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Further Development of the Internet Based, Business Process Utility (“BPU”) for Insurance Claims

Further Development of the Internet Based, Business Process Utility (“BPU”) for Insurance Claims. Moderator William F. Swiggart, Esq. Panelists Ellen Wilcox – ES Wilcox & Assoc., LLC William F. Swiggart, Esq. Josh Lee - Microsoft David Ferrara - ProcessClaims . Agenda. Claims Utility

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Further Development of the Internet Based, Business Process Utility (“BPU”) for Insurance Claims

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  1. Further Development of theInternet Based,Business Process Utility (“BPU”)for Insurance Claims Moderator William F. Swiggart, Esq. Panelists Ellen Wilcox – ES Wilcox & Assoc., LLC William F. Swiggart, Esq. Josh Lee - Microsoft David Ferrara - ProcessClaims

  2. Agenda • Claims Utility • Market Overview • Business Implications • BPU Legal Considerations • Technology Implications • Real World Example • Panel Discussion / Q&A

  3. Claims Utility Market Overview • What is a Claims Utility? • Initial Offerings • Current Trends • Potential Future Markets ES Wilcox & Associates, LLC

  4. Claims Utility Business Implications • Competitive Positioning • Operating Models • In-house • Package • ASP • Outsourcing ES Wilcox & Associates, LLC

  5. Legal ConsiderationsQ: What is Legal Basis for BPU? • State Street Bank Case (1998) • Pure Software Patentable • AT&T v. Excel Case (1999) • Business Methods Patentable Swiggart & Agin, LLC

  6. Legal ConsiderationsQ: What is best Business Structure? • Ownership • Spin-Off vs. Joint Venture • Vehicle • Corporation vs. LLC • Venue • Delaware vs. Bermuda, etc. Swiggart & Agin, LLC

  7. Legal ConsiderationsQ: Are there Anti-Trust Concerns? • Spin-Offs • Rules and Procedures to prevent customers from using BPU to violate anti-trust laws • Joint Ventures • Must prevent any appearance of Price-Fixing Swiggart & Agin, LLC

  8. Legal ConsiderationsOther Issues • Privacy of Customer Data • Gramm-Leach-Bliley • EU Privacy Directive, etc. • Laws re computer transactions • UCITA, • Electronic Signatures, etc. Swiggart & Agin, LLC

  9. Technology Implications • Loosely coupled integration • Seamless desktop to back office communication • Use of data analysis for cost optimization Microsoft Corporation

  10. Technology Implications • Technology facilitated “exchange” • How much data is “good” for your company • Usage of standards, who is leading and who is lagging Microsoft Corporation

  11. Staff Appraiser Real WorldPhysical DamageWeb Based Hub INSURANCE COMPANY Management Management: Report, Analyze & Optimize Total Loss Dispatch Audit Adjuster Pay Clerk Claims Creator Claims Review TL Processor Claims Handle Claims Payer MD Claims Enabler Assignment Estimate Photos Rules Scorecard Workflow Engine Parts Black Box Info. Etc. Download & Upload Estimate Aggregator Partner Aggregator Injury Sciences Hyperquest Etc. Salvage, Visibillity, Rental ProcessClaims DRP Body Shops & Indep. Appraisers

  12. Panel Discussion • Moderator • William F. SwiggartSwiggart & Agin, LLC, Boston, MA • Panelists • Ellen Wilcox – ES Wilcox and Associates, LLC • William F. Swiggart • Josh Lee - Microsoft • David Ferrara - ProcessClaims

  13. Questions and Answers • What is an insurance claims utility ("ICU")? • Is there a perceived need for ICUs? • Is there a demonstrated need? • What is the current state of the market for an ICU? • What is the most likely future market for an ICU? • Describe recent past ICUs ? • Are there any current successful examples?

  14. Questions and Answers • What are current successful examples of ICUs? • What has made current ICUs successful? • Are there any serious technical obstacles to the development of an ICU today? • If so, what are they? • What institutional obstacles are there, if any to the development of ICUs? • What ICUs are most likely to be available five years from now?

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