Systems and methods for insurance underwriting

• US 8,326,657 B2
• Filed: 09/29/2010
• Issued: 12/04/2012
• Est. Priority Date: 06/27/2003
• Status: Expired due to Fees

• Current Assignee: Quantitative Data Solutions LLC (Scor Se)
• Original Assignee: Quantitative Data Solutions LLC (Scor Se)
• Inventors: Morse, Robert D., Conrad, Gerald L., Goodwin, Linda, Kane, Loren S., Clark, Harry W.
• Primary Examiner(s): JOHNSON, GREGORY L
• Application Number:
  US12/893,403
• Publication Number:
  US 20110022420A1
• Time in Patent Office: 797 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

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 comprising a plurality of prescription drugs grouped into a plurality of disease categories; and

a processor configured to;

receive a list of applicant characteristics;

obtain, from the pharmacy benefits management database, an identification of a prescription drug that was dispensed to an insurance applicant,

identify a disease category from among the plurality of disease categories of the drug risk category database based on the prescription drug that was dispensed to the insurance applicant,

determine a risk score for the insurance applicant based on the disease category identified from among the plurality of disease categories, and

modify the determined risk score based on the list of applicant characteristics.

2. The system of claim 1, wherein the pharmacy benefits management database comprises 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 plurality of disease categories comprise cardiovascular, cancer, smoking, hepatitis, HIV infection, diabetes, substance abuse, pulmonary, gastrointestinal, renal, psychological, neurological, endocrine, rheumatological, musculoskeletal, hematological, or 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, or smoking status.

5. The system of claim 1, further comprising a second processor configured to:

modify the risk score determined by the processor according to a modification scheme preset externally by an underwriter.

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

7. The system of claim 5, wherein the modification scheme comprises a multiplier, and the second processor is configured to multiply the risk score determined by the processor by the multiplier to produce a second risk score.

8. A tangible computer readable medium having instructions stored thereon for insurance underwriting based on prescription drug histories, the instructions when executed by a processor configure the processor to:

obtain a list of applicant characteristics;

obtain, from a pharmacy benefits management database, an identification of a prescription drug that was dispensed to an insurance applicant;

identify a disease category from among a plurality of disease categories of a drug risk category database based on the prescription drug that was dispensed to the insurance applicant, wherein the drug risk category database comprises a plurality of prescription drugs grouped into the plurality of disease categories;

determine a risk score for the insurance applicant based on the disease category identified from among the plurality of disease categories; and

modify the determined risk score based on the list of applicant characteristics.

9. The tangible computer readable medium of claim 8, wherein the pharmacy benefits management database comprises 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 tangible computer readable medium of claim 8, wherein the plurality of disease categories comprise cardiovascular, cancer, smoking, hepatitis, HIV infection, diabetes, substance abuse, pulmonary, gastrointestinal, renal, psychological, neurological, endocrine, rheumatological, musculoskeletal, hematological, or a category for drugs not fitting into any of the other categories.

11. The tangible computer readable medium of claim 8, wherein the list of applicant characteristics comprises one or more of sex, birth date, height, weight, or smoking status.

12. The tangible computer readable medium of claim 8, the instructions when executed by a second processor configure the second processor to:

modify the risk score determined by the processor according to a modification scheme preset externally by an underwriter.

13. The tangible computer readable medium of claim 12, wherein the modification scheme comprises a translation table that the second processor uses to translate the risk score determined by the processor into a second risk score.

14. The tangible computer readable medium of claim 12, wherein the modification scheme comprises a multiplier, and the second processor is further configured to multiply the risk score determined by the processor by the multiplier to produce a second risk score.

15. A method for insurance underwriting based on prescription drug histories, comprising:

obtaining, by a first processor, a list of applicant characteristics;

obtaining, by the first processor from a pharmacy benefits management database, an identification of a prescription drug that was dispensed to an insurance applicant;

identifying, by the first processor, a disease category from among a plurality of disease categories of a drug risk category database based on the prescription drug that was dispensed to the insurance applicant, wherein the drug risk category database comprises a plurality of prescription drugs grouped into the plurality of disease categories;

determining, by the first processor, a risk score for the insurance applicant based on the disease category identified from among the plurality of disease categories; and

modifying, by the first processor, the determined risk score based on the list of applicant characteristics.

16. The method of claim 15, wherein the pharmacy benefits management database comprises 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.

17. The method of claim 15, wherein the plurality of disease categories comprise cardiovascular, cancer, smoking, hepatitis, HIV infection, diabetes, substance abuse, pulmonary, gastrointestinal, renal, psychological, neurological;

endocrine, rheumatological, musculoskeletal, hematological, or a category for drugs not fitting into any of the other categories.

18. The method of claim 15, wherein the list of applicant characteristics comprises one or more of sex, birth date, height, weight, or smoking status.

19. The method of claim 15, further comprising:

modifying, by a second processor, the risk score determined by the first processor according to a modification scheme preset externally by an underwriter.

20. The method of claim 19, wherein the modification scheme comprises a translation table, the method further comprising:

translating, by the second processor, the risk score determined by the first processor into a second risk score using the translation table.

21. The method of claim 19, wherein the modification scheme comprises a multiplier, the method further comprising:

multiplying, by the second processor, the risk score determined by the first processor by the multiplier to produce a second risk score.

22. The method of claim 20, wherein the risk score and the second risk score comprise a numeric risk score.

23. The method of claim 15, wherein the pharmacy benefits management database further comprises a date on which the prescription drug was dispensed, the method further comprising:

obtaining, by the first processor, the date on which the prescription drug was dispensed; and

modifying, by the first processor, the risk score for the insurance applicant based on the date on which the prescription drug was dispensed.

24. The method of claim 23, wherein modifying the risk score for the insurance applicant based on the date on which the prescription drug was dispensed comprises:

increasing, by the first processor, a risk associated with the risk score when an elapsed time since the date on which the prescription drug was dispensed is less than a threshold length of time; and

decreasing, by the first processor, the risk associated with the risk score when the elapsed time since the date on which the prescription drug was dispensed is greater than the threshold length of time.

25. The method of claim 15, wherein the pharmacy benefits management database further comprises a refill pattern of the prescription drug, the method further comprising:

obtaining, by the first processor, the refill pattern; and

modifying, by the first processor, the risk score for the insurance applicant based on the refill pattern.