DE10128244A1 - Telecommunications and data processing system for motor vehicle accident claims processing incorporates a database of repair partners that allows a client to be offered a repair partner within a given distance of a location - Google Patents

Abstract

Telecommunications and data processing system for claims processing has means (11) for entry of a location at which an accident has taken place, a database (12) for accessing coded partner data for garage or repair partners capable of undertaking repair work on a vehicle and a computer program (14) for determining at least one partner located within a preset distance of the location. An Independent claim is made for a method for processing a vehicle accident insurance claim.

Description

The invention relates to a telecommunications and data processing system, a Computerpro Gram and procedure for claims processing.

Insurance claims are usually processed in such a way that the loss of the insurance company is reported in writing or by telephone from a customer. The Ver securing a form for the notification of damage to the customer. If necessary, the Insurance an expert to assess the damage.  

The customer fills out the claim notification form and sends it to the post the insurance back. After the written notice of damage and the report to the Ver security has been received, this prompts the customer to issue invoices for the rectification submit the damage. The customer sends these invoices to the insurance company by post.

After checking the invoices, the insurance company creates a check and sends it to the Customers. In the best case, about 15 Ta ge needed. This is due to technical delays, especially the generation of posters in batch, internal and external mail delivery times and customer response times.

Another disadvantage of the form-based query of the claim notification is the unspecific and broad query of the initial information, which often requires a written request.

Another disadvantage of this damage handling process known from the prior art is that the insurance company is not involved in the value creation of the damage repair, but only refund the corresponding invoice amounts. The customer feels that disadvantageous that he has to take care of the damage repair himself, without the Versi can help with this. It is also disadvantageous for the insurance that it is due to the insufficient involvement of the insurance company in the repair of fraud can.

The classic claims processing process is divided into two main sections: Erstbear processing and subsequent processing.

The initial processing includes the process entry, responsibility control and triggering the necessary processing steps, information gathering (e.g. writing documents, Auf grant orders) to prepare a regulatory decision. Only in a minor Number of cases is the initial information for a final and therefore one-off processing reaching.

Subsequent processing is delayed by several working days. It only sets after Informa return - usually by post - and often spans several times separate individual processing.  

The invention is therefore based on the object of an improved telecommunications and data processing system, computer program and claims processing method create.

The object underlying the invention is in each case with the features of the independent Claims resolved.

The invention allows the insurance to be integrated into the damage value chain Remedy. For this purpose, the customer is offered, for example based on the customer location Select partner companies of the insurance company for the damage repair. For this, the corresponding partner data geocoded stored in a database. After entering the customer location can then from this database using a corresponding computer program a list of Partners are generated in a radius around the customer location from which the customer is one Partner can choose. Corresponding computer programs suitable for this are provided by Company Map & Guide GmbH, Wilhelm-Schickard-Strasse 10, 76131 Karlsruhe.

After the customer has selected a specific partner to repair the damage, a Mediation order to the appropriate partner for the damage repair from the insurance company tion can be sent. In addition to information regarding the actual placement order Damage repair even more services for the customer, through the partner company too are to be specified. In the event of a vehicle damage, this can be about one Pick-up service for the vehicle to be repaired and / or the provision of a replacement act vehicle.

The partner company draws up a cost estimate on the placement order. Preferably this estimate will be made electronically by taking a digital photo of the damage is carried out and the amount of damage is forecast with a cost prognosis program. The out Submission of the cost forecast program together with the digital photo is then a cost advance preferably sent electronically to the insurance company.

For example, the AudaMail program can be used for vehicle damage Company Audatex (Schweiz) GmbH can be used. After approval of the estimate the order can then be carried out. The billing then takes place according to the cost advance  impact; only in the event of a major deviation from the cost estimate is one possibly further verification with plausibility check required.

The invention allows the customer, the injured party, an insurance agent or one other third parties via a uniform number with the insurance claims processing Get in touch with. The corresponding call is made through a so-called intelligent network Platform forwarded to a specific call center. The selection of the call center can be done for example based on a geographical assignment of the caller to the call in question Center.

The damage is then recorded by an employee of the call center. This uses that Data processing system according to the invention for processing the facts of the course of damage and the review of the information given regarding the course of damage. To do this Information service providers, for example via the Internet, are available. If the Describing the course of the damage proves to be implausible, can automatically be assigned to another processor.

In addition, the employee can use the data processing system according to the invention telbar during the call a premium check, the check of coverage, liability and fulfillment Execution of obligations.

Overall, the telephone and data processing system according to the invention has damage processing the advantage of minimizing the transaction costs of the insurance, the integration of the Insurance in the value chain of damage repair and increased customers satisfaction.

In particular, this is achieved in that the first processing and the subsequent processing due to the use of the telecommunications and data processing system according to the invention can be summarized in the great majority of cases, so that all processing steps until the final decision on the reason for the claim and also the amount of the claim can be carried out within one work process.

The invention is further illustrated by a preferred embodiment using the drawing nations explained in more detail.  

Show it:

Fig. 1 is a block diagram of a telecommunication system for assigning a ANRU fers to a call center,

Fig. 2 is a block diagram of with the telecommunications system of FIG. 1 BUILT-IN data processing system for the processing of claims,

Fig. 3 is a flow chart for claims processing and

Fig. 4 is a flow chart for the claims settlement.

Fig. 1 shows a block diagram of a telecommunication system. A customer, injured party, insurance agent or another third party can, for example, use a telephone 1 from the fixed network to call a specific number for the claims processing. Alternatively, the call can also be made from a mobile phone 2 . The call is then switched over a telephone network 3 to a call center A, a call center B and / or other call centers not shown in FIG. 1. The telephone network 3 is connected to a so-called intelligent network platform 4 , which che routing to the call centers A, B.. , performs.

A database S is available in the intelligent platform 4 for assigning a caller to a specific call center. The database 5 contains for each of the call centers A, B.. , an assignment to a certain number of phone numbers and / or area codes.

If the call center A is located in Wiesbaden, for example, the corresponding entry in the database 5 for the call center A contains the area codes of Wiesbaden and the area codes of the municipalities located in a predetermined area around Wiesbaden. The situation is similar for the other geographically distributed call centers. In this way, at least part of the territory to be covered is mapped; however, there may also be areas that are not permanently assigned to one of the call centers, since they are not located in a predetermined area around one of the call centers.

For such areas, the intelligent network platform 4 contains the registers 6 , in which the percentage distribution of incoming calls to the various call centers is specified.

For example, the call center should receive A x% of the calls that are not regionally assignable, while the call center B receives Y% of the corresponding calls, etc. The percentage distribution specified in the register 6 is also used for incoming calls via a mobile telephone 2 Calls are used that cannot be assigned regionally based on the phone number.

In principle, however, such a regional assignment of incoming calls via a mobile telephone 2 is possible. For this purpose, the assignment of the mobile telephone 2 to a cell of the cellular mobile telephone network can be transmitted to the intelligent network platform 4 , which, based on this geographical information, can, if necessary, make an assignment to one of the call centers.

When calling from telephone 1 , the number of the caller is transmitted when using ISDN via the so-called caller line identification service, which is an ISDN service. Through this service, the complete call number of the caller is transmitted via the telephone network 3 to the intelligent network platform 4 when there is a call; the caller's number is also transmitted when a call is received from a mobile phone.

As soon as the call to one of the call centers A, B ,. , , is switched through, the call is optionally placed in one of the queues 7 until an employee of the call center concerned at his terminal 8 accepts the call.

FIG. 2 shows a data processing system that is integrated with the telecommunication system of FIG. 1. A terminal 8 (see FIG. 1) of the telecommunication system and a terminal 9 of the data processing system are available for each of the employees of one of the call centers. Terminal 8 and Terminal 9 can also be integrated in one device.

Terminal 9 is connected to a geocoded system 10 . The geocoded system 10 allows entry of a location in the memory 11 . The location can, for example, be a location of the customer, the injured party or the damaged object. The location can be entered using a full address or the postcode. Alternatively, the assignment to the cell of the cellular network from which the call is made by the mobile telephone 2 can also be used to determine the location.

The geocoded system 10 also has a database 12 with geocoded partner data. The partners are, for example, partner companies for damage repair. This can be, for example, motor vehicle workshops and / or other repair shops. The corresponding data of the partner companies are stored geocoded in the database 12 , it being possible, for example, to use the postal codes or the assignment to mobile radio cells for geocoding.

A distance is stored in the memory 13 , which defines the radius around the location within which partner companies are to be selected. The distance can be specified as a straight line, as a route or as a route time. The memory 11 and 13 and the database 12 are associated with a program 14 which bank from the geocoded partner data of the data 12 determined by means of in the memory 11 stored location information and the distance of the memory 13 a list of partners defined within Distance from the location. A corresponding list of partner data is provided in the output 15 of the geocoded system 10 to the terminal 9 .

The terminal 9 is also connected to a central unit 17 via a network 16 . Network 16 may be an internal insurance network; the central unit 17 is preferably designed as a server computer with customer databases.

Furthermore, the terminal 9 with local tools 18 and over the Internet 19 with other tools 20 can be connected . The tools 18 and 19 can be information services for checking the plausibility of a damage event or information about a damage amount.

If an employee of the call center answers a call at his terminal 8 , the employee will initially create this in the central unit 17 via the terminal 9 if there is new damage. For this purpose, the employee accesses the master data of the policyholder concerned, for example via the insurance number or the vehicle registration number.

The employee will then record the facts relating to the course of the damage and check them as far as possible for their plausibility using the tools 18 and 20 . If, for example, storm damage is reported, it can be determined by querying a weather service via the Internet 19 whether the storm in question has actually occurred. If, on the other hand, the theft of a mobile phone and a certain amount of damage are specified, the actual commercial value of a corresponding used mobile phone can be determined via a corresponding internet platform; the same applies to motor vehicle accidents at their current value can be determined via the internet platform www.dekra.de or www.schwacke.de.

If the description of the course of damage is not plausible, the employee is automatically assigned to another processor by entering the employee in Terminal 9 .

In the opposite case, an insurance protection check is carried out by the employee of the call center. The insurance protection check includes a premium check, a check on coverage, liability and the fulfillment of obligations. For these exams, databases of the central unit 17 as well as help texts are available to the employee.

For the damage settlement, the employee then accesses the geocoded system 10 via the terminal 9 in order to enter the relevant location in the memory 11 . A selection can then be made from the resulting list of partner data.

This method is explained in more detail with reference to FIGS. 3 and 4.

In step 30 , a call is first made to a customer, a victim, a sales employee or agent or another third party. In step 31 , the call is assigned to one of the call centers. If necessary, in step 32 the call is queued until in step 33 the call is accepted by an employee of the call center.

In step 34 , the damage is picked up by the call center employee using the telecommunications and data processing system of FIGS. 1 and 2. For this purpose, the facts of the claimed course of damage are first recorded in step 35 . The plausibility of the facts of the alleged course of damage is then checked in step 36 for their plausibility. The call center employee can use tools that can be accessed either locally or via the Internet. These tools can be different information services.

In step 37 , a decision is made as to whether the described facts of the course of damage appear plausible. If this is not the case, the sequence of events is used to assign the damage to another processor in step 38 , who can determine the details in detail in the off-line operation.

If the plausibility check of step 37 passes, an insurance protection check is then carried out in step 39 . The insurance protection check includes, among other things, a premium check, a check on coverage, liability and the fulfillment of obligations.

For the premium check, the employee can check the incoming payment via a database query Check due premium payments. Coverage can be obtained via a database query for the Policyholders applicable insurance conditions are checked.

With regard to liability, the employee can call up a help text that contains typical defenses and / or contains objections to the policyholder's liability. at for example, liability for damage caused by a child who is not to blame is fundamental excluded etc.

The policyholder's compliance with obligations may also be checked For this purpose, the employee of the call center can provide a help text with typical duties ask. Such obligations are violated, for example, if Modifi is not permitted cations are carried out on a vehicle, for example the so-called "hairdressing", or after the damage occurs the driver commits to flee the driver.

In addition, the call center employee can also use a database query to call the so-called Surrender value of the contract, d. H. the damage free discount for the customer to determine for the customer to check whether a regulation of the damage by the insurance for the customer that makes economic sense.  

Then, in step 40 , the damage settlement follows if necessary.

The corresponding process is explained in detail with reference to FIG. 4.

In step 41 , the location is first entered. In step 42 , those partners are then determined from the geocoded partner list that are within a predetermined radius around the location. One or more of these partners are offered to the caller in step 43 . This is done via the telecommunication system.

The partner is also selected in step 44 via the telecommunications system. In addition to selecting the partner, the caller can also specify additional services provided by the partner company, such as picking up the vehicle to be repaired from the location, providing a replacement vehicle and cleaning the vehicle after the repair has been carried out. These services are offered to the customer free of charge.

In step 45 , a corresponding placement order with the selected services is transmitted from the insurance company to the partner company. The partner company then creates a cost estimate in step 46 . The cost estimate can be sent, for example, via e-mail to the insurance company or the relevant employee of the call center, and can include a digital photo of the damaged object and an output of a corresponding cost forecast program in the system.

After checking the plausibility of the photo in comparison with the output of the cost prognosis program, the cost estimate is approved in step 47 and the order execution by the partner company in step 48 .

In step 49 , the partner company is billed to the insurance company in accordance with the cost estimate. If there is a deviation of the billing from the cost estimate that exceeds a tolerance measure, a further plausibility check may be carried out by telephone.

In this process, the communication between the partner company and the insurance company can take place via telecommunication means, such as fax or e-mail. 1 phone
2 mobile phones
3 telephone network
4 intelligent network platform
5 database
6 registers
7 queue
8 terminal
9 terminal
10 geocoded system
11 memory
12 database
13 memory
14 program
15 edition
16 network
17 central unit
18 tools
19 Internet
20 tools

Claims (26)

1. Telecommunications and data processing system for claims processing with
Means ( 11 ) for entering a location,
Means ( 12 ) for accessing geocoded partner data from partners for the repair of damage,
Means ( 14 ) for determining at least one partner from the geocoded partner data, who is located within a predetermined distance from the location. 2. Telecommunications and data processing system according to claim 1, wherein the geoco dation of the partner data using the postcodes or the assignment of the partners to cells cellular cellular network. 3. Telecommunications and data processing system according to claim 1 or 2, wherein the given distance is a straight line. 4. Telecommunications and data processing system according to claim 1, 2 or 3, in which the specified distance is a distance or a time. 5. Telecommunications and data processing system according to one of the preceding claims 1 to 4 with means ( 15 ) for outputting a list of partner data based on the means ( 10 ) for determining partners and with means for selecting one or more partners from the list. 6. Telecommunications and data processing system according to one of the preceding An Proverbs 1 to 5 with means of sending a placement order with user-defined services to the selected partner.   7. Telecommunications and data processing system according to one of the preceding An claims 1 to 6 with means for receiving an estimate from the selected one Partner, whereby the estimate is preferably a digital photo to represent the Damage event and the output of a cost forecast applied to the damage event programs included. 8. Telecommunications and data processing system according to one of the preceding An claims 1 to 7 with means to approve the cost estimate of the selected part ners. 9. Telecommunications and data processing system according to one of the preceding An say 1 to 8 with at least a first and a second call center, the first and the second call center each have the same telephone number, and with means to assigning a call to one of the call centers. 10. Telephone and data processing system according to claim 9 with means for assigning the Call based on the caller's number. 11. Telephone and data processing system according to claim 9 or 10, in which each of the call Center is assigned a geographical region from which the caller can call the respective Center is automatically assigned. 12. Telephone and data processing system according to claim 9, 10 or 11, wherein the assignment a geographic region is assigned to one of the call centers via a database, which assigns the area codes of the geographic region to the respective call center. 13. Telephone and data processing system according to one of the preceding claims 9 to 12, in which the assignment of a caller who is not assigned to any of the geographic regions can be arranged based on a predetermined percentage distribution of the callers to the call center.   14. Telecommunications and data processing system according to one of the preceding claims 1 to 13 with means ( 18 , 19 ) for checking the plausibility of a course of damage and / or an amount of damage. 15. The telecommunications and data processing system according to claim 14, wherein the means for checking the plausibility are offered via the Internet ( 19 ) information services ( 20 ). 16. Telecommunications and data processing system according to one of the preceding claims 1 to 15 with means for checking premiums, means for checking coverage, means for checking liability and means for checking obligations. 17. Procedure for damage processing with a telecommunications and data processing system with the following steps:

• - entering a location,
• - Access to geocoded partner data from partners for damage repair,
• - Determination of partners from the geocoded partner data that are within a predetermined distance from the location.

18. The method according to claim 17, wherein the determination of the partners from a geocoding the partner data using the respective zip code or the assignment to a cell Cellular network takes place. 19. The method of claim 17 or 18, wherein the predetermined distance is a straight line. 20. The method of claim 17, 18 or 19, which is at the predetermined distance is a distance or a time.   21. The method according to any one of the preceding claims 17 to 20 with the following further steps:

• - Proposal of one or more partners from the identified partners, selection of a partner,
• - Sending a placement order with user-specific services to the selected partner.

22. The method according to any one of the preceding claims 17 to 21 with the following further steps:

• - Obtaining a cost estimate from the selected partner, the cost estimate preferably including a digital photo of the damage to be repaired and a cost prognosis program relating to the damage,
• - checking the cost estimate,
• - Send approval of the quote to the selected partner.

23. The method according to any one of the preceding claims 17 to 22, wherein the plausibility the damage event and the amount of damage by means of information services, preferably is checked by a database query or via the Internet.   24. The method according to any one of the preceding claims 17 to 23 with the following further steps:

• - premium check,
• - checking coverage,
• - checking liability,
• - checking the fulfillment of obligations,

the tests are each carried out with the support of the data processing system through appropriate databases and I or the retrieval of help texts. 25. The method according to any one of the preceding claims 17 to 24, wherein the Schadenbear processing is automatically assigned to another processor when the damage occurs or the amount of damage does not pass the plausibility check. 26. Computer program product on a computer readable medium with computer readable Program means for performing a method according to one of the preceding An say 17 to 25 if the program is on a telecommunications and data processing system is executed.