SYSTEMS AND METHODS FOR INSURANCE UNDERWRITING

• US 20110022420A1
• Filed: 09/29/2010
• Published: 01/27/2011
• Est. Priority Date: 06/27/2003
• Status: Active Grant

• Current Assignee: Quantitative Data Solutions LLC (Scor Se)
• Original Assignee: Quantitative Data Solutions LLC (Scor Se)
• Inventors: Conrad, Gerald L., Clark, Harry W., Kane, Loren S., Goodwin, Linda, Morse, Robert D.
• Granted Patent: US 8,326,657 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: G16H 10/60 for patient-specific data, e.g. for electronic patient records
• CPC Class Codes: G16H 50/30 for calculating health indices; for individual health risk assessment

Abstract

The systems and methods described herein may automate insurance underwriting by integrating information from multiple online databases and creating decision making advice useful to insurance underwriters. One system includes a client, database, and server. The client allows an underwriter to enter applicant information, enter customized risk modifiers, and receive an underwriting decision. The database provides additional applicant information. This information can include one or more of prescription drug history, credit history, motor vehicle records, and geocentric mortality risk. The server obtains the applicant information, calculates the applicant'"'"'s risk, and makes an underwriting decision. Another system calculates a prescription drug risk for an applicant from pharmacy benefits management data, drug risk category data, and application data. Another system calculates a geocentric mortality risk for an applicant from census data, mortality data, credit information, and application data. Preset external modifiers are added to systems and methods of calculating risk in order to allow the underwriter to customize the risk results.

Claims

1. A system for insurance underwriting based on prescription drug histories, the system comprising:

a pharmacy benefits management database;

a drug risk category database;

a list of applicant characteristics; and

a processor, wherein the processor obtains an insurance applicant'"'"'s list of prescription drugs, their dosages and dates they were dispensed from the pharmacy benefits management database, matches the list of prescription drugs to disease categories from the drug category database, calculates a risk score for the insurance applicant based on the disease categories matched and the list of prescription drugs dosages and dates dispensed, and modifies the risk score according to the list of applicant characteristics.

2. The system of claim 1, wherein the pharmacy benefits management database contains a list of prescription drugs for each individual in the pharmacy benefits management database and information about each prescription drug on the list comprising a national drug code, a number of individual doses dispensed, and a date each of the individual doses were dispensed.

3. The system of claim 1, wherein the drug risk category database contains prescription drugs grouped into one or more specific disease categories that could contribute to premature death comprising cardiovascular, cancer, smoking, hepatitis, HIV infection, diabetes, substance abuse, pulmonary, gastrointestinal, renal, psychological, neurological, endocrine, rheumatological, musculoskeletal, hematological, and a category for drugs not fitting into any of the other categories.

4. The system of claim 1, wherein the list of applicant characteristics comprises one or more of sex, birth date, height, weight, and smoking status.

5. The system of claim 1, further comprising a second processor that modifies the risk score calculated by the processor according to a modification scheme preset externally by an underwriter.

6. The system of claim 5, wherein the modification scheme is a translation table that the second processor uses to translate the risk score calculated by the processor into a second risk score.

7. The system of claim 5, wherein the modification scheme is a multiplier that the second processor multiples the risk score calculated by the processor by to produce a second risk score.

8. A method for calculating a prescription drug risk score for an insurance applicant on a computer server with access to online databases, the method comprising:

obtaining a list of prescription drugs for the insurance applicant from a pharmacy benefits management database;

obtaining a list of characteristics of the insurance applicant;

obtaining a list of drug risk categories for the insurance applicant from a drug risk category database;

calculating a body mass index of the insurance applicant from the list of characteristics and if the body mass index cannot be calculated using a default value;

setting the risk score of each of the drug risk categories for the insurance applicant to the default no risk value;

determining one or more drug risk categories and a risk score of a prescription drug from the list of prescription drugs by querying the drug risk category database with the insurance applicant'"'"'s sex and a code for the prescription drug;

determining if the prescription drug is different representation of a drug already processed;

determining if a drug category of the prescription drug is smoking and if it is setting smoking status of the insurance applicant to smoking;

modifying a risk score of the prescription drug based on date of dispensing;

modifying the risk score of the prescription drug based on refill pattern;

adding the prescription drug to one or more drug risk categories for the insurance applicant;

calculating risk scores of each drug risk category from the risk scores of prescription drugs in each drug risk category;

determining a drug risk category with a highest risk score;

removing all prescription drugs found in the drug risk category with the highest risk score from all other drug risk categories to prevent biasing from multiple purpose prescription drugs and recalculating risk scores of drug categories from which prescription drugs were removed;

modifying a risk score of the drug risk category with the highest risk score according to the smoking status of the insurance applicant and the drug risk category;

modifying a risk score of the drug risk category with the highest risk score according to the body mass index of the insurance applicant and the drug risk category; and

calculating a final prescription drug risk factor by multiplying the individual drug score of the second and third highest risk categories by constants and adding these values to the risk score of the drug risk category with the highest risk score.

9. The method of claim 8, wherein the pharmacy benefits management database contains a list of prescription drugs for each individual in the pharmacy benefits management database and information about each prescription drug on the list comprising a national drug code, a number of individual doses dispensed, and a date each of the individual doses were dispensed.

10. The method of claim 8, wherein the drug risk category database contains prescription drugs grouped into one or more specific disease categories that could contribute to premature death comprising cardiovascular, cancer, smoking, hepatitis, HIV infection, diabetes, substance abuse, pulmonary, gastrointestinal, renal, psychological, neurological, endocrine, rheumatological, musculoskeletal, hematological, and a category for drugs not fitting into any of the other categories.

11. The method of claim 10, wherein modifying a risk score of the drug risk category with the highest risk score according to the smoking status of the insurance applicant and the drug risk category comprises multiplying the risk score of the drug risk category with the highest risk score by a constant if the drug risk category comprises cancer, pulmonary, cardiovascular, and diabetes and the smoking status of the insurance applicant comprises smoking.

12. The method of claim 10, wherein modifying a risk score of the drug risk category with the highest risk score according to the smoking status of the insurance applicant and the drug risk category comprises multiplying the risk score of the drug risk category with the highest risk score by a constant if the drug risk category comprises pulmonary and the smoking status of the insurance applicant comprises non-smoking.

13. The method of claim 10, wherein modifying a risk score of the drug risk category with the highest risk score according to the body mass index of the insurance applicant and the drug risk category comprises multiplying the risk score of the drug risk category with the highest risk score by a constant if the drug risk category comprises cancer, HIV infection, smoking, neurological, musculoskeletal, endocrine, and hematological and the body mass index is less than nineteen and greater than or equal to seventeen.

14. The method of claim 10, wherein modifying a risk score of the drug risk category with the highest risk score according to the body mass index of the insurance applicant and the drug risk category comprises multiplying the risk score of the drug risk category with the highest risk score by a constant if the drug risk category comprises psychological and the body mass index is less than nineteen and greater than or equal to seventeen.

15. The method of claim 10, wherein modifying a risk score of the drug risk category with the highest risk score according to the body mass index of the insurance applicant and the drug risk category comprises multiplying the risk score of the drug risk category with the highest risk score by a constant if the drug risk category comprises cardiovascular and diabetes and the body mass index is less than thirty-five and greater than or equal to thirty-two.

16. The method of claim 10, further comprising removing the risk contribution from the category for drugs not fitting into any of the other categories if the drug risk category with the highest risk score is not the category for drugs not fitting into any of the other categories.

17. The method of claim 8, wherein the list of characteristics of the insurance applicant comprises one or more of sex, birth date, height, weight, and smoking status.

18. The method of claim 17, wherein the body mass index of the insurance applicant is calculated by dividing the weight in kilograms by the height in meters squared.

19. The method of claim 8, wherein determining if the prescription drug is a different representation of a drug already processed comprises comparing drug categorization, dosage, and route of administration of the prescription drug with categorization, dosage, and routes of administration of all other drugs on a list of processed prescription drugs in order to determine if the prescription drug is a different representation of a drug already processed, discarding the prescription drug if it is a different representation of a drug already processed, and adding the prescription drug to the list of processed prescription drugs if it is not a different representation of a drug already processed.

20. The method of claim 8, wherein modifying a risk score of the prescription drug based on date of dispensing comprises multiplying the risk score of the prescription drug by a modifier specified in a table containing different modifiers for different date ranges from the data of dispensing.

21. The method of claim 8, wherein modifying a risk score of the prescription drug based on refill pattern comprises multiplying the risk score of the prescription drug by a modifier specified in a table containing different modifiers for different amounts of refills within different time periods.

22. The method of claim 8, further comprising modifying a risk score of the prescription drug based on a dosage pattern comprising multiplying the risk score of the prescription by a modifier specified in a table containing different modifiers for different dosages of the prescription drug.

23. The method of claim 8, wherein calculating risk scores of each drug risk category from the risk scores of prescription drugs in each drug risk category comprises examining each prescription a drug risk category, finding a prescription drug with the highest risk score within the drug risk category, and adding to a risk score of the prescription drug with the highest risk score within the drug risk category a number of unique, non-zero risk prescription drugs in the drug risk category multiplied by a factor.

24. The method of claim 8, wherein calculating a final prescription drug risk factor by multiplying the individual drug score of the second and third highest risk categories by constants and adding these values to the risk score of the drug risk category with the highest risk score comprises multiplying a drug score of the second highest risk category by 0.5 and a drug score of the third highest risk category by 0.25 and adding these values to the risk score of the drug risk category with the highest risk score.

25. The method of claim 8, further comprising modifying the final prescription drug risk by a preset external factor set by an underwriter.

26. A system for insurance underwriting based on geocentric mortality data, the system comprising:

a census database;

a mortality database;

a credit information database;

a list of applicant characteristics; and

a processor, wherein the processor obtains population data for a region of an insurance applicant from the census database, gathers mortality data for the region of the insurance applicant from the mortality database, retrieves financial data for the region of the insurance applicant from the credit information database, generates a mortality table for the region of the insurance applicant based on age, sex and financial information, and calculates a geocentric mortality risk score for the insurance applicant by comparing the list of applicant characteristic with the mortality table.

27. The system of claim 26, wherein the list of applicant characteristics comprises one or more of sex, age, income, account balances, number of accounts, credit limits, original mortgage amount, and mortgage account balance.

28. The system of claim 26, further comprising a second processor that modifies the geocentric mortality risk score calculated by the processor according to a modification scheme preset externally by an underwriter.

29. A method for calculating a geocentric mortality risk score for an insurance applicant on a computer server with access to online databases, the method comprising:

obtaining a table containing populations of a region in which the insurance applicant lives grouped by age and sex;

obtaining a table containing the number of deaths that have occurred in the region in which the insurance applicant lives grouped by age and sex;

obtaining a table containing the financial data in the region in which the insurance applicant lives grouped by age and sex;

generating a mortality table for the region in which the insurance applicant lives based on financial data, age, and sex;

obtaining a list of applicant characteristics about the insurance applicant; and

calculating a geocentric mortality risk score by comparing the list of applicant characteristics to the mortality table.

30. The method of claim 29, wherein the list of applicant characteristics comprises one or more of sex, age, income, account balances, number of accounts, credit limits, original mortgage amount, and mortgage account balance.

31. The method of claim 29, further comprising modifying the geocentric mortality risk score by a preset external factor set by an underwriter.