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

Automatic claim settlement system and method including a claim settlement server having a storage unit, a communication unit, and a processing unit Download PDF

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TW202011325A
TW202011325A TW107130502A TW107130502A TW202011325A TW 202011325 A TW202011325 A TW 202011325A TW 107130502 A TW107130502 A TW 107130502A TW 107130502 A TW107130502 A TW 107130502A TW 202011325 A TW202011325 A TW 202011325A
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insurance
server
information
natural disaster
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TWI676954B (en
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何英蘭
葉日進
蔡世賢
詹筱蕙
周敬翔
王順民
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新光產物保險股份有限公司
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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

自動理賠系統及其方法Automatic claim settlement system and method

本發明是有關於一種理賠系統，特別是指一種自動理賠系統及其方法。The invention relates to a claims settlement system, in particular to an automatic claims settlement system and its method.

現有保險的理賠方式是理賠人員調閱理賠申請人的保單的契約，並根據理賠申請人提供的資料及保單的契約內容，判斷是否可以支付本次的理賠及所要理賠的金額，不僅過程繁瑣且費時，理賠申請人也需要經過漫長的等待才能拿到理賠金。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.

再者，在處理理賠案件的過程中，常因理賠申請人填寫的資訊不正確或提供的資料不完全，進而需要再次補件，不僅造成理賠申請人困擾，亦降低保險公司辦理理賠業務的效率。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 .

因此，本發明的目的，即在提供一種自動理賠系統。Therefore, the object of the present invention is to provide an automatic claim settlement system.

於是，本發明自動理賠系統，經由一通訊網路與一資料開放平台伺服器連接，該資料開放平台伺服器用以儲存與保險理賠相關的一發布資料，該自動理賠系統包含一理賠伺服器，該理賠伺服器包括一儲存單元、一連接該通訊網路的通訊單元，及一電連接該儲存單元及該通訊單元的處理單元。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.

該儲存單元儲存多筆分別相關於多個被保人所承保之指數型保險的保險資料，每一保險資料包括相關於所對應之該指數型保險的至少一理賠項目、相關於所對應之該指數型保險之保險標的的一標的資訊，及相關於該被保人的一被保人帳戶資訊，其中，每一理賠項目對應一理賠金額。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.

其中，該處理單元經由該通訊單元傳送一資料請求至該資料開放平台伺服器，以致該資料開放平台伺服器在判定出其儲存有當日的發布資料時，回傳當日的該發布資料至該處理單元，在該處理單元經由該通訊單元接收到來自該資料開放平台伺服器的該發布資料後，該處理單元對於每一保險資料，根據該發布資料，判定該保險資料的該標的資訊及該至少一理賠項目是否符合一理賠條件，並對於每一判定出符合該理賠條件的保險資料，該處理單元根據該保險資料的該至少一理賠項目中的一目標理賠項目對應的理賠金額及該被保人帳戶資訊進行一匯款交易。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

本發明的另一目的，即在提供一種自動理賠方法。Another object of the present invention is to provide an automatic claim settlement method.

於是，本發明自動理賠方法，由一自動理賠系統執行，該自動理賠系統包括一理賠伺服器，該理賠伺服器儲存有儲存多筆分別相關於多個被保人所承保之指數型保險的保險資料，每一保險資料包括相關於所對應之該指數型保險的至少一理賠項目、相關於所對應之該指數型保險之保險標的的一標的資訊，及相關於該被保人的一被保人帳戶資訊，每一理賠項目對應一理賠金額，該理賠伺服器經由一通訊網路與一資料開放平台伺服器連接，該資料開放平台伺服器用以儲存一與保險理賠相關的一發布資料，該自動理賠方法包含一步驟(A)、一步驟(B)，及一步驟(C)。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).

在該步驟(A)中，該理賠伺服器經由該通訊網路傳送一資料請求至該資料開放平台伺服器，以致該資料開放平台伺服器在判定出其儲存有當日的發布資料時，回傳當日的該發布資料至該理賠伺服器。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.

在該步驟(B)中，該理賠伺服器在經由該通訊網路接收到來自該資料開放平台伺服器的發布資料後，對於每一保險資料，該理賠伺服器根據該發布資料，判定該保險資料的該標的資訊及該至少一理賠項目是否符合一理賠條件。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.

在該步驟(C)中，對於每一判定出符合該理賠條件的保險資料，該理賠伺服器根據該保險資料的該至少一理賠項目中的一目標理賠項目對應的理賠金額及該被保人帳戶資訊進行一匯款交易。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.

本發明之功效在於：該理賠伺服器的該處理單元在接收到來自該資料開放平台伺服器的該發布資料後，判定該保險資料的該標的資訊及該至少一理賠項目是否符合一理賠條件，並對於每一判定出符合該理賠條件的保險資料，該處理單元根據該保險資料的該至少一理賠項目中的一目標理賠項目對應的理賠金額及該被保人帳戶資訊進行一匯款交易，被保人不需要提供任何資料，該處理單元即能自動理賠，方便且迅速。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.

參閱圖1，本發明自動理賠系統1的一實施例，包含一要保人伺服器11及一理賠伺服器12。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.

該要保人伺服器11包括一儲存模組111、一通訊模組112，及一電連接該儲存模組111及該通訊模組112的處理模組113。該要保人伺服器11例如為金融、銀行業所架設之伺服器。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.

該儲存模組111儲存多筆分別相關於多個客戶的客戶資料，每一客戶資料包括一客戶帳戶及一個人資訊，其中，該個人資訊例如包括相關於該客戶的一客戶帳戶資訊及相關於該客戶的登記的地址(如戶籍地、居住地、或通訊地址)的一客戶登記位置資訊，該客戶登記位置資訊例如具有相關於該客戶的登記地址的一郵遞區號，但不以此為限。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.

該通訊模組112連接一通訊網路100，其中，該通訊網路100例如為網際網路(Internet），但不以此為限。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.

該理賠伺服器12包括一儲存單元121、一通訊單元122，及一電連接該儲存單元121及該通訊單元122的處理單元123。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.

該儲存單元121儲存多筆分別相關於多個被保人所承保之指數型保險(Parametric insurance)的保險資料，每一保險資料包括相關於所對應之該指數型保險的多個理賠項目、相關於所對應之該指數型保險之保險標的的一標的資訊，及相關於該被保人的一被保人帳戶資訊，其中，每一理賠項目對應一理賠金額，每一標的資訊包括相關於該保險標的之地理位置的一保險標的位置資訊。值得注意的是，該指數型保險是例如以自然氣候狀況數值如氣溫、降雨量、風速、地震強度、地震規模、海嘯、潮汐、海水溫度等作為保險給付條件，但不此為限。要再注意的是，在本實施例中，每一保險資料包括多個理賠項目，在其他實施例中，每一保險資料亦可僅包括一理賠項目，不以此為限。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.

要特別注意的是，該等理賠項目，例如以下表1所示 表1

Figure 107130502-A0304-0001
It should be particularly noted that such claims items, such as Table 1 shown in Table 1 below
Figure 107130502-A0304-0001

該通訊單元122連接該通訊網路100，並經由該通訊網路100與該要保人伺服器11的該通訊模組112及一資料開放平台伺服器101連接，該資料開放平台伺服器101用以儲存與保險理賠相關的一發布資料，該發布資料例如為政府公開資訊(Big Data)。該資料開放平台伺服器101例如為國家災害防救科技中心(National Science and Technology Center for Disaster Reduction, NCDR)或是交通部中央氣象局(Central Weather Bureau, CWB)所架設的伺服器，或是其他國家當地的災害發布單位或氣象局，但不以此為限。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.

參閱圖2與圖3，本發明自動理賠方法的一實施例，包含一保單建立程序S2及一理賠程序S3。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.

參閱圖1與圖2，說明本發明自動理賠100如何執行該保單建立程序S2，該保單建立S2程序包含步驟S22~S23。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.

在步驟S22中，該處理模組113根據該客戶資料產生一包括該客戶資料的客戶帳戶及該個人資訊的保險請求，並經由該通訊模組112傳送該保險請求至該理賠伺服器12。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.

在步驟S23中，該理賠伺服器12的該處理單元123藉由該通訊單元122接收該要保人伺服器11傳送的該保險請求，並根據該保險請求產生一保險資料，且儲存該保險資料至該儲存單元121。該保險資料包括相關於一指數型保險的多個理賠項目、相關於該指數型保險之保險標的的一標的資訊，及該個人資訊的該客戶帳戶資訊。要特別注意的是，在本實施例中，該保險請求所對應的客戶即為被保人，該標的資訊的該保險標的位置資訊即為該個人資訊的該客戶登記位置資訊，但不以此為限。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.

參閱圖1與圖3，說明本發明自動理賠100如何執行該理賠程序S3，該理賠程序S3包含步驟S31~S35。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.

在步驟S31中，該理賠伺服器12的該處理單元123週期性地經由該通訊單元122傳送一資料請求至該資料開放平台伺服器101。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.

在步驟S32中，該資料開放平台伺服器101判定是否有儲存有當日的發布資料。若該資料開放平台伺服器101判定出儲存有當日的發布資料，則流程進行步驟S33；若該資料開放平台伺服器101判定出不儲存有當日的發布資料，則流程結束。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.

在步驟S33中，該資料開放平台伺服器101傳送當日的該發布資料至該理賠伺服器12。In step S33, the data open platform server 101 transmits the release data on the day to the claims server 12.

值得注意的是，在本實施例中，該發布資料例如包括相關於天災發生地理位置的多筆天災位置資訊，及分別對應該等天災位置資訊的多個天災分數，該理賠伺服器12利用例如周期性的從該資料開放平台伺服器101獲得當日的發布資料，但不以此為限。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.

要再注意的是，在本實施例中，天災例如為地震，天災分數例如為地震震度（Seismic intensity）。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).

在步驟S34中，該處理單元123在經由該通訊單元122接收到來自該資料開放平台伺服器101的該發布資料後，該處理單元123對於每一保險資料，根據該發布資料，判定該保險資料的該標的資訊及該等理賠項目是否符合一理賠條件，其中，該理賠條件為該保險標的位置資訊所相關的保險標的之地理位置在該等天災位置資訊中之至少一目標天災位置資訊所相關的天災發生地理位置的一預定距離範圍內，該至少一目標天災位置資訊所對應的天災分數大於一預定值。若該處理單元123判定出該保險資料的該標的資訊及該等理賠項目符合該理賠條件，則流程進行步驟S35；若該處理單元123判定出該保險資料的該標的資訊及該等理賠項目不符合該理賠條件，則流程結束。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.

要特別注意的是，在本實施例中，每一標的資訊的保險標的位置資訊包括一保險標的郵遞區號，搭配參閱圖4，步驟S34包括子步驟S341~S343，以下說明步驟S34所包括的子步驟。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.

在子步驟S341中，該處理單元123在經由該通訊單元122接收到來自該資料開放平台伺服器101的該發布資料後，該處理單元123根據該發布資料的該等天災位置資訊所對應的該等天災分數，獲得該至少一目標天災位置資訊。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.

舉例來說，所對應的天災分數(地震震度)大於等於6者，即為目標天災位置資訊。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.

在子步驟S342中，該處理單元123根據該至少一目標天災位置資訊，產生分別對應該至少一目標天災地理位置資訊的至少一天災郵遞區號。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.

在子步驟S343中，該處理單元123判定該保險資料的該標的資訊的位置資訊之保險標的郵遞區號是否與該至少一天災郵遞區號存在一匹配，以判定該等保險標的位置資訊所相關的保險標的地理位置是否在該至少一目標天災位置資訊所相關的天災發生地理位置的該預定距離範圍內。若該處理單元123判定出該等標的資訊的保險標的位置資訊之保險標的郵遞區號與該至少一天災郵遞區號存在一匹配，則流程進行步驟S35；若該處理單元123判定出該等標的資訊的保險標的位置資訊之保險標的郵遞區號與該至少一天災郵遞區號不存在一匹配，則流程結束。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.

在步驟S35中，該處理單元123根據該保險資料的該等理賠項目中的一目標理賠項目對應的理賠金額及該被保人帳戶資訊進行一匯款交易。值得注意的是，在本實施例中，該被保人帳戶資訊包括該被保人的***帳戶，該匯款交易即為該處理單元123匯入等同該目標理賠項目對應的理賠金額的刷卡金至該被保人的***帳戶。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.

綜上所述，本發明自動理賠系統及其方法，對於每一客戶資料，該處理模組113產生並傳送該保險請求至該處理單元123，以致該處理單元123根據該保險請求產生該保險資料，以達到無現金交換、新興支付、保險串接金融商品等新型態消費方式；該處理單元123在接收到來自該資料開放平台伺服器101的該發布資料後，判定該保險資料的該標的資訊及該至少一理賠項目是否符合一理賠條件，並對於每一判定出符合該理賠條件的保險資料，該處理單元123根據該保險資料的該至少一理賠項目中的一目標理賠項目對應的理賠金額及該被保人帳戶資訊進行一匯款交易，被保人不需要提供任何資料，該處理單元123即能自動理賠，方便且迅速，故確實能達成本發明的目的。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.

惟以上所述者，僅為本發明的實施例而已，當不能以此限定本發明實施的範圍，凡是依本發明申請專利範圍及專利說明書內容所作的簡單的等效變化與修飾，皆仍屬本發明專利涵蓋的範圍內。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:自動理賠系統11:要保人伺服器111:儲存模組112:通訊模組113:處理模組12:理賠伺服器121:儲存單元122:通訊單元123:處理單元100:通訊網路101:資料開放平台伺服器S2:保單建立程序S22~S23:步驟S3:理賠程序S31~S35:步驟 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

本發明的其他的特徵及功效，將於參照圖式的實施方式中清楚地呈現，其中： 　圖1是一方塊圖，說明本發明自動理賠系統的一實施例； 　圖2是一流程圖，說明本發明自動理賠方法之一實施例的一保單建立程序； 　圖3是一流程圖，說明本發明自動理賠方法之該實施例的一理賠程序；及 　圖4是一流程圖，輔助說明圖3的步驟S34所包含之子步驟。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:自動理賠系統 1: Automatic claims system

11:要保人伺服器 11: To protect the server

111:儲存模組 111: storage module

112:通訊模組 112: Communication module

113:處理模組 113: Processing module

12:理賠伺服器 12: Claims server

121:儲存單元 121: Storage unit

122:通訊單元 122: Communication unit

123:處理單元 123: processing unit

100:通訊網路 100: communication network

101:資料開放平台伺服器 101: data open platform server

Claims (10)

一種自動理賠系統，經由一通訊網路與一資料開放平台伺服器連接，該資料開放平台伺服器用以儲存與保險理賠相關的一發布資料，包含： 一理賠伺服器，包括 一儲存單元，儲存多筆分別相關於多個被保人所承保之指數型保險的保險資料，每一保險資料包括相關於所對應之該指數型保險的至少一理賠項目、相關於所對應之該指數型保險之保險標的的一標的資訊，及相關於該被保人的一被保人帳戶資訊，其中，每一理賠項目對應一理賠金額， 一通訊單元，連接該通訊網路，並經由該通訊網路與該資料開放平台伺服器連接，及 一處理單元，電連接該儲存單元及該通訊單元， 其中，該處理單元經由該通訊單元傳送一資料請求至該資料開放平台伺服器，以致該資料開放平台伺服器在判定出其儲存有當日的發布資料時，回傳當日的該發布資料至該處理單元，在該處理單元經由該通訊單元接收到來自該資料開放平台伺服器的該發布資料後，該處理單元對於每一保險資料，根據該發布資料，判定該保險資料的該標的資訊及該至少一理賠項目是否符合一理賠條件，並對於每一判定出符合該理賠條件的保險資料，該處理單元根據該保險資料的該至少一理賠項目中的一目標理賠項目對應的理賠金額及該被保人帳戶資訊進行一匯款交易。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. 如請求項1所述的自動理賠系統，其中，每一標的資訊包括相關於該保險標的之地理位置的一保險標的位置資訊，該發布資料包括相關於天災發生地理位置的多筆天災位置資訊，及分別對應該等天災位置資訊的多個天災分數，該理賠條件為保險標的位置資訊所相關的保險標的之地理位置在該等天災位置資訊中之至少一目標天災位置資訊所相關的天災發生地理位置的一預定距離範圍內，該至少一目標天災位置資訊所對應的天災分數大於一預定值。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. 如請求項2所述的自動理賠系統，其中，每一標的資訊的保險標的位置資訊包括一保險標的郵遞區號，該處理單元在經由該通訊單元接收到來自該資料開放平台伺服器的該發布資料後，該處理單元根據該發布資料的該等天災位置資訊所對應的該等天災分數，獲得該至少一目標天災位置資訊，並根據該至少一目標天災位置資訊，產生分別對應該至少一目標天災地理位置資訊的至少一天災郵遞區號，且判定該等標的資訊的保險標的位置資訊之保險標的郵遞區號是否與該至少一天災郵遞區號存在一匹配，以判定該等保險標的位置資訊所相關的保險標的地理位置是否在該至少一目標天災位置資訊所相關的天災發生地理位置的該預定距離範圍內。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. 如請求項1所述的自動理賠系統，還包含一要保人伺服器，該要保人伺服器包括 一儲存模組，儲存多筆分別相關於多個客戶的客戶資料，每一客戶資料包括一客戶帳戶資訊及一個人資訊； 一通訊模組，連接該通訊網路，並經由該通訊網路連接該理賠伺服器的該通訊單元；及 一處理模組，電連接該儲存模組及該通訊模組； 其中，對於每一客戶資料，該要保人伺服器的該處理模組根據該客戶資料產生一包括該客戶資料的客戶帳戶資訊及該個人資訊的保險請求，並經由該通訊模組傳送該保險請求至該理賠伺服器的該處理單元，該理賠伺服器的該處理單元根據所接收到的保險請求產生一保險資料，並將該保險資料儲存至該理賠伺服器的該儲存單元。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. 如請求項1所述的自動理賠系統，其中，該等保險資料的該等被保人帳戶資訊分別包括該等被保人的***帳戶。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. 一種自動理賠方法，由一自動理賠系統執行，該自動理賠系統包括一理賠伺服器，該理賠伺服器儲存有儲存多筆分別相關於多個被保人所承保之指數型保險的保險資料，每一保險資料包括相關於所對應之該指數型保險的至少一理賠項目、相關於所對應之該指數型保險之保險標的的一標的資訊，及相關於該被保人的一被保人帳戶資訊，每一理賠項目對應一理賠金額，該理賠伺服器經由一通訊網路與一資料開放平台伺服器連接，該資料開放平台伺服器用以儲存一與保險理賠相關的一發布資料，該自動理賠方法包含以下步驟： (A)藉由該理賠伺服器，經由該通訊網路傳送一資料請求至該資料開放平台伺服器，以致該資料開放平台伺服器在判定出其儲存有當日的發布資料時，回傳當日的該發布資料至該理賠伺服器； (B)藉由該理賠伺服器，在經由該通訊網路接收到來自該資料開放平台伺服器的該發布資料後，對於每一保險資料，根據該發布資料，判定該保險資料的該標的資訊及該至少一理賠項目是否符合一理賠條件；及 (C)藉由該理賠伺服器，對於每一判定出符合該理賠條件的保險資料，根據該保險資料的該至少一理賠項目中的一目標理賠項目對應的理賠金額及該被保人帳戶資訊進行一匯款交易。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. 如請求項6所述的自動理賠方法，每一標的資訊包括相關於該保險標的之地理位置的一保險標的位置資訊，該發布資料包括相關於天災發生地理位置的多筆天災位置資訊，及分別對應該等天災位置資訊的多個天災分數，其中，在步驟(B)中，該理賠條件為保險標的位置資訊所相關的保險標的之地理位置在該等天災位置資訊中之至少一目標天災位置資訊所相關的天災發生地理位置的一預定距離範圍內，該至少一目標天災位置資訊所對應的天災分數大於一預定值。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. 如請求項7所述的自動理賠方法，每一標的資訊的保險標的位置資訊包括一保險標的郵遞區號，其中，步驟(B)包括以下子步驟： (B-1)藉由該理賠伺服器，在經由該通訊網路接收到來自該資料開放平台伺服器的該發布資料後，根據該發布資料的該等天災位置資訊所對應的該等天災分數，獲得該至少一目標天災位置資訊； (B-2)藉由該理賠伺服器，根據該至少一目標天災位置資訊，產生分別對應該至少一目標天災地理位置資訊的至少一天災郵遞區號；及 (B-3)藉由該理賠伺服器，對於每一保險資料，判定該保險資料的該標的資訊的保險標的位置資訊之保險標的郵遞區號是否與該至少一天災郵遞區號存在一匹配，以判定該等保險標的位置資訊所相關的保險標的地理位置是否在該至少一目標天災位置資訊所相關的天災發生地理位置的該預定距離範圍內。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. 如請求項6所述的自動理賠方法，該自動理賠系統還包括一要保人伺服器，該要保人伺服器儲存有多筆分別相關於多個客戶的客戶資料，每一客戶資料包括一客戶帳戶及一個人資訊，並經由該通訊網路連接該理賠伺服器，在步驟(A)之前該自動理賠方法還包含以下步驟： (D)藉由該要保人伺服器，對於每一客戶資料，根據該客戶資料產生一包括該客戶資料的客戶帳戶及相關於該個人資訊的保險請求，並經由該通訊模組傳送該保險請求至該理賠伺服器；及 (E)藉由該理賠伺服器，根據所接收到的保險請求，產生並儲存包括一保險資料。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. 如請求項6所述的自動理賠方法，其中，該等保險資料的該等被保人帳戶資訊分別包括該等被保人的***帳戶。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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