System to determine a credibility weighting for electronic records

Patent metadata

Field	Value
Publication number	US-11853337-B2
Application number	US-202117347767-A
Country	US
Kind code	B2
Filing date	Jun 15, 2021
Priority date	Oct 5, 2016
Publication date	Dec 26, 2023
Grant date	Dec 26, 2023

Abstract

Text input data may be aggregated and mapped to create composite text input data for electronic records. A semantic event may be automatically detected, triggered by a semantic rule and associated semantic tag. The detected semantic event may be flagged, and a text mining result database may be updated by adding an entry to the database. An indication associated with the event may be transmitted, and a back-end application computer server may establish a hierarchy for multiple elements of the electronic records. The computer server may determine a weight variable and response variable for each element in the hierarchy and apply a hierarchical credibility weighting methodology to the elements from level 1, representing the least granular level in the hierarchy, to level n, representing the most granular level in the hierarchy, calculated recursively from level n, to determine a final estimated credibility for the electronic records.

First claim

What is claimed:

1. A system for determining a credibility weighting associated with electronic records associated with workers' compensation insurance claims, comprising:
a text mining platform, including:
a text mining communication device to receive text input data associated with the electronic records;
a text mining processor coupled to the text mining communication device; and
a text mining storage device in communication with said text mining processor and storing instructions adapted to be executed by said text mining processor to:
(i) aggregate and map the received text input data to create composite text input data,
(ii) automatically detect a semantic event in the composite text input data triggered by a semantic rule graphically defined by a user,
(iii) update a text mining result database, responsive to the detection, by adding an entry to the database identifying the detected semantic event, and
(iv) transmit an indication associated with the semantic event based on data in the text mining result database; and

a back-end application computer server coupled to the text mining platform, including:
a back-end communication device to receive the indication for the electronic record transmitted by the text mining platform;
a back-end processor coupled to the back-end communication device; and
a back-end storage device in communication with said back-end processor and storing instructions adapted to be executed by said back-end processor to:
(i) establish a hierarchy for multiple elements of the electronic records,
(ii) determine a weight variable, comprising a text flag total claim count, and a response variable, comprising a text flag ratio, for each element in the established hierarchy,
(iii) apply a hierarchical credibility weighting methodology to the elements of the electronic records from level 1, representing the least granular level in the hierarchy, to level n, representing the most granular level in the hierarchy, calculated recursively from level n, to determine a final estimated credibility for the electronic records based on the weight variable and response variable, wherein the credibility for level i is calculated based on ω i representing a weight for level i and K representing a credibility factor,
(iv) receive from a user of a web browser credibility weighting tool an indication of a geographic region, and
(v) responsive to the received indication of the geographic region, graphically display a map-based presentation of the credibility information for the electronic records,

wherein the observed experience for level i, excluding lower levels in the hierarchy, is calculated as:

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=

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i

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ω
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-

X

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1

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ω

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1

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.

2. The system of claim 1 , wherein if there is not enough data associated with a granular level in the hierarchy to be credible, then the level of granularity is decreased until enough data is obtained for the level to be credible.

3. The system of claim 1 , wherein the semantic event is associated with at least one of: (i) a word, (ii) a phrase, (iii) a shorthand term, (iv) a course of action, and (v) an enterprise name.

4. The system of claim 1 , wherein the triggering semantic rule is associated with at least one of: (i) a noun, (ii) a verb, (iii) a definition, (iv) a semantic tree, (v) a named entity recognition rule, (vi) a root, (vii) a noun phrase, (viii) a prepositional phrase, and (ix) a verb phrase.

5. The system of claim 4 , wherein the triggering semantic rule was defined by an administrator using a graphical user interface.

6. The system of claim 1 , wherein the credibility for level i, excluding lower levels in the hierarchy, is calculated as:
Z i ′=Z i −Z i+1 .

7. The system of claim 6 , wherein the credibility weighted estimate for level n is calculated as:

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n

=

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1

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Z
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.

8. The system of claim 1 , wherein the final estimated credibility is associated with at least one of claim litigiousness and adverse claim severity summarized at a geographic level.

9. The system of claim 8 , wherein the established hierarchy includes at least four of: (i) effective year, (ii) a risk state, (iii) a Combined Statistical Area (“CSA”), (iv) a Core Based Statistical Area (“CBSA”), (v) a Federal Information Processing Standard (“FIPS”) code, (vi) a county, and (vii) a five-digital ZIP code.

10. The system of claim 1 , wherein higher levels of the established hierarchy exclude the experience and credibility from the lower levels, credibility weighted values of the full hierarchy are set relative to the credibility weighted values of the hierarchy to normalize the data, and the final estimated credibility is used in connection with at least one of: (i) an insurance pricing process, and (ii) a risk score model.

11. The system of claim 1 , wherein the text input data is associated with at least one of: (i) an insurance claim file, (ii) an insurance claim note, (iii) a medical report, (iv) a police report, (v) social network data, (vi) big data information, (vii) a loss description, (viii) an injury description, (ix) a first notice of loss statement, (x) telephone call transcript, (xi) optical character recognition data, (xii) third-party data, and (xiii) a governmental agency.

12. A computer-implemented method for determining a credibility weighting associated with electronic records associated with workers' compensation insurance claims, comprising:
aggregating and mapping, by a tex

Assignees

• Hartford Fire Insurance Comp

Inventors

• Houser Reuben Emory
• Wang Qiao
• Drennan Iii Arthur Paul
• Sims Nicole Rose
• Steger Tracey Ellen

Classifications

• G06F16/3344 Primary

  using natural language analysis · CPC title

• G06F16/36 Primary

  Creation of semantic tools, e.g. ontology or thesauri · CPC title

• G06F16/951

  Indexing; Web crawling techniques · CPC title