Automated processing of medical data for disability rating determinations

• US 7,630,913 B2
• Filed: 06/20/2005
• 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:
  US11/155,908
• Publication Number:
  US 20070038479A1
• Time in Patent Office: 1,632 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

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, by a computer and into a storage, medical evidence data concerning a claimant; and

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

generating a disability rating report comprising an indicator of the degree of disability of the claimant,

wherein the medical evidence data is obtained by a second method comprising the following steps;

receiving, by a computer and into a storage, at least one claim by the claimant 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 the disability rating rules collection;

displaying the generated medical evidence queries in a data collection protocol; and

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

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 first method of claim 1, wherein the degree of disability of the claimant comprises:

a disability percentage.

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

4. The first method of claim 1, wherein the receiving medical evidence data into the storage comprises receiving medica l evidence data collected by conducting a laboratory test of the claimant.

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

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

7. The first 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 second 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 9, 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 second 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 second 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 first method of claim 1, further comprising eliminating duplicate generated medical evidence queries.

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

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

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

17. The second 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.

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

20. The method of claim 19, wherein the selected medical information queries vary by the claimant, vary by the claim, and vary by the claim-type.