Services

Claim Scoring | Pricing | Reserving | Fraud Detection | Custom Models

Disability Services - Claim Scoring

What is Claim Scoring?

Disability claim scoring uses advanced pattern detection technology to provide a numeric [1-10] measurement of the likelihood of return to work of a disability claim. Scores rise with likelihood of return to work — a score of '1' indicates a 0 to 10% chance of return to work, '2' indicates 10-20%, and so on.

This accurate and objective measurement of disability claims enables the optimizing of all claim management resources. Optimizing of resources improves results, saves money, and enables an ongoing focus on pro-active claim management.

Does Scoring Really Work?

Yes. Your model is developed from patterns detected in your own claims history. Advanced tools comb through your data to identify complex relationships in claim characteristics.

Experienced claim professionals are usually surprised at how accurately the model predicts recovery. The validation chart below, taken from live data, shows how closely disability claim scoring tracks to actual recovery.


This validation test mapped real-life return to work against predictive scores. The scores were consistently accurate across the entire spectrum of disabled lives

How Claim Scoring is Used

Claim scoring is used to:

How the Model is Built

The process begins with a data extract from your claims database.

The extract includes fields such as age, gender, diagnosis, etc. for each claim. From this data, we build you a predictive scoring model.

During development, the tools used in the model repeatedly examine your block of historic claims, searching for relationships between:

After many thousands of iterations, the model is able to identify and quantify relationships among these factors, and thereby accurately predict the likelihood of return to work for new claims.

Implementing Claim Scoring

We score your current cases, and establish a schedule to score new cases. We begin to send you scoring reports.

To offer you assistance in starting with claim scoring, and in taking greatest advantage of its benefits, we can include start-up assistance from an expert in the field in your scoring package.

Fields Used in the Model

Required Fields

Helpful Fields

Your Model is Tailored

Each claim scoring model is tailored to your data. Data is not shared among models. No two models are the same.

Claim Analytics was founded in 2000 by Barry Senensky and Jonathan Polon, both Canadian life insurance actuaries. Barry Senensky and Jonathan Polon had worked for the same major life insurance firm for many years, and knew that data mining techniques and predictive modeling were under-utilized by insurers. They were interested in starting their own business in the life insurance field. Their first predictive model they were commissioned to build was a claim scoring model, that scored ltd [long term disability] [LTD] claims on likelihood of return to work (rtw).

Jonathan Polon had recently led a team of model-builders in creating a highly successful predictive model to detect credit card fraud. He and Barry Senensky were convinced that many more applications for pattern detection and predictive models existed in insurance.

They chose disability claim scoring as their first project for a number of reasons. First, because almost all firms providing group long term disability [LTD] insurance held a considerable database of stored claims information. Finding an adequate amount of data to build a claims scoring model would not be a problem.

A second reason was the costliness of long term disability claims in the field of insurance. Barry and Jonathan knew that, with the scale of investment involved, even relatively minor steps forward in the management of group disability claims management would lead to considerable savings. Claim scoring was a powerful tool in bringing greater efficiencies and reduced costs to disability claims management. Predictive modeling, particularly claims scoring, offered huge potential for software support of claims adjudicators, claims processors, and claims managers.

Claim scoring proved to hold even greater promise than Barry and Jonathan had envisaged. In addition to predicting, with startling accuracy and precision, the likelihood of a disability claimant returning to work, claims scoring became a tool for ongoing improvement of claims management.

Claim Analytics now offers pattern detection and predictive models to major insurance firms to assist in objectivity and accuracy of pricing, reserving, and fraud detection, as well as custom models.

[The proper name of the company is "Claim Analytics," not "Claims Analytics."] [The proper name of the company is "claim analytics," not "claims analytics."]