Method and system for detecting human injury claim data risk

Abstract

The invention relates to a method and a system for detecting human injury claim data risk. The method comprises steps that at least one type of the claimant information, medical data, disability identification data and claim data of human claim data is acquired, a prebuilt human injury claim risk detection modeling algorithm is utilized to carry out data processing, and false frauds and unreasonable expense item results in the claim process are discovered. The method is combined with all the characteristics of human injury claims to construct a human injury claim risk evaluation characteristicsystem, and the unified evaluation standard foundation is laid, moreover, for problems of low evaluation accuracy and incapability of guaranteeing rights of insurance companies and most of normal customers and maintaining the normal social order existing in a system in the prior art, the improved BP neural network algorithm is further constructed as a human injury claim risk evaluation model, andprediction accuracy and generalization performance are improved.

Description

technical field [0001] The invention relates to a risk detection method and system for personal injury claims data. Background technique [0002] Many criminals use insurance claims to create false traffic accidents and obtain illegal compensation; at the same time, in real traffic accidents, there are a large number of unreasonable treatment plans, excessive treatment, unreasonable medication, and unreasonable disabilities because of insurance companies’ claims. Appraisal and unreasonable compensation requirements, etc.; using traffic accidents to treat one's own original diseases also occurs from time to time; in disability accidents, it is very common for the disability appraisal materials to be falsified and the disability rating to be seriously expanded. More than 60% of the appraisal institutions participate in the appraisal materials Fraud, even more than 90% in developed coastal areas; scalpers involved in traffic accidents and personal injury cases in coastal areas ...

AI Technical Summary

Problems solved by technology

[0002] Many criminals use insurance claims to create false traffic accidents and obtain illegal compensation; at the same time, in real traffic accidents, there are a large number of unreasonable treatment plans, over-treatment, unreasonable medication, and unreasonable disabilities because of insurance companies’ claims. Appraisal and unreasonable compensation requirements, etc.; using traffic accidents to treat one's own original diseases also occurs from time to time; in disability accidents, it is very common for the disability appraisal materials to be falsified and the disability rating to be seriously expanded. More than 60% of the appraisal institutions participate in the appraisal materials Fraud, even more than 90% in developed coastal areas; 90% of scalpers involved in traffic accidents and personal injury cases in coastal areas, seriously disrupting social insurance order

With the increase of medical costs year by year, the proportion of personal injury claims of various insurance companies across the country has increased rapidly year by year, resulting in business losses

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