AUTOMATED PROCESSING OF MEDICAL DATA FOR DISABILITY RATING DETERMINATIONS

• US 20100106526A1
• Filed: 10/21/2009
• Published: 04/29/2010
• Est. Priority Date: 10/24/2001
• Status: Active Grant

• Current Assignee: QTC Management, Inc. (Leidos Holdings, Inc.)
• Original Assignee: QTC Management, Inc. (Leidos Holdings, Inc.)
• Inventors: KAY, Lay K.
• Granted Patent: US 7,949,550 B2
• Time in Patent Office: Days
• US Class Current: 705/3
• CPC Class Codes: G06N 5/025 Extracting rules from data
• CPC Class Codes: G06Q 10/10 Office automation; Time management
• CPC Class Codes: G06Q 40/08 Insurance

Abstract

Methods and systems are described for automated processing of medical data for insurance and disability determinations. Based on medical conditions claimed by the claimant, medical evidence queries are automatically generated to provide instructions to medical providers for conducting physical exams and laboratory tests and for retrieving medical records. After medical evidence is collected according to the queries, the medical evidence and related rating codes and decisions are displayed to rating personnel in a user-friendly format to assist in making a rating decision.

Claims

1. A computer-implemented first method for facilitating adjudication of a medical disability request, the first method comprising:

receiving, into a computer-readable storage, medical evidence data concerning a claimant, and at least one claim by the claimant of a medical condition;

selecting, from a predetermined set of medical evidence queries, a plurality of claim-type specific medical evidence queries based on and limited by the at least one claim and based on and limited by the disability rating rules collection;

receiving answers to the medical evidence queries, said answers corresponding to the medical evidence data;

determining a degree of disability of the claimant based on the medical evidence data and on a disability rating rules collection; and

wherein the selecting the plurality of claim-type specific medical evidence queries comprises excluding queries, from the predetermined set of medical evidence queries, that are, based on the disability rating rules collection, not specific to the claim or claim type.

2. The method of claim 1, wherein the degree of disability of the claimant comprises a disability percentage.

3. The method of claim 1, wherein the receiving medical evidence data into the computer-readable storage comprises receiving medical evidence data by conducting a physical examination of the claimant.

4. The method of claim 1, wherein the receiving medical evidence data into the computer-readable storage comprises receiving medical evidence data by conducting a laboratory test of the claimant.

5. The method of claim 1, wherein the receiving medical evidence data into the computer-readable storage comprises receiving medical evidence data from medical records of the claimant.

6. The method of claim 1, wherein the receiving medical evidence data into the computer-readable storage comprises receiving medical history data of the claimant.

7. The method of claim 1, further comprising associating each of the selected medical evidence queries with a rating code of the disability rating rules collection.

8. The method of claim 1, further comprising displaying at least a portion of the selected queries in a medical provider'"'"'s exam protocol.

9. The method of claim 8, wherein the displaying at least a portion of the selected queries in a medical provider'"'"'s exam protocol comprises arranging the displayed queries according to modules.

10. The method of claim 9, wherein the displaying at least a portion of the selected queries in a medical provider'"'"'s exam protocol comprises arranging the displayed queries according to classifications in the disability rating rules collection.

11. The method of claim 1, further comprising displaying at least a portion of the selected queries in an assistant'"'"'s query protocol.

12. The method of claim 1, further comprising displaying at least a portion of the selected queries in a claimant questionnaire.

13. The method of claim 1, further comprising eliminating duplicate generated medical evidence queries.

14. The method of claim 1, wherein the disability rating rules collection comprises a federal law.

15. The method of claim 1, wherein the disability rating rules collection comprises a court case law.

16. The method of claim 1, wherein the disability rating rules collection comprises an administrative decision.

17. The method of claim 1, further comprising:

separating the selected medical evidence queries into at least a first set of queries and a second set of queries;

displaying the first set of queries in a medical provider'"'"'s exam protocol; and

displaying the second set of queries in an assistant'"'"'s query protocol.

18. The method of claim 17, wherein the first set and the second set of queries include a duplicate query, the method further comprising:

receiving medical evidence data for the duplicate query collected based on the assistant'"'"'s query protocol; and

removing the duplicate query from the medical provider'"'"'s exam protocol.

19. The method of claim 1, wherein the plurality of medical evidence queries is claimant-specific and claim-specific.

20. The method of claim 25, wherein the selected medical information queries vary by the claimant, vary by the claim, and vary by the claim-type.