CN109447828A - A kind of settlement of insurance claim method and device - Google Patents
A kind of settlement of insurance claim method and device Download PDFInfo
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- CN109447828A CN109447828A CN201811229383.4A CN201811229383A CN109447828A CN 109447828 A CN109447828 A CN 109447828A CN 201811229383 A CN201811229383 A CN 201811229383A CN 109447828 A CN109447828 A CN 109447828A
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- 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
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Abstract
The embodiment of the invention provides a kind of settlement of insurance claim method and devices, this method comprises: obtaining Claims Resolution request, Claims Resolution request carries the injury information of the wounded, and injury information includes that the condition of the injury describes text and medical image, and medical image carries the internal injury information of the wounded.Diagnosis report is generated according to the injury information of the wounded.Policy information is obtained, policy information includes insurer's information, beneficiary's information, insurance subject, the Limitation on Liability of insured amount, reparation or payment.Policy information and diagnosis report are compared, Claims Resolution scheme is generated.Technical solution provided in an embodiment of the present invention is able to solve the problem of artificial underwriting low efficiency in the prior art.
Description
[technical field]
The present invention relates to settlement of insurance claim technical field more particularly to a kind of settlement of insurance claim method and devices.
[background technique]
In business insurance, when accident occurs for user, claims personnel artificial nucleus are needed to test the condition of the injury of the wounded, according to the condition of the injury
It settles a claim, efficiency is very low.
Therefore, artificial underwriting low efficiency how is solved as a technical problem to be solved urgently.
[summary of the invention]
In view of this, the embodiment of the invention provides a kind of settlement of insurance claim method and devices, to solve in the prior art
The problem of artificial underwriting low efficiency.
To achieve the goals above, according to an aspect of the invention, there is provided a kind of settlement of insurance claim method, the method
It include: to obtain Claims Resolution request, the Claims Resolution request carries the injury information of the wounded, and the injury information includes condition of the injury description text
This and medical image, the medical image carry the internal injury information of described the wounded；According to the injury information of described the wounded
Generate diagnosis report；Policy information is obtained, the policy information includes insurer's information, beneficiary's information, insurance subject, insurance
The amount of money, reparation or the Limitation on Liability of payment；
The policy information and the diagnosis report are compared, Claims Resolution scheme is generated.
Further, described that diagnosis report is generated according to the injury information of described the wounded, comprising: to describe text from the condition of the injury
Keyword is extracted in this, obtains the first diagnostic result；Extract medical features from the medical image, by the medical features with
The medical features of standard medical image are matched, and second opinion result is obtained；According to first diagnostic result and described
Two diagnostic results generate the diagnosis report.
Further, described that diagnosis report is generated according to the injury information of described the wounded, comprising: to send the injury information
To third party, the third party includes one of hospital, the private doctor of described the wounded and physical examination mechanism or a variety of；Obtain institute
State third party's diagnosis report that third party provides；Using third party's diagnosis report as the diagnosis report of described the wounded.
Further, described to compare the policy information and the diagnosis report, generate Claims Resolution scheme, comprising:
Obtain the condition of the injury type and recommended therapy scheme in the diagnosis report；The condition of the injury type includes condition of the injury position and condition of the injury journey
Degree；The recommended therapy scheme includes diagnosis and treatment mode, estimates medical expense, treatment department and duration in hospital；Obtain the declaration form
Claims Resolution limit corresponding with the condition of the injury type in information；By the insurance subject in the condition of the injury type and the policy information
It is matched, judges whether the condition of the injury type meets straight knot Claims Resolution condition；If meeting, according to the recommended therapy revision of option
The Claims Resolution ratio of the Claims Resolution limit generates the first Claims Resolution scheme.
Further, it is described judge whether the condition of the injury type meets straight knot Claims Resolution condition after, the method is also wrapped
Include: if not meeting the straight knot Claims Resolution condition, the Claims Resolution limit according to the recommended therapy revision of option pays for ratio, life first
At the second Claims Resolution scheme.
Further, after the generation Claims Resolution scheme, the method also includes: the Claims Resolution side is sent to insurer
Case；The electronic signature of the insurer is received, the electronic signature authorizes the Claims Resolution scheme for veritifying.
To achieve the goals above, according to an aspect of the invention, there is provided a kind of settlement of insurance claim device, described device
It include: first acquisition unit, for obtaining Claims Resolution request, the Claims Resolution request carries the injury information of the wounded, the condition of the injury
Information includes that the condition of the injury describes text and medical image, and the medical image carries the internal injury information of described the wounded；It generates
Unit, for generating diagnosis report according to the injury information of described the wounded；Second acquisition unit, for obtaining policy information, institute
Stating policy information includes insurer's information, beneficiary's information, insurance subject, the Limitation on Liability of insured amount, reparation or payment；Place
Unit is managed, for comparing the policy information and the diagnosis report, generates Claims Resolution scheme.
Further, the generation unit includes: the first extraction subelement, for describing to extract in text from the condition of the injury
Keyword obtains the first diagnostic result；Second extracts subelement, for extracting medical features from the medical image, by institute
It states medical features to be matched with the medical features of standard medical image, obtains second opinion result；First generates subelement, uses
According to first diagnostic result and the second opinion result generation diagnosis report.
Further, the processing unit includes: that third obtains subelement, for obtaining the condition of the injury in the diagnosis report
Type and recommended therapy scheme；The condition of the injury type includes condition of the injury position and condition of the injury degree；The recommended therapy scheme includes examining
Treatment mode estimates medical expense, treatment department and duration in hospital；4th obtains subelement, for obtaining in the policy information
Claims Resolution limit corresponding with the condition of the injury type；Judgment sub-unit, for will be in the condition of the injury type and the policy information
Insurance subject matched, judge whether the condition of the injury type meets straight knot Claims Resolution condition；Second generates subelement, for working as
When the condition of the injury type meets straight knot Claims Resolution condition, the Claims Resolution ratio for limit of settling a claim according to the recommended therapy revision of option
Example generates the first Claims Resolution scheme.
To achieve the goals above, according to an aspect of the invention, there is provided a kind of storage medium, the storage medium
Program including storage, wherein equipment where controlling the storage medium in described program operation executes above-mentioned settlement of insurance claim
Method.
To achieve the goals above, according to an aspect of the invention, there is provided a kind of server, including memory and place
Device is managed, the memory is used to control the execution of program instruction, institute for storing the information including program instruction, the processor
State the step of above-mentioned settlement of insurance claim method is realized when program instruction is loaded and executed by processor.
In the present solution, describe text and medical image by the condition of the injury for obtaining the wounded, and based on the condition of the injury describe text and
Medical image generates diagnosis report, by the way that diagnosis report to be compared with policy information, generates Claims Resolution scheme, occurs in user
The problem of capable of quickly generating Claims Resolution scheme after accident, avoid artificial underwriting low efficiency, improves underwriting effect
Rate.
[Detailed description of the invention]
In order to illustrate the technical solution of the embodiments of the present invention more clearly, below will be to needed in the embodiment attached
Figure is briefly described, it should be apparent that, drawings in the following description are only some embodiments of the invention, for this field
For those of ordinary skill, without any creative labor, it can also be obtained according to these attached drawings other attached
Figure.
Fig. 1 is a kind of flow chart of settlement of insurance claim method according to an embodiment of the present invention；
Fig. 2 is a kind of schematic diagram of settlement of insurance claim device according to an embodiment of the present invention；
Fig. 3 is a kind of schematic diagram of server according to an embodiment of the present invention.
[specific embodiment]
For a better understanding of the technical solution of the present invention, being retouched in detail to the embodiment of the present invention with reference to the accompanying drawing
It states.
It will be appreciated that described embodiments are only a part of the embodiments of the present invention, instead of all the embodiments.Base
Embodiment in the present invention, it is obtained by those of ordinary skill in the art without making creative efforts it is all its
Its embodiment, shall fall within the protection scope of the present invention.
The term used in embodiments of the present invention is only to be not intended to be limiting merely for for the purpose of describing particular embodiments
The present invention.In the embodiment of the present invention and the "an" of singular used in the attached claims, " described " and "the"
It is also intended to including most forms, unless the context clearly indicates other meaning.
It should be appreciated that term "and/or" used herein is only a kind of incidence relation for describing affiliated partner, indicate
There may be three kinds of relationships, for example, A and/or B, can indicate: individualism A, exist simultaneously A and B, individualism B these three
Situation.In addition, character "/" herein, typicallys represent the relationship that forward-backward correlation object is a kind of "or".
It will be appreciated that though terminal may be described using term first, second, third, etc. in embodiments of the present invention,
But these terminals should not necessarily be limited by these terms.These terms are only used to for terminal being distinguished from each other out.For example, not departing from the present invention
In the case where scope of embodiments, the first diagnostic result can also be referred to as second opinion as a result, similarly, second opinion result
The first diagnostic result can be referred to as.
Depending on context, word as used in this " if " can be construed to " ... when " or " when ...
When " or " in response to determination " or " in response to detection ".Similarly, depend on context, phrase " if it is determined that " or " if detection
(condition or event of statement) " can be construed to " when determining " or " in response to determination " or " when the detection (condition of statement
Or event) when " or " in response to detection (condition or event of statement) ".
Fig. 1 is a kind of flow chart of settlement of insurance claim method according to an embodiment of the present invention, as shown in Figure 1, this method comprises:
Step S102 obtains Claims Resolution request, and Claims Resolution request carries the injury information of the wounded, and injury information includes that the condition of the injury is retouched
Text and medical image are stated, medical image carries the internal injury information of the wounded.
Claims Resolution request can be initiated by Claims Resolution veritification personnel by mobile terminal, and Claims Resolution request includes that the identity of the wounded is believed
Cease, product contract of insuring number etc..Mobile terminal can be mobile phone, vehicle-mounted computer, ipad, any one in laptop
Kind.Optionally, the condition of the injury that Claims Resolution veritification personnel can input the wounded by mobile terminal describes text, and the condition of the injury describes text and includes
Whether there is or not moving obstacles, injury, and injured area, whether there is or not bleedings etc..
Optionally, claims personnel can obtain the medical image of the wounded, medical treatment detection by the medical treatment detection device of profession
Equipment includes one of folding X-ray equipment, vehicle-mounted CT equipment, portable ultrasonic equipment, MR equipment or a variety of.Medical treatment
Detection device is connected with mobile terminal communication, and claims personnel examines patient by these medical treatment detection devices at injures and deaths scene
It looks into, acquire medical image and is transferred to mobile terminal, injury information is sent to system again by mobile terminal, and system is insurance company
Claims Resolution system.
The condition of the injury is diagnosed by portable moveable medical treatment detection device, the serious of the practical condition of the injury can be obtained rapidly
Degree, and can be as the reliable basis of Claims Resolution schemes generation.Claims personnel can select one or more according to injury
Medical treatment detection device shoots abdomen organ's figure to be acquired internal injury information to injury, such as by ultrasonic equipment
Piece shoots the picture at the positions such as bone by X-ray equipment.To avoid claims personnel in field reconnaissance, inside can not be hurt
Feelings make correct judgement, cause Claims Resolution scheme not reasonable, or even situations such as insurance fraud occur.
It, can be without using doctor when the veritification personnel that settle a claim judge that the condition of the injury of the wounded is only the lighter body surface condition of the injury such as galled spots
It treats detection device and acquires the intracorporal medical image of the wounded, text is only described by the condition of the injury that mobile terminal inputs the wounded.When
When Claims Resolution veritification personnel can not judge the condition of the injury in the wounded's body, then need to acquire medical image by medical treatment detection device with further
The condition of the injury is accurately judged, to give more reasonable Claims Resolution scheme.
Step S104 generates diagnosis report according to the injury information of the wounded.The mode for generating diagnosis report include system from
Dynamic generation and third party generate.
The method of system automatically generated specifically includes: describing to extract keyword in text from the condition of the injury, obtains the first diagnosis knot
Fruit.Such as: the keyword of the description condition of the injury such as " right leg ", " knee ", " minor scratches ".Medical features are extracted from medical image,
Medical features are matched with the medical features of standard medical image, obtain second opinion result.
Specifically, medical features include picture edge characteristic, shape feature, color characteristic and local feature；According to doctor
It learns feature to be matched one by one with the medical features of standard medical image, to obtain second opinion result.For example, medical image
It is the right leg shin bone normotopia X-ray of the wounded, by obtaining the second opinion result of right leg fracture of tibia after matching.
Diagnosis report is generated according to the first diagnostic result and second opinion result.Diagnosis report includes condition of the injury type and suggestion
Therapeutic scheme.Condition of the injury type includes condition of the injury position and condition of the injury degree, such as: Zhang San, right leg knee scratch, right leg tibial bone
Folding.Recommended therapy scheme includes diagnosis and treatment mode, estimates medical expense, treatment department and duration in hospital, such as suggests removing hospital's bone
Section carries out replacement and fixation treatment in hospital, it is contemplated that be hospitalized duration 2 weeks, medical expense 20,000.By identifying the medical image of the wounded, obtain
To the diagnostic result with scientific basis, the risk of mistaken diagnosis is reduced, to improve the accuracy of underwriting.
The method that third party generates specifically includes: sending injury information to third party, third party includes the private of hospital, the wounded
One of people doctor and physical examination mechanism are a variety of.It, can be according to the wounded or insurer after claims personnel collects injury information
Wish, send injury information to third party.Obtain third party's diagnosis report that third party provides；And by third party's diagnosis report
Diagnosis report as the wounded.The diagnosis report that third party is generated is as the foundation of Claims Resolution implementation process, so that Claims Resolution process
It is more transparent just, promote user satisfaction.
Step S106 obtains policy information, and policy information includes insurer's information, beneficiary's information, insurance subject, insurance
The amount of money, reparation or the Limitation on Liability of payment.It, can also be with it is to be appreciated that insurer and beneficiary (the wounded) can be same people
It is not same people, such as the insurance that Zhang buys to oneself wife or child.Insurance subject can be divided into personal insurance, property is protected
Danger, liability insurance and credit assurance insurance etc..The Limitation on Liability of reparation or payment is the liability clause set in insurance contract, reason
Pay for the contents such as the amount of money.
Step S108, policy information and diagnosis report are compared, and generate Claims Resolution scheme.Specifically:
Obtain the condition of the injury type and recommended therapy scheme in diagnosis report；Condition of the injury type includes condition of the injury position and condition of the injury journey
Degree；Recommended therapy scheme includes diagnosis and treatment mode, estimates medical expense, treatment department and duration in hospital.
Obtain Claims Resolution limit corresponding with condition of the injury type in policy information.
Condition of the injury type is matched with the insurance subject in policy information, judges whether condition of the injury type meets straight knot Claims Resolution
Condition.Such as condition of the injury type is minor scratches, meets straight knot Claims Resolution condition.It is to be appreciated that straight knot Claims Resolution is by insurance company
It directly pays the medical expense that the wounded's diagnosis and treatment generate to hospital, foots a bill without user.
If meeting, according to the Claims Resolution ratio of recommended therapy revision of option Claims Resolution limit, the first Claims Resolution scheme is generated.It can manage
Xie Di, using straight knot Claims Resolution scheme, simplifies Claims Resolution process, improves efficiency under the wounded's condition of the injury not serious situation.
If not meeting straight knot Claims Resolution condition, ratio is paid for first according to recommended therapy revision of option Claims Resolution limit, generates second
Claims Resolution scheme.It first pays for part expense first, pays for ratio first and executed according to the regulation in the Limitation on Liability of reparation or payment.To hospital
After the medical bills information for providing the wounded, remaining settling fee is made into the wounded.By paying for amount for which loss settled first, the wounded point is helped
Medical expense is carried on a shoulder pole, underwriting efficiency is improved, preferably increases customer satisfaction degree.
Optionally, after generating Claims Resolution scheme, method further include: send Claims Resolution scheme to insurer；Receive insurer's
Electronic signature, electronic signature is for veritifying authorization Claims Resolution scheme.The case where to avoid the occurrence of insurance fraud.
The embodiment of the invention provides a kind of settlement of insurance claim device, the settlement of insurance claim device is for executing above-mentioned settlement of insurance claim
Method, as shown in Fig. 2, the device includes: first acquisition unit 10, generation unit 20, second acquisition unit 30, processing unit
40。
First acquisition unit 10, for obtaining Claims Resolution request, Claims Resolution request carries the injury information of the wounded, injury information
Text and medical image are described including the condition of the injury, medical image carries the internal injury information of the wounded.
Claims Resolution request can be initiated by Claims Resolution veritification personnel by mobile terminal, and Claims Resolution request includes that the identity of the wounded is believed
Cease, product contract of insuring number etc..Mobile terminal can be mobile phone, vehicle-mounted computer, ipad, any one in laptop
Kind.Optionally, the condition of the injury that Claims Resolution veritification personnel can input the wounded by mobile terminal describes text, and the condition of the injury describes text and includes
Whether there is or not moving obstacles, injury, and injured area, whether there is or not bleedings etc..
Optionally, claims personnel can obtain the medical image of the wounded, medical treatment detection by the medical treatment detection device of profession
Equipment includes one of folding X-ray equipment, vehicle-mounted CT equipment, portable ultrasonic equipment, MR equipment or a variety of.Medical treatment
Detection device is connected with mobile terminal communication, and claims personnel examines patient by these medical treatment detection devices at injures and deaths scene
It looks into, acquire medical image and is transferred to mobile terminal, injury information is sent to system again by mobile terminal, and system is insurance company
Claims Resolution system.
The condition of the injury is diagnosed by portable moveable medical treatment detection device, the serious of the practical condition of the injury can be obtained rapidly
Degree, and can be as the reliable basis of Claims Resolution schemes generation.Claims personnel can select one or more according to injury
Medical treatment detection device shoots abdomen organ's figure to be acquired internal injury information to injury, such as by ultrasonic equipment
Piece shoots the picture at the positions such as bone by X-ray equipment.To avoid claims personnel in field reconnaissance, inside can not be hurt
Feelings make correct judgement, cause Claims Resolution scheme not reasonable, or even situations such as insurance fraud occur.
It, can be without using doctor when the veritification personnel that settle a claim judge that the condition of the injury of the wounded is only the lighter body surface condition of the injury such as galled spots
It treats detection device and acquires the intracorporal medical image of the wounded, text is only described by the condition of the injury that mobile terminal inputs the wounded.When
When Claims Resolution veritification personnel can not judge the condition of the injury in the wounded's body, then need to acquire medical image by medical treatment detection device with further
The condition of the injury is accurately judged, to give more reasonable Claims Resolution scheme.
Generation unit 20, for generating diagnosis report according to the injury information of the wounded.Generation unit 20 includes the first extraction
Subelement, second extract subelement and the first generation subelement.First extraction unit is closed for describing to extract in text from the condition of the injury
Key word obtains the first diagnostic result.Second extracts subelement, for extracting medical features from medical image, by medical features
It is matched with the medical features of standard medical image, obtains second opinion result.First generates subelement, for according to first
Diagnostic result and second opinion result generate diagnosis report.
Generation unit 20 further includes transmission sub-unit, the 5th acquisition subelement, the 4th generation subelement.Transmission sub-unit,
For sending injury information to third party, third party includes one of hospital, the private doctor of the wounded and physical examination mechanism or more
Kind.5th obtains subelement, the third party's diagnosis report provided for obtaining third party.4th generates subelement, for by the
Diagnosis report of tripartite's diagnosis report as the wounded.Using third party generate diagnosis report as settle a claim implementation process foundation,
So that Claims Resolution process is more transparent just, user satisfaction is promoted.
Processing unit 40 generates Claims Resolution scheme for comparing policy information and diagnosis report.Processing unit 40 wraps
It includes third and obtains subelement, the 4th acquisition subelement, judgment sub-unit and the second generation subelement.
Third obtains subelement, for obtaining condition of the injury type and recommended therapy scheme in diagnosis report；Condition of the injury type packet
Include condition of the injury position and condition of the injury degree；Recommended therapy scheme include diagnosis and treatment mode, estimate medical expense, treatment department and in hospital when
It is long.4th obtains subelement, for obtaining Claims Resolution limit corresponding with condition of the injury type in policy information.Judgment sub-unit is used
In matching condition of the injury type with the insurance subject in policy information, judge whether condition of the injury type meets straight knot Claims Resolution condition,
It is to be appreciated that straight knot Claims Resolution is directly to pay the medical expense that the wounded's diagnosis and treatment generate to hospital by insurance company, it is not necessarily to user
It foots a bill.Second generates subelement, for being settled a claim according to recommended therapy revision of option when condition of the injury type meets straight knot Claims Resolution condition
The Claims Resolution ratio of limit generates the first Claims Resolution scheme.
Processing unit further includes that third generates subelement.Third generates subelement, for closing straight knot when condition of the injury type mismatch
When Claims Resolution condition, ratio is paid for first according to recommended therapy revision of option Claims Resolution limit, generates the second Claims Resolution scheme.First pay for portion first
Divide expense, pays for ratio first and executed according to the regulation in the Limitation on Liability of reparation or payment.The medical bills of the wounded are provided to hospital
After information, remaining settling fee is made into the wounded.
Optionally, method further includes transmission unit and receiving unit.Transmission unit, for sending Claims Resolution side to insurer
Case；Receiving unit, for receiving the electronic signature of insurer, electronic signature is for veritifying authorization Claims Resolution scheme.To avoid out
The case where existing insurance fraud.
The embodiment of the invention provides a kind of storage medium, storage medium includes the program of storage, wherein is run in program
When control storage medium where equipment execute following steps:
Obtain Claims Resolution request, Claims Resolution request carries the injury information of the wounded, injury information include the condition of the injury describe text and
Medical image, medical image carry the internal injury information of the wounded；Diagnosis report is generated according to the injury information of the wounded；It obtains
Policy information, policy information include insurer's information, beneficiary's information, insurance subject, the responsibility of insured amount, reparation or payment
Range；Policy information and diagnosis report are compared, Claims Resolution scheme is generated.
Optionally, when program is run, equipment where control storage medium executes following steps: obtaining Claims Resolution request
Afterwards, it describes to extract keyword in text from the condition of the injury, obtains the first diagnostic result；Medical features are extracted from medical image, will be cured
It learns feature to be matched with the medical features of standard medical image, obtains second opinion result；According to the first diagnostic result and
Two diagnostic results generate diagnosis report.
Optionally, when program is run, equipment where control storage medium executes following steps: obtaining Claims Resolution request
Afterwards, injury information is sent to third party, and third party includes one of hospital, the private doctor of the wounded and physical examination mechanism or more
Kind；Obtain third party's diagnosis report that third party provides；Using third party's diagnosis report as the diagnosis report of the wounded.
Optionally, when program is run, equipment where control storage medium executes following steps: obtaining in diagnosis report
Condition of the injury type and recommended therapy scheme；Condition of the injury type includes condition of the injury position and condition of the injury degree；Recommended therapy scheme includes diagnosis and treatment side
Formula estimates medical expense, treatment department and duration in hospital；Obtain Claims Resolution limit corresponding with condition of the injury type in policy information；
Condition of the injury type is matched with the insurance subject in policy information, judges whether condition of the injury type meets straight knot Claims Resolution condition；If
Meet, according to the Claims Resolution ratio of recommended therapy revision of option Claims Resolution limit, generates the first Claims Resolution scheme.
Optionally, when program is run, equipment where control storage medium executes following steps: if not meeting straight knot Claims Resolution
Condition pays for ratio first according to recommended therapy revision of option Claims Resolution limit, generates the second Claims Resolution scheme.
Optionally, program run when control storage medium where equipment execute following steps: generate Claims Resolution scheme it
Afterwards, Claims Resolution scheme is sent to insurer；The electronic signature of insurer is received, electronic signature is for veritifying authorization Claims Resolution scheme.
As shown in figure 3, the embodiment of the invention provides a kind of server 50, including memory 52 and processor 51, storage
Device 52 is used to control the execution of program instruction 53, program instruction 53 for storing the information including program instruction 53, processor 51
It is performed the steps of when being loaded and executed by processor
Obtain Claims Resolution request, Claims Resolution request carries the injury information of the wounded, injury information include the condition of the injury describe text and
Medical image, medical image carry the internal injury information of the wounded；Diagnosis report is generated according to the injury information of the wounded；It obtains
Policy information, policy information include insurer's information, beneficiary's information, insurance subject, the responsibility of insured amount, reparation or payment
Range；Policy information and diagnosis report are compared, Claims Resolution scheme is generated.
Optionally, it is performed the steps of when program instruction is loaded and executed by processor after obtaining Claims Resolution request, from
The condition of the injury describes to extract keyword in text, obtains the first diagnostic result；Medical features are extracted from medical image, by medical features
It is matched with the medical features of standard medical image, obtains second opinion result；According to the first diagnostic result and second opinion
As a result diagnosis report is generated.
Optionally, it is performed the steps of when program instruction is loaded and executed by processor after obtaining Claims Resolution request, hair
Send injury information to third party, third party includes one of hospital, the private doctor of the wounded and physical examination mechanism or a variety of；It obtains
Third party's diagnosis report that third party provides；Using third party's diagnosis report as the diagnosis report of the wounded.
Optionally, the condition of the injury obtained in diagnosis report is performed the steps of when program instruction is loaded and executed by processor
Type and recommended therapy scheme；Condition of the injury type includes condition of the injury position and condition of the injury degree；Recommended therapy scheme includes diagnosis and treatment mode, pre-
Estimate medical expense, treatment department and duration in hospital；Obtain Claims Resolution limit corresponding with condition of the injury type in policy information；By the condition of the injury
Type is matched with the insurance subject in policy information, judges whether condition of the injury type meets straight knot Claims Resolution condition；If meeting, root
It is suggested that the Claims Resolution ratio of therapeutic scheme amendment Claims Resolution limit, generates the first Claims Resolution scheme.
Optionally, if program instruction performs the steps of when being loaded and executed by processor does not meet straight knot Claims Resolution condition,
Ratio is paid for first according to recommended therapy revision of option Claims Resolution limit, generates the second Claims Resolution scheme.
Optionally, it is performed the steps of when program instruction is loaded and executed by processor after generating Claims Resolution scheme, to
Insurer sends Claims Resolution scheme；The electronic signature of insurer is received, electronic signature is for veritifying authorization Claims Resolution scheme.
It should be noted that terminal involved in the embodiment of the present invention can include but is not limited to personal computer
(Personal Computer, PC), personal digital assistant (Personal Digital Assistant, PDA), wireless handheld
Equipment, tablet computer (Tablet Computer), mobile phone, MP3 player, MP4 player etc..
It is understood that the application can be mounted in the application program (nativeApp) in terminal, or may be used also
To be a web page program (webApp) of browser in terminal, the embodiment of the present invention is to this without limiting.
It is apparent to those skilled in the art that for convenience and simplicity of description, the system of foregoing description,
The specific work process of device and unit, can refer to corresponding processes in the foregoing method embodiment, and details are not described herein.
In several embodiments provided by the present invention, it should be understood that disclosed system, device and method can be with
It realizes by another way.For example, the apparatus embodiments described above are merely exemplary, for example, the unit
It divides, only a kind of logical function partition, there may be another division manner in actual implementation, for example, multiple units or group
Part can be combined or can be integrated into another system, or some features can be ignored or not executed.Another point, it is shown
Or the mutual coupling, direct-coupling or communication connection discussed can be through some interfaces, device or unit it is indirect
Coupling or communication connection can be electrical property, mechanical or other forms.
The unit as illustrated by the separation member may or may not be physically separated, aobvious as unit
The component shown may or may not be physical unit, it can and it is in one place, or may be distributed over multiple
In network unit.It can select some or all of unit therein according to the actual needs to realize the mesh of this embodiment scheme
's.
It, can also be in addition, the functional units in various embodiments of the present invention may be integrated into one processing unit
It is that each unit physically exists alone, can also be integrated in one unit with two or more units.Above-mentioned integrated list
Member both can take the form of hardware realization, can also realize in the form of hardware adds SFU software functional unit.
The above-mentioned integrated unit being realized in the form of SFU software functional unit can store and computer-readable deposit at one
In storage media.Above-mentioned SFU software functional unit is stored in a storage medium, including some instructions are used so that a computer
It is each that device (can be personal computer, server or network equipment etc.) or processor (Processor) execute the present invention
The part steps of embodiment the method.And storage medium above-mentioned includes: USB flash disk, mobile hard disk, read-only memory (Read-
Only Memory, ROM), random access memory (Random Access Memory, RAM), magnetic or disk etc. it is various
It can store the medium of program code.
The foregoing is merely illustrative of the preferred embodiments of the present invention, is not intended to limit the invention, all in essence of the invention
Within mind and principle, any modification, equivalent substitution, improvement and etc. done be should be included within the scope of the present invention.
Claims (10)
1. a kind of settlement of insurance claim method, which is characterized in that the described method includes:
Claims Resolution request is obtained, the Claims Resolution request carries the injury information of the wounded, and the injury information includes condition of the injury description text
This and medical image, the medical image carry the internal injury information of described the wounded；
Diagnosis report is generated according to the injury information of described the wounded；
Policy information is obtained, the policy information includes insurer's information, beneficiary's information, insurance subject, insured amount, reparation
Or the Limitation on Liability of payment；
The policy information and the diagnosis report are compared, Claims Resolution scheme is generated.
2. the method according to claim 1, wherein described generate diagnosis report according to the injury information of described the wounded
It accuses, comprising:
It describes to extract keyword in text from the condition of the injury, obtains the first diagnostic result；
Medical features are extracted from the medical image, by the medical features and the progress of the medical features of standard medical image
Match, obtains second opinion result；
The diagnosis report is generated according to first diagnostic result and the second opinion result.
3. the method according to claim 1, wherein described generate diagnosis report according to the injury information of described the wounded
It accuses, comprising:
The injury information is sent to third party, the third party includes hospital, the private doctor of described the wounded and physical examination mechanism
One of or it is a variety of；
Obtain third party's diagnosis report that the third party provides；
Using third party's diagnosis report as the diagnosis report of described the wounded.
4. the method according to claim 1, wherein described carry out the policy information and the diagnosis report
Comparison generates Claims Resolution scheme, comprising:
The condition of the injury type and recommended therapy scheme in the diagnosis report are obtained, the condition of the injury type includes condition of the injury position and the condition of the injury
Degree, the recommended therapy scheme include diagnosis and treatment mode, estimate medical expense, treatment department and duration in hospital；
Obtain Claims Resolution limit corresponding with the condition of the injury type in the policy information；
The condition of the injury type is matched with the insurance subject in the policy information, judges whether the condition of the injury type meets
Straight knot Claims Resolution condition；
If meeting, the Claims Resolution ratio for limit of settling a claim according to the recommended therapy revision of option generates the first Claims Resolution scheme.
5. according to the method described in claim 4, it is characterized in that, judging whether the condition of the injury type meets straight knot reason described
After compensation condition, the method also includes:
If not meeting the straight knot Claims Resolution condition, the Claims Resolution limit according to the recommended therapy revision of option pays for ratio first,
Generate the second Claims Resolution scheme.
6. the method according to claim 1, wherein after the generation Claims Resolution scheme, the method also includes:
The Claims Resolution scheme is sent to insurer；
The electronic signature of the insurer is received, the electronic signature authorizes the Claims Resolution scheme for veritifying.
7. a kind of settlement of insurance claim device, which is characterized in that described device includes:
First acquisition unit, for obtaining Claims Resolution request, the Claims Resolution request carries the injury information of the wounded, the condition of the injury letter
Breath includes that the condition of the injury describes text and medical image, and the medical image carries the internal injury information of described the wounded；
Generation unit, for generating diagnosis report according to the injury information of described the wounded；
Second acquisition unit, for obtaining policy information, the policy information includes insurer's information, beneficiary's information, insurance
Target, insured amount, reparation or the Limitation on Liability of payment；
Processing unit generates Claims Resolution scheme for comparing the policy information and the diagnosis report.
8. device according to claim 7, which is characterized in that the generation unit includes:
First extraction subelement obtains the first diagnostic result for describing to extract keyword in text from the condition of the injury；
Second extracts subelement, for extracting medical features from the medical image, by the medical features and standard medical
The medical features of image are matched, and second opinion result is obtained；
First generates subelement, reports for generating the diagnosis according to first diagnostic result and the second opinion result
It accuses.
9. device according to claim 7, which is characterized in that the processing unit includes:
Third obtains subelement, for obtaining condition of the injury type and recommended therapy scheme in the diagnosis report；The condition of the injury class
Type includes condition of the injury position and condition of the injury degree；The recommended therapy scheme include diagnosis and treatment mode, estimate medical expense, treatment department and
Duration in hospital；
4th obtains subelement, for obtaining Claims Resolution limit corresponding with the condition of the injury type in the policy information；
Judgment sub-unit, for matching the condition of the injury type with the insurance subject in the policy information, described in judgement
Whether condition of the injury type meets straight knot Claims Resolution condition；
Second generates subelement, for when the condition of the injury type meets straight knot Claims Resolution condition, according to the recommended therapy scheme
The Claims Resolution ratio for correcting the Claims Resolution limit generates the first Claims Resolution scheme.
10. a kind of server, including memory and processor, the memory is for storing the information including program instruction, institute
Processor is stated for controlling the execution of program instruction, it is characterised in that: described program instruction is real when being loaded and executed by processor
The step of settlement of insurance claim method described in existing claim 1 to 6 any one.
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| Application Number | Priority Date | Filing Date | Title |
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| CN201811229383.4A CN109447828A (en) | 2018-10-22 | 2018-10-22 | A kind of settlement of insurance claim method and device |
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| CN108230160A (en) * | 2016-12-15 | 2018-06-29 | 平安科技（深圳）有限公司 | A kind of Claims Resolution application generation method and device |
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