System for summerizing information for insurance underwriting suitable for use by an automated system

• US 20030177032A1
• Filed: 06/20/2002
• Published: 09/18/2003
• Est. Priority Date: 12/31/2001
• Status: Abandoned Application

• Current Assignee: Pacific Life Insurance Company (Pacific Mutual Holding Company)
• Original Assignee: Pacific Life Insurance Company (Pacific Mutual Holding Company)
• Inventors: Merchent, Valerie Annette, Bonissone, Piero Patrone, Yang, Dan, Patterson, Angela Neff, Pavese, Marc, Messmer, Richard Paul, Mogro-Campero, Antonio, Durham, William Michael, Russell, Diane Marie, Orlando, John Anthony, Coburn, David Hjalmar
• Application Number:
  US10/175,419
• Publication Number:
  US 20030177032A1
• Time in Patent Office: Days
• US Class Current: 705/2
• CPC Class Codes: G06F 40/174 Form filling; Merging
• CPC Class Codes: G06Q 10/10 Office automation; Time management
• CPC Class Codes: G06Q 40/02 Banking, e.g. interest calculation or account maintenance credit or loans G06Q40/03
• CPC Class Codes: G06Q 40/08 Insurance
• CPC Class Codes: G16H 15/00 ICT specially adapted for medical reports, e.g. generation or transmission thereof

Abstract

A system to structure and summarize the key information required by automated decision-making systems for insurance underwriting is described. The automated underwriting system may be based on rules corresponding to underwriting components, wherein based on the degree of satisfaction of each rule, a component may be assigned to a category, and based on the category for each component, the insurance application may be assigned an underwriting category, or the automated underwriting system may be based on an evaluation of the similarity of a given application to previous application requests, to decide an underwriting category. Most of the key information required for automated insurance underwriting is structured and standardized, except for the Attending Physician Statement (APS), which is almost as unique as each individual physician. The system to structure and summarize the APS information captures the relevant variables that characterize a given medical impairment, allowing an automated reasoning system to determine the degree of severity of such impairment and to estimate the underlying insurance risk.

Claims

1. A system for summarizing and standardizing attending physician statements for use in an insurance application underwriting system, the system comprising:

means for accessing a general form for a patient;

means for verifying that the attending physician statement to be summarized and standardized corresponds to the patent associated with the general form;

means for entering information into a plurality of data fields within the general form based on information contained within the attending physician statement, where the plurality of data fields comprise at least one required field;

means for presenting the completed general form for validation, where validation comprises ensuring that the information has been entered into any required data fields;

means for selecting at least one condition specific form;

means for entering information into a plurality of condition specific data fields within the at least one condition specific form based on information contained within the attending physician statement, where the plurality of condition specific data fields comprise at least one required data field; and

means for presenting the completed at least one condition specific form for validation.

2. The system according to claim 1, where the plurality of data fields further comprise at least one optional data field.

3. The system according to claim 2, where the plurality of condition specific data fields further comprise at least one optional data field.

4. The system according to claim 1, where the plurality of condition specific data fields further comprise at least one optional data field.

5. The system according to claim 1, further comprising means for storing the validated general form and the at least one condition specific form in a database.

6. The system according to claim 1, wherein the insurance application underwriting system is automated.

7. The system according to claim 1, wherein the means for entering information further comprise selecting the information to enter from a presentation of a plurality of entry options.

8. The system according to claim 7, where the presentation of the plurality of entry options comprises a pull-down menu.

9. The system according to claim 1, where the at least one condition specific form comprises a plurality of condition specific forms.

10. The system according to claim 1, where the at least one condition specific form corresponds to a medical condition of the patient.

11. The system according to claim 2, where the general form further includes at least one conditionally mandatory field associated with one of the optional field and the required field, where information is entered into a conditionally mandatory field based on the information entered into the one of the optional field and the required field.

12. The system according to claim 4, where the at least one condition specific form further includes at least one conditionally mandatory field associated with one of the optional field and the required field, where information is entered into a conditionally mandatory field based on the information entered into the one of the optional field and the required field.

13. A system for summarizing and standardizing an information submission for use in an insurance application underwriting system, the system comprising:

means for accessing a general form for an applicant;

means for verifying that the information submission to be summarized and standardized corresponds to the applicant associated with the general form;

means for entering information into a plurality of data fields within the general form based on information contained within the information submission, where the plurality of data fields comprise at least one required data field;

means for presenting the completed general form for validation, where validation comprises ensuring that the information has been entered into the at least one required data field, and verifying that the data entered is within specific numerical or text ranges;

means for selecting at least one supplemental form;

means for entering information into a plurality of supplemental data fields within the at least one supplemental form based on information contained within the information submission, where the plurality of supplemental data fields comprise at least one required data field; and

means for presenting the completed at least one condition specific form for validation.

14. The system according to claim 13, where the plurality of data fields further comprise at least one optional data field.

15. The system according to claim 14, where the plurality of condition specific data fields further comprise at least one optional data field.

16. The system according to claim 13, where the plurality of condition specific data fields further comprise at least one optional data field.

17. The system according to claim 13, further comprising means for storing the validated general form and the at least one condition specific form in a database.

18. The system according to claim 13, wherein the means for entering information further comprise selecting the information to enter from a presentation of a plurality of entry options.

19. The system according to claim 18, where the presentation of the plurality of entry options comprises a pull-down menu.

20. The system according to claim 13, where the at least one condition specific form comprises a plurality of condition specific forms.

21. The system according to claim 14, where the general form further includes at least one conditionally mandatory field associated with the at least one of an optional field and a required field, where information is entered into a conditionally mandatory field based on the information entered into the at least one of an optional field and a required field.

22. The system according to claim 16, where the at least one condition specific form further includes at least one conditionally mandatory field associated with the at least one of an optional field and a required field, where information is entered into a conditionally mandatory field based on the information entered into the at least one of an optional field and a required field.

23. A system for summarizing and standardizing attending physician statements for use in an insurance application underwriting system, the system comprising:

means for accessing a general form for an applicant;

means for verifying that the attending physician statement to be summarized and standardized corresponds to the applicant associated with the general form;

means for entering information into a plurality of data fields within the general form based on information contained within the attending physician statement, where the plurality of data fields comprise at least one required field; and

means for presenting the completed general form for validation, where validation comprises ensuring that the information has been entered into the at least of the required data field and may include range (for numerical entries) and membership (for text entries) validation.

24. The system according to claim 23, where the plurality of data fields further comprise at least one optional data field.

25. The system according to claim 23, further comprising means for storing the validated general form.

26. The system according to claim 23, wherein the insurance application underwriting system is automated.

27. The system according to claim 23, wherein the means for entering information further comprises selecting the information to enter from a presentation of a plurality of entry options.

28. The system according to claim 27, where the presentation of the plurality of entry options comprises a pull-down menu.

29. The system according to claim 23, where the general form further includes at least one conditionally mandatory field associated with the at least one required data field, where information is entered into a conditionally mandatory field based on the information entered into the at least one required data field.

30. The system according to claim 23, further comprising:

means for selecting at least one of a plurality of condition specific forms, where each of the plurality of condition specific forms corresponds to a different medical condition of the patient;

means for entering information into a plurality of condition specific data fields within the at least one condition specific form based on information contained within the attending physician statement, where the plurality of condition specific data fields comprise at least one required data field; and

means for presenting the completed at least one condition specific form for validation.

31. The system according to claim 30, where the plurality of condition specific data fields further comprise at least one optional data field.

32. The system according to claim 31, where the plurality of condition specific data fields further comprise at least one optional data field.

33. The system according to claim 30, further comprising means for storing the validated general form.

34. The system according to claim 30, wherein the insurance application underwriting system is automated.

35. The system according to claim 30, wherein the means for entering information further comprises selecting the information to enter from a presentation of a plurality of entry options.

36. The system according to claim 31, where the presentation of the plurality of entry options comprises a pull-down menu.

37. The system according to claim 30, where the general form further includes at least one conditionally mandatory field associated with the at least one of an optional field and a required field, where information is entered into a conditionally mandatory field based on the information entered into the at least one of an optional field and a required field.

38. The system according to claim 32, where the condition specific form further includes at least one conditionally mandatory field associated with the at least one of an optional field and a required field, where information is entered into a conditionally mandatory field based on the information entered into the at least one of an optional field and a required field.

39. A system for summarizing and standardizing attending physician statements for use in an insurance application underwriting system, the system comprising:

an access module for accessing a general form for a patient;

a verification module for verifying that the attending physician statement to be summarized and standardized corresponds to the patent associated with the general form;

a selection module for selecting at least one condition specific form;

an input module for;

a) entering information into a plurality of data fields within the general form based on information contained within the attending physician statement, where the plurality of data fields comprise at least one required field; and

b) entering information into a plurality of condition specific data fields within the at least one condition specific form based on information contained within the attending physician statement, where the plurality of condition specific data fields comprise at least one required data field; and

a presentation module for;

a) presenting the completed general form for validation, where validation comprises ensuring that the information has been entered into the at least one required data field; and

b) a presentation module for presenting the completed at least one condition specific form for validation.

40. The system according to claim 39, where the plurality of data fields further comprise at least one optional data field.

41. The system according to claim 40, where the plurality of condition specific data fields further comprise at least one optional data field.

42. The system according to claim 39, where the plurality of condition specific data fields further comprise at least one optional data field.

43. The system according to claim 39, further a storage module for storing the validated general form and the at least one condition specific form in a database.

44. The system according to claim 39, wherein the insurance application underwriting system is automated.

45. The system according to claim 39, wherein the entering of information further comprises selecting the information to enter from a presentation of a plurality of entry options.

46. The system according to claim 45, where the presentation of the plurality of entry options comprises a pull-down menu.

47. The system according to claim 39, where the at least one condition specific form comprises a plurality of condition specific forms.

48. The system according to claim 39, where the at least one condition specific form corresponds to a medical condition of the patient.

49. The system according to claim 40, where the general form further includes at least one condition mandatory field associated with the at least one optional field and at least one required field, where information is entered into condition mandatory field based on the information entered into the at least one optional field and at least one required field.

50. The system according to claim 42, where the at least one condition specific form further includes at least one conditionally mandatory field associated with the at least one of an optional field and a required field, where information is entered into a conditionally mandatory field based on the information entered into the at least one of an optional field and a required field.

51. A system for summarizing and standardizing an information submission for use in an insurance application underwriting system, the system comprising:

an access module for accessing;

a) a general form for an applicant; and

b) at least one supplemental form;

a verification module for verifying that the information submission to be summarized and standardized corresponds to the applicant associated with the general form;

an input module for;

a) entering information into a plurality of data fields within the general form based on information contained within the information submission, where the plurality of data fields comprise at least one required data field; and

b) entering information into a plurality of supplemental data fields within the at least one supplemental form based on information contained within the information submission, where the plurality of data fields comprises at least one required data field; and

a presentation module for;

a) presenting the completed general form for validation, where validation comprises ensuring that the information has been entered into the at least one required data field;

b) means for presenting the completed at least one supplemental form for validation.

52. The system according to claim 51, where the plurality of data fields further comprise at least one optional data field.

53. The system according to claim 52, where the plurality of data fields further comprise at least one optional data field.

54. The system according to claim 51, where the plurality of supplemental data fields further comprise at least one optional data field.

55. The system according to claim 51, further comprising a storage module for storing the validated general form and the at least one supplemental form in a database.

56. The system according to claim 51, wherein the entering of information further comprises selecting the information to enter from a presentation of a plurality of entry options.

57. The system according to claim 56, where the presentation of the plurality of entry options comprises a pull-down menu.

58. The system according to claim 51, where the at least one condition specific form comprises a plurality of condition specific forms.

59. The system according to claim 52, where the general form further includes at least one conditionally mandatory field associated with one of the at least one optional data field and the at least one required data field, where information is entered into a conditionally mandatory field based on the information entered into one of the at least one optional data field and the at least one required data field.

60. The system according to claim 54, where the at least one supplemental form further includes at least one conditionally mandatory field associated with one of the at least one optional data field and the at least one required data field, where information is entered into a conditionally mandatory field based on the information entered into the at least one of an optional field and a required field.

61. A system for summarizing and standardizing attending physician statements for use in an insurance application underwriting system, the system comprising:

an access module for accessing a general form for a patient;

a verification module for verifying that the attending physician statement to be summarized and standardized corresponds to the patient (better to use applicant) associated with the general form;

an input module for entering information into a plurality of data fields within the general form based on information contained within the attending physician statement, where the plurality of data fields comprise at least one required data field; and

a presentation module for presenting the completed general form for validation, where validation comprises ensuring that the information has been entered into the at least one required data field.

62. The system according to claim 61, where the plurality of data fields further comprise at least one optional data field.

63. The system according to claim 61, further comprising a storage module for storing the validated general form.

64. The system according to claim 61, wherein the insurance application underwriting system is automated.

65. The system according to claim 61, wherein the entering of information further comprises selecting the information to enter from a presentation of a plurality of entry options.

66. The system according to claim 65, where the presentation of the plurality of entry options comprises a pull-down menu.

67. The system according to claim 62, where the general form further includes at least one conditionally mandatory field associated with one of the at least one optional data field and the at least one required data field, where information is entered into a conditionally mandatory field based on the information entered into the one of the at least one optional data field and the at least one required data field.

68. The system according to claim 61, wherein:

the access module enables accessing at least one of a plurality of condition specific forms, where each of the plurality of condition specific forms corresponds to a different medical condition of the patient;

the input module enables entering information into a plurality of condition specific data fields within the at least one condition specific form based on information contained within the attending physician statement, where the plurality of condition specific data fields comprise at least one required data field; and

the presentation module enables presenting the completed at least one condition specific form for validation.

69. The system according to claim 68, where the plurality of condition specific data fields further comprise at least one optional data field.

70. The system according to claim 69, where the plurality of condition specific data fields further comprise at least one optional data field.

71. The system according to claim 68, further comprising a storage module for storing the validated general form.

72. The system according to claim 68, wherein the insurance application underwriting system is automated.

73. The system according to claim 68, wherein the entering of information further comprises selecting the information to enter from a presentation of a plurality of entry options.

74. The system according to claim 68, where the presentation of the plurality of entry options comprises a pull-down menu.

75. The system according to claim 70, where the general form further includes at least one conditionally mandatory field associated with one of the at least one optional data field and the at least one required data field, where information is entered into a conditionally mandatory field based on the information entered into the one of the at least one optional data field and the at least one required data field.

76. The system according to claim 70, where the condition specific form further includes at least one condition mandatory field associated with one of the at least one optional data field and the at least one required data field, where information is entered into condition mandatory field based on the information entered into the one of the at least one optional data field and the at least one required data field.