flow chart of basic steps for obtaining Future Collateral Benefit / Other Income. The amount is used to balance the Future Loss of Income by taking Future Collateral Benefit / Other Income off. At step 470, it calculates a present value of total Amount per Annum from the date of loss till the age of sixty-five based on the user supplied discount rate and contingency rate.
With reference, once again, to Figure 5, after obtaining Net General Damage at step 400, Net Damages for FLA Claimants at step 401, Net Past and Future Loss of Care at step 402, Net Loss of Past Income at step 403 and Net Loss of Future Income at step 404, Contributory Negligence shall be applied for obtaining correct figure of the damages at step 405. Contributory Negligence is expressed in terms of percentage, indicating how much fault that the claimant has contributed resulting in the injury. Legal costs and expenses are then calculated based on the subtotal with Contributory Negligence being applied. Legal costs consist of Contribution to Plaintiff of Legal Costs (at step 406) and Defense Cost and Expenses (at step 407).
The foregoing description of the present invention is presented in connection with Canadian jurisdiction as a preferred embodiment; however, it is to be noted that the adjustments may be made to accommodate requirements of the jurisdictions of other territories or countries.
It is to be understood that the embodiments and variations shown and described herein are merely illustrations of the principles of this invention and that various modifications may be implemented by those skilled in the art without departing from the spirit and scope of the invention.
PERSONAL INJURY INSURANCE CLAIMS
FIELD OF THE INVENTION
The present invention relates to a method and system for estimating reserve for personal injury insurance claims.
BACKGROUND OF THE INVENTION
Insurance companies are required to set reserves when the insurer becomes aware of a loss in all jurisdictions. In Canada, the adequacy of the reserves set by insurers is monitored by the Office of the Superintendent of Financial Institutions of Canada if the insurer is federally incorporated and a comparable provincial authority if the insurer is provincially incorporated.
If the insurer has not established adequate reserves then the insurer may not be able to meet its financial obligations to its own insured or to third parties.
If insurers over reserve then the insurer's financial performance may appear poor, which will affect share value. It is therefore critical that insurers set reserves that are as accurate as possible when the insurer is made aware of a potential claim.
However, the setting of reserves is complex because there are many variables to consider and calculations to perform when determining a reserve for a personal injury claim. The determination of the reserve amount depends heavily on the experiences, judgments, interpretation of case laws and applicable legislation by insurance professionals.
Insurance professionals have been calculating reserves for personal injury claims manually for many years, causing the methods of reserve calculation to vary significantly depending on the knowledge, experience and judgment of the insurance professional.
Automation of such a process has merely been materialized. For example, US
Patent No. 5,613,072 issued March 18, 1997 to Hammond (the Hammond System) teaches a method for funding future workers compensation losses in California.
This is a statutory based system by utilizing statistical models for estimating /
calculating indemnity, vocational rehabilitation, medical and allocated costs based on injury type, severity and other factors that the statisticians may find; however, due to the high cost in implementing such statistical models which requires deploying professional statisticians) in terms of time and money, it is not a practical solution for many insurance professionals who requires such estimation. Moreover, since the Hammond System is based on statutory requirement of workers' compensation insurance claims, it cannot be applied or easily modified for personal injury reserve estimation, since most of the decisions in this area are based on the common law of tort.
Therefore, it is necessary to develop a standard method, which does not rely on statistical models that require professional manual refinement, but still provides an accurate result for estimating insurance reserve for personal injury cases based on case law. The present invention addresses these issues by providing simplified estimation models based on case law.
SUMMARY OF THE INVENTION
The present invention provides a method and system for estimating reserve for personal injury insurance claims.
According to one aspect of the invention, it provides a computer-implemented method of estimating reserve for a personal injury claim comprising the steps of: (i) displaying a user interface on a display means to guide a user to enter information associated with the personal injury claim; (ii) storing entered information in a storage means; (iii) calculating a reserve amount using an Automatic Estimation method based on case law; (iv) storing the reserve amount in the storage means; and (v) displaying the reserve amount in the display for user verification.
According to another aspect of the invention, it provides a computer-implemented method of estimating reserve for personal injury claim via a communication network comprising the steps of: (i) establishing a communication from a remote site where a user resides to a computing means; (ii) authenticating the user at the remote site for granting an access; (iii) displaying a user interface on a display to guide the user to enter information regarding the personal injury claim; (iv) storing entered information in a storage means; (v) calculating a reserve amount using automatic estimation method based on case law; (vi) storing the reserve amount in the storage means; and displaying the reserve amount on the display for user verification..
BRIEF DESCRIPTION OF THE DRAWINGS
The invention will now be described in more detail with reference to the accompanying drawings, in which:
Figure 1 illustrates the primary elements in one embodiment of the present invention;
Figures 2 & 3 illustrate user interface navigation of user in the embodiment of the present invention;
Figure 4 is a flow chart of basic steps implemented in the embodiment of the present invention;
Figure 5 is a flow chart of basic steps for automatic reserve estimation;
Figure 6 is a flow chart of basic steps for obtaining Net General Damages;
Figure 7 is a flow chart of basic steps for obtaining Net Damages for Family Law Acts (or FLA) Claimants;
Figure $ is a flow chart of basic steps for obtaining Net Past and Future Loss of Care;
Figure 9 is a flow chart of basic steps for obtaining Loss of Past Income;
Figure 10 is a flow chart of basic steps for obtaining Collateral Benefit /
Other Income to Date;
Figure 11 is a flow chart of basic steps for obtaining Loss of Future Income;
and Figure 12 is a flow chart of basic steps for obtaining Future Collateral Benefit / Other Income.
DETAILED DESCRIPTION OF THE INVENTION
The present invention teaches a computer-implemented method and a system for providing an innovative platform for predicting reserves for a personal injury claims. The description of the following embodiment of the invention illustrates a system and method adapted for Canadian jurisdiction.
A system as illustrated in Figure 1 consists of a user terminal 10 having a display 11 to enable a user to enter User ID 12 for authenticating an access to a computing means, such as a server 14 over a communication network 13. Once authentication is granted, server engine 15 provides the user access to computer-implemented method for Automatic Estimation 16 and the method for Manual Estimation 17. The server 14 has access to Claim Database 18. The Automatic Estimation method 16 has an access to Claim Database 18 and Model Data 19. The Claim Database 18 maintains relevant information regarding personal injury insurance claims. The Model Data 19 maintains estimation models and data including coefficients for calculation, list of typical gross earnings per year for occupations, levels and corresponding financial figures for estimating particular parts or steps of reserve estimation. The user may enter claim data from the user terminal 10 and may store data in Claim Database 18. The Model Data 19 may be embedded inside or reside remotely from Automatic Estimation method 16. In this embodiment of the present invention, the Model Data 19 is remotely located outside of Automatic Estimation method 16 and is maintained by a system administrator. The user may not be able to alter the content of the Model Data 19. The user may enter data from user terminal 10 to the Claim Database 18. Automatic Estimation method 16 and Manual Estimation method 17 utilizes data entered and stored in the Claim Database 18 to estimate reserve automatically and manually, respectively. User terminal 10 may be remotely located from server 14. The display 11 may be a display of personal computer, or the LCD of a PDA, or of a cellular phone, which may be connected through communication network 13, including wired or wireless communication.
Transferring data across communication network 13 may be secured by encryption algorithm, which are widely and publicly available.
Figures 2 and 3 illustrate a user interface, which guides the user to enter required data to estimate the reserve automatically. Figure 2 shows the first half of the display of a user interface describing the types of information required from the user. The user interface in this embodiment of the present invention was sent from the server to the user terminal, contains Client Information 101, Preliminary Information 102, Injuries information 103, FLA Claimants information 104, and Net Past and Future Loss of Care 105. Client Information 101 directs the user to enter administrative information, including the name of claimant, policy number, claim number, and file number; however, most important information necessary for the user to supply for calculating estimation of reserve are gender, date of loss, date of birth, and expected mediation or trial date, to determine and to calculate various aspects and parts of the reserve estimation method. Preliminary Information 102 is for obtaining information regarding general financial situation, including estimated employment starting date, occupation, gross earnings per year, percent of full time work and injuries. These information are used to assess General Damages, Past and Future Loss of Income, etc. Injuries Information 103 is to refine injuries of Preliminary Information 102. The user enters categories, types and severities of injuries to assess General Damage, and to decide degree of disability. FLA Claimants information is provided for the user to assess net damages of FLA Claimants by specifying number of claimants and amount per FLA category, and Deduction selection. Net Past and Future Loss of Care 105 consists of Net Past Loss of Care, Future Loss of Care and Collateral Benefits. Net Past Loss of Care, Future Loss of Care and Collateral Benefits can be modeled by a plurality of levels and can be estimated by the user selecting these levels, where these levels are predefined based on case law.
In this embodiment of the invention, Net past Loss of Care defines three levels;
Future Loss of Care defines five levels; and Collateral Benefits defines five levels.
The user may select a level for each of these three contents in Net Past and Future Loss of Care 105.
Figure 3 illustrates the second half of the display of a user interface describing further information required from the user. Loss of Past Income 106 guides the user to enter information related to obtaining Increase in Salary Loss, Collateral Benefits/Other Income to Date and Pre judgment Interest. Net earnings per year, including income tax, CPP and EI are automatically calculated based on the gross earnings per year entered in interface step 102, and may be displayed to confirm the calculation. Collateral Benefits / Other Income to Date information is obtained from Collateral Benefits / Other Income to Date 201. Pre judgment interest is obtained based on predetermined interest for a particular year of interest. Loss of Future Income 107 leads to one of three interfaces, including Disability 202, Change of Occupation 203, and Risk of Loss of Earning Capacity 204. Future Collateral Benefit / Other Income 205 is another interface called from Loss of Future Income 107, and is to specify Amount per Annum, Discount Rate and Contingency.
Figure 4 is a flow chart of basic steps implemented in the embodiment of the present invention. The user interface is provided in step 300 to obtain all the claim information required for Automatic Estimation method step 301 and most of the information required for Manual Estimation method step 302. After going through both Automatic Estimation method step 301 and Manual Estimation method step 302, results may be compared to confirm validity of computations from both estimations.
Automated Reserve Estimation for personal injury insurance claims consists a number of sub-steps. Each step is modeling selected elements / decision factors for the reserve estimation based on case law, to calculate the amount based on the information supplied by the user through the user interface guidance described earlier.
The processing means, such as a server, implements these case law models for personal injury insurance claim to estimate reserve. Figure 5 illustrates a flow chart of basic steps for Automatic Reserve Estimation, comprising the steps to Calculate Net General Damage 400, to Calculate Net Damage for FLA Claimants 401, to Calculate Net Past and Future Loss of Care 402, to Calculate Net Loss of Past Income 403, to Calculate Net Loss of Future Income 404, to Apply Contributory Negligence 405, to Apply Contribution to Plaintiff on Legal Cost 406, and to Apply Defense Cost and Expense 407. To optimize the computation, two or more of the steps 400 to can be processed in parallel depending on the dependency of the parameters and results of each of these steps.
Calculation of Net General Damages further comprises steps described in Figure 6. Net General Damage estimates damages for pain and suffering for personal injuries. Injury amounts are predetermined based on case law accordingly to category, type and severity of the injury. In this embodiment of the invention, severity of injury is generalized into three levels, including mild, moderate and severe. The user may choose multiple injury types, and may indicate degree of severity associated with the selection. Based on the user's choices, Automatic Estimation method retrieves injury amounts based on selected categories, types and seventies 420, then sorts the amounts by ascending order 421. Generally, it is highly unlikely that full amount of the total of all the injuries that sustained by the claimant would be compensated, but carefully considered portion of each injury amount may be summed up to decide the net general damage. For this reason, an estimation method shall simulate such process. In this embodiment of the present invention, based on those selections, Net General Damages are calculated by applying weighting coefficients 422 and then summing weighted injury amounts 423. The weighting coefficients are predetermined based on case law. In the preferred embodiment of the present invention, weighting coefficients are 100% for the highest injury amount, 50% for the second highest injury amount, and 0% for the rest of injury amounts the user entered. The value of the weighted coefficients may be modified by changing the Model Data 19.
Figure 7 is a flow chart of basic steps for obtaining Net Damages for FLA
Claimants. Net Damages for FLA Claimants is calculated based on the family members) involved in the personal injury case, and is categorized into: (i) Spouse, (ii) Parent(s), (iii) Child(ren), (iv) Grandparent(s), (v) Grandchild(ren), and (vi) sibling(s). Damages amount per claimant are predetermined or can be modified for each category of claimants. The user may also apply a certain deduction to this computation. In this embodiment of the present invention, Bill 59 or Bill 198 deduction (or no deduction) may apply to estimate Net Damages of FLA Claimants 430. If Bill 198 were selected, deduction would be 15000; if Bill 59 were selected, then it would be 7500; and if both of them or none of them were selected, deduction would be 0 as shown in step 431, 432 and 433 respectively. In a case of non-automobile related personal injury, deduction would always be 0. Then, at step 434, each of damage amount per claimant is examined against the deduction amount determined in the previous step; if the amount is less than the deduction amount, damage amount per claimant on that category is considered to be 0. Subtotal for each category is calculated at step 435, and the sum of subtotals is Net Damages for FLA
claimants at step 436.
Figure 8 is a flow chart of basic steps for obtaining Net Past and Future Loss of Care. Net Past and Future Loss of Care calculation comprises the steps of calculating (i) Net Past Loss of Care in step 440, (ii) Future Loss of Care in step 441, and (iii) Collateral Benefits in step 442. These are modeled in levels, i.e.
the amounts are calculated based on the user selecting the appropriate levels of losses and benefits.
Each level has an associated financial figure. The number of levels and financial figure associated with each level for these three steps are predetermined based on case law. In this embodiment of the present invention, there are three levels in Net Past Loss of Care, ranging from $5,000 to $25,000; five levels predefined in Future Loss of Care, ranging from $100,000 to $3,000,000; five levels predefined in Collateral Benefits, ranging from $250,000 to $2,000,000. The number of levels and ranges may be modified by changing the Model Data 19 (not shown). Net Future Loss of Care is obtained by subtracting Collateral Benefits amount from Future Loss of Care amount (if the result is less than 0, treat the result as 0), and then, Net Past and Future Loss of Care is obtained by adding Net Past Loss of Care and Net Future Loss of Care in step 443.
Figure 9 illustrates a flow chart of basic steps for obtaining Loss of Past Income. Net Loss of Past Income is a financial figure to estimate damages caused by the personal injury from the date of loss (injury) till the settlement date.
In this embodiment of the present invention, Net Earnings per Year, Increase in Salary Loss, Collateral Benefits and Pre judgment Interest are considered for obtaining Net Loss of Past Income. Net Earnings per Year is obtained from Gross Earnings per Year, Income Tax, CPP and EI in step 450. If the case is automobile related personal injury at 451, then coefficient of 80% is applied to the Net Earnings per Year in step 452;
otherwise, step 452 will be skipped. Loss of Past Income from date of loss till the settlement is estimated based on Net Earnings per Year, date of loss and date of settlement calculated in step 453; then, Net Loss of Past Income is calculated by applying Increase of Salary Loss at step 454, subtracting Collateral Benefits to Loss of Past Income at step 455 and applying Pre judgment Interest by looking up appropriate rate for the year of interest at step 456.
Figure 10 illustrates a flow chart of these basic steps for obtaining Collateral Benefit / Other Income To Date in this embodiment of the present invention. In the step 480, Canadian Pension Plan (CPP) received to date is calculated based on the starting date of the payment, the end date of the payment, frequency of payment and the amount of the payment. The user supplies data related these through step 201 (not shown). Employment Insurance (EI) in step 481, Income Replacement Benefit (IRB) in step 483 in the case of automobile related personal injury claim confirmed at step 482, Disability in step 484 and Other Benefit in step 485 are all calculated in the similar manner to the way to calculate CPP, based on the user supplied starting date, end date, payment frequency and the amount of payment for each of them. After CPP, EI, IRB, Disability and Other Benefits received to date are calculated, all these amounts are summed up at step 486 to obtain Collateral Benefit / Other Income To Date amount.
Figure 11 illustrates a flow chart of these basic steps for obtaining Loss of Past Income. Net Loss of Future Income estimates how much loss the injury affected based on Disability (temporary or permanent), Change of Occupation, and Risk of Loss of Earning Capacity. In the preferred embodiment of the present invention, one of these three categories is selected to represent Net Loss of Future Income at step 460.
Disability is calculated based on Gross Earnings per Year, by applying percentage of disability (one hundred percent being completely disabled) at step 461;
based on the number of years left from the date of loss till the age of sixty-five (retirement), and discount rate (or interest rate), and then, calculate present value at the time of trial or mediation date of total gross earnings the claimant would earn till the age of sixty-five at step 462. In the case of student, including university, college or high school, Expected Graduation Age would be used as in the calculation of present value, thus Disability amount, i.e. a present value of total gross earnings from the Expected Graduation Age till the age of sixty-five.
Change of Occupation is the second way of estimating Loss of Future Income if the gross earning from new occupation is less than before the date of loss in the case where the claimants is not able to continue the current occupation, but is forced to change his/her occupation. By selecting new occupation code, it estimates current average gross earning by looking up typical gross earnings per year for the selected occupation (at step 463), and then applies percentage of full-time work to new gross earnings per year estimated at step 464. Comparing it with the gross earning that the claimant had before the date of loss (for obtaining difference), and to determine the present value of total difference from the date of trial or mediation date till the age of sixty-five is calculated using user supplied discount rate (or interest rate) at step 465.
Risk of Loss of Earning is the third way of estimating Loss of Future Income.
In this embodiment of the present invention, there are four different levels predetermined based on case law, the associated amount ranging from $25,000 to $100,000. The user selects a level according to the claimant's situation at step 466.
If there is no Loss of Future Income, no selection is made, thus the value would be 0 for Loss of Future Income (at step 467).
Figure 12 is a flow chart of basic steps for obtaining Future Collateral Benefit / Other Income. The amount is used to balance the Future Loss of Income by taking Future Collateral Benefit / Other Income off. At step 470, it calculates a present value of total Amount per Annum from the date of loss till the age of sixty-five based on the user supplied discount rate and contingency rate.
With reference, once again, to Figure 5, after obtaining Net General Damage at step 400, Net Damages for FLA Claimants at step 401, Net Past and Future Loss of Care at step 402, Net Loss of Past Income at step 403 and Net Loss of Future Income at step 404, Contributory Negligence shall be applied for obtaining correct figure of the damages at step 405. Contributory Negligence is expressed in terms of percentage, indicating how much fault that the claimant has contributed resulting in the injury. Legal costs and expenses are then calculated based on the subtotal with Contributory Negligence being applied. Legal costs consist of Contribution to Plaintiff of Legal Costs (at step 406) and Defense Cost and Expenses (at step 407).
The foregoing description of the present invention is presented in connection with Canadian jurisdiction as a preferred embodiment; however, it is to be noted that the adjustments may be made to accommodate requirements of the jurisdictions of other territories or countries.
It is to be understood that the embodiments and variations shown and described herein are merely illustrations of the principles of this invention and that various modifications may be implemented by those skilled in the art without departing from the spirit and scope of the invention.
Claims (44)
1. A computer-implemented method of estimating reserve for a personal injury claim comprising the steps of:
(i) displaying a user interface on a display means to guide a user to enter information associated with said personal injury claim;
(ii) storing entered information in a storage means;
(iii) calculating a reserve amount using an Automatic Estimation method based on case law;
(iv) storing said reserve amount in said storage means; and (v) displaying said reserve amount in said display for user verification.
(i) displaying a user interface on a display means to guide a user to enter information associated with said personal injury claim;
(ii) storing entered information in a storage means;
(iii) calculating a reserve amount using an Automatic Estimation method based on case law;
(iv) storing said reserve amount in said storage means; and (v) displaying said reserve amount in said display for user verification.
2. The method as recited in claim 1 further comprises a step of estimating reserve amount manually and comparing said manually estimated reserve amount with the reserve amount calculated from said Automatic Estimation method.
3. The method as recited in claim 1, wherein said Automatic Estimation method comprising the steps of:
(i) calculating Net General Damages by processing said entered information by said user, wherein a value of said Net General Damages is obtained by applying an estimation function to all injury amounts determined by said user's selections of injury types and severities;
(ii) calculating net losses by processing said entered information, wherein said net losses comprising:
Net Damages for Family Law Act claimants calculated based on a number of claimants in family member and damages amount per claimant, and deduction selection;
Net Past and Future Loss of Care; and Net Loss of Past and Future Income;
(iii) calculating total reserve amount by applying contributory negligence and estimated legal costs and expenses to said net general damages and said net losses calculated in step (i) and (ii) respectively;
(i) calculating Net General Damages by processing said entered information by said user, wherein a value of said Net General Damages is obtained by applying an estimation function to all injury amounts determined by said user's selections of injury types and severities;
(ii) calculating net losses by processing said entered information, wherein said net losses comprising:
Net Damages for Family Law Act claimants calculated based on a number of claimants in family member and damages amount per claimant, and deduction selection;
Net Past and Future Loss of Care; and Net Loss of Past and Future Income;
(iii) calculating total reserve amount by applying contributory negligence and estimated legal costs and expenses to said net general damages and said net losses calculated in step (i) and (ii) respectively;
4. The method as recited in claim 3, wherein said injury amounts are predefined according to injury type and its severity based on case law.
5. The method as recited in claim 3, wherein said estimation function is a weighted function, which applies predetermined weight to each of selected injury amounts and sums weighted injury amounts for obtaining estimated total general damages.
6. The method as recited in claim 5, wherein said weighted function applies 100% to the highest injury amount, 50% to the second highest injury amount, and 0% to anything lower, then sums weighted injury amounts for obtaining an estimation of total general damage amount.
7. The method as recited in claim 3, wherein said net Damages for Family Law Act claimants are calculated based on information entered by said user regarding family member of said claimant who is involved in personal injury.
8. The method as recited in claim 3, wherein said Net Past and Future Loss of Care is calculated based on a combination of:
(i) Net Past Loss of Care amount;
(ii) Future Loss of Care amount; and (iii) Collateral Benefits amount.
(i) Net Past Loss of Care amount;
(ii) Future Loss of Care amount; and (iii) Collateral Benefits amount.
9. The method as recited in claim 8, wherein said Net Past Loss of Care comprises a plurality of levels, wherein said plurality of levels have associated values.
10. The method as recited in claim 9, wherein said associated values are predetermined based on case law.
11. The method as recited in claim 8, wherein said Future Loss of Care comprises a plurality of levels, wherein said plurality of levels has associated values.
12 12. The method as recited in claim 11, wherein said associated values are predetermined based on case law.
13. The method as recited in claim 8, wherein said Collateral Benefits comprise a plurality of levels, wherein said plurality of levels has associated values.
14. The method as recited in claim 13, wherein said associated values are predetermined based on case law.
15. The method as recited in claim 3, wherein said Net Loss of Past and Future Income is a sum of Loss of Past Income and Loss of Future Income.
16. The method as recited in claim 15, wherein said Loss of Past Income is income assumed to be lost from the date of loss when said personal injury occurred till the date of settlement, and increase in loss income in percentage and pre judgment interest are applied to Loss of Past Income for accurate estimation.
17. The method as recited in claim 15, wherein said Loss of Future Income is estimated to be the highest of either Total Disability, Change of Occupation Salary or Risk of Loss of Earning Capacity.
18. The method as recited in claim 17, wherein said Total Disability is adjusted for obtaining present value using discount rate for accurate estimation.
19. The method as recited in claim 17, wherein said Change of Occupation Salary is adjusted for obtaining present value using discount rate for accurate estimation.
20. The method as recited in claim 17, wherein said Risk of Loss of Earning Capacity comprises a plurality of levels, and predetermined amount is assigned to each level based on case law.
21. The method as recited in claim 1, wherein said storage means is a database.
22. A computer-implemented method of estimating reserve for personal injury claim via communication network comprising the steps of:
(i) establishing a communication from a remote site where a user resides to a computing means;
(ii) authenticating said user at said remote site for granting an access;
(iii) displaying a user interface on a display to guide said user to enter information regarding said personal injury claim;
(iv) storing entered information in a storage means;
(v) calculating a reserve amount using automatic estimation method based on case law;
(vi) storing said reserve amount in said storage means; and (vii) displaying said reserve amount on said display for user verification.
(i) establishing a communication from a remote site where a user resides to a computing means;
(ii) authenticating said user at said remote site for granting an access;
(iii) displaying a user interface on a display to guide said user to enter information regarding said personal injury claim;
(iv) storing entered information in a storage means;
(v) calculating a reserve amount using automatic estimation method based on case law;
(vi) storing said reserve amount in said storage means; and (vii) displaying said reserve amount on said display for user verification.
23. The method as recited in claim 22 further comprises a step of estimating reserve amount manually and comparing manually estimated reserve amount with the reserve amount calculated from said automatic estimation method.
24. The method as recited in claim 22, wherein said estimation procedures comprising the steps of:
(i) calculating Net General Damages by processing said entered information by said user, wherein a value of said net general damages is obtained by applying an estimation function to all injury amount predefined by injury type and severity;
(ii) calculating net losses by processing said entered information, wherein said net losses comprising:
Net Damages for Family Law Act claimants calculated based on a number of claimants in family member and damages amount per the claimant and deduction selection;
Net Past and Future Loss of Care; and Net Loss of Past and Future Income;
(iii) calculating total reserve amount by applying contributory negligence and estimated legal costs and expenses to said net general damages and said net losses calculated in step (i) and (ii) respectively;
(i) calculating Net General Damages by processing said entered information by said user, wherein a value of said net general damages is obtained by applying an estimation function to all injury amount predefined by injury type and severity;
(ii) calculating net losses by processing said entered information, wherein said net losses comprising:
Net Damages for Family Law Act claimants calculated based on a number of claimants in family member and damages amount per the claimant and deduction selection;
Net Past and Future Loss of Care; and Net Loss of Past and Future Income;
(iii) calculating total reserve amount by applying contributory negligence and estimated legal costs and expenses to said net general damages and said net losses calculated in step (i) and (ii) respectively;
25. The method as recited in claim 22, wherein said communication is established over communication network.
26. The method as recited in claim 24, wherein said injury amounts are predefined according to injury type and its severity based on case law.
27. The method as recited in claim 24, wherein said estimation function is a weighted function, which applies predetermined weight to each of selected injury amounts and sums weighted injury amounts for obtaining estimated total general damages.
28. The method as recited in claim 27, wherein said weighted function applies 100% to the highest injury amount, 50% to the second highest amount, and 0% to anything lower, then sums weighted injury amounts for obtaining an estimation of total general damages amount.
29. The method as recited in claim 24, wherein said Net Damages for Family Law Act claimants are calculated based on information entered by said user regarding family member(s) of said claimant who is (are) involved in personal injury.
30. The method as recited in claim 24, wherein said Net Past and Future Loss of Care is calculated based on a combination of:
(i) Net Past Loss of Care amount;
(ii) Future Loss of Care amount; and (iii) Collateral Benefits amount.
(i) Net Past Loss of Care amount;
(ii) Future Loss of Care amount; and (iii) Collateral Benefits amount.
31. The method as recited in claim 30, wherein said Net Past Loss of Care comprises a plurality of levels, wherein said plurality of levels have associated values.
32. The method as recited in claim 31, wherein said associated values to said levels are predetermined based on case law.
33. The method as recited in claim 30, wherein said Future Loss of Care comprises a plurality of levels, wherein said plurality of levels have associated values.
34. The method as recited in claim 33, wherein said associated values to said levels are predetermined based on case law.
35. The method as recited in claim 30, wherein said Collateral Benefits comprises a plurality of levels, wherein said plurality of levels has associated values.
36. The method as recited in claim 35, wherein said associated values are predetermined based on case law.
37. The method as recited in claim 24, wherein said Net Loss of Past and Future is a sum of Loss of Past Income and Loss of Future Income.
38. The method as recited in claim 37, wherein said Loss of Past Income is income assumed to be lost from the date of loss when said personal injury occurred till the date of settlement, and increase in Loss of Income in percentage and pre-judgment interest are applied to Loss of Past Income for accurate estimation.
39. The method as recited in claim 37, wherein said Loss of Future Income is estimated to be the highest amount of either Total Disability, Change of Occupation Salary, or Risk of Loss of Earning Capacity.
40. The method as recited in claim 39, wherein said Total Disability is adjusted for obtaining present value using discount rate for accurate estimation.
41. The method as recited in claim 39, wherein said Change of Occupation Salary is adjusted for obtaining present value using discount rate for accurate estimation.
42. The method as recited in claim 39, wherein said Risk of Loss of Earning Capacity comprises a plurality of levels, and predetermined amount is assigned to each level based on case law.
43. A computer-implemented system for estimating reserve for personal injury insurance claims comprising:
(i) a means for displaying a user interface to guide a user to enter information associated with a personal injury claim;
(ii) a storage means for storing entered information by said user; and (iii) a computing means for retrieving data from said storage means and automatically and manually calculating reserve amount predicted based on entered information by said user.
(i) a means for displaying a user interface to guide a user to enter information associated with a personal injury claim;
(ii) a storage means for storing entered information by said user; and (iii) a computing means for retrieving data from said storage means and automatically and manually calculating reserve amount predicted based on entered information by said user.
44. A computer-implemented system for estimating reserve for personal injury insurance claims over a communication network, comprising:
(i) a means for displaying a user authentication interface and a user interface to guide a user to enter information regarding a personal injury claim remotely at said user's location;
(ii) a storage means for storing entered information by said user;
(iii) a computing means for retrieving data from said storage means and automatically and manually calculating reserve amount predicted based on entered information by said user; and (iv) a communication means for transferring data between said means for displaying user interface, said storage means and said computing means.
(i) a means for displaying a user authentication interface and a user interface to guide a user to enter information regarding a personal injury claim remotely at said user's location;
(ii) a storage means for storing entered information by said user;
(iii) a computing means for retrieving data from said storage means and automatically and manually calculating reserve amount predicted based on entered information by said user; and (iv) a communication means for transferring data between said means for displaying user interface, said storage means and said computing means.
Priority Applications (1)
| Application Number | Priority Date | Filing Date | Title |
|---|---|---|---|
| CA 2502336 CA2502336A1 (en) | 2005-03-24 | 2005-03-24 | A method and system for estimating reserves for personal injury insurance claims |
Applications Claiming Priority (1)
| Application Number | Priority Date | Filing Date | Title |
|---|---|---|---|
| CA 2502336 CA2502336A1 (en) | 2005-03-24 | 2005-03-24 | A method and system for estimating reserves for personal injury insurance claims |
Publications (1)
| Publication Number | Publication Date |
|---|---|
| CA2502336A1 true CA2502336A1 (en) | 2006-09-24 |
Family
ID=37055030
Family Applications (1)
| Application Number | Title | Priority Date | Filing Date |
|---|---|---|---|
| CA 2502336 Abandoned CA2502336A1 (en) | 2005-03-24 | 2005-03-24 | A method and system for estimating reserves for personal injury insurance claims |
Country Status (1)
| Country | Link |
|---|---|
| CA (1) | CA2502336A1 (en) |
Cited By (1)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| US20230110486A1 (en) * | 2021-10-13 | 2023-04-13 | Assured Insurance Technologies, Inc. | Interactive claimant injury interface |
-
2005
- 2005-03-24 CA CA 2502336 patent/CA2502336A1/en not_active Abandoned
Cited By (1)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| US20230110486A1 (en) * | 2021-10-13 | 2023-04-13 | Assured Insurance Technologies, Inc. | Interactive claimant injury interface |
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