US2014358591A1PendingUtilityA1

System and method for providing a disability insurance claim triage platform

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Individually held — no corporate assignee on recordPriority: May 31, 2013Filed: May 31, 2013Published: Dec 4, 2014
Est. expiryMay 31, 2033(~6.9 yrs left)· nominal 20-yr term from priority
Inventors:Willie F. GrayAmanda Sue HarperAllison M. ScaiaLisa Workin
G06F 16/22G06Q 40/08G06N 20/00
36
PatentIndex Score
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Claims

Abstract

According to some embodiments, a triage platform may receive data indicative of a disability insurance claim submitted in connection with a disability insurance policy, including at least one claim characteristic. The triage platform may determine, based on the claim characteristic, a claim segment to be associated with the disability insurance claim. A claim handler may be assigned to the disability insurance claim in accordance with the determined claim segment. Information about the disability insurance claim may then be automatically routed to the assigned claim handler.

Claims

exact text as granted — not AI-modified
1 . A system associated with a disability insurance policy, the system comprising:
 a computer storage unit for receiving, storing, and providing data indicative of a disability insurance claim submitted in connection with the disability insurance policy, including at least one claim characteristic; and   a processor in communication with the storage unit, wherein the processor is configured for:
 determining, based on the claim characteristic, a claim segment to be associated with the disability insurance claim, 
 assigning a claim handler to the disability insurance claim in accordance with the determined claim segment, and 
 automatically routing information about the disability insurance claim to the assigned claim handler. 
   
     
     
         2 . The system of  claim 1 , wherein the disability insurance claim comprises one of: (i) a long term disability insurance claim, (ii) a short term disability insurance claim, or (iii) a workers' compensation insurance claim. 
     
     
         3 . The system of  claim 1 , wherein the disability insurance claim comprises a long term disability claim and at least some of the data indicative of the long term disability insurance claim is based on information copied from a short term disability insurance system. 
     
     
         4 . The system of  claim 1 , wherein the processor is further configured for:
 automatically transmitting information about the disability insurance claim to at least one of: (i) an email server, (ii) a workflow application, and (iii) a calendar application.   
     
     
         5 . The system of  claim 1 , wherein the computer storage unit receives the data indicative of the disability insurance claim via at least one of: (i) a submitted paper claim, and (ii) a telephone call center. 
     
     
         6 . The system of  claim 1 , wherein the claim characteristic comprises at least one of: (i) a date of birth, (ii) a date of disability, (iii) a waiting period, (iv) diagnosis information, (v) a claimant salary, (vi) an own occupation period, (vii) a job type, (viii) a marriage status, (ix) a benefit percentage, (x) claimant gender, and (xi) information from an attending physician. 
     
     
         7 . The system of  claim 1 , wherein potential claim segments include at least (i) a segment for higher complexity disability insurance claims and (ii) a segment for lower complexity disability insurance claims. 
     
     
         8 . The system of  claim 7 , wherein the segment for higher complexity disability insurance claims is determined when at least two of the following conditions are true for the disability insurance claim: (i) a subjective diagnosis is associated with the insurance claim, (ii) an uncertain recovery profile is associated with the insurance claim, and (iii) a pre-determined level of financial complexity is associated with the insurance claim. 
     
     
         9 . The system of  claim 7 , wherein the segment for lower complexity disability insurance claims is determined when either of following conditions is true for the disability insurance claim: (i) a likelihood of recovery is below a first pre-determined threshold value or (ii) the likelihood of recovery is above a second pre-determined threshold value. 
     
     
         10 . The system of  claim 1 , wherein the processor is further configured for:
 outputting an indication of the determined claim segment to a team leader.   
     
     
         11 . The system of  claim 1 , wherein the processor is further configured for:
 determining and outputting an indication of a diagnosis description for the disability insurance claim.   
     
     
         12 . The system of  claim 1 , wherein the processor is further configured for:
 determining and outputting a recovery profile for the disability insurance claim based on a predictive model.   
     
     
         13 . The system of  claim 12 , wherein a plurality of recovery profiles are determined and output, each associated with a different recovery period. 
     
     
         14 . The system of  claim 1 , wherein the processor is further configured for:
 determining and outputting a test change outlook for the disability insurance claim.   
     
     
         15 . The system of  claim 1 , wherein the determination is based at least in part on a predictive model trained with historical disability insurance claim information. 
     
     
         16 . The system of  claim 15 , wherein the predictive mode utilizes high level diagnosis groupings. 
     
     
         17 - 18 . (canceled) 
     
     
         19 . A method associated with a long term disability insurance policy, the method comprising:
 receiving at a triage platform data indicative of a long term disability insurance claim submitted in connection with the long term disability insurance policy, including at least one claim characteristic;   determining, by a computer processor of the triage platform, based on the claim characteristic, a claim segment to be associated with the long term disability insurance claim;   assigning, by the computer processor of the triage platform, a claim handler to the long term disability insurance claim in accordance with the determined claim segment; and   automatically routing, by the computer processor of the triage platform, information about the long term disability insurance claim to the assigned claim handler.   
     
     
         20 . The method of  claim 19 , wherein potential claim segments include at least (i) a segment for higher complexity long term disability insurance claims and (ii) a segment for lower complexity long term disability insurance claims. 
     
     
         21 . The method of  claim 20 , wherein the segment for higher complexity long term disability insurance claims is determined when at least two of the following conditions are true for the long term disability insurance claim: (i) a subjective diagnosis is associated with the insurance claim, (ii) an uncertain recovery profile is associated with the insurance claim, and (iii) a pre-determined level of financial complexity is associated with the insurance claim. 
     
     
         22 . The method of  claim 20 , wherein the segment for lower complexity long term disability insurance claims is determined when either of following conditions is true for the long term disability insurance claim: (i) a likelihood of recovery is below a first pre-determined threshold value or (ii) the likelihood of recovery is above a second pre-determined threshold value. 
     
     
         23 . A non-transitory, computer-readable medium storing instructions adapted to be executed by a computer processor to perform a method associated with a long term disability insurance policy, said method comprising:
 receiving at a triage platform data indicative of a long term disability insurance claim submitted in connection with the long term disability insurance policy, including at least one claim characteristic;   determining, by a computer processor of the triage platform based on the claim characteristic, a claim segment to be associated with the long term disability insurance claim;   assigning a claim handler to the long term disability insurance claim in accordance with the determined claim segment; and   automatically routing information about the long term disability insurance claim to the assigned claim handler.   
     
     
         24 . The medium of  claim 23 , wherein potential claim segments include at least (i) a segment for higher complexity long term disability insurance claims and (ii) a segment for lower complexity long term disability insurance claims. 
     
     
         25 . The medium of  claim 24 , wherein the segment for higher complexity long term disability insurance claims is determined when at least two of the following conditions are true for the long term disability insurance claim: (i) a subjective diagnosis is associated with the insurance claim, (ii) an uncertain recovery profile is associated with the insurance claim, and (iii) a pre-determined level of financial complexity is associated with the insurance claim. 
     
     
         26 . The medium of  claim 24 , wherein the segment for lower complexity long term disability insurance claims is determined when either of following conditions is true for the long term disability insurance claim: (i) a likelihood of recovery is below a first pre-determined threshold value or (ii) the likelihood of recovery is above a second pre-determined threshold value.

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