DETAILED ACTION
Acknowledgements
The amendment filed 08/31/2026 is acknowledged.
Claims 1-5, 16-21, 23, 25-29, and 31 are pending.
Claims 1-5, 16-21, 23, 25-29 and 31 have been examined.
Notice of Pre-AIA or AIA Status
The present application, filed on or after March 16, 2013, is being examined under the first inventor to file provisions of the AIA .
Examiner’s comment
This is a final office action in response to an amendment submission (8/31/2026) after a PTAB decision (6/30/2026). (MPEP 1214.01)
Response to Amendment/Arguments
Claims 1, 16 and 25 are amended.
Regarding applicant’s arguments on Claim Rejections - 35 U.S.C. §101, the arguments have been fully considered but they are not persuasive.
It is the Applicant’s position that the “claims are thus directed to a practical application,” because “The construction of a relationship graph is not essential or typical in the traditional provisioning of insurance or adjudication of insurance claims,”. The Examiner respectfully disagrees.
Graph theory has been around since ancient time. Social graph was popularized in 2007. Using social graph in processing insurance claims does not determine whether it integrates an abstract ideal into a practical application. The additional element(s) of the claim(s) such as the use of social graph, computer system, blockchain, mobile device, machine learning, processors, and non-transitory computer readable medium use computer as a tool to perform an abstract idea of processing insurance enrollment or processing insurance claim. However, it does not purport to improve the functioning of the computer system, mobile devices, machine learning, blockchain or social graph. Therefore, the judicial exception is not integrated into a practical application
The rejection is maintained.
Claim Rejections – 35 USC §101
35 U.S.C. 101 reads as follows:
Whoever invents or discovers any new and useful process, machine, manufacture, or composition of matter, or any new and useful improvement thereof, may obtain a patent therefor, subject to the conditions and requirements of this title.
Claims 1-5, 16-21, 23, 25-29, and 31 are rejected under 35 U.S.C. 101 because the claimed invention is directed to a judicial exception (i.e., a law of nature, a natural phenomenon, or an abstract idea) without significantly more.
Analysis
In the instant case, claims 1-5 and 21 are directed to a method, claims 16-20 and 23 are directed to system, and claims 25-29 and 31 are directed to CRM. Therefore, these claims fall within the four statutory categories of invention.
The claim(s) recite(s) processing insurance enrollment or processing an insurance claim. Specifically, the claims recite “sending, by a [computing system], an offer to a user to provide an insurance product that uses a peer-to-peer risk pool; constructing, by the [computing system], a [graph] representing real-life relationships between users; receiving, by the [computing system], an acceptance of the offer by the user; responsive to the acceptance, automatically binding the user to the insurance product, thereby making the user a member of the peer-to-peer risk pool; receiving, by the [computing system], data characterizing claim information submitted by the member to be reviewed by a plurality of additional members of the peer-to-peer risk pool; inserting, by the [computing system], the claim information as a transaction into a block using a private key; adding, by the [computing system], the block to a [blockchain], the [blockchain] including prior claim and payment information of the member; distributing, by the [computing system], the [blockchain] to the plurality of additional members of the peer-to-peer risk pool for review by each of the plurality of additional members for approving or denying the claim; receiving, by the [computing system], from each additional member of the plurality of additional members, a response to approve or deny the claim; determining, by the [computing system], a number of the received responses that indicate approval of the claim; responsive to the determined number of received responses indicating approval exceeding a threshold number of responses indicating approval, approving, by the [computing system], the claim; receiving, by the [computing system], from the member of the peer-to-peer risk pool, subsequent to approving the claim, mobile device data from a [mobile device] of the member; accessing a [graph] built around the member, the [graph] representing real life connections between the member and other members of the peer-to-peer risk pool; identifying one or more approvals, provided by the member, of claims of other members of the risk pool that have one-degree of separation from the member in the [graph] at least some of the claims of other members that were approved by the member having been determined to be fraudulent; and determining, using [machine learning] and based on the received mobile device data and the one or more approvals of claims of other members of the risk pool having one-degree of separation from the member, that the claim was fraudulent, wherein determining that the claim was fraudulent is based on a score of the member, the score of the member generated by [machine learning] and indicating a likelihood that the member approves fraudulent claims of the other members of the risk pool having one degree of separation from the member, as indicated on the [blockchain].”, which is fundamental economic principles or practices and commercial or legal interactions within the “certain methods of organizing human activity” grouping of abstract ideas in prong one of step 2A of the Alice/Mayo test (See MPEP 2106) because the claims involve a series of steps for processing insurance enrollment or processing insurance claim. Accordingly, the claims recite an abstract idea.
This judicial exception is not integrated into a practical application because, when analyzed under prong two of step 2A of the Alice/Mayo test (See MPEP 2106), the additional element(s) of the claim(s) such as the use of graph, computer system, blockchain, mobile device, machine learning, processors, and non-transitory computer readable medium merely use(s) a computer as a tool to perform an abstract idea. The processors and memories are recited at a high-level of generality (i.e., as a generic processor performing a generic computer function of processing insurance registration or processing insurance claim) such that it amounts to no more than mere instructions to apply the exception using a generic computer components. Accordingly, the additional elements do not impose any meaningful limits on practicing the abstract idea, and the claims are directed to an abstract idea.
The claims do not include additional elements that are sufficient to amount to significantly more than the abstract idea. The function performed by the computer at each step of the process is conventional. Using a computer to retrieval, select, and apply decision criteria to data and modify the data is one of the basic functions of a computer. These computer functions are well-understood, routine, conventional activities previously known to the trading industry. See Elec. Power Grp., LLC V. Alstom S.A., 830 F.3d 1350, 1354 (Fed. Cir. 2016); see also In re Katz Interactive Call Processing Patent Litig., 639 F.3d 1303, 1316 (Fed. Cir. 2011) ("Absent a possible narrower construction of the terms 'processing,' 'receiving,' and 'storing,' those functions can be achieved by any general purpose computer without special programming"). The additional element of using graph, computer system, blockchain, mobile device, machine learning, processors, and non-transitory computer readable medium to perform processing of insurance enrollment or insurance claim steps amounts to no more than mere instructions to apply the exception using a generic computer components. Mere instructions to apply an exception using a generic computer components cannot provide an inventive concept. The claim is not patent eligible.
Dependent claims 2-4, 17-19 and 26-28 describe insurance claim information. Dependent claims 5, 20 and 29 describe payment information. Dependent claims 21, 23, and 31 describe the blockchain. These claims further recite the abstract idea of certain methods of organizing human activity. This judicial exception is not integrated into a practical application because the additional element(s) of the claim(s) such as the use of graph, computer system, blockchain, mobile device, machine learning, processors, and non-transitory computer readable medium merely use(s) a computer as a tool to perform an abstract idea. The claims do not include additional elements that are sufficient to amount to significantly more than the judicial exception. The claims are not patent eligible.
Viewed as a whole, the combination of elements recited in the method claims simply recite the concept of processing insurance enrollment and claim. The claims do not, for example, purport to improve the functioning of the computer itself. Nor do they effect an improvement in any other technology or technical field.
The use of graph, blockchain, mobile device, machine learning, processor and memory to implement the abstract idea does not render the claim patent eligible because it does not provide meaningful limitations beyond generally linking the use of an abstract idea to a particular technological environment and requires no more than a computer performing functions that correspond to acts required to carry out the abstract idea.
Conclusion
The following prior art made of record and not relied upon is considered pertinent to applicant's disclosure.
US20130317867A1 (“Cecil”) discloses a system and method for processing an appeal of an insurance claim. The method involves a computer implemented process of receiving information about of a denied insurance claim, preparing the appeal, and generating a webpage that provides status information about the appeal to the parties to the appeal. The generated webpage can also provide an option to submit the appeal to an external appeals body when an internal appeals body has ruled unfavorably. Accordingly, the present invention can provide a single interface where an insured can submit appeals in a standard manner to facilitate the process of preparing and submitting appeals of denied insurance claims.
US20160164884A1 (“Sriram et al.”) discloses a provenance management system. The provenance management system can authenticate an entity account to register a public identity key and an identity address that are associated with the entity account. The provenance management system can receive a logistic transaction record having a cryptographic signature thereon. The provenance management system can authenticate the cryptographic signature against the public identity key and publish the logistic transaction record to a distributed consensus system that implements a block chain. Each block in the block chain are in sequence with one another and can contain one or more logistic transaction records to ensure a sequence of the logistic transaction records is cryptographically irrepudiable.
US20170069030A1 (“Alleyne”) discloses a system and method for collaborative risk sharing within a peer-to-peer social network. The system and method allows transparent participation in event pools with other participating members who agree to in the same risk. Benefits are paid to participating members who receive a valid loss associated with the shared risk from enrolment funds paid by all participating members within the event pool. Funds received from participating members of one event group are not used to pay benefits to members of another event pool.
THIS ACTION IS MADE FINAL. Applicant is reminded of the extension of time policy as set forth in 37 CFR 1.136(a).
A shortened statutory period for reply to this final action is set to expire THREE MONTHS from the mailing date of this action. In the event a first reply is filed within TWO MONTHS of the mailing date of this final action and the advisory action is not mailed until after the end of the THREE-MONTH shortened statutory period, then the shortened statutory period will expire on the date the advisory action is mailed, and any extension fee pursuant to 37 CFR 1.136(a) will be calculated from the mailing date of the advisory action. In no event, however, will the statutory period for reply expire later than SIX MONTHS from the mailing date of this final action.
Any inquiry concerning this communication or earlier communications from the examiner should be directed to YINGYING ZHOU whose telephone number is (571)272-5308. The examiner can normally be reached 9-5.
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/YINGYING ZHOU/Primary Examiner, Art Unit 3697
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