Systems and methods for insurance underwriting

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.

What is claimed is: 
     
         1 . A system for insurance underwriting, the system comprising:
 a client, wherein the client allows application information about an insurance applicant obtained from the applicant to be entered into the system and an insurance risk calculated for the insurance applicant to be returned from the system;   a database, wherein the database contains information about the applicant not obtained from the applicant; and   a server in communication with both the client and the database, wherein the server is configured to:   obtain the application information entered through the client;   retrieve the applicant information not obtained from the applicant that is contained in the database;   calculate an insurance risk from the application information entered through the client and the applicant information not obtained from the applicant that is contained in the database, wherein the applicant information contained in the database includes at least prescription drug information;   translate the insurance risk into an insurance underwriting decision; and   make the insurance underwriting decision available to the client.   
     
     
         2 . The system of  claim 1 , wherein the insurance risk is represented by one or more of a risk score and risk classification. 
     
     
         3 . The system of  claim 1 , wherein the client allows a modifier to be entered into the system that will modify the insurance risk determined by the server and made available to the client. 
     
     
         4 . A system for insurance underwriting based on prescription drug histories, the system comprising:
 a pharmacy benefits management database;   a drug risk category database;   a list of applicant characteristics; and   a processor, wherein the processor is configured to:
 obtain an insurance applicant's prescription drug history from the pharmacy benefits management database; 
 match the list of prescription drugs to disease categories from the drug category database; 
 calculate a risk score for the insurance applicant based on the disease categories matched and the list of prescription drugs dosages and dates dispensed; and 
 modify the risk score according to the list of applicant characteristics. 
   
     
     
         5 . The system of  claim 4 , wherein the pharmacy benefits management database contains 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, and usage information. 
     
     
         6 . The system of  claim 4 , wherein the drug risk category database contains prescription drugs grouped into one or more specific disease categories that could contribute to premature death, and a category for drugs not fitting into any of the other categories. 
     
     
         7 . The system of  claim 4 , wherein the list of applicant characteristics comprises one or more of sex, birth date, height, weight, and smoking status. 
     
     
         8 . The system of  claim 4 , further comprising a second processor that modifies the risk score calculated by the processor according to a modification scheme preset externally by an underwriter. 
     
     
         9 . The system of  claim 8 , wherein the modification scheme is a translation table that the second processor uses to translate the risk score calculated by the processor into a second risk score. 
     
     
         10 . The system of  claim 8 , wherein the modification scheme is a multiplier that the second processor multiples the risk score calculated by the processor by to produce a second risk score. 
     
     
         11 . A method for calculating a prescription drug risk score for an insurance applicant on a computer server with access to online databases, the method comprising:
 obtaining a list of prescription drugs for the insurance applicant from a pharmacy benefits management database;   obtaining a list of characteristics of the insurance applicant;   obtaining a list of drug risk categories for the insurance applicant from a drug risk category database;   calculating a body mass index of the insurance applicant from the list of characteristics and if the body mass index cannot be calculated using a default value;   setting the risk score of each of the drug risk categories for the insurance applicant to the default no risk value;   determining one or more drug risk categories and a risk score of a prescription drug from the list of prescription drugs by querying the drug risk category database with the insurance applicant's sex and a code for the prescription drug;   determining if the prescription drug is different representation of a drug already processed;   determining if a drug category of the prescription drug is smoking and if it is setting smoking status of the insurance applicant to smoking;   modifying a risk score of the prescription drug based on date of dispensing;   modifying the risk score of the prescription drug based on refill pattern;   adding the prescription drug to one or more drug risk categories for the insurance applicant;   calculating risk scores of each drug risk category from the risk scores of prescription drugs in each drug risk category;   determining a drug risk category with a highest risk score;   removing all prescription drugs found in the drug risk category with the highest risk score from all other drug risk categories to prevent biasing from multiple purpose prescription drugs and recalculating risk scores of drug categories from which prescription drugs were removed;   modifying a risk score of the drug risk category with the highest risk score according to the smoking status of the insurance applicant and the drug risk category; and   modifying a risk score of the drug risk category with the highest risk score according to the body mass index of the insurance applicant and the drug risk category.   
     
     
         12 . The method of  claim 11 , wherein the pharmacy benefits management database contains 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, and usage information. 
     
     
         13 . The method of  claim 11 , wherein the drug risk category database contains prescription drugs grouped into one or more specific disease categories that could contribute to premature death, and a category for drugs not fitting into any of the other categories. 
     
     
         14 . The method of  claim 13 , further comprising removing the risk contribution from the category for drugs where the drug risk category has no mortality implications. 
     
     
         15 . The method of  claim 11 , wherein the list of characteristics of the insurance applicant comprises one or more of sex, birth date, height, weight, and smoking status. 
     
     
         16 . The method of  claim 15 , wherein the body mass index of the insurance applicant is calculated by dividing the weight in kilograms by the height in meters squared. 
     
     
         17 . The method of  claim 11 , wherein determining if the prescription drug is a different representation of a drug already processed comprises comparing drug categorization, dosage, and route of administration of the prescription drug with categorization, dosage, and routes of administration of all other drugs on a list of processed prescription drugs in order to determine if the prescription drug is a different representation of a drug already processed, discarding the prescription drug if it is a different representation of a drug already processed, and adding the prescription drug to the list of processed prescription drugs if it is not a different representation of a drug already processed. 
     
     
         18 . The method of  claim 11 , wherein modifying a risk score of the prescription drug based on date of dispensing comprises multiplying the risk score of the prescription drug by a modifier specified in a table containing different modifiers for different date ranges from the data of dispensing. 
     
     
         19 . The method of  claim 11 , wherein modifying a risk score of the prescription drug based on refill pattern comprises multiplying the risk score of the prescription drug by a modifier specified in a table containing different modifiers for different amounts of refills within different time periods. 
     
     
         20 . The method of  claim 11 , further comprising modifying a risk score of the prescription drug based on a dosage pattern comprising multiplying the risk score of the prescription by a modifier specified in a table containing different modifiers for different dosages of the prescription drug. 
     
     
         21 . The method of  claim 11 , wherein calculating risk scores of each drug risk category from the risk scores of prescription drugs in each drug risk category comprises examining each prescription a drug risk category, determining a risk score for each category, and adding this to an overall risk score. 
     
     
         22 . The method of  claim 11 , further comprising modifying the final prescription drug risk by a preset external factor set by an underwriter. 
     
     
         23 . A system for insurance underwriting, the system comprising:
 a client, wherein the client allows application information about an insurance applicant obtained from the applicant to be entered into the system and an insurance risk calculated for the insurance applicant to be returned from the system;   a database, wherein the database contains medical information about the applicant not obtained from the applicant; and   a server in communication with both the client and the database, wherein the server is configured to:   obtain the application information entered through the client;   retrieve the applicant information not obtained from the applicant that is contained in the database;   calculate an insurance risk from the application information entered through the client and the applicant information not obtained from the applicant that is contained in the database, wherein the applicant information contained in the database includes at least medical information pertaining to the applicant's health;   translate the insurance risk into an insurance underwriting decision; and   make the insurance underwriting decision available to the client.   
     
     
         24 . The system according to  claim 23 , wherein the database is the Medical Information Bureau.