Systems and methods for insurance underwriting

• US 7,831,451 B1
• Filed: 06/25/2004
• Issued: 11/09/2010
• Est. Priority Date: 06/27/2003
• Status: Expired due to Fees

• Current Assignee: Quantitative Data Solutions LLC (Scor Se)
• Original Assignee: Quantitative Data Solutions Incorporated
• Inventors: Conrad, Gerald L., Clark, Harry W., Kane, Loren S., Goodwin, Linda, Morse, Robert D.
• Primary Examiner(s): Kazimi; Hani
• Assistant Examiner(s): JOHNSON, GREGORY L
• Application Number:
  US10/875,798
• Time in Patent Office: 2,328 Days
• Field of Search: None
• 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

Embodiments of the present invention relate to systems and methods for automating 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, 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, comprising:

at least one database containing information about an insurance applicant, wherein the information about the insurance applicant includes insurance application information obtained from the insurance applicant and additional information not obtained from the insurance applicant, wherein the additional information not obtained from the insurance applicant comprises a plurality of prescription drugs dispensed to the insurance applicant;

a drug risk category database that groups the plurality of prescription drugs dispensed to the insurance applicant within a drug risk category; and

a server in communication with the at least one database and a client computer used to enter the insurance application information obtained from the insurance applicant, wherein the server is configured to;

retrieve the insurance application information obtained from the insurance applicant and the additional information not obtained from the insurance applicant from the database;

determine a plurality of risk scores for the insurance applicant from the insurance application information and the additional information retrieved from the database, wherein the plurality of risk scores include an initial prescription drug risk score, a geocentric mortality risk score, a motor vehicle records risk score, and a credit information risk score;

modify at least the initial prescription drug risk score according to a predetermined modification scheme established by an external underwriter, wherein to modify the initial prescription drug risk score according to the predetermined modification scheme, the server is further configured to;

determine a plurality of risk scores for the plurality of prescription drugs grouped within the drug risk category, wherein the server identifies one of the plurality of prescription drugs grouped within the drug risk category having a highest risk score;

multiply a remaining number of the plurality of prescription drugs grouped within the drug risk category having unique, non-zero risk scores by a predetermined factor; and

add the highest risk score associated with the identified prescription drug to a value obtained from multiplying the remaining number of the plurality of prescription drugs by the predetermined factor, wherein the server adds the highest risk score and the obtained value to calculate a risk score for the drug risk category, and wherein the server modifies the initial prescription drug score based on the risk score calculated for the drug risk category;

calculate an overall risk score for the insurance applicant, wherein the server combines the modified prescription drug risk score with one or more of the geocentric mortality risk score, the motor vehicle records risk score, or the credit information risk score to calculate the overall risk score for the insurance applicant;

translate the overall risk score into an insurance underwriting decision for the insurance applicant; and

return the insurance underwriting decision for the insurance applicant to the client computer.

2. The system of claim 1, wherein the additional information in the at least one database not obtained from the insurance applicant comprises one or more of a prescription drug history, a credit history, a motor vehicle record, or a geocentric mortality index.

3. The system of claim 1, wherein the insurance underwriting decision comprises a decision to underwrite an insurance policy for the insurance applicant in response to the overall risk score having a numeric value within a first numeric risk range, a decision to refer to the insurance applicant to traditional underwriting in response to the overall risk score having a numeric value within a second numeric risk range, and a decision to not underwrite the insurance policy for the insurance applicant in response to the overall risk score having a numeric value within a third numeric risk range.

4. The system of claim 1, wherein the server is further configured to modify the overall risk score calculated for the insurance applicant according to the predetermined modification scheme established by the external underwriter.

9. The system of claim 1, wherein the additional information in the at least one database not obtained from the insurance applicant comprises at least one prescription drug dispensed to the insurance applicant.

10. The system of claim 9, wherein the server is further configured to query the drug risk category database with a gender for the insurance applicant and a national drug code for the prescription drug dispensed to the insurance applicant, wherein the server queries the drug risk category database with the gender for the insurance applicant and the national drug code for the prescription drug dispensed to the insurance applicant to determine the initial prescription drug risk score for the insurance applicant.

11. The system of claim 10, wherein the server is further configured to:

determine a date when the prescription drug was dispensed to the insurance applicant, wherein the server determines the date when the prescription drug was dispensed to the insurance applicant to identify a date range modifier in the predetermined modification; and

multiply the initial prescription drug risk score by the identified date range modifier, wherein the modified prescription drug risk score comprises the initial prescription drug risk score multiplied by the identified date range modifier.

12. The system of claim 10, wherein the server is further configured to:

determine a number of refills dispensed to the insurance applicant for the prescription drug, wherein the server determines the number of refills dispensed to the insurance applicant to identify a refill pattern modifier in the predetermined modification; and

multiply the initial prescription drug risk score by the identified refill pattern modifier, wherein the modified prescription drug risk score comprises the initial prescription drug risk score multiplied by the identified refill pattern modifier.

13. The system of claim 10, wherein the server is further configured to:

determine a dosage for the prescription drug dispensed to the insurance applicant, wherein the server determines the dosage for the prescription drug to identify a dosage pattern modifier in the predetermined modification scheme; and

multiply the initial prescription drug risk score by the identified dosage pattern modifier, wherein the modified prescription drug risk score comprises the initial prescription drug risk score multiplied by the identified dosage pattern modifier.

14. The system of claim 9, wherein the server is further configured to:

query a drug risk category database with a national drug code for the prescription drug dispensed to the insurance applicant, wherein the drug risk category database groups a plurality of prescription drugs into a plurality of disease categories that could contribute to premature death; and

determine a drug risk category for the prescription drug dispensed to the insurance applicant from one or more of the plurality of disease categories matching the prescription drug dispensed to the insurance applicant.

15. The system of claim 14, wherein the server is further configured to assign a smoking status to the insurance applicant in response to the determined drug risk category comprising a smoking drug risk category.

16. The system of claim 1, wherein one or more of the initial prescription drug risk score or the modified prescription drug risk score are based on the risk score calculated for the drug risk category.

17. The system of claim 1, wherein the additional information in the at least one database not obtained from the insurance applicant comprises a plurality of prescription drugs dispensed to the insurance applicant, and wherein a drug risk category database groups the plurality of prescription drugs dispensed to the insurance applicant within a plurality of drug risk categories.

18. The system of claim 17, wherein the server is further configured to:

determine that the plurality of prescription drugs dispensed to the insurance applicant include multiple different representations of one prescription drug; and

discard all but one of the multiple different representations of the one prescription drug from the plurality of prescription drugs dispensed to the insurance applicant.

19. The system of claim 17, wherein the server is further configured to calculate a plurality of initial risk scores for the plurality of drug risk categories that group the plurality of prescription drugs dispensed to the insurance applicant, wherein the server identifies one of the plurality of drug risk categories having a highest initial risk score.

20. The system of claim 19, wherein the server is further configured to:

identify any of the plurality of prescription drugs grouped within the identified drug risk category having the highest initial risk score that are further grouped within other ones of the plurality of drug risk categories; and

remove the identified prescription drugs from the other drug risk categories, wherein the server remove the identified prescription drugs from the other drug risk categories to prevent biasing from multiple purpose prescription drugs.

21. The system of claim 19, wherein the server is further configured to:

determine a smoking status assigned to the insurance applicant, wherein the server determines the smoking status assigned to the insurance applicant to identify a smoking constant in the predetermined modification scheme; and

multiply the initial risk score associated with the drug risk category having the highest initial risk score by the identified smoking constant, wherein the modified prescription drug risk score comprises the initial risk score associated with the drug risk category having the highest initial risk score multiplied by the identified smoking constant.

22. The system of claim 19, wherein the server is further configured to:

determine a weight in kilograms and a height in meters for the insurance applicant from the insurance application information obtained from the insurance applicant;

calculate a body mass index for the insurance applicant from the weight in kilograms and the height in meters determined for the insurance applicant, wherein the calculated body mass index includes the weight in kilograms divided by the height in meters squared;

identify a body mass index constant in the predetermined modification scheme from the body mass index calculated for the insurance applicant; and

multiply the initial risk score associated with the drug risk category having the highest initial risk score by the identified body mass index constant, wherein the modified prescription drug risk score comprises the initial risk score associated with the drug risk category having the highest initial risk score multiplied by the identified body mass index constant.

23. The system of claim 19, wherein the server is further configured to:

identify one of the plurality of drug risk categories having a second highest initial risk score and one of the plurality of drug risk categories having a third highest initial risk score;

multiply the second highest initial risk score by a first constant;

multiply the third highest initial risk score by a second constant, wherein the second constant comprises a lower value than the first constant; and

add the highest initial risk score to the second highest initial risk score multiplied by the first constant and the third highest initial risk score multiplied by the second constant, wherein the modified prescription drug risk score comprises the highest initial risk score added to the multiplied second highest initial risk score and multiplied the third highest initial risk score.

5. A system for insurance underwriting, comprising:

at least one database containing information about an insurance applicant, wherein the information about the insurance applicant includes insurance application information obtained from the insurance applicant and additional information not obtained from the insurance applicant, wherein the additional information not obtained from the insurance applicant comprises a plurality of prescription drugs dispensed to the insurance applicant;

a drug risk category database that groups the plurality of prescription drugs dispensed to the insurance applicant within a drug risk category;

a first processor configured to determine an initial prescription drug risk score for the insurance applicant from the insurance application information in the database;

a second processor configured to determine a geocentric mortality risk score for the insurance applicant from the insurance application information in the database;

a third processor configured to determine a motor vehicle records risk score for the insurance applicant from the insurance application information in the database;

a fourth processor configured to determine a credit information risk score for the insurance applicant from the insurance application information in the database; and

a fifth processor configured to;

modify at least the initial prescription drug risk score according to a predetermined modification scheme established by an external underwriter, wherein to modify the initial prescription drug risk score according to the predetermined modification scheme, the fifth processor is further configured to;

determine a plurality of risk scores for the plurality of prescription drugs grouped within the drug risk category, wherein the fifth processor identifies one of the plurality of prescription drugs grouped within the drug risk category having a highest risk score;

multiply a remaining number of the plurality of prescription drugs grouped within the drug risk category having unique, non-zero risk scores by a predetermined factor; and

add the highest risk score associated with the identified prescription drug to a value obtained from multiplying the remaining number of the plurality of prescription drugs by the predetermined factor, wherein the fifth processor adds the highest risk score and the obtained value to calculate a risk score for the drug risk category, and wherein the fifth processor modifies the initial prescription drug score based on the risk score calculated for the drug risk category;

combine the modified prescription drug risk score with one or more of the geocentric mortality risk score, the motor vehicle records risk score, or the credit information risk score to calculate an overall risk score for the insurance applicant;

translate the overall risk score into an insurance underwriting decision for the insurance applicant.

6. The system of claim 5, wherein the insurance underwriting decision comprises a decision to underwrite an insurance policy for the insurance applicant in response to the overall risk score having a numeric value within a first numeric risk range, a decision to refer to the insurance applicant to traditional underwriting in response to the overall risk score having a numeric value within a second numeric risk range, and a decision to not underwrite the insurance policy for the insurance applicant in response to the overall risk score having a numeric value within a third numeric risk range.

7. A method for insurance underwriting, comprising:

storing information about an insurance applicant in at least one database, wherein the information about the insurance applicant includes insurance application information obtained from the insurance applicant;

storing additional information about the insurance applicant not obtained from the insurance applicant in a drug risk category database, wherein the additional information not obtained from the insurance applicant includes a plurality of prescription drugs dispensed to the insurance applicant, and wherein the drug risk category database groups the plurality of prescription drugs dispensed to the insurance applicant within a drug risk category;

determining, on a computer server, an initial prescription drug risk score for the insurance applicant from a prescription drug history associated with the insurance application information obtained from the insurance applicant and stored in the database;

determining, on the computer server, a geocentric mortality risk score for the insurance applicant from geocentric mortality data associated with the insurance application information obtained from the insurance applicant and stored in the database;

determining, on the computer server, a motor vehicle records risk score for the insurance applicant from a motor vehicle report history associated with the insurance application information obtained from the insurance applicant and stored in the database;

determining, on the computer server, a credit information risk score for the insurance applicant from a credit report associated with the insurance application information obtained from the insurance applicant and stored in the database;

modifying, on the computer server, at least the initial prescription drug risk score according to a predetermined modification scheme established by an external underwriter, wherein modifying the initial prescription drug risk score according to the predetermined modification scheme includes;

determining, on the computer server, a plurality of risk scores for the plurality of prescription drugs grouped within the drug risk category, wherein the computer server identifies one of the plurality of prescription drugs grouped within the drug risk category having a highest risk score;

multiplying, on the computer server, a remaining number of the plurality of prescription drugs grouped within the drug risk category having unique, non-zero risk scores by a predetermined factor; and

adding, on the computer server, the highest risk score associated with the identified prescription drug to a value obtained from multiplying the remaining number of the plurality of prescription drugs by the predetermined factor, wherein the computer server adds the highest risk score and the obtained value to calculate a risk score for the drug risk category, and wherein the computer server modifies the initial prescription drug score based on the risk score calculated for the drug risk category;

calculating, on the computer server, an overall risk score for the insurance applicant, wherein calculating the overall risk score for the insurance applicant includes combining the modified prescription drug risk score with one or more of the geocentric mortality risk score, the motor vehicle records risk score, or the credit information risk score; and

translating the overall risk score into an insurance underwriting decision for the insurance applicant.

8. The method of claim 7, wherein the insurance underwriting decision comprises a decision to underwrite an insurance policy for the insurance applicant in response to the overall risk score having a numeric value within a first numeric risk range, a decision to refer to the insurance applicant to traditional underwriting in response to the overall risk score having a numeric value within a second numeric risk range, and a decision to not underwrite the insurance policy for the insurance applicant in response to the overall risk score having a numeric value within a third numeric risk range.