DETAILED ACTION
This Non-Final Office Action is in response to the application filed on 02/12/2024, the Amendment & Remark filed on 02/02/2026 and the Request for Continued Examination of filed on 03/02/2026.
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 .
Continued Examination Under 37 CFR 1.114
A request for continued examination under 37 CFR 1.114, including the fee set forth in 37 CFR 1.17(e), was filed in this application after final rejection. Since this application is eligible for continued examination under 37 CFR 1.114, and the fee set forth in 37 CFR 1.17(e) has been timely paid, the finality of the previous Office action has been withdrawn pursuant to 37 CFR 1.114. Applicant's submission filed on 03/02/2026 has been entered.
Status of Claims
Claim 10 is canceled.
Claims 1 and 19 are amended.
Claims 1, 2, 4-6, 9 and 11-23 are pending.
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, 2, 4-6, 9 and 11-23 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.
As an initial matter, the claims as a whole are to a system and a method, which falls within one or more statutory categories. (Step 1: YES) The recitation of the claimed invention is then further analyzed as follow, in which the abstract elements are boldfaced.
The claim 1 recites:
A digital life and health claims processing system for electronically integrating multiple digital claims channels, where each of the claims channels includes a claims data set of claims characteristics related to a claim event, a policy data set of policy characteristics related to a claim policy regarding the claim event, a services data set of services characteristics related to claims services, and/or a risk-transfer product data set of product characteristics related to a product, and for processing one or more claims of a customer based on the multiple digital claims channel related to the customer, the system comprising:
a cloud-based infrastructure platform accessible via a digital network and configured to host a storage module, a data modelling module, a claims processing module, and a communication module including a signal generator; and
at least one data transmission interface configured to exchange data and/or information provided by at least one user device with the infrastructure platform via the digital network,
wherein at least the claims data set, the policy data set, and/or the services data set includes claimants doctors and medical cause data at least including measuring data for physical characteristics values quantifying the claim event and/or historic policy disclosure parameter values and/or product rule parameters and medical cause data and/or diagnostic measuring parameter values and/or laboratory measuring parameter values and/or measuring data for physical characteristics values quantifying a life or health claim event, wherein at least the policy data set includes the measuring data for physical characteristics values quantifying a life or health risk event exposure and/or a probability for an occurrence of a life or health risk event captured by diagnostic data, laboratory measuring data, and/or on-body sensor devices;
wherein the data modelling module includes a data validation structure configured to validate data of characteristics values of the claims data sets, the policy data sets, and/or the services data sets received via the data transmission interface,
wherein the data modelling module comprises a machine learning structure configured to analyze data sets of the multiple claims channels, the machine learning structure is realized as a supervised or unsupervised machine learning algorithm configured to analyze input data sets and to provide validation for the data of the input data sets, and the data modelling module provides the validated data for the structured data sets, and
wherein the data modelling module combines a structured claims data set, a structured policy data set, and a structured services data set referring to the claim event to an integrated claims processing data set providing a master data set for said customer, which includes structured measuring data for physical characteristics values quantifying a claim life or health event and structured measuring data quantifying a life or health event impact exposure and/or a probability for an occurrence of a life event or health event or critical illness event or terminal illness event impacting physically an individual and capturable by sensor or measuring laboratory or diagnostic devices;
wherein for analyzing the input data sets and providing validation for the data of the input data sets, the machine learning structure provides dimensionality reduction of the integrated claims processing data set, wherein the machine learning structure is realized to select and/or extract data variables from the multiple claims channels data sets and the structured data sets simplifying the integrated claims processing data set, wherein dimensional reduction is realized to transform high dimensional representation of the integrated claims processing data set in low dimension representations
wherein validated data sets of the multiple claims channels of the customer are stored as structured data sets in the storage module,
wherein the claims processing module includes a processing and analyzing structure configured to analyze the structured data sets according to claims requirements defined in the digital claims channels, and to define a claim processing status, and wherein the communication module provides a digital communication signal representing the claim processing status via the signal generator to a user device within the digital network.
The claim 2 recites:
wherein at least the policy data set includes the historic policy disclosure parameter values, and/or the product rule parameters and the medical cause data and/or the diagnostic measuring parameter values, and/or the laboratory measuring parameter values.
The claim 4 recites:
wherein a plurality of combined structured data sets of a plurality of customers is stored in the storage module.
The claim 5 recites:
wherein the multiple claim channels include policy data sets of policy characteristics and/or and service data sets of services characteristics related to historical, outdated, or retired claim policies.
The claim 6 recites:
wherein the data transmission interface is realized as an application programming interface providing digital applications access between the infrastructure platform and user devices.
The claim 9 recites:
wherein the data modelling module comprises a text mining structure configured to analyze textual data of the claims channel data sets, the text mining structure is realized as an information extraction module and/or interface configured to identify and to categorize claims, policy, and/or services characteristics in the textual data as validated data, and the data modelling module provides the validated data for the structured data set.
The claim 11 recites:
wherein the processing and analyzing structure of the claims processing module includes several workflow algorithms, and each of the workflow algorithms defines a processing step of a claims processing workflow.
The claim 12 recites:
wherein the processing and analyzing structure includes workflow algorithms at least for workflow processing steps of recording of a claims submission by a customer, analyzing of missing data information, analyzing of incorrect data information, analyzing of claim entitlement, and recording of a settlement decision.
The claim 13 recites:
wherein the claims processing module includes a prioritizing structure configured to identify and prioritize outstanding work tasks in a claims processing workflow.
The claim 14 recites:
wherein the cloud-based infrastructure platform hosts a tracking module configured to track the claim processing status and to create notification signals regarding the claim processing status, incorrect claim data/information, missing claim data/information, outstanding work tasks, and/or work task allocation.
The claim 15 recites:
wherein the claims processing module, the communication module, and/or the tracking module include a notification algorithm configured to create notification data for a notification signal for allocating work tasks and/or requesting missing claim data/information.
The claim 16 recites:
wherein the cloud-based infrastructure platform hosts a timeline module configured to indicate key data of the integrated claims processing data set on a timeline, and the key data at least indicates a policy activation date, a claim event date, a claim submission date, and a claim settlement date.
The claim 17 recites:
wherein the cloud-based infrastructure platform hosts a dashboard module, which is linked to the storage module, the claims processing module, the tracking module, and/or the timeline module, and the dashboard module is configured to create a visual display of at least the claim processing status and/or the communication signal.
The claim 18 recites:
wherein the user devices are network-compatible devices, and the cloud-based infrastructure platform hosts an authentication module configured to provide authentication credentials for a user and allowing access to the digital claims processing system.
The claim 19 recites:
A method for a digital claims processing system including integrated and automated digital multiple claims channels and for processing one or more claims based on the multiple claims channels,
wherein a claims channel includes a claims data set of claims characteristics related to a claim event, a policy data set of policy characteristics related to a claim policy regarding the claim event, and/or a services data set of services characteristics related to claims services,
wherein at least the claims data set, the policy data set, and/or the services data set includes measuring data for physical characteristics values quantifying a claim event and/or historic policy disclosure parameter values and/or product rule parameters and medical cause data and/or diagnostic measuring parameter values and/or laboratory measuring parameter values, wherein at least the policy data set includes the measuring data for physical characteristics values quantifying a life or health risk event exposure and/or a probability for an occurrence of a life or health risk event captured by diagnostic data, laboratory measuring data, and/or on-body sensor devices; and
wherein a cloud-based infrastructure platform of the digital claims processing system is accessible via a digital network, the method comprising:
exchanging data sets from the multiple digital claim channels and/or information between the cloud-based infrastructure platform and at least one user device via at least one data transmission interface via the digital network,
validating, via a data modelling module of the digital claims processing system including a data validation structure, data of characteristics values of the claims data sets, the policy data sets, and/or the services data sets received via the data transmission interface,
wherein the data modelling module comprises a machine learning structure configured to analyze data sets of the multiple claims channels, the machine learning structure is realized as a supervised or unsupervised machine learning algorithm configured to analyze input data sets and to provide validation for the data of the input data sets, and the data modelling module provides the validated data for the structured data sets, and
wherein the data modelling module combines a structured claims data set, a structured policy data set, and/or a structured services data set referring to the claim event to an integrated claims processing data set providing a master data set, which includes structured measuring data for physical characteristics values quantifying a claim life or health event and structured measuring data quantifying a life or health event impact exposure and/or a probability for an occurrence of a life event or health event or critical illness event or terminal illness event impacting physically an individual and capturable by sensor or measuring laboratory or diagnostic devices;
wherein for analyzing the input data sets and providing validation for the data of the input data sets, the machine learning structure provides dimensionality reduction of the integrated claims processing data set, wherein the machine learning structure is realized to select and/or extract data variables from the multiple claims channels data sets and the structured data sets simplifying the integrated claims processing data set, wherein dimensional reduction is realized to transform high dimensional representation of the integrated claims processing data set in low dimension representations
storing validated data as structured data sets in a data storage module of the digital claims processing system,
processing, via a claims processing module of the digital claims processing system including a processing and analyzing structure, the structured data sets according to requirements of structured policy data sets and/or structured services data sets referring to the claim event,
analyzing and determining, via processing and analyzing structure, a claim processing status, and providing, via a communication module of the digital claims processing system a communication signal of the claim processing status to a user device via a signal generator within the digital network.
The claim 20 recites:
creating, via a notification algorithm, a notification signal for requesting missing claim data and/or information and providing the notification signal to the communication module for transmission to the user device using the signal generator.
The claim 21 recites:
following a claims processing workflow for processing a structured claims processing data set, the claims processing workflow at least including processing steps of recording of a claims submission by a customer, analyzing of missing data information, analyzing of incorrect data information, analyzing of claim entitlement and recording of a settlement decision.
The claim 22 recites:
Identifying an outstanding work task in the claims processing by a prioritizing algorithm of the claims processing module, prioritizing the outstanding work task, and providing a notification signal to a tracking module of the digital claims processing system.
The claim 23 recites:
analyzing, via a machine learning structure, the claims data sets, the policy data sets, the services data sets, and/or the structured claims processing data set of the digital claims channels for optimizing work task recognition.
Based on the limitations above, the claims describe a process that covers processing insurance claim information. Insurance is considered to be a fundamental economic practice, which falls within the “Certain Method of Organizing Human Practice” grouping of abstract ideas. As such, the claim(s) recite(s) a Judicial Exception. (Step 2A prong one: Yes)
This analysis then evaluates whether the claims as a whole integrates the recited Judicial Exception into a practical application of the exception. In particular, the claims recite the additional element(s) of “…module”, “… structure”, as a mere tool to perform the … steps of the Judicial Exception, which encompasses no more than Mere Instruction to Apply.
For example, the limitation “A digital life and/or health claims processing system for electronically integrating multiple digital claims channels, where a claims channel includes a claims data set of claims characteristics related to a claim event, a policy data set of policy characteristics related to a claim policy regarding the claim event, a services data set of services characteristics related to claims services, and/or a risk-transfer product data set of product characteristics related to a product, and for processing one or more claims of a customer based on at least one digital claims channel related to the customer” encompasses no more than generically invoking the generic computing module or structure to apply the Judicial Exception step of integrating claims channels to process claims of a customer;
the limitation “a cloud-based infrastructure platform accessible via a digital network and configured to host a storage module, a data modelling module, a claims processing module, and a communication module including a signal generator” encompasses no more than generically invoking the generic computing module or structure to apply the Judicial Exception step of organizing the storage, modeling, claim processing and communication tasks;
the limitation “at least one data transmission interface configured to exchange data and/or information provided by at least one user device with the infrastructure platform via the digital network” encompasses no more than generically invoking the generic computing module or structure to apply the Judicial Exception step of exchanging data and/or information between the user and the platform;
the limitation “wherein the data modelling module includes a data validation structure configured to validate data of characteristics values of the claims data sets, the policy data sets, and/or the services data sets received via the data transmission interface” encompasses no more than generically invoking the generic computing module or structure to apply the Judicial Exception step of validating data of characteristic values of the data sets received;
the limitation “wherein validated data sets of the multiple claims channels of the customer are stored as structured data sets in the storage module” encompasses no more than generically invoking the generic computing module or structure to apply the Judicial Exception step of storing the validated data sets;
the limitation “wherein the claims processing module includes a processing and analyzing structure configured to analyze the structured data sets according to claims requirements defined in the digital claims channels, and to define a claim processing status, and wherein the communication module provides a digital communication signal representing the claim processing status via the signal generator to a user device within the digital network” encompasses no more than generically invoking the generic computing module or structure to apply the Judicial Exception step of processing and analyzing the structured data sets according to claim requirements and defining claim status;
the limitation “wherein a plurality of combined structured data sets of a plurality of customers is stored in the storage module” encompasses no more than generically invoking the generic computing module or structure to apply the Judicial Exception step of storing the combined structured data set;
the limitation “wherein the data modelling module combines a structured claims data set, a structured policy data set, and/or a structured services data set referring to the claim event to an integrated claims processing data set, which includes structured measuring data for physical characteristics values quantifying a claim life or health event and/or structured measuring data quantifying a life or health event impact exposure and/or a probability for an occurrence of a life event or health event or critical illness event or terminal illness event impacting physically an individual and capturable by sensor or measuring laboratory or diagnostic devices” encompasses no more than generically invoking the generic computing module or structure to apply the Judicial Exception step of combing the structured data sets;
the limitation “wherein the data modelling module comprises a machine learning structure configured to analyze data sets of the claims channels, the machine learning structure is realized as a supervised or unsupervised machine learning algorithm configured to analyze input data sets and to provide validation for the data of the input data sets, and the data modelling module provides the validated data for the structured data sets” encompasses no more than generically invoking the generic computing module or structure to apply the Judicial Exception step of analyzing data sets of the claims channels using machine learning structure;
the limitation “wherein the data modelling module comprises a text mining structure configured to analyze textual data of the claims channel data sets, the text mining structure is realized as an information extraction module and/or interface configured to identify and to categorize claims, policy, and/or services characteristics in the textual data as validated data, and the data modelling module provides the validated data for the structured data set” encompasses no more than generically invoking the generic computing module or structure to apply the Judicial Exception step of analyzing textual data of the claims channel data sets;
the limitation “wherein for analyzing the input data sets and providing validation for the data of the input data sets, the machine learning structure provides dimensionality reduction of the integrated claims processing data set, wherein the machine learning structure is realized to select and/or extract data variables from the multiple claims channels data sets and the structured data sets simplifying the integrated claims processing data set, wherein dimensional reduction is realized to transform high dimensional representation of the integrated claims processing data set in low dimension representation” encompasses no more than generically invoking the generic computing module or structure to apply the Judicial Exception step of reducing dimensionality of the claims processing data set;
the limitation “wherein the processing and analyzing structure of the claims processing module includes several workflow algorithms, and each of the workflow algorithms defines a processing step of a claims processing workflow” encompasses no more than generically invoking the generic computing module or structure to apply the Judicial Exception step of defining the processing step of a claim processing workflow;
the limitation “wherein the processing and analyzing structure includes workflow algorithms at least for workflow processing steps of recording of a claims submission by a customer, analyzing of missing data information, analyzing of incorrect data information, analyzing of claim entitlement, and recording of a settlement decision” encompasses no more than generically invoking the generic computing module or structure to apply the Judicial Exception step of recording claim submission, analyzing missing data information, analyzing incorrect data information, analyzing claim entitlement and recording settlement decision;
the limitation “wherein the claims processing module includes a prioritizing structure configured to identify and prioritize outstanding work tasks in a claims processing workflow” encompasses no more than generically invoking the generic computing module or structure to apply the Judicial Exception step of identify and prioritize outstanding work tasks;
the limitation “wherein the cloud-based infrastructure platform hosts a tracking module configured to track the claim processing status and to create notification signals regarding the claim processing status, incorrect claim data/information, missing claim data/information, outstanding work tasks, and/or work task allocation” encompasses no more than generically invoking the generic computing module or structure to apply the Judicial Exception step of track the claim processing status and to create notification signal;
the limitation “wherein the claims processing module, the communication module, and/or the tracking module include a notification algorithm configured to create notification data for a notification signal for allocating work tasks and/or requesting missing claim data/information” encompasses no more than generically invoking the generic computing module or structure to apply the Judicial Exception step of create notification data for a notification signal;
the limitation “wherein the cloud-based infrastructure platform hosts a timeline module configured to indicate key data of the integrated claims processing data set on a timeline, and the key data at least indicates a policy activation date, a claim event date, a claim submission date, and a claim settlement date” encompasses no more than generically invoking the generic computing module or structure to apply the Judicial Exception step of indicate key data of the integrated claims processing data set on a timeline;
the limitation “wherein the cloud-based infrastructure platform hosts a dashboard module, which is linked to the storage module, the claims processing module, the tracking module, and/or the timeline module, and the dashboard module is configured to create a visual display of at least the claim processing status and/or the communication signal” encompasses no more than generically invoking the generic computing module or structure to apply the Judicial Exception step of organizing the various tasks of the Judicial Exception and creating visual displaying of claim processing status or the communication signal;
the limitation “wherein the user devices are network-compatible devices, and the cloud-based infrastructure platform hosts an authentication module configured to provide authentication credentials for a user and allowing access to the digital claims processing system” encompasses no more than generically invoking the generic computing module or structure to apply the Judicial Exception step of provide authentication credentials for a user and allowing access to the digital claims processing system;
the limitation “processing, via a claims processing module of the digital claims processing system including a processing and analyzing structure, the structured data sets according to requirements of structured policy data sets and/or structured services data sets referring to the claim event” encompasses no more than generically invoking the generic computing module or structure to apply the Judicial Exception step of processing the structured data sets;
the limitation “analyzing and determining, via processing and analyzing structure, a claim processing status, and providing, via a communication module of the digital claims processing system a communication signal of the claim processing status to a user device via a signal generator within the digital network” encompasses no more than generically invoking the generic computing module or structure to apply the Judicial Exception step of analyzing and determining claim processing status and providing the status to the user;
the limitation “creating, via a notification algorithm, a notification signal for requesting missing claim data and/or information and providing the notification signal to the communication module for transmission to the user device using the signal generator” encompasses no more than generically invoking the generic computing module or structure to apply the Judicial Exception step of creating a notification signal for requesting missing claim data and/or information and providing the notification signal to the user.
Other than being generally linked to the steps of the Judicial Exception, the additional elements in the above step(s) is/are recited at a high-level of generality, without technological detail of how the particular steps are performed technologically.
The additional element(s) of “storage module” are generically recited to store data and/or instructions of the Judicial Exception.
The additional element(s) of “on-body sensor devices”, “sensors” and “diagnostic devices” are generically recited as sources of data to be analyzed by the Judicial Exception without technological detail of how the particular data capturing are performed technologically.
The additional element(s) of “cloud-based infrastructure platform” are generically recited to host the generic computing modules performing steps of the Judicial Exception.
The additional element(s) of “machine learning structure” and “supervised or unsupervised machine learning algorithm configured to” are generically recited to perform the analyzing steps of the Judicial Exception.
The additional element(s) of “via the digital network”, “data transmission interface” and “application programming interface” are generically recited to perform communication steps such as receiving and transmitting.
The examiner further noted generic computer affixes such as “digital” or “automated” are appended to abstract elements such as “claim channel” and the additional element of device is linked to the user, but found that to be mere instructions to implement the Judicial Exception idea on a computer.
Indeed, the instant claims (1) attempted to cover a solution to an identified problem with no restriction on how the result is accomplished and no description of the mechanism for accomplishing the result; (2) used of a computer or other machinery in its ordinary capacity for economic or other tasks or simply added a general purpose computer or computer components after the fact to the Judicial Exception and (3) generally applied the Judicial Exception to a generic computing environment without limitation indicative of practical application (See MPEP 2106.04(d)I). Thus, the claims are no more than Mere Instruction to Apply the Judicial Exception (See MPEP 2106.05(f)) or adding insignificant extra-solution activity to the judicial exception (See MPEP 2106.05(g)), which do not integrate the cited Judicial Exception into practical application (Step 2A prong two: No) The claims are directed to a Judicial Exception.
The claim does not include additional elements that are sufficient to amount to significantly more than the judicial exception. As discussed above with respect to integration of the abstract idea into a practical application, the additional element of using a computer modules / structure to process insurance claim data to no more than mere instructions to apply the exception using generic computer components. The recited ordered combination of additional elements includes non-meaningfully invoking generically recited computing element to perform step of the Judicial Exception. Mere instructions to apply an exception using a generic computer component cannot provide an inventive concept. Dependent claim 2, 3 and 5 are merely limit the abstract idea but do not recite any additional element beyond the cited abstract idea, thus, do not amount to significantly more. No additional element currently recited in the claims amount the claims to be significantly more than the cited abstract idea. (Step 2B: No)
Therefore, claims 1, 2, 4-6, 9 and 11-23 are rejected under 35 U.S.C. 101 as being directed to non-statutory subject matter.
Claim Rejections - 35 USC § 103
The following is a quotation of 35 U.S.C. 103 which forms the basis for all obviousness rejections set forth in this Office action:
A patent for a claimed invention may not be obtained, notwithstanding that the claimed invention is not identically disclosed as set forth in section 102, if the differences between the claimed invention and the prior art are such that the claimed invention as a whole would have been obvious before the effective filing date of the claimed invention to a person having ordinary skill in the art to which the claimed invention pertains. Patentability shall not be negated by the manner in which the invention was made.
Claim(s) 1, 2, 4-6, 9 and 11-23 is/are rejected under 35 U.S.C. 103 as being unpatentable over Gunjan et al. (US 2016/0132969) in view of Smith et al. (US 2019/0080416).
As per claim 1, Gunjan discloses a systems comprising:
A digital life and/or health claims processing system for electronically integrating multiple digital claims channels, where a claims channel includes a claims data set of claims characteristics related to a claim event, a policy data set of policy characteristics related to a claim policy regarding the claim event, a services data set of services characteristics related to claims services, and/or a risk-transfer product data set of product characteristics related to a product, and for processing one or more claims of a customer based on at least one digital claims channel related to the customer, (See Gunjan 0007-0009, 0023-0055, 0059-0062 0065-0072 and 0078-0083) the system comprising:
a cloud-based infrastructure platform accessible via a digital network and configured to host a storage module, a data modelling module, a claims processing module, and a communication module including a signal generator; , (See Gunjan 0007-0009, 0023-0055, 0059-0062 0065-0072 and 0078-0083) and
at least one data transmission interface configured to exchange data and/or information provided by at least one user device with the infrastructure platform via the digital network, (See Gunjan 0007-0009, 0023-0055, 0059-0062 0065-0072 and 0078-0083)
wherein at least the claims data set, the policy data set, and/or the services data set includes claimants doctors and/or medical cause data at least including measuring data for physical characteristics values quantifying the claim event and/or historic policy disclosure parameter values and/or product rule parameters and medical cause data and/or diagnostic measuring parameter values and/or laboratory measuring parameter values and/or measuring data for physical characteristics values quantifying a life or health claim event, (See Gunjan 0007-0009, 0023-0055, 0059-0062 0065-0072 and 0078-0083)
wherein at least the policy data set includes the measuring data for physical characteristics values quantifying a life or health risk event exposure and/or a probability for an occurrence of a life or health risk event captured by diagnostic data, laboratory measuring data, and/or on-body sensor devices. (See Gunjan 0007-0009, 0023-0055, 0059-0062 0065-0072 and 0078-0083)
wherein the data modelling module includes a data validation structure configured to validate data of characteristics values of the claims data sets, the policy data sets, and/or the services data sets received via the data transmission interface,
wherein validated data sets of the multiple claims channels of the customer are stored as structured data sets in the storage module, (See Gunjan 0007-0009, 0023-0055, 0059-0062 0065-0072 and 0078-0083)
wherein the data modelling module comprises a machine learning structure configured to analyze data sets of the claims channels, the machine learning structure is realized as a supervised or unsupervised machine learning algorithm configured to analyze input data sets and to provide validation for the data of the input data sets, and the data modelling module provides the validated data for the structured data sets. (See Gunjan 0007-0009, 0023-0055, 0059-0062 0065-0072 and 0078-0083)
wherein the data modelling module combines a structured claims data set, a structured policy data set, and/or a structured services data set referring to the claim event to an integrated claims processing data set, which includes structured measuring data for physical characteristics values quantifying a claim life or health event and/or structured measuring data quantifying a life or health event impact exposure and/or a probability for an occurrence of a life event or health event or critical illness event or terminal illness event impacting physically an individual and capturable by sensor or measuring laboratory or diagnostic devices. (See Gunjan 0007-0009, 0023-0055, 0059-0062 0065-0072 and 0078-0083)
wherein the claims processing module includes a processing and analyzing structure configured to analyze the structured data sets according to claims requirements defined in the digital claims channels, and to define a claim processing status, and wherein the communication module provides a digital communication signal representing the claim processing status via the signal generator to a user device within the digital network. (See Gunjan 0007-0009, 0023-0055, 0059-0062 0065-0072 and 0078-0083)
Gunjan does not explicitly teach:
wherein for analyzing the input data sets and providing validation for the data of the input data sets, the machine learning structure provides dimensionality reduction of the integrated claims processing data set, wherein the machine learning structure is realized to select and/or extract data variables from the multiple claims channels data sets and the structured data sets simplifying the integrated claims processing data set, wherein dimensional reduction is realized to transform high dimensional representation of the integrated claims processing data set in low dimension representations.
However, Smith teaches using machine learning structure(s) to apply dimensionality reduction to insurance related data set, simplification the data set. (See Smith Paragraph 0028. Dimensionality reduction inherently transform data in high dimension representations to data with lower dimension representation.)
It would have been obvious to one of ordinary skill in the art at the time of the effective filing date to modify the insurance analytic system taught by Gunjan with teaching from Smith to perform dimensionality reduction. One of ordinary skill in the art would have been motivated as dimensionality reduction reduces the amount of data to a smaller and more representative set of data. (See Smith Paragraph 0028)
As per claim 2, Gunjan in view of Smith teaches:
wherein at least the policy data set includes the historic policy disclosure parameter values, and/or the product rule parameters and the medical cause data and/or the diagnostic measuring parameter values, and/or the laboratory measuring parameter values. (See Gunjan 0007-0009, 0023-0055, 0059-0062 0065-0072 and 0078-0083)
As per claim 4, Gunjan in view of Smith teaches:
wherein a plurality of combined structured data sets of a plurality of customers is stored in the storage module. (See Gunjan 0007-0009, 0023-0055, 0059-0062 0065-0072 and 0078-0083)
As per claim 5, Gunjan in view of Smith teaches:
wherein the multiple claim channels include policy data sets of policy characteristics and/or and service data sets of services characteristics related to historical, outdated, or retired claim policies. (See Gunjan 0007-0009, 0023-0055, 0059-0062 0065-0072 and 0078-0083)
As per claim 6, Gunjan in view of Smith teaches:
wherein the data transmission interface is realized as an application programming interface providing digital applications access between the infrastructure platform and user devices. (See Gunjan 0007-0009, 0023-0055, 0059-0062 0065-0072 and 0078-0083)
As per claim 9, Gunjan in view of Smith teaches:
wherein the data modelling module comprises a text mining structure configured to analyze textual data of the claims channel data sets, the text mining structure is realized as an information extraction module and/or interface configured to identify and to categorize claims, policy, and/or services characteristics in the textual data as validated data, and the data modelling module provides the validated data for the structured data set. (See Gunjan 0007-0009, 0023-0055, 0059-0062 0065-0072 and 0078-0083)
As per claim 11, Gunjan in view of Smith teaches:
wherein the processing and analyzing structure of the claims processing module includes several workflow algorithms, and each of the workflow algorithms defines a processing step of a claims processing workflow. (See Gunjan 0007-0009, 0023-0055, 0059-0062 0065-0072 and 0078-0083)
As per claim 12, Gunjan in view of Smith teaches:
wherein the processing and analyzing structure includes workflow algorithms at least for workflow processing steps of recording of a claims submission by a customer, analyzing of missing data information, analyzing of incorrect data information, analyzing of claim entitlement, and recording of a settlement decision. (See Gunjan 0007-0009, 0023-0055, 0059-0062 0065-0072 and 0078-0083)
As per claim 13, Gunjan in view of Smith teaches:
wherein the claims processing module includes a prioritizing structure configured to identify and prioritize outstanding work tasks in a claims processing workflow. (See Gunjan 0007-0009, 0023-0055, 0059-0062 0065-0072 and 0078-0083)
As per claim 14, Gunjan in view of Smith teaches:
wherein the cloud-based infrastructure platform hosts a tracking module configured to track the claim processing status and to create notification signals regarding the claim processing status, incorrect claim data/information, missing claim data/information, outstanding work tasks, and/or work task allocation. (See Gunjan 0007-0009, 0023-0055, 0059-0062 0065-0072 and 0078-0083)
As per claim 15, Gunjan in view of Smith teaches:
wherein the claims processing module, the communication module, and/or the tracking module include a notification algorithm configured to create notification data for a notification signal for allocating work tasks and/or requesting missing claim data/information. (See Gunjan 0007-0009, 0023-0055, 0059-0062 0065-0072 and 0078-0083)
As per claim 16, Gunjan in view of Smith teaches:
wherein the cloud-based infrastructure platform hosts a timeline module configured to indicate key data of the integrated claims processing data set on a timeline, and the key data at least indicates a policy activation date, a claim event date, a claim submission date, and a claim settlement date. (See Gunjan 0007-0009, 0023-0055, 0059-0062 0065-0072 and 0078-0083)
As per claim 17, Gunjan in view of Smith teaches:
wherein the cloud-based infrastructure platform hosts a dashboard module, which is linked to the storage module, the claims processing module, the tracking module, and/or the timeline module, and the dashboard module is configured to create a visual display of at least the claim processing status and/or the communication signal. (See Gunjan 0007-0009, 0023-0055, 0059-0062 0065-0072 and 0078-0083)
As per claim 18, Gunjan in view of Smith teaches:
wherein the user devices are network-compatible devices, and the cloud-based infrastructure platform hosts an authentication module configured to provide authentication credentials for a user and allowing access to the digital claims processing system. (See Gunjan 0007-0009, 0023-0055, 0059-0062 0065-0072 and 0078-0083)
As per claim 19, Gunjan teaches a method comprising:
exchanging data sets from the multiple digital claim channels and/or information between the cloud-based infrastructure platform and at least one user device via at least one data transmission interface via the digital network, (See Gunjan 0007-0009, 0023-0055, 0059-0062 0065-0072 and 0078-0083)
validating, via a data modelling module of the digital claims processing system including a data validation structure, data of characteristics values of the claims data sets, the policy data sets, and/or the services data sets received via the data transmission interface, (See Gunjan 0007-0009, 0023-0055, 0059-0062 0065-0072 and 0078-0083)
wherein the data modelling module comprises a machine learning structure configured to analyze data sets of the claims channels, the machine learning structure is realized as a supervised or unsupervised machine learning algorithm configured to analyze input data sets and to provide validation for the data of the input data sets, and the data modelling module provides the validated data for the structured data sets. (See Gunjan 0007-0009, 0023-0055, 0059-0062 0065-0072 and 0078-0083)
wherein the data modelling module combines a structured claims data set, a structured policy data set, and/or a structured services data set referring to the claim event to an integrated claims processing data set, which includes structured measuring data for physical characteristics values quantifying a claim life or health event and/or structured measuring data quantifying a life or health event impact exposure and/or a probability for an occurrence of a life event or health event or critical illness event or terminal illness event impacting physically an individual and capturable by sensor or measuring laboratory or diagnostic devices. (See Gunjan 0007-0009, 0023-0055, 0059-0062 0065-0072 and 0078-0083)
storing validated data as structured data sets in a data storage module of the digital claims processing system, (See Gunjan 0007-0009, 0023-0055, 0059-0062 0065-0072 and 0078-0083)
processing, via a claims processing module of the digital claims processing system including a processing and analyzing structure, the structured data sets according to requirements of structured policy data sets and/or structured services data sets referring to the claim event, (See Gunjan 0007-0009, 0023-0055, 0059-0062 0065-0072 and 0078-0083)
analyzing and determining, via processing and analyzing structure, a claim processing status, and providing, via a communication module of the digital claims processing system a communication signal of the claim processing status to a user device via a signal generator within the digital network. (See Gunjan 0007-0009, 0023-0055, 0059-0062 0065-0072 and 0078-0083)
Gunjan does not explicitly teach:
wherein for analyzing the input data sets and providing validation for the data of the input data sets, the machine learning structure provides dimensionality reduction of the integrated claims processing data set, wherein the machine learning structure is realized to select and/or extract data variables from the multiple claims channels data sets and the structured data sets simplifying the integrated claims processing data set, wherein dimensional reduction is realized to transform high dimensional representation of the integrated claims processing data set in low dimension representations.
However, Smith teaches using machine learning structure(s) to apply dimensionality reduction to insurance related data set, simplification the data set. (See Smith Paragraph 0028. Dimensionality reduction inherently transform data in high dimension representations to data with lower dimension representation.)
It would have been obvious to one of ordinary skill in the art at the time of the effective filing date to modify the insurance analytic system taught by Gunjan with teaching from Smith to perform dimensionality reduction. One of ordinary skill in the art would have been motivated as dimensionality reduction reduces the amount of data to a smaller and more representative set of data. (See Smith Paragraph 0028)
As per claim 20, Gunjan in view of Smith teaches:
creating, via a notification algorithm, a notification signal for requesting missing claim data and/or information and providing the notification signal to the communication module for transmission to the user device using the signal generator. (See Gunjan 0007-0009, 0023-0055, 0059-0062 0065-0072 and 0078-0083)
As per claim 21, Gunjan in view of Smith teaches:
following a claims processing workflow for processing a structured claims processing data set, the claims processing workflow at least including processing steps of recording of a claims submission by a customer, analyzing of missing data information, analyzing of incorrect data information, analyzing of claim entitlement and recording of a settlement decision. (See Gunjan 0007-0009, 0023-0055, 0059-0062 0065-0072 and 0078-0083)
As per claim 22, Gunjan in view of Smith teaches:
Identifying an outstanding work task in the claims processing by a prioritizing algorithm of the claims processing module, prioritizing the outstanding work task, and providing a notification signal to a tracking module of the digital claims processing system. (See Gunjan 0007-0009, 0023-0055, 0059-0062 0065-0072 and 0078-0083)
As per claim 23, Gunjan in view of Smith teaches:
analyzing, via a machine learning structure, the claims data sets, the policy data sets, the services data sets, and/or the structured claims processing data set of the digital claims channels for optimizing work task recognition. (See Gunjan 0007-0009, 0023-0055, 0059-0062 0065-0072 and 0078-0083)
Response to Arguments
Applicant's arguments filed on 02/02/2025 have been fully considered but they are not persuasive.
Regarding the applicant’s argument that the claims provide improvement to technology, the examiner respectfully disagrees. The applicant asserted that the claims provide “various technological improvements, including: (1) improving digitization and automation; (2) providing efficient communication channels; (3) improving data accessibility; (4) improving data quality; (5) avoiding data duplication; (6) avoiding data loss in the short- and long-term; and (7) supporting data exchange across various claims channels (i.e., data compatibility)”. (See Remark Page 13) However, the examiner noted that other merely apply result-oriented language “it is one object of the present invention to … allow for improving …”, none of the alleged improvement (1)-(7) is substantiated technologically by the disclosure of the application. It should also be noted that 1) the mere usage of a technology such as automating a claim processing process does not improve the technology (See MPEP 2106.05(a) - Mere automation of manual processes, such as using a generic computer to process an application for financing a purchase, Credit Acceptance Corp. v. Westlake Services ) and 2) improvement attributable solely to the generic usage of an existing technology is not a technological improvement. (See MPEP 2106.05(a) - Accelerating a process of analyzing audit log data when the increased speed comes solely from the capabilities of a general-purpose computer, FairWarning IP, LLC v. Iatric) As such, the applicant’s argument is not persuasive.
Regarding the applicant’s argument that Gunjan does not disclose “an extraction of structural data from a multitude of different digital channels”, the examiner respectfully disagrees. Gunjan Paragraph 0039 recites “In one example, the behavior of the insured patient is analyzed from the video streams. In one implementation, the one or more behavioural parameters are retrieved from one or more data sources over the communication network 102. In an exemplary embodiment, the one or more data sources include, but are not limited to, social network servers 105 related to social blogs, and social media. The one or more data sources also includes, but are not limited to, Customer Relationship Management (CRM) based data sources associated to the one or more insurance providers 103, data sources associated to the one or more medical service providers 104, and the one or more assessment servers 106 associated with behavioural examiner/inspector.”. It is clear that the one or more data sources including social media blogs, CRM sources associated with insurance providers, data sources associated with medical service provider and assessment servers associated with behavioural examiner are different digital channels with different data structures are extracted. As such, the argument is not persuasive.
Regarding the applicant’s argument that Gunjan does not disclose or suggest a machine learning structure that is implemented as a supervised machine learning algorithm for extraction and dimension, the examiner respectfully disagrees. It should be noted that the claims explicitly recites “the machine learning structure is realized as a supervised or unsupervised machine learning algorithm configured to analyze input data sets and to provide validation for the data of the input data sets”. Since any machine learning model is either supervised or unsupervised, any disclosure of machine learning model used to analyze input data set and to provide validation for data would anticipate the limitation. Gunjan Paragraph 0023 recites “Then, the information contained in the insurance application form is segmented into medical data and behavioral data. Upon segmenting, diseases from the medical data and behavioural parameters from behavioural data are classified into different groups using ontologies. The groups comprise medical group and behavioural group which classified using medical ontologies and behavioural ontologies respectively.” Gunjan Paragraph 0053 recite “The classification module 225 is configured to classify both the structured and unstructured data using the machine learning and natural language processing engines”. Gunjan Paragraph 0023 recites “the relevancy of insurance claims claimed for the insured patient is validated and verified using the classification. The relevancy is validated and verified in order to determine authenticity of the insurance claims for the insured patient”, which anticipate provide validation for data. As to dimensionality reduction, a prior art is applied in combination with Gunjan to cure the deficiency. The applicant further argued that certain “concepts and advantages are nowhere found in the Gunjan reference”, but those concepts and advantages are not recited in the claims. As such, the argument is not persuasive.
Conclusion
Any inquiry concerning this communication or earlier communications from the examiner should be directed to CHO KWONG whose telephone number is (571)270-7955. The examiner can normally be reached 9am - 5pm EST M-F.
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/CHO YIU KWONG/Primary Examiner, Art Unit 3693