Patent ID: 8359255

Claim:
A computer system comprising: a data storage module programmed to receive, store, and provide access to claim data, the claim data representing historical disability claims and current disability claims; a proactive referral model component, the proactive referral model component is at least one of a multiple linear regression model and a backward regression variable selection model, the proactive referral model component coupled to the data storage module, and configured to determine whether to identify one of said current disability claims for referral to an investigation unit, said proactive referral model based on a plurality of variables, the variables including at least two of: (a) a variable indicates that a claimant's diagnosis has changed; (b) a variable indicates that the one of said current disability claims was brought under any-occupation coverage; (c) a variable that reflects a market segment for a policy under which the one of said current long term disability claims was brought; (d) a variable that has a value based on a state in which a claimant resides; and (e) a variable that represents an amount of experience of a claims handler who handled the one of said current disability claims; a computer processor for executing programmed instructions and for storing and retrieving said data related to current disability claims; program memory, coupled to the computer processor, for storing program instruction steps for execution by the computer processor; a model training component, coupled to the computer processor, programmed to train the proactive referral model component based on the claim data related to the historical disability claims in accordance with program instructions stored in the program memory and executed by the computer processor, thereby providing a trained proactive referral model component; an output device, coupled to the computer processor, programmed to output an output indicative of whether said one of said current disability claims should be referred to the investigation unit, wherein the computer processor generates the output in accordance with program instructions in the program memory and executed by the computer processor, said output generated in response to application of data for said one of said current disability claims to the trained proactive referral model component; and a routing module to direct workflow based on the output from the output device.