Patent ID: 8438049
Filing Date: 2013-05-07
Classification: G06Q,G16H

Abstract:
1. A computer system for processing data related to a group benefit insurance policy issued to a group policyholder to extend coverage to individual insureds and having a critical illness benefit, comprising: a data storage device storing data indicative of: a plurality of categories of medical diagnoses; a plurality of diagnoses associated with each of the categories; a first occurrence value; a second occurrence value; and prior claims under the critical illness benefit by the insured; and a processor in communication with the data storage device, the processor configured to: receive via a network from a user-accessible device data associated with a current claim for a critical illness benefit, the data including data indicative of an insured and a diagnosis of a medical condition of the insured; access from the data storage device the data indicative of diagnoses, categories, and prior claims; determine a category corresponding the diagnosis of the current claim; determine whether a prior claim had been paid to the insured for a diagnosis in the determined category; responsive to determining that no prior claim had been paid to the insured for a diagnosis in the determined category, provide an output signal having data indicative of instructions to pay the insured the first occurrence value; and responsive to determining that one and only one prior claim had been paid to the insured for a diagnosis in the determined category, provide an output signal having data indicative of instructions to pay the insured the second occurrence value.