DETAILED ACTION
The communication is a First Action Non-Final on the merits. Claims 1-20 are currently pending and have been considered below.
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 .
Information Disclosure Statement
The information disclosure statement(s) (IDS) submitted on 2025 July 25 was/were in compliance with the provisions of 37 CFR 1.97. Accordingly, the information disclosure statement is being considered by the examiner.
Claim Objections
Claims 5 and 16 are objected to because of the following informalities: these claims contain the language of “further comprising determining if the generated compensation profile matches and existing profile” but the “and” should be “an”. Appropriate correction is required.
Specification
Applicant’s preliminary amendment to the specification filed 25 July 2024 is accepted.
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 1-20 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.
Step 1: Claims 1-12 are directed towards a method. Claims 13-20 are directed towards a system. Thus, these claims, on their face, are directed to one of the statutory categories of 35 U.S.C. § 101.
Step 2A - Prong One: As per MPEP 2106.04, Prong One asks does the claim recite an abstract idea, law of nature, or natural phenomenon. In Prong One examiners evaluate whether the claim(s) recites a judicial exception; that is, whether the claim(s) set forth or describe a law of nature, natural phenomenon, or abstract idea.
Claim 1 is presented here as a representative claim for specific analysis (The underlined claim terms here are interpreted as additional elements beyond the abstract idea.):
A method of disability management comprising:
receiving at a management server identification of evaluation requirements for a disability condition associated with an employee of an associated case identifier;
generating a collection profile for the employee;
determining a cultural profile associated with the employee;
determine data collection requirements for associated disability condition;
converting data collection requirements based on cultural profile associated with the employee;
presenting a data collection interface to employee through a remote computing device;
receiving disability assessment responses through the data collection interface from the remote computing device;
converting received disability assessment responses to standard format from a determined translation mapping based upon the associated cultural profile;
processing collected data against a plurality of stored profiles;
generating a disability compensation profile;
determining expected outcomes associated with the disability compensation profile;
processing events associated with the disability compensation profile;
and generating one or more analytics from the processed events.
The claims here are based on the recitation of an abstract idea (i.e. recitation other than the additional elements delineated here with underlining and further addressed per Step 2A - Prong Two and Step 2B). The claims recite the abstract idea of standardizing collected health data for estimation of health benefits costs which falls withing certain methods of organizing human activity and also mental processes.
The phrase "certain methods of organizing human activity" applies to fundamental economic principles or practices including hedging insurance, mitigating risk; commercial or legal interactions including agreements in the form of contracts, legal obligations, advertising, marketing or sales activities or behaviors business relations; managing personal behavior or relationships or interactions between people including social activities teaching, and following rules or instructions. Refer to MPEP 2106.04(a)(2) II. A-C.
The phrase "mental processes" applies to concepts performed in the human mind (including an observation, evaluation, judgement, opinion). Here the claims are making judgements regarding disability status of patients. Refer to MPEP 2106.04(a)(2)III.A-C.
The Remaining Claims: Independent claim 13 contains the additional elements of “a network interface”, “a wide area network”, “a computing device”, “a processor”, “a computer readable medium”. The dependent claims recite fail to recite any additional elements beyond those already identified.
The dependent claims further reiterate the same abstract idea with further embellishments: collecting data using a template (claims 2, 14); using a selected language (claims 3, 4, 15); matching to existing data (claims 5, 6, 16, 17); estimating outcomes based on collected data (claims 7-12, 17-20). Therefore, the identified claims fall within the subject matter groupings of abstract ideas enumerated in MPEP 2106.04(a)(2).
Step 2A - Prong Two: As per MPEP 2106.04.II.A.2, Prong Two determines if the claim(s) recite additional elements that integrate the judicial exception into a practical application.
As for the additional elements of: “a network interface”, “a wide area network”, “a computing device”, “a processor”, “a computer readable medium”. To be patent-eligible, the elements additional to the identified abstract idea must amount to more than "an instruction to apply the abstract idea . . . using some unspecified, generic computer" to render the claim patent-eligible. Alice Corp. v. CLS Bank Int'l, 573 U.S. 208, 226 (2014). It would have been readily apparent to one having ordinary skill in the art (PHOSITA) at the time the invention was filed that the additional elements represent generic computing devices. Therefore, the claims amount to no more than a mere method, system, and/or computer program product to implement the abstract idea on a generic computer system. See MPEP § 2106.05(f).
As for the additional element(s) of: a data collection interface, receiving at a management server identification of evaluation requirements for a disability condition associated with an employee of an associated case identifier; and receiving disability assessment responses through the data collection interface from the remote computing device. The gathering of data represents insignificant extra-solution activity that comprises mere data gathering. The gathering of data represents insignificant extra-solution activity that comprises mere data gathering. The additional element(s) represent insignificant extra-solution activity incidental to the primary process or product that are merely a nominal or tangential addition to the claim as noted in MPEP 2106.05(g).
Step 2B: As per MPEP 2106.05, the additional elements are analyzed, both individually and in combination, to determine whether an "inventive concept" is furnished by an element or combination of elements that is recited in the claim in addition to (beyond) the judicial exception, and is sufficient to ensure that the claim, as a whole, amounts to significantly more than the judicial exception itself.
As for the additional element(s):
receiving at a management server identification of evaluation requirements for a disability condition associated with an employee of an associated case identifier; and receiving disability assessment responses through the data collection interface from the remote computing device represent receiving or transmitting data over a network, e.g., using the Internet to gather data, Symantec, 838 F.3d at 1321, 120 USPQ2d at 1362 (utilizing an intermediary computer to forward information)
a data collection interface, represents using an "interface" to display information as in Affinity v DirecTV in which "The court rejected the argument that the computer components recited in the claims constituted an 'inventive concept'. It held that the claims added 'only generic computer components such as an 'interface', 'network', and 'database' and that 'recitation of generic computer limitations does not make an otherwise ineligible claim patent-eligible". Id. at 1324-25 (citations omitted). The court noted that nothing in the asserted claims purported to improve the functioning of the computer itself or "effect an improvement in any other technology or technical field". Mortgage Grader, 811 F.3d at 1325 (quoting Alice, 134 S. Ct. at 2359)".
References of Record but not Applied in the Current Grounds of Rejection
The prior art listed below is made of record as considered pertinent to applicant's disclosure and is not relied upon in the grounds of rejection presented in this Office action. Those starred with '*' were added to this list in this Office action. Those without "*" were added in a previous Office action and are not repeated on a PTO-892 Notice of References Cited form, but are maintained herein for informational purposes only.
* Hunt et al., in “Cross-cultural adaptation of health measures”, discloses adjusting measurement of health statistics based on cultural factors.
Examiner's Note on the Format of the Prior Art Rejections
The prior art rejections below contain underlined markings of the limitations (e.g. sample limitation). The underlined portions of a claim are addressed at the end of the grounds of rejection for that claim. Examiner notes that the underlining of the claim language is not a statement that the primary reference does not teach that language, but simply that said claim language is addressed at the end of the grounds of rejection for that claim.
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) 1-3, 7-14, 16, 18-20 is/are rejected under 35 U.S.C. § 103 as being unpatentable over
Edwards et al. (Pub. #: US 2016/0125544 A1) in view of
Jain et al. (Pub. #: US 2019/0180879 A1).
Claim(s) 1, 13:
These claims are analogous with different representative embodiments: claim 1 is a method embodiment, claim 13 is a system embodiment. Edwards teaches a computer system with computer-readable media in at least 0071-0075 for performing the steps:
receiving at a management server identification of evaluation requirements for a disability condition associated with an employee of an associated case identifier;
(Edwards discloses receiving evaluation requirements for an employee and that employee's case identifier in at least 0055, 0056.)
generating a collection profile for the employee;
(Edwards discloses generating a profile for the employee in at least Figure 26, 0076-0078.)
determining a cultural profile associated with the employee;
determine data collection requirements for associated disability condition;
(Edwards discloses collecting data pertaining to the employee according to a set of "Workers' Compensation Benefit Rules" in at least Figure 3, 0036, Figure 5, 0041, and 0042.)
converting data collection requirements based on cultural profile associated with the employee;
presenting a data collection interface to employee through a remote computing device; receiving disability assessment responses through the data collection interface from the remote computing device;
(Edwards discloses entry of disability assessment response through an "online claim submission web page" in at least 0037-0041.)
converting received disability assessment responses to standard format from a determined translation mapping based upon the associated cultural profile;
processing collected data against a plurality of stored profiles;
(Edwards discloses processing a claim against "historical information" in at least 0025.)
generating a disability compensation profile;
(Edwards discloses creating a "profile" of information corresponding to a "claim identifier" in at least Figure 26 and 0077, 0078.)
determining expected outcomes associated with the disability compensation profile;
(Edwards discloses that the amount owed may be "automatically calculated" in at least 0077, 0078 and Figure 26.)
processing events associated with the disability compensation profile;
and generating one or more analytics from the processed events.
(Edwards discloses processing payments (i.e., "events") associated with the worker's compensation claim in at least 0078 and Figure 27 with all of the payments recalculated when any of the factors changes. Edwards further discloses analyzing a claim for fraud detection purposes in at least 0035.)
As for, "determining a cultural profile associated with the employee;", "converting data collection requirements based on cultural profile associated with the employee;", and "converting received disability assessment responses to standard format from a determined translation mapping based upon the associated cultural profile;": However, Jain teaches a technique of adjusting user health input based upon "distal factors" that include "cultural context" in at least Figure 5 and 0233-0238.
It would have been obvious to a person of ordinary skill in the art before the effective filing date of the claimed invention to modify the health data collection of Edwards with the technique of accounting for cultural context of the data as taught by Jain. Motivation to combine Edwards and Jain comes from both references pertaining to health data collection and analysis and from the desire to manage health in an efficient manner (Jain: 0034-0035).
Claim(s) 2, 14:
wherein the data collection requirements are associated with a base collection template, the base collection template defining one of more measures associated with the determined disability compensation profile.
(Edwards discloses collecting data pertaining to the employee according to a set of "Workers' Compensation Benefit Rules" in at least Figure 3, 0036, Figure 5, 0041, and 0042. Examiner notes that the specification in the instant application includes "place of residence" (i.e., a state of residence) as comprising a "cultural group" in 0028.)
Claim(s) 3:
wherein an employee language or cultural requirements is selected from a plurality of language or cultural definitions.
(Edwards discloses collecting data pertaining to the employee according to a selected state in at least Figure 5, 0041, and 0042. Examiner notes that the specification in the instant application includes "place of residence" (i.e., a state of residence) as comprising a "cultural group" in 0028.)
Claim(s) 7:
generating profile tasks and threshold based upon the existing profile.
(Edwards discloses tasks with the teaching of specified payments in at least 0077, 0078 and Figure 26 and thresholds with the teaching of "benefit minimums and maximums" in at least 0043-0054 and Figure 6.)
Claim(s) 8, 18:
determining an expected outcome for the disability compensation profile.
(Edwards discloses that the amount owed may be "automatically calculated" in at least 0077, 0078 and Figure 26.)
Claim(s) 9:
generating a recommended approval or denial for the case identifier is generated and presented for selection.
(Edwards discloses generating an approval or denial and presenting it for selection in at least Figure 9 (see item 920) and 0057.)
Claim(s) 10, 19:
generating profile events when the case identifier is approved defining actions to be performed in relation to the employee claim process.
(Edwards discloses tasks with the teaching of specified payments in at least 0077, 0078 and Figure 26.)
Claim(s) 11:
comparing collected case events with the determined existing profile and identifying when one or more thresholds are exceeded for the case identifier.
(Edwards discloses a case profile that includes a "minimum" and "maximum" benefit in at least 0036 and further discloses accounting for "over payment" situations" in at least 0078.)
Claim(s) 12:
aggregating case identifiers into an aggregate event associated with a disability compensation profile.
(Edwards discloses aggregating insurance claims into segments in at least 0027.)
Claim(s) 20:
comparing collected case events with the determined existing profile and identifying when one or more thresholds are exceeded for the case identifier.
(Edwards discloses a case profile that includes a "minimum" and "maximum" benefit in at least 0036 and further discloses accounting for "over payment" situations" in at least 0078.)
aggregating case identifiers into an aggregate event associated with a disability compensation profile.
(Edwards discloses aggregating insurance claims into segments in at least 0027.)
Claim(s) 4, 15 is/are rejected under 35 U.S.C. § 103 as being unpatentable over
Edwards et al. (Pub. #: US 2016/0125544 A1) in view of
Jain et al. (Pub. #: US 2019/0180879 A1) in view of
Del Rio et al. (Pub. #: US 2011/0209065 A1).
Claim(s) 4:
wherein the employee language or cultural requirements is defined by one or more of a language mapping, a condition expression terminology, rating scales, or graphic mappings.
Edwards in view of Jain does not appear to specify that the cultural requirements are defined by a language mapping, a condition expression terminology, rating scales, or graphic mappings. However, Del Rio teaches a technique that adjusts the presentation and recording of patient information with respect to at least a "cultural and ethnic background" and based on at least a language mapping and graphic mapping in at least 0018, 0020, 0028-0030, and 0044.
It would have been obvious to a person of ordinary skill in the art before the effective filing date of the claimed invention to modify the health data collection of Edwards in view of Jain with the technique of adjusting presentation of an interface to a user based on the user's cultural context as taught by Del Rio. Motivation to combine the references derives from improving user outcomes by increased comprehension (Del Rio: 0005).
Claim(s) 15:
wherein an employee language or cultural requirements is selected from a plurality of language or cultural definitions.
(Edwards discloses collecting data pertaining to the employee according to a selected state in at least Figure 5, 0041, and 0042. Examiner notes that the specification in the instant application includes "place of residence" (i.e., a state of residence) as comprising a "cultural group" in 0028.)
wherein the employee language or cultural requirements is defined by one or more of a language mapping, a condition expression terminology, rating scales, or graphic mappings.
Edwards in view of Jain does not appear to specify that the cultural requirements are defined by a language mapping, a condition expression terminology, rating scales, or graphic mappings. However, Del Rio teaches a technique that adjusts the presentation and recording of patient information with respect to at least a "cultural and ethnic background" and based on at least a language mapping and graphic mapping in at least 0018, 0020, 0028-0030, and 0044.
It would have been obvious to a person of ordinary skill in the art before the effective filing date of the claimed invention to modify the health data collection of Edwards in view of Jain with the technique of adjusting presentation of an interface to a user based on the user's cultural context as taught by Del Rio. Motivation to combine the references derives from improving user outcomes by increased comprehension (Del Rio: 0005).
Claim(s) 5, 6, 16, 17 is/are rejected under 35 U.S.C. § 103 as being unpatentable over
Edwards et al. (Pub. #: US 2016/0125544 A1) in view of
Jain et al. (Pub. #: US 2019/0180879 A1) in view of
Kravets et al. (Pub. #: US 8,630,878 B1).
Claim(s) 5, 16:
determining if the generated compensation profile matches an existing profile.
Edwards, in view of Jain, does not appear to specify matching to existing compensation profiles. However, Kravets teaches a technique of matching diagnoses using a number of fields including creating a consolidated code in at least Col. 6, Ll. 23-64.
It would have been obvious to a person of ordinary skill in the art before the effective filing date of the claimed invention to modify the health data collection of Edwards, in view of Jain, with the technique of matching to existing profiles as taught by Kravets. Motivation to combine the references comes from the desire to more closely estimate costs for medical claims (Kravets: Col. 1, Ll. 15-31).
Claim(s) 6:
generating a new profile category if an existing profile does not exist
Edwards, in view of Jain, does not appear to specify matching to existing compensation profiles. However, Kravets teaches a technique of matching diagnoses using a number of fields including creating a consolidated code in at least Col. 6, Ll. 23-64.
It would have been obvious to a person of ordinary skill in the art before the effective filing date of the claimed invention to modify the health data collection of Edwards, in view of Jain, with the technique of matching to existing profiles as taught by Kravets. Motivation to combine the references comes from the desire to more closely estimate costs for medical claims (Kravets: Col. 1, Ll. 15-31).
Claim(s) 17:
(i) generating a new profile category if an existing profile does not exist
(ii) generating profile tasks and threshold based upon the existing profile
(Edwards discloses tasks with the teaching of specified payments in at least 0077, 0078 and Figure 26 and thresholds with the teaching of "benefit minimums and maximums" in at least 0043-0054 and Figure 6.)
(iii) generating a recommended approval or denial for the case identifier is generated and presented for selection.
(Edwards discloses generating an approval or denial and presenting it for selection in at least Figure 9 (see item 920) and 0057.)
As for, “(i) generating a new profile category if an existing profile does not exist”: Edwards, in view of Jain, does not appear to specify matching to existing compensation profiles. However, Kravets teaches a technique of matching diagnoses using a number of fields including creating a consolidated code in at least Col. 6, Ll. 23-64.
It would have been obvious to a person of ordinary skill in the art before the effective filing date of the claimed invention to modify the health data collection of Edwards, in view of Jain, with the technique of matching to existing profiles as taught by Kravets. Motivation to combine the references comes from the desire to more closely estimate costs for medical claims (Kravets: Col. 1, Ll. 15-31).
Conclusion
Any inquiry concerning this communication or earlier communications from the examiner should be directed to SCOTT SNIDER whose telephone number is (571)272-9604. The examiner can normally be reached M-W: 9:00-4:30 Mountain (11:00-6:30 Eastern).
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/SCOTT SNIDER/Examiner, Art Unit 3621