DETERMINING AMOUNTS FOR CLAIMS SETTLEMENT USING LIKELIHOOD VALUES

• US 20090187429A1
• Filed: 06/06/2008
• Published: 07/23/2009
• Est. Priority Date: 01/18/2008
• Status: Active Grant

• Current Assignee: Computer Sciences Corporation (DXC Technology Company)
• Original Assignee: Computer Sciences Corporation (DXC Technology Company)
• Inventors: Henry, Scott, Dulock, Scott, Scalet, Frank, Watters, Clifton
• Granted Patent: US 8,219,424 B2
• Time in Patent Office: Days
• US Class Current: 705/4
• CPC Class Codes: G06Q 10/10 Office automation; Time management
• CPC Class Codes: G06Q 40/08 Insurance
• CPC Class Codes: G06Q 50/188 Electronic negotiation

Abstract

Methods and systems are provided for determining and displaying amounts for use in settling insurance claims are disclosed. Closed claims that match an open claim are identified based on one or more characteristics of the open claim. A likelihood value associated with at least one of the matching closed claims is determined. An amount for use by an adjuster in settling the open claim is determined based on the likelihood value for at least one of the matching claims. A most likely amount and most likely range associated with the open claim may be determined based on the likelihood values.

Claims

1. A computer-implemented method for determining amounts for use in settling insurance claims, comprising:

automatically identifying on an insurance claims processing system one or more closed claims that match an open claim based on one or more characteristics of the open claim;

automatically determining on the insurance claims processing system a likelihood value associated with at least one of the matching closed claims; and

determining an amount for the open claim based at least in part on the likelihood value for at least one of the matching closed claims.

2. The method of claim 1, wherein determining the likelihood value at least one of the matching claims comprises maximum likelihood estimation.

3. The method of claim 1, wherein the amount for the open claim is a most likely amount.

4. The method of claim 1, wherein the most likely amount corresponds to the matching closed claim with the highest likelihood value of the likelihood values associated with the matching closed claims.

6. The method of claim 1, wherein the amount is a general damages amount.

7. The method of claim 1, wherein the amount is a medicals amount.

8. The method of claim 1, further comprising determining a most likely range associated with the open claim based at least in part on the likelihood value associated with at least one of the matching closed claims.

9. The method of claim 1, further comprising determining which of the matching closed claims fall into a predetermined range within a likelihood curve for the matching closed claims.

10. The method of claim 9, wherein the predetermined range is about the top quartile of the likelihood curve for the matching closed claims.

12. The method of claim 1, wherein the most likely settlement amount includes at least one adjustment for disfigurement, medical expenses, lost wages, comparative negligence, or contribution.

13. The method of claim 1, wherein determining a likelihood value associated with a least one of the matching closed claims comprises determining likelihood values associated with at least two matching closed claims, wherein the determined amount for the open claim is based at least in part on the highest likelihood value of the determined likelihood values.

14. The method of claim 1, further comprising adjusting an amount for at least one of the matching closed claims based on at least one characteristic of the matching closed claim.

16. The method of claim 14, wherein the amount for the open claim is based at least in part on a most likely value.

17. The method of claim 1, wherein determining a likelihood value associated with a least one of the matching closed claims comprises calculating a kernel density estimate associated with the matching closed claim.

18. The method of claim 17, wherein calculating a kernel density estimate associated with the matching closed claim comprises determining a bandwidth for the kernel density estimate.

21. The method of claim 1, wherein identifying the one or more closed claims that match an open claim comprises determining whether a major injury for the open claim is predominantly a demonstrable injury or not a demonstrable injury.

22. The method of claim 1, wherein identifying the one or more closed claims that match an open claim comprises determining a most injured body part for the open claim.

23. The method of claim 1, wherein identifying the one or more closed claims that match an open claim comprises determining one or more medical codes for at least one injury to a claimant for the open claim.

24. The method of claim 23, wherein determining an amount for the open claim comprises determining a combined value for at least one body part if more than one medical code is determined for the injury.

25. The method of claim 1, wherein identifying the one or more closed claims that match an open claim comprises identifying a dominant medical feature associated with at least one injury to a claimant for the open claim.

26. The method of claim 1, wherein identifying the one or more closed claims that match an open claim comprises ranking or rating at least one of the matching claims.

27. The method of claim 1, wherein identifying the one or more closed claims that match an open claim comprises applying at least one filter to a set of closed claim data.

29. The method of claim 27, wherein at least one of the applied filters considers whether the EDR data indicates that an injury associated with the claim was low-impact.

30. The method of claim 27, further comprising selecting at least one filter setting, wherein the filter settings include at least two filter settings, wherein at least one of the setting is looser than at least one other of the settings.

31. The method of claim 27, further comprising:

changing at least one filter setting to be tighter or looser after the matching closed claims are identified; and

identifying an updated set of matching closed claims based on the tightened or loosened filter setting.

32. The method of claim 1, further comprising displaying at least one likelihood value associated with at least one of the matching closed claims.

5. (canceled)

11. (canceled)

15. (canceled)

19. (canceled)

20. (canceled)

28. (canceled)

33. A system, comprising:

a processor;

a memory coupled to the processor and configured to store program instructions executable by the processor to implement;

identifying one or more closed claims that match an open claim based on one or more characteristics of the open claim;

determining a likelihood value associated with at least one of the matching closed claims; and

determining an amount for the open claim based at least in part on the likelihood value for at least one of the matching closed claims.

34. A tangible, computer readable medium comprising program instructions, wherein the program instructions are computer-executable to implement:

identifying one or more closed claims that match an open claim based on one or more characteristics of the open claim;

determining a likelihood value associated with at least one of the matching closed claims; and

determining an amount for the open claim based at least in part on the likelihood value for at least one of the matching closed claims.

35-168. -168. (canceled)