Reversible Subrogation Claim Identification System

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Solution Overview

Problem

Current systems fail to efficiently identify and reverse improper subrogation payments due to the complexity of analyzing large data sets and varying jurisdictional statutes, often resulting in unrecovered improper payments.

Innovation Solution

A method and system for identifying reversible subrogation claims by analyzing insurance claims, determining the relevant jurisdictional statutes, and initiating recovery when improper payments are detected, utilizing a software application that can execute on a processor and access databases of subrogation rules.

Engineering Contradictions & Design Principles

VSEngineering Contradiction Analysis

1Productivity

If analytics and algorithms are used to identify subrogation cases, then identification efficiency is improved, but improper payments that require statutory analysis are not detected

Engineering Contradiction:

Improvesubrogation case identification efficiencyVSAvoidimproper payment detection accuracy

Core Design Contradiction:

ProductivityVSReliability

Solution Approach 1:

The system segments the subrogation analysis process into two distinct pathways: a fast-track algorithmic analysis for straightforward cases and a detailed statutory analysis pathway for complex cases. This segmentation allows efficient processing of simple claims while ensuring thorough legal review of potentially improper payments, resolving the contradiction between speed and accuracy.

Inventive Principle:

Principle #1Segmentation

Solution Approach 2:

The system introduces an intermediary layer of statutory rule databases and analysis frameworks that bridge the gap between simple algorithmic identification and complex legal determination. This intermediary enables automated yet legally-compliant detection of improper payments by applying jurisdiction-specific subrogation statutes to algorithmically identified cases.

Inventive Principle:

Principle #24Intermediary (Mediator)

2Reliability

If a comprehensive analysis of all subrogation data is performed to detect improper payments, then detection accuracy is improved, but processing time and computational resources increase significantly

Engineering Contradiction:

Improveimproper payment detection accuracyVSAvoiddata analysis processing time

Core Design Contradiction:

ReliabilityVSLoss of time

Solution Approach 1:

The system performs preliminary algorithmic filtering and categorization of subrogation cases before applying detailed statutory analysis. By pre-identifying cases that warrant closer examination based on basic patterns and red flags, the system reduces the volume of data requiring comprehensive analysis, thereby maintaining high detection accuracy while minimizing processing time and resource consumption.

Inventive Principle:

Principle #10Preliminary action

3Reliability

If jurisdictional statutes are manually reviewed for each subrogation case, then legal compliance is improved, but processing efficiency deteriorates

Engineering Contradiction:

Improvelegal compliance accuracyVSAvoidsubrogation case processing efficiency

Core Design Contradiction:

ReliabilityVSProductivity

Solution Approach 1:

The system replaces manual legal review with an automated computational system that applies statutory rules algorithmically. By encoding subrogation statutes and legal criteria into software, the system achieves consistent legal compliance across all cases while dramatically increasing processing efficiency, eliminating the need for manual review of every claim.

Inventive Principle:

Principle #28Mechanics substitution (Replace mechanical system)

Solution Approach 2:

The system changes the parameter of legal analysis from human expert judgment to computational rule application. By transforming statutory requirements into structured data parameters and logical conditions, the system maintains legal accuracy while enabling high-volume automated processing, resolving the contradiction between compliance and efficiency.

Inventive Principle:

Principle #35Parameter changes

4Adaptability or versatility

If the scope of subrogation rule analysis is expanded to cover all claim types and jurisdictions, then coverage completeness is improved, but system complexity increases

Engineering Contradiction:

Improvesubrogation rule coverage scopeVSAvoidsystem architecture complexity

Core Design Contradiction:

Adaptability or versatilityVSDevice complexity

Solution Approach 1:

The system implements a universal statutory analysis framework that can handle diverse claim types and jurisdictions through a single integrated platform. By designing modular, configurable rule engines that can be adapted to different legal jurisdictions and claim categories, the system achieves comprehensive coverage without proportionally increasing complexity, as the same core architecture serves multiple functions.

Inventive Principle:

Principle #6Universality (Multi-functionality)

Data Source

PatentUS20240112268A1Method for identifying and initiating reversible subrogation claims

Publication Date: 2024.04.04 SECOND LOOK INC

AI summary

A computer-implemented method for identifying and initiating reversible subrogation claims. A subrogation demand for an insurance claim is received and analyzed to determine a type and a jurisdiction of the insurance claims. A subrogation rule is then ascertained based on the type and jurisdiction of the insurance claim, and a determination of whether the subrogation demand is proper or improper is made. If the subrogation demand has been fulfilled and found to be improper, a recommendation to initiate recovery of all or a portion of a settlement amount of the subrogation demand is generated.