Method of automated processing of medical data for insurance and disability determinations

• US 7,630,911 B2
• Filed: 10/23/2002
• Issued: 12/08/2009
• Est. Priority Date: 10/24/2001
• Status: Expired due to Fees

• Current Assignee: QTC Management, Inc. (Leidos Holdings, Inc.)
• Original Assignee: QTC Management, Inc. (Leidos Holdings, Inc.)
• Inventors: Kay, Lay K.
• Primary Examiner(s): O'Connor; Gerald J.
• Assistant Examiner(s): LE, LINH GIANG
• Application Number:
  US10/279,759
• Publication Number:
  US 20070038478A1
• Time in Patent Office: 2,603 Days
• Field of Search: 705 2- 4, 703/6, 707/104, 707/1
• US Class Current: 705/4
• 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

The present invention relates to methods and systems 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 are displayed to rating personnel in a user-friendly format to assist in making a rating decision.

Claims

1. A computer-implemented method of assisting medical evidence collection for adjudication of a medical disability request, the method comprising:

receiving, by a computer and from a claimants at least one claim of a medical condition;

generating, by a computer, a plurality of medical evidence queries based on and limited by the at least one claim and based on and limited by a disability rating rules collection;

displaying the generated medical evidence queries in at least one data collection protocol;

receiving medical evidence data collected responsive to the generated medical evidence queries;

determining, by a computer, a degree of disability based on the collected medical evidence data and the disability rating rules collection; and

generating a report comprising the degree of disability;

wherein the plurality of medical evidence queries is claim-type specific and is selected from a predetermined set of medical evidence queries, the set containing a greater number of queries than the number of queries in the plurality of queries; and

wherein the selected plurality of medical evidence queries excludes 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 receiving medical evidence data comprises receiving medical evidence data collected by conducting a physical examination of the claimant.

3. The method of claim 1, wherein the receiving medical evidence data comprises receiving medical evidence data collected by conducting a laboratory test of the claimant.

4. The method of claim 1, wherein the receiving medical evidence data comprises receiving medical evidence data collected from medical records of the claimant.

5. The method of claim 1, wherein the receiving medical evidence data comprises receiving medical history data of the claimant.

6. The method of claim 1, wherein the degree of disability comprises a recommended disability percentage.

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

8. The method of claim 1, wherein the displaying the generated medical evidence queries comprises displaying at least a portion of the generated queries in a medical provider'"'"'s exam protocol.

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

10. The method of claim 8, wherein the displaying at least a portion of the generated 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, wherein the displaying the generated medical evidence queries comprises displaying at least a portion of the generated queries in an assistant'"'"'s data collection protocol.

12. The method of claim 1, wherein the displaying the generated medical evidence queries comprises displaying at least a portion of the generated 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 generated 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 data collection 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 data collection protocol; and

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

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

26. 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.

19. A computer-implemented method of assisting adjudication of a medical disability request, the method comprising:

receiving, by a computer and from a claimant, at least one claim of a medical condition;

generating, by a computer, a plurality of medical evidence queries based on and limited by the at least one claim and based on and limited by a disability rating rules collection;

receiving medical evidence collected responsive to the generated medical evidence queries;

determining, by a computer, a degree of disability based on the collected medical evidence data and the disability rating rules collection;

displaying, in a rating report, at least a portion of the collected medical evidence and the degree of disability; and

wherein the plurality of medical evidence queries is claim-type specific and is selected from a predetermined set of medical evidence queries, the set containing a greater number of queries than the number of queries in the plurality of queries and

wherein the selected plurality of medical evidence queries excludes 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.

20. The method of claim 19, wherein each of the generated queries is associated with a rating code of the disability rating rules collection, and wherein displaying in a rating report further comprises displaying in the rating report rating codes associated with the displayed medical evidence.

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

28. The method of claim 27, wherein the selected medical information queries vary by the claimant, vary by the claim, and vary by the claim-type.

21. A medical disability claims benefits system comprising:

a rules mapping component embodied in a computer readable medium that organizes a medical disability rating rules collection into at least a first plurality of general medical evidence queries;

a knowledge library embodied in a computer readable medium that stores at least the first plurality of general medical evidence queries;

a claimant-specific query creation component embodied in a computer readable medium that selects from the first plurality of general queries a second plurality of medical evidence queries based on and limited by at least one claimed medical condition of a claimant and based on and limited by the disability rating rules collection;

a protocol creation component embodied in a computer readable medium that creates at least one data collection protocol based on the second plurality of queries;

a report creation component embodied in a computer readable medium that receives medical evidence collected responsive to the at least one data collection protocol, and adapted to determine a degree of disability based on the collected medical evidence data and the medical disability rating rules collection; and

a display component adapted to display at least a portion of the received medical evidence and the degree of disability;

wherein the second plurality of medical evidence queries is claim-type specific and is selected from a predetermined set of medical evidence queries, the set containing a greater number of queries than the number of queries in the second plurality of queries; and

wherein the selected plurality of medical evidence queries excludes 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.

22. The system of claim 21, wherein the rules mapping component further associates each of the first plurality of queries with a rating code of the disability rating rules collection.

23. The system of claim 21, wherein the first plurality of general medical evidence queries includes a triggering query and one or more conditional queries associated with the triggering query.

24. The system of claim 21, wherein the claimant-specific query creation component eliminates duplicate queries from the second plurality of medical evidence queries.

29. The system of claim 21, wherein the plurality of medical evidence queries is claimant-specific and claim-specific.

30. The system of claim 29, wherein the selected medical information queries vary by the claimant, vary by the claim, and vary by the claim-type.