Computer system for applying proactive referral model to long term disability claims

• US 8,359,255 B2
• Filed: 03/22/2011
• Issued: 01/22/2013
• Est. Priority Date: 08/22/2008
• Status: Active Grant

• Current Assignee: Hartford Fire Insurance Company (The Hartford Financial Services Group, Inc.)
• Original Assignee: Hartford Fire Insurance Company (The Hartford Financial Services Group, Inc.)
• Inventors: Scully, Timothy J.
• Primary Examiner(s): Liu, Marissa
• Application Number:
  US13/053,760
• Publication Number:
  US 20110173030A1
• Time in Patent Office: 672 Days
• Field of Search: 705 1- 80, 212 3- 15, 715 22- 88, 713150-176, 235 1-386, 380 1- 30
• US Class Current: 705/35
• CPC Class Codes: G06Q 10/10 Office automation; Time management
• CPC Class Codes: G06Q 10/1095 Meeting or appointment
• CPC Class Codes: G06Q 30/0202 Market predictions or forecasting for commercial activities
• CPC Class Codes: G06Q 40/00 Finance; Insurance; Tax strategies; Processing of corporate or income taxes
• CPC Class Codes: G06Q 40/04 Trading; Exchange, e.g. stocks, commodities, derivatives or currency exchange
• CPC Class Codes: G06Q 40/08 Insurance

Abstract

A computer system includes a data storage module. The data storage module receives, stores, and provides access to data related to long term disability claims. A proactive referral model component is coupled to the data storage module, and determines whether to refer a current claim to an investigation unit. The proactive referral model is based on at least two of the following variables: (a) a variable that indicates that the claimant'"'"'s diagnosis has changed; (b) a variable that indicates that the current claim in question was brought under any-occupation coverage; (c) a variable that reflects a market segment for a policy under which the current claim in question was brought; (d) a variable that has a value based on a state in which the claimant resides; and (e) a variable that represents an amount of experience of a claims handler who handled the current claim in question.

Claims

1. A computer system comprising:

a data storage module programmed to receive, store, and provide access to claim data, the claim data representing historical disability claims and current disability claims;

a proactive referral model component, the proactive referral model component is at least one of a multiple linear regression model and a backward regression variable selection model, the proactive referral model component coupled to the data storage module, and configured to determine whether to identify one of said current disability claims for referral to an investigation unit, said proactive referral model based on a plurality of variables, the variables including at least two of;

(a) a variable indicates that a claimant'"'"'s diagnosis has changed;

(b) a variable indicates that the one of said current disability claims was brought under any-occupation coverage;

(c) a variable that reflects a market segment for a policy under which the one of said current long term disability claims was brought;

(d) a variable that has a value based on a state in which a claimant resides; and

(e) a variable that represents an amount of experience of a claims handler who handled the one of said current disability claims;

a computer processor for executing programmed instructions and for storing and retrieving said data related to current disability claims;

program memory, coupled to the computer processor, for storing program instruction steps for execution by the computer processor;

a model training component, coupled to the computer processor, programmed to train the proactive referral model component based on the claim data related to the historical disability claims in accordance with program instructions stored in the program memory and executed by the computer processor, thereby providing a trained proactive referral model component;

an output device, coupled to the computer processor, programmed to output an output indicative of whether said one of said current disability claims should be referred to the investigation unit, wherein the computer processor generates the output in accordance with program instructions in the program memory and executed by the computer processor, said output generated in response to application of data for said one of said current disability claims to the trained proactive referral model component; and

a routing module to direct workflow based on the output from the output device.

2. The computer system of claim 1, wherein the routing module programmed to route said one of the current disability claims to the investigation unit based on the output from the output device.

3. The computer system of claim 2, wherein the routing module programmed to route said one of the current disability claims to an investigative analyst in the investigation unit.

4. A computer system comprising:

a data storage module programmed to receive, store and provide access to claim data, the claim data representing historical disability claims and current long term disability claims;

a proactive referral model component, coupled to the data storage module, configured to determine whether to identify one of said current disability claims for referral to an investigation unit, said proactive referral model based on a plurality of variables, the proactive referral model component is at least one of a multiple linear regression model and a backward regression variable selection model;

a computer processor for executing programmed instructions and for storing and retrieving said claim data related to current disability claims;

program memory, coupled to the computer processor, for storing program instruction steps for execution by the computer processor;

a model training component, coupled to the computer processor, to train the proactive referral model component based on the claim data related to the historical disability claims in accordance with program instructions stored in the program memory and executed by the computer processor, thereby providing a trained proactive referral model component;

an output device, coupled to the computer processor, programmed to output an output indicative of whether said one of said current disability claims should be referred to the investigation unit, wherein the computer processor generates the output in accordance with program instructions in the program memory and executed by the computer processor, said output generated in response to application of data for said one of said current disability claims to the trained proactive referral model component; and

a routing module programmed to direct workflow based on the output from the output device;

wherein at least two of the variables includes;

(a) a geographical state in which a claimant resides being a state that has a high rate of questionable disability claims;

(b) the geographical state in which the claimant resides being a state that has a low rate of questionable disability claims;

(c) a claimant'"'"'s diagnosis code being one which exhibits a high rate of questionable disability claims;

(d) a change in a claimant'"'"'s diagnosis;

(e) an amount of experience of a claims handler;

(f) a claim having been brought under any-occupation coverage;

(g) whether the claimant has been classified as disabled for purposes of Social Security benefits;

(h) whether a claimant'"'"'s occupation was classified as sedentary;

(i) a market segment for a policy under which the claim was brought;

(j) whether the claimant'"'"'s diagnosis code was in a subcategory that was highly likely to experience questionable claims;

(k) a claimant'"'"'s employer having a SIC (standard industrial classification) code that is highly likely to experience questionable claims;

(l) a duration of the claim;

(m) claim geographic related data and (n) claim characteristic data.

5. The computer system of claim 4, wherein the routing module programmed to route said one of the current disability claims to the investigation unit based on the output from the output device.

6. The computer system of claim 5, wherein the routing module programmed to route said one of the current disability claims to an investigative analyst in the investigation unit.

7. The computer system of claim 4, wherein the data storage module includes a data warehouse.