Description:BACKGROUND
Field of Invention
[001] Embodiments of the present invention generally relate to an insurance claim system and particularly to a blockchain-based insurance claim system.
Description of Related Art
[002] The insurance industry faces persistent challenges in the areas of claim verification, fraud detection, and dispute resolution. Insurance fraud causes providers to lose substantial amounts each year due to fabricated incidents, manipulated evidence, and overstated damages. Traditional claims processing relies on human adjusters, who assess documents, witness statements, and other forms of submitted evidence. This manual approach introduces delay, inconsistency, and the potential for error, which undermines both operational efficiency and customer satisfaction.
[003] Several advancements in technology have addressed aspects of this issue. Some platforms allow secure claim documentation and provide greater transparency through tamper-resistant data storage. Likewise, artificial intelligence solutions such as Shift Technology and FRISS assist in fraud detection by identifying patterns and anomalies in submitted data. Despite these developments, human review continues to dominate final settlement decisions. Dispute resolution remains largely dependent on conventional arbitration or litigation, both of which consume time and resources and fail to ensure uniformity or impartiality.
[004] Current automated systems tend to limit their functions to basic tasks such as claim validation or fraud flagging. These solutions do not resolve disputes that arise from partial or conflicting evidence. Furthermore, current automated systems do not suggest fair settlement amounts based on complex policy interpretations or precedent cases.
[005] There is thus a need for an improved and advanced blockchain-based insurance claim system that can administer the aforementioned limitations in a more efficient manner.
SUMMARY
[006] Embodiments in accordance with the present invention provide a blockchain-based insurance claim system. The system comprising a data acquisition unit adapted to receive supporting data corresponding to an insurance policy from a computing device. The supporting data is uploaded using the computing device upon initiation of a claim settlement. The system further comprising a processing unit communicatively connected to the data acquisition unit. The processing unit is configured to receive the supporting data corresponding to the insurance policy from the data acquisition unit; analyze the received supporting data using an Artificial Intelligence (AI) algorithm to detect inconsistencies and fraud; store, in an immutable ledger, the analyzed supporting data in a blockchain upon detecting no inconsistencies and fraud in the analyzed supporting data; evaluate a validity of an insurance claim by assessing the stored supporting data, against a set of factors, using machine learning algorithms. The set of factors are selected from policy terms, damages, historical data, or a combination thereof; and propose a fair settlement of the insurance claim based on the evaluated validity.
[007] Embodiments in accordance with the present invention further provide a method for verification of insurance claim using a blockchain-based insurance claim system. The method comprising steps of receiving supporting data corresponding to an insurance policy from a data acquisition unit; analyzing the received supporting data using an Artificial Intelligence (AI) algorithm to detect inconsistencies and fraud; storing, in an immutable ledger, the analyzed supporting data in a blockchain upon detecting no inconsistencies and fraud in the analyzed supporting data; evaluating a validity of an insurance claim by assessing the stored supporting data, against a set of factors, using machine learning algorithms. The set of factors is selected from policy terms, damages, historical data, or a combination thereof; and proposing a fair settlement of the insurance claim based on the evaluated validity.
[008] Embodiments of the present invention may provide a number of advantages depending on their particular configuration. First, embodiments of the present application may provide a blockchain-based insurance claim system.
[009] Next, embodiments of the present application may provide an insurance claim system that automates fraud detection, claim verification, settlement proposal, and dispute resolution. This reduces reliance on human adjusters and shortens the overall claims lifecycle.
[0010] Next, embodiments of the present application may provide an insurance claim system that verifies documents, images, and videos to detect inconsistencies and fraudulent patterns, improving accuracy in identifying illegitimate claims.
[0011] Next, embodiments of the present application may provide an insurance claim system that uses secure, immutable data storage that preserves the authenticity of submitted claim evidence, ensuring trust and transparency for both insurers and policyholders.
[0012] Next, embodiments of the present application may provide an insurance claim system that show partial validity, the AI system proposes reasonable settlement amounts based on policy terms, historical data, and actual damages, minimizing disputes and delays.
[0013] Next, embodiments of the present application may provide an insurance claim system that applies predefined logic to resolve disputes quickly and impartially, avoiding costly and time-consuming arbitration or litigation.
[0014] These and other advantages will be apparent from the present application of the embodiments described herein.
[0015] The preceding is a simplified summary to provide an understanding of some embodiments of the present invention. This summary is neither an extensive nor exhaustive overview of the present invention and its various embodiments. The summary presents selected concepts of the embodiments of the present invention in a simplified form as an introduction to the more detailed description presented below. As will be appreciated, other embodiments of the present invention are possible utilizing, alone or in combination, one or more of the features set forth above or described in detail below.
BRIEF DESCRIPTION OF THE DRAWINGS
[0016] The above and still further features and advantages of embodiments of the present invention will become apparent upon consideration of the following detailed description of embodiments thereof, especially when taken in conjunction with the accompanying drawings, and wherein:
[0017] FIG. 1 illustrates a schematic block diagram of a blockchain-based insurance claim system, according to an embodiment of the present invention;
[0018] FIG. 2 illustrates a block diagram of a processing unit, according to an embodiment of the present invention; and
[0019] FIG. 3 depicts a flowchart of a method for verification of insurance claims using a blockchain-based insurance claim system, according to an embodiment of the present invention.
[0020] The headings used herein are for organizational purposes only and are not meant to be used to limit the scope of the description or the claims. As used throughout this application, the word "may" is used in a permissive sense (i.e., meaning having the potential to), rather than the mandatory sense (i.e., meaning must). Similarly, the words “include”, “including”, and “includes” mean including but not limited to. To facilitate understanding, like reference numerals have been used, where possible, to designate like elements common to the figures. Optional portions of the figures may be illustrated using dashed or dotted lines, unless the context of usage indicates otherwise.
DETAILED DESCRIPTION
[0021] The following description includes the preferred best mode of one embodiment of the present invention. It will be clear from this description of the invention that the invention is not limited to these illustrated embodiments but that the invention also includes a variety of modifications and embodiments thereto. Therefore, the present description should be seen as illustrative and not limiting. While the invention is susceptible to various modifications and alternative constructions, it should be understood, that there is no intention to limit the invention to the specific form disclosed, but, on the contrary, the invention is to cover all modifications, alternative constructions, and equivalents falling within the scope of the invention as defined in the claims.
[0022] In any embodiment described herein, the open-ended terms "comprising", "comprises”, and the like (which are synonymous with "including", "having” and "characterized by") may be replaced by the respective partially closed phrases "consisting essentially of", “consists essentially of", and the like or the respective closed phrases "consisting of", "consists of”, the like.
[0023] As used herein, the singular forms “a”, “an”, and “the” designate both the singular and the plural, unless expressly stated to designate the singular only.
[0024] FIG. 1 illustrates a schematic block diagram of a blockchain-based insurance claim system 100 (hereinafter referred to as the system 100), according to an embodiment of the present invention. The system 100 may be adapted to verify a claim raised against reimbursement of an insurance settlement. Moreover, upon verification, the system 100 may pronounce a suitable amount of recovery based on damages and/or loss incurred. The system 100 may further proceed to settle the reimbursed amount into an account of a policy holder.
[0025] The system 100 may be used in sector such as, but not limited to, auto insurances, home insurances, travel insurances, pet insurances, gadget insurances, health insurances, accidental damage protections, Mediclaim insurances, business insurances, and so forth. Embodiments of the present invention are intended to include or otherwise cover any sector, including known, related art, and/or later developed technologies, for utilization of the system 100.
[0026] According to the embodiments of the present invention, the system 100 may incorporate non-limiting hardware components to enhance the processing speed and efficiency such as the system 100 may comprise a computing device 102, a data acquisition unit 104, a processing unit 106, an Artificial Intelligence (AI) algorithm 108, a blockchain 110, an immutable ledger 112, and machine learning algorithms 114. In an embodiment of the present invention, the hardware components of the system 100 may be integrated with computer-executable instructions for overcoming the challenges and the limitations of the existing systems.
[0027] In an embodiment of the present invention, the computing device 102 may be adapted to upload supporting data, corresponding to an insurance policy, to the system 100. The supporting data uploaded by the computing device 102 may enable the system 100 to initiate a claim settlement. The supporting data may be, but not limited to, policy documents, images, videos, documents, audio, and so forth. Embodiments of the present invention are intended to include or otherwise cover any type of the supporting data, including known, related art, and/or later developed technologies. The computing device 102 may be, but not limited to, a laptop, a mobile, and so forth. Embodiments of the present invention are intended to include or otherwise cover any type of the computing device 102, including known, related art, and/or later developed technologies.
[0028] In an embodiment of the present invention, the data acquisition unit 104 may be adapted to receive the supporting data, corresponding to an insurance policy, from the computing device 102.
[0029] In an embodiment of the present invention, the processing unit 106 may be in communication with the data acquisition unit 104. The processing unit 106 may further be configured to execute computer-executable instructions to generate an output relating to the system 100. According to embodiments of the present invention, the processing unit 106 may be, but not limited to, a Programmable Logic Control (PLC) unit, a microprocessor, a development board, and so forth. Embodiments of the present invention are intended to include or otherwise cover any type of the processing unit 106 including known, related art, and/or later developed technologies. In an embodiment of the present invention, the processing unit 106 may further be explained in conjunction with FIG. 2.
[0030] FIG. 2 illustrates a block diagram of the processing unit 106, according to an embodiment of the present invention. The processing unit 106 may comprise the computer-executable instructions in form of programming modules such as a data receiving module 200, a data organization module 202, a data assessment module 204, and a data settlement module 206.
[0031] In an embodiment of the present invention, the data receiving module 200 may be configured to receive the supporting data corresponding to an insurance policy from the computing device 102. The data receiving module 200 may be configured to transmit the supporting data to the data organization module 202.
[0032] The data organization module 202 may be activated upon receipt of the supporting data from the data receiving module 200. In an embodiment of the present invention, the data organization module 202 may be configured to analyze the received supporting data using the Artificial Intelligence (AI) algorithm 108 to detect inconsistencies and fraud. The inconsistencies and fraud may be, but not limited to staged accident reports, fake medical bills, tampered evidence, a counterfeit death certificate, and so forth. Embodiments of the present invention are intended to include or otherwise cover any inconsistencies and fraud, including known, related art, and/or later developed technologies, that may be exhibited by the supporting data.
[0033] Further, upon detection of no inconsistencies and fraud in the analyzed supporting data, and deeming the analyzed supporting data as authentic, the data organization module 202 may be configured to store the analyzed supporting data in the blockchain 110. The blockchain 110 may be configured to store the analyzed supporting data in the immutable ledger 112. The immutable ledger 112 may enable transparent and tamper-proof access to the analyzed supporting data.
[0034] Upon verification and storage of the analyzed supporting data in the immutable ledger 112 of the blockchain 110, the data organization module 202 may be configured to transmit an activation signal to the data assessment module 204.
[0035] The data assessment module 204 may be activated upon receipt of the activation signal from the data organization module 202. In an embodiment of the present invention, the data assessment module 204 may be configured to access the immutable ledger 112 of the blockchain 110 for assessment of the supporting data. The data assessment module 204 may be configured to deploy the machine learning algorithms 114 for assessing the stored supporting data, against a set of factors. The assessment against the set of factors may evaluate the stored supporting data for validation of the insurance claim. The set of factors may be, but not limited to, policy terms, damages, historical data, and so forth. Embodiments of the present invention are intended to include or otherwise cover any set of factors, including known, related art, and/or later developed technologies.
[0036] Upon evaluation, if the stored supporting data comes to be partially valid or fully valid, then the data assessment module 204 may transmit a first activation signal to the data settlement module 206. Else, the data assessment module 204 may transmit a second activation signal to the data settlement module 206.
[0037] In an embodiment of the present invention, the data settlement module 206 when activated through the first activation signal, then the data settlement module 206 may be configured to propose a fair settlement. The fair settlement of the insurance claim may be proposed based on the evaluated validity. Furthermore, the data settlement module 206 may be configured to initiate a process of reimbursement of the insurance claim based on the proposed fair settlement. Additionally, the data settlement module 206 may be configured to provide a reasoning for the corresponding fair settlement.
[0038] In another embodiment of the present invention, the data settlement module 206 when activated through the second activation signal, then the data settlement module 206 may be configured to initiate an arbitration. The second activation signal may indicate invalidation of the stored supporting data. The arbitration may be based on a smart contract for a dispute resolution. The smart contracts may be pre-configured with pre-defined rules. The dispute resolution may be carried out by following the pre-defined rules to arrive at a fair decision for the settlement.
[0039] FIG. 3 depicts a flowchart of a method 300 for the verification of insurance claims using the system 100, according to an embodiment of the present invention.
[0040] At step 302, the system 100 may receive the supporting data corresponding to the insurance policy from the computing device 102.
[0041] At step 304, the system 100 may analyze the received supporting data using the Artificial Intelligence (AI) algorithm 108 for detecting inconsistencies and fraud.
[0042] At step 306, the system 100 may store the analyzed supporting data in the immutable ledger 112 of the blockchain 110 upon detecting no inconsistencies and/or fraud in the analyzed supporting data.
[0043] At step 308, the system 100 may assess the stored supporting data using the machine learning algorithms 114 for evaluating the validity of the insurance claim.
[0044] At step 310, if the evaluation of the stored supporting data is partially valid or fully valid, then the method 300 may proceed to a step 312. Else, the method 300 may proceed to a step 314.
[0045] At step 312, the system 100 may propose the fair settlement of the insurance claim based on the evaluated validity.
[0046] At step 314, the system 100 may initiate the arbitration for the dispute resolution.
[0047] At step 316, the system 100 may initiate the process of reimbursement of the insurance claim based on the proposed fair settlement.
[0048] While the invention has been described in connection with what is presently considered to be the most practical and various embodiments, it is to be understood that the invention is not to be limited to the disclosed embodiments, but on the contrary, is intended to cover various modifications and equivalent arrangements included within the scope of the appended claims.
[0049] This written description uses examples to disclose the invention, including the best mode, and also to enable any person skilled in the art to practice the invention, including making and using any devices or systems and performing any incorporated methods. The patentable scope of the invention is defined in the claims, and may include other examples that occur to those skilled in the art. Such other examples are intended to be within the scope of the claims if they have structural elements that do not differ from the literal language of the claims, or if they include equivalent structural elements within substantial differences from the literal languages of the claims. , Claims:CLAIMS
I/We Claim:
1. A blockchain-based insurance claim system (100), the system (100) comprising:
a data acquisition unit (104) adapted to receive supporting data corresponding to an insurance policy from a computing device (102), wherein the supporting data is uploaded using the computing device (102) upon initiation of a claim settlement; and
a processing unit (106) communicatively connected to the data acquisition unit (104), characterized in that the processing unit (106) is configured to:
receive the supporting data corresponding to the insurance policy from the data acquisition unit (104);
analyze the received supporting data using an Artificial Intelligence (AI) algorithm (108) to detect inconsistencies and fraud;
store, in an immutable ledger (112), the analyzed supporting data in a blockchain (110) upon detecting no inconsistencies and fraud in the analyzed supporting data;
evaluate a validity of an insurance claim by assessing the stored supporting data, against a set of factors, using machine learning algorithms (114), wherein the set of factors is selected from policy terms, damages, historical data, or a combination thereof; and
propose a fair settlement of the insurance claim based on the evaluated validity.
2. The system (100) as claimed in claim 1, wherein the supporting data is selected from policy documents, images, videos, documents, audios, or a combination thereof.
3. The system (100) as claimed in claim 1, wherein the processing unit (106) is configured to initiate a process of reimbursement of the insurance claim based on the proposed fair settlement.
4. The system (100) as claimed in claim 1, wherein the processing unit (106) is configured to initiate an arbitration for a dispute resolution, when the evaluation of the stored supporting data is invalid.
5. The system (100) as claimed in claim 1, wherein the processing unit (106) is configured to provide a reasoning for a corresponding fair settlement.
6. The system (100) as claimed in claim 1, wherein the inconsistencies and fraud are selected from a staged accident report, fake medical bills, tampered evidence, a counterfeit death certificate, or a combination thereof.
7. A method (300) for verification of insurance claims using a blockchain-based insurance claim system (100), the method (300) is characterized by steps of:
receiving supporting data corresponding to an insurance policy from a data acquisition unit (104);
analyzing the received supporting data using an Artificial Intelligence (AI) algorithm (108) to detect inconsistencies and fraud;
storing, in an immutable ledger (112), the analyzed supporting data in a blockchain (110) upon detecting no inconsistencies and fraud in the analyzed supporting data;
evaluating a validity of an insurance claim by assessing the stored supporting data, against a set of factors, using machine learning algorithms (114), wherein the set of factors is selected from policy terms, damages, historical data, or a combination thereof; and
proposing a fair settlement of the insurance claim based on the evaluated validity.
8. The method (300) as claimed in claim 7, comprising a step of initiating a process of reimbursement of the insurance claim based on the proposed fair settlement
9. The method (300) as claimed in claim 7, comprising a step of initiating an arbitration an arbitration for a dispute resolution, when the evaluation of the stored supporting data is invalid.
10. The method (300) as claimed in claim 7, wherein the supporting data is selected from policy documents, images, videos, documents, audios, or a combination thereof.
Date: May 06, 2025
Place: Noida

Nainsi Rastogi
Patent Agent (IN/PA-2372)
Agent for the Applicant