TW202011325A - Automatic claim settlement system and method including a claim settlement server having a storage unit, a communication unit, and a processing unit - Google Patents

Abstract

An automatic claim settlement system includes a claim settlement server. The claim settlement server includes a storage unit, a communication unit, and a processing unit. The processing unit sends a data request to an open data platform server via the communication unit, so that when the open data platform server determines that it has stored a published data of the day, the open data platform server returns the published data of the day to the processing unit. After receiving the published data, the processing unit determines, for each insurance data, whether the subject information and at least one claim item of the insurance data meet a claim condition based on the published data. For each insurance data that is determined to meet the claim condition, the processing unit performs a remittance transaction based on the insurance data and the insured account information. In addition, the present invention further provides an automatic claim settlement method.

Description

Automatic claim settlement system and method

The invention relates to a claims settlement system, in particular to an automatic claims settlement system and its method.

The existing insurance compensation method is that the claimant consults the contract of the claimant’s insurance policy, and determines whether the claim and the amount of the claim can be paid based on the information provided by the claimant and the contractual content of the insurance policy. Time-consuming, claims claimants also need to wait for a long time to get claims.

In addition, in the process of handling claims, the claimant often fills in incorrect information or provides incomplete information, and then needs to make up for it again, which not only causes distress to the claimant, but also reduces the efficiency of the insurance company in handling claims .

Therefore, the object of the present invention is to provide an automatic claim settlement system.

Therefore, the automatic claims system of the present invention is connected to a data open platform server via a communication network, the data open platform server is used to store a release data related to insurance claims, the automatic claims system includes a claims server, the The claim server includes a storage unit, a communication unit connected to the communication network, and a processing unit electrically connected to the storage unit and the communication unit.

The storage unit stores a plurality of insurance data respectively related to index insurances insured by multiple insured persons, each insurance data includes at least one claim item related to the corresponding index insurance, and related to the corresponding The index information of the insurance subject of the index insurance and the information of an insured account related to the insured, where each claim item corresponds to a claim amount.

Wherein, the processing unit sends a data request to the data open platform server via the communication unit, so that when the data open platform server determines that it stores the release data of the day, it returns the release data of the day to the process Unit, after the processing unit receives the distribution data from the data open platform server via the communication unit, the processing unit determines, for each insurance data, the target information of the insurance data and the at least Whether a claim item meets a claim condition, and for each insurance data determined to meet the claim condition, the processing unit is based on the claim amount corresponding to a target claim item in the at least one claim item of the insurance data and the insured Person's account information for a remittance transaction

Another object of the present invention is to provide an automatic claim settlement method.

Therefore, the automatic claim settlement method of the present invention is executed by an automatic claim settlement system. The automatic claim settlement system includes a claim server, and the claim server stores a plurality of insurances related to index insurances insured by multiple insured persons Data, each insurance data includes at least one claim item related to the corresponding index insurance, corresponding target information related to the corresponding insurance subject of the index insurance, and an insured person related to the insured Account information, each claim item corresponds to a claim amount, the claim server is connected to a data open platform server via a communication network, and the data open platform server is used to store a release data related to insurance claims, the The automatic claims method includes one step (A), one step (B), and one step (C).

In step (A), the claims server sends a data request to the data open platform server via the communication network, so that the data open platform server returns the day when it determines that it stores the release data of the day The published information is sent to the claims server.

In step (B), after receiving the release data from the data open platform server via the communication network, the claims server determines the insurance data based on the release data for each insurance data The subject information and whether the at least one claim item meets a claim condition.

In this step (C), for each insurance data that is determined to meet the claim condition, the claim server according to the claim amount corresponding to a target claim item in the at least one claim item of the insurance data and the insured person Account information for a remittance transaction.

The effect of the present invention is that the processing unit of the claims server determines whether the target information of the insurance data and the at least one claim item meet a claim condition after receiving the published data from the data open platform server And for each insurance data that is determined to meet the claim condition, the processing unit performs a remittance transaction based on the claim amount corresponding to a target claim item in the at least one claim item of the insurance data and the insured's account information. The insurer does not need to provide any information, and the processing unit can automatically settle claims, which is convenient and fast.

Referring to FIG. 1, an embodiment of the automatic claim settlement system 1 of the present invention includes a guarantor server 11 and a claim server 12.

The security server 11 includes a storage module 111, a communication module 112, and a processing module 113 electrically connected to the storage module 111 and the communication module 112. The sponsor server 11 is, for example, a server installed in the financial and banking industries.

The storage module 111 stores a plurality of pieces of customer data related to a plurality of customers, each customer data includes a customer account and a person's information, wherein the personal information includes, for example, a customer account information related to the customer and the relevant A customer's registered location information of the customer's registered address (such as residence, residence, or correspondence address). The customer's registered location information has, for example, a postal code associated with the customer's registered address, but not limited thereto.

The communication module 112 is connected to a communication network 100, wherein the communication network 100 is, for example, the Internet, but it is not limited thereto.

The claim server 12 includes a storage unit 121, a communication unit 122, and a processing unit 123 electrically connected to the storage unit 121 and the communication unit 122.

The storage unit 121 stores a plurality of insurance data related to the index insurance (Parametric insurance) insured by each insured, each insurance data includes a plurality of claims related to the corresponding index insurance, related The information of a target corresponding to the insurance subject of the index type insurance and the information of an insured account related to the insured, wherein each claim item corresponds to a claim amount, and each target information includes information related to the subject The location information of an insurance subject in the geographic location of the insurance subject. It is worth noting that the index insurance is based on, for example, natural climate conditions such as temperature, rainfall, wind speed, earthquake intensity, earthquake magnitude, tsunami, tide, sea temperature, etc., as insurance payment conditions, but not limited to this. It should be further noted that, in this embodiment, each insurance data includes multiple claim items. In other embodiments, each insurance data may also include only one claim item, which is not limited to this.

It should be particularly noted that such claims items, such as Table 1 shown in Table 1 below

The communication unit 122 is connected to the communication network 100, and is connected to the communication module 112 of the client server 11 and a data open platform server 101 via the communication network 100. The data open platform server 101 is used to store A release data related to insurance claims, such as the public data (Big Data). The data open platform server 101 is, for example, a server set up by the National Science and Technology Center for Disaster Reduction (NCDR) or the Central Weather Bureau (CWB) of the Ministry of Transport, or other National local disaster release unit or meteorological bureau, but not limited to this.

2 and 3, an embodiment of the automatic claim settlement method of the present invention includes a policy creation procedure S2 and a claim settlement procedure S3.

Referring to FIGS. 1 and 2, it is illustrated how the automatic claim 100 of the present invention executes the policy creation procedure S2. The policy establishment S2 procedure includes steps S22-S23.

In step S22, the processing module 113 generates an insurance request including the customer account and the personal information based on the customer data, and transmits the insurance request to the claims server 12 through the communication module 112.

In step S23, the processing unit 123 of the claim server 12 receives the insurance request transmitted by the requestor server 11 through the communication unit 122, generates an insurance data according to the insurance request, and stores the insurance data To the storage unit 121. The insurance data includes multiple claim items related to an index type insurance, information about a target related to the insurance subject of the index type insurance, and the customer account information of the personal information. It should be particularly noted that in this embodiment, the customer corresponding to the insurance request is the insured, and the location information of the insurance subject of the subject information is the registered location information of the customer of the personal information, but not Limited.

Referring to FIGS. 1 and 3, it is described how the automatic claim 100 of the present invention executes the claim program S3, and the claim program S3 includes steps S31 to S35.

In step S31, the processing unit 123 of the claims server 12 periodically sends a data request to the data open platform server 101 via the communication unit 122.

In step S32, the data open platform server 101 determines whether there is any current release data stored. If the data opening platform server 101 determines that the published data of the day is stored, the flow proceeds to step S33; if the data opening platform server 101 determines that the published data of the day is not stored, the flow ends.

In step S33, the data open platform server 101 transmits the release data on the day to the claims server 12.

It is worth noting that, in this embodiment, the release data includes, for example, multiple pieces of natural disaster location information related to the geographical location of the natural disaster, and multiple natural disaster scores corresponding to the natural disaster location information, respectively. The claim server 12 uses, for example, Periodically obtain the published data from the data open platform server 101, but not limited to this.

It should be further noted that, in this embodiment, the natural disaster is, for example, an earthquake, and the natural disaster score is, for example, an earthquake intensity (Seismic intensity).

In step S34, after the processing unit 123 receives the distribution data from the data open platform server 101 via the communication unit 122, the processing unit 123 determines the insurance data based on the distribution data for each insurance data The subject information and whether the claim items meet a claim condition, where the claim condition is that the geographic location of the insurance subject related to the location information of the insurance subject is related to at least one target natural disaster location information in the natural disaster location information Within a predetermined distance of the geographical location where the natural disaster occurs, the natural disaster score corresponding to the at least one target natural disaster location information is greater than a predetermined value. If the processing unit 123 determines that the subject information of the insurance data and the claim items meet the claim conditions, the flow proceeds to step S35; if the processing unit 123 determines that the subject information of the insurance data and the claim items are not If the claim conditions are met, the process ends.

It should be particularly noted that, in this embodiment, the location information of the insurance label of each target information includes a postal code of the insurance label, with reference to FIG. 4, step S34 includes sub-steps S341~S343, the following describes the sub-steps included in step S34 step.

In sub-step S341, after the processing unit 123 receives the published data from the data open platform server 101 via the communication unit 122, the processing unit 123 corresponds to the corresponding natural disaster location information of the published data Wait for the natural disaster score to obtain the at least one target natural disaster location information.

For example, if the corresponding natural disaster score (earthquake magnitude) is greater than or equal to 6, it is the target natural disaster location information.

In sub-step S342, the processing unit 123 generates at least one day postal code corresponding to at least one target natural disaster geographical location information according to the at least one target natural disaster location information.

In sub-step S343, the processing unit 123 determines whether there is a match between the postal code of the insurance subject of the location information of the target information of the insurance data and the postal code of the disaster at least one day to determine the insurance related to the location information of the subject of insurance Whether the target geographic location is within the predetermined distance range of the natural disaster occurrence geographic location related to the at least one target natural disaster location information. If the processing unit 123 determines that there is a match between the postal code of the insurance label and the postal area code of the disaster at least one day, the process proceeds to step S35; if the processing unit 123 determines the information of the target information If there is no match between the postal code of the insurance mark and the postal code of the disaster at least one day, the process ends.

In step S35, the processing unit 123 performs a remittance transaction according to the settlement amount corresponding to a target settlement item among the settlement items of the insurance data and the insured account information. It is worth noting that in this embodiment, the insured account information includes the insured’s credit card account, and the remittance transaction is that the processing unit 123 remits the credit card amount equivalent to the claim amount corresponding to the target claim item to The insured's credit card account.

In summary, in the automatic claim settlement system and method of the present invention, for each customer data, the processing module 113 generates and transmits the insurance request to the processing unit 123, so that the processing unit 123 generates the insurance data according to the insurance request , In order to achieve new types of consumption methods such as cashless exchange, emerging payment, and insurance concatenated financial commodities; the processing unit 123 determines the subject of the insurance data after receiving the published data from the data open platform server 101 Information and whether the at least one claim item meets a claim condition, and for each insurance data that determines that the claim condition is met, the processing unit 123 makes a claim corresponding to a target claim item in the at least one claim item of the insurance data The amount and the insured's account information are used for a remittance transaction. The insured does not need to provide any information. The processing unit 123 can automatically settle claims, which is convenient and fast, so it can indeed achieve the purpose of cost invention.

However, the above are only examples of the present invention, and the scope of implementation of the present invention cannot be limited by this, any simple equivalent changes and modifications made according to the scope of the patent application of the present invention and the content of the patent specification are still classified as Within the scope of the invention patent.

1: automatic claim system 11: guarantor server 111: storage module 112: communication module 113: processing module 12: claim server 121: storage unit 122: communication unit 123: processing unit 100: communication network 101: Information open platform server S2: policy creation procedure S22~S23: step S3: claim settlement procedure S31~S35: step

Other features and functions of the present invention will be clearly presented in the embodiment with reference to the drawings, in which: 　 FIG. 1 is a block diagram illustrating an embodiment of the automatic claims system of the present invention; 　 FIG. 2 is a flowchart illustrating A policy creation procedure of an embodiment of the automatic claim settlement method of the present invention; 　 FIG. 3 is a flowchart illustrating a claim procedure of the embodiment of the automatic claim settlement method of the present invention; and FIG. 4 is a flowchart illustrating the assistance of FIG. 3 Sub-steps included in step S34.

1: Automatic claims system

11: To protect the server

111: storage module

112: Communication module

113: Processing module

12: Claims server

121: Storage unit

122: Communication unit

123: processing unit

100: communication network

101: data open platform server

Claims (10)

An automatic claims system is connected to a data open platform server via a communication network. The data open platform server is used to store a release data related to insurance claims, including: a claims server, including a storage unit, storing multiple The insurance data related to the index insurance underwritten by multiple insured persons respectively, each insurance data includes at least one claim item related to the corresponding index insurance and the insurance related to the corresponding index insurance The subject’s subject’s information, and an insured’s account information related to the insured, where each claim item corresponds to a claim amount, a communication unit, is connected to the communication network, and is open to the data through the communication network The platform server is connected, and a processing unit is electrically connected to the storage unit and the communication unit, wherein the processing unit transmits a data request to the data open platform server through the communication unit, so that the data open platform server is determining When it stores the release data of the current day, it returns the release data of the current day to the processing unit. After the processing unit receives the release data from the data open platform server via the communication unit, the processing unit An insurance data, according to the release data, determine whether the subject information of the insurance data and the at least one claim item meet a claim condition, and for each insurance data determined to meet the claim condition, the processing unit is based on the insurance data A remittance transaction is performed on the settlement amount corresponding to a target settlement item in the at least one settlement item and the insured account information. The automatic claim settlement system according to claim 1, wherein the information of each target includes location information of an insurance subject related to the geographic location of the insurance subject, and the release data includes multiple pieces of natural disaster location information related to the geographical location of natural disasters, And multiple natural disaster scores corresponding to the natural disaster location information respectively, and the claim condition is the geographic location of the insurance subject related to the insurance subject location information in at least one target natural disaster location information in the natural disaster location information Within a predetermined distance range of the location, the natural disaster score corresponding to the at least one target natural disaster location information is greater than a predetermined value. The automatic claim system according to claim 2, wherein the location information of the insurance subject of each subject information includes a postal code of the insurance subject, and the processing unit receives the release data from the data open platform server via the communication unit Then, the processing unit obtains the at least one target natural disaster location information according to the natural disaster scores corresponding to the published natural disaster location information of the published data, and generates at least one target natural disaster location information corresponding to the at least one target natural disaster location information, respectively At least one day of postal disaster area code of geographic location information, and determine whether there is a match between the postal code of the insurance label and the at least one day postal disaster area code of the insured location information of the insured information to determine the insurance related to the insured location information Whether the target geographic location is within the predetermined distance range of the natural disaster occurrence geographic location related to the at least one target natural disaster location information. The automatic claim settlement system as described in claim 1 further includes a guarantor server. The guarantor server includes a storage module that stores multiple pieces of customer data related to multiple customers. Each customer data includes A customer account information and a person information; a communication module, connected to the communication network, and connected to the communication unit of the claims server through the communication network; and a processing module, electrically connected to the storage module and the communication module ; For each customer data, the processing module of the guarantor server generates an insurance request including the customer account information and the personal information of the customer data based on the customer data, and transmits the insurance request through the communication module An insurance request is sent to the processing unit of the claims server. The processing unit of the claims server generates an insurance data according to the received insurance request and stores the insurance data to the storage unit of the claims server. The automatic claim settlement system according to claim 1, wherein the information of the insured account of the insurance data includes the credit card account of the insured, respectively. An automatic claims method is executed by an automatic claims system. The automatic claims system includes a claims server. The claims server stores insurance data for multiple index-type insurances that are insured by multiple insured persons respectively. An insurance data includes at least one claim item related to the corresponding index-type insurance, a target information related to the corresponding insurance subject of the index-type insurance, and information about an insured account related to the insured Each claim item corresponds to a claim amount. The claim server is connected to a data open platform server via a communication network. The data open platform server is used to store a release data related to insurance claims. The automatic claim method It includes the following steps: (A) Through the claims server, a data request is sent to the data open platform server through the communication network, so that when the data open platform server determines that it stores the published data of the day, it returns Transmit the published data on the day to the claims server; (B) through the claims server, after receiving the published data from the data open platform server through the communication network, for each insurance data, according to the Publish data to determine whether the subject information of the insurance data and the at least one claim item meet a claim condition; and (C) through the claim server, for each insurance data that determines that the claim condition is met, based on the insurance A remittance transaction is performed on the claim amount corresponding to a target claim item in the at least one claim item of the data and the insured account information. According to the automatic claim settlement method described in claim 6, each target information includes the location information of an insurance subject related to the geographic location of the insurance subject, and the release data includes multiple natural disaster location information related to the geographic location of the natural disaster, and Multiple natural disaster scores corresponding to the natural disaster location information, wherein, in step (B), the claim condition is that the geographic location of the insurance subject related to the insurance subject location information is at least one target natural disaster location in the natural disaster location information Within a predetermined distance range of the geographical location of the natural disaster related to the information, the natural disaster score corresponding to the at least one target natural disaster location information is greater than a predetermined value. According to the automatic claim method described in claim 7, the location information of the insurance subject of each subject information includes a postal code of the insurance subject, wherein step (B) includes the following sub-steps: (B-1) With the claim server, After receiving the published data from the data open platform server via the communication network, obtain the at least one target natural disaster location information according to the natural disaster scores corresponding to the natural disaster location information of the published data; (B- 2) Using the claim server, based on the at least one target natural disaster location information, generating at least one day postal code corresponding to at least one target natural disaster geographic location information; and (B-3) using the claim server, for For each insurance data, it is determined whether there is a match between the postal code of the insured object and the postal code of the disaster at least one day for the location information of the insured object of the insured information, to determine the geographic location of the insured object related to the location information Whether it is within the predetermined distance range of the natural disaster occurrence geographic location related to the at least one target natural disaster location information. As described in claim 6, the automatic claim settlement method, the automatic claim settlement system further includes a requestor server, the requestor server stores a plurality of customer data related to multiple customers, each customer data includes a Customer account and individual information, and connect to the claims server through the communication network. Before step (A), the automatic claims method also includes the following steps: (D) With the client server, for each customer data, Generating a customer account including the customer data and an insurance request related to the personal information based on the customer data, and transmitting the insurance request to the claim server through the communication module; and (E) by the claim server, According to the received insurance request, an insurance data is generated and stored. The automatic claim settlement method according to claim 6, wherein the information of the insured account of the insurance data includes the credit card account of the insured, respectively.

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