Solutions, Life & Health, Individual Disability

More than a medical question

Own-occ definitions, partial-disability math, K-1 reconstruction, and a claimant with the time and means to be selective about what they tell you. Owl reads the medicals end-to-end, reconstructs pre-disability earnings from external income data, and writes the own-occ analysis with citations attached.

Own-occ, stated vs. actual4-yr window
STATED
Surgical practice, 100%
2022
Surgical, 78%
2023
Surgical, 62%
Admin / consult, 31%
2024 (pre-DOL)
Surgical, 41%
Admin / consult, 49%

100% 41%

Stated own-occ vs. actual surgical revenue

+ $42K

Pre-disability earnings understated

Conf 2025-08-12

Public appearance contradicts restriction

03A real claim, walked end to end

One file: orthopedic surgeon, $384K PDE, own-occ rider on the line.

Anonymized composite. Claimant Dr. M.S., orthopedic surgeon, age 53. Filed IDI on 2025-09-02 with cognitive-impairment diagnosis. Pre-disability earnings stated $384,200 (3-year average).

Claim #
IDI-2025-0902-M
LOB
IDI, own-occ rider
Occ stated
Orthopedic surgeon, 100% surgical
DOL
2025-08-19
Reserve
$1.84M
OwlVision
What it read
Tax returns + Schedule C (3yr)
92 pp
Read, Indexed, Cited
APS + neuropsych battery
248 pp
Read, Indexed, Cited
Practice management report
64 pp
Read, Composition extracted
Occ duties (own-occ rider)
18 pp
Read, Cross-checked
Surveillance (3 days)
42 pp
Read, Contradiction flagged
Structured extraction
Pre-disability earnings $384,200 stated. K-1 reconstruction $426,400 (avg 3yr). Own-occ stated “100% surgical”. Practice mgmt report shows surgical share 78% (2022) → 41% (2024). Neuropsych supports cognitive impairment dx. Surveillance day 2 shows 11-min uninterrupted standing during golf swing, flagged
OwlSignal
What the world said about the claimant

External data only. None of this lives in your CMS. Owl gathered it from public records, professional networks, registries and the open web, then resolved it to this claimant.

INC-09
Active medical-consulting LLC

“MS Orthopedic Consulting LLC” registered 2024-01 in claimant’s state, claimant listed as sole member. Active filings in 2025-Q2. Maps to the administrative-revenue line in the practice management report and to a public bio listing “expert witness” services.

Secretary of StatePublic attorney directory listingNPPES affiliation
ACT-13
Conference appearance, 2025-08-12

Claimant gave a 45-minute keynote at an orthopedic society conference 7 days before the date of loss. Conference site lists him as a panelist on a 2025-11-03 event still scheduled. Both contradict the sworn restriction “cannot stand >15 min.”

Conference public agenda (2 events)YouTube uploaded sessionSociety program PDF
CLM-02
Prior IDI claim, separate carrier

Public regulatory filing references a prior IDI claim filed 2018-2020 with another carrier, closed without payment. Was not disclosed in the application’s prior-claim question (Q22).

State DOI complaint searchCarrier-side public filings
INC-04
Active CME teaching role

A CME provider lists claimant as faculty for two ongoing online courses, with paid honoraria publicly disclosed in the 2024-2025 disclosure period. Income not reflected in the IDI application.

CME provider public faculty listACCME disclosure filings
OwlAssist
What it answered
Examiner asked
Is the claimant’s stated material-duty composition consistent with the financial records?
Owl answered in 1.8s

No. The application states “100% surgical practice” pre-disability. K-1 schedules and the practice management report show surgical revenue declined from 78% (2022) to 41% (2024 pre-DOL). Administrative consulting income increased 4.2x in the same period. Under the policy’s own-occ rider §3.1.a, “regular occupation” is defined as the duties performed for the 12 months immediately preceding disability, which were 41% surgical, not 100%.

K-1 2022–2024Practice mgmt report p.7Statement on file 2025-09-02Policy §3.1.a
Examiner asked
Reconstruct pre-disability earnings from external sources and tell me the gap.
Owl answered in 2.2s

Reconstructed PDE $426,400 (avg 3yr). Stated PDE $384,200. Gap +$42,200 = +11%. Reconstruction sources: IRS Form 4506-T returns 2022–2024, state UI wage records, K-1 distributions from the practice partnership, and the consulting LLC pass-through. Recommend revising PDE upward: net effect on benefit calculation is +$1,760/mo at the 80% benefit rate.

IRS 4506-T 2022–2024State UI wage recordsK-1 partnership pp.4–6Consulting LLC K-1 pp.1–2
04OwlSignal external data

What the world says about your Individual Disability claimants, none of which lives in your CMS.

Internal claim data is half the picture: it tells you what the claimant told you. OwlSignal continuously gathers external data (public records, professional and corporate registries, court dockets, social and open web) and matches it back to the claimant. These are the families that move the needle on Individual Disability.

INCUnreported Income: external reconstruction

IDI economics live in the gap between stated earnings and actual earnings. We reconstruct from IRS, state UI, corporate registries and pass-through entities: the data the claimant has but didn’t hand you.

IRS Form 4506-T returnsState UI wage recordsSecretary of State filingsCME / honoraria disclosuresNPPES + provider claim history
ACTIrregular Activities: public appearances

For high-occ IDI claimants, the gold is in public appearances: conferences, panel agendas, expert-witness logs, board meetings, social posts. We resolve them to the claimant and rate them against stated restrictions.

Conference public agendasYouTube / Vimeo session uploadsExpert-witness directory listingsBoard meeting minutes (public)
NETProvider, vendor and counsel network

The treating physicians, IME vendors, neuropsychologists and plaintiff attorneys associated with this IDI claim, scored against industry-wide claim outcomes, using cross-carrier data Owl curates.

Cross-carrier provider claim outcomesState medical board sanctionsPlaintiff-bar pairing patternsIME vendor concordance scores
ADVAdverse Reports

Court dockets, license actions, malpractice filings, financial distress. The IDI-relevant ones (bankruptcy, divorce, DOI complaints) change the eligibility shape of an open IDI file.

PACER + state court docketsState medical board actionsNPDB-adjacent public recordsBankruptcy filings
CLMPrior-claim & multi-carrier ties

Prior IDI claims with other carriers, undisclosed at application. Concurrent IDI or LTD claims with another carrier. Surfaced from external claim networks and DOI complaint records.

ISO ClaimSearchState DOI complaint searchPublic regulatory filings
STATPractice-composition shifts

NPPES affiliation changes, state board renewal filings, and hospital-privilege changes: together they describe how the claimant’s actual occupation drifted in the years before the date of loss. The number that decides own-occ.

NPPES affiliation graphState medical board renewalsHospital privilege public recordsPractice-management public mentions
Refreshed daily, matched by identity-resolution, every observation cited to its source.
05What changes

Numbers from L&H carriers running Owl on Individual Disability in production.

MetricWithout OwlWith Owl
Records read end-to-end28%100%
Income reconstruction accuracy± 14%± 2.1%
Surveillance review hours11.4 hr0.6 hr
Own-occ-shift detection rate12%74%
Avg cycle on contested IDI11 mo4.2 mo
Misrep / non-disclosure surfaced6.4%17.8%
Source: rolling 12-month average across 4 IDI carriers, n = 9,800 claims.

Built for the regulatory shape of Individual Disability.

HIPAABAA executed before any PHI is processed. Minimum-necessary by default. PHI never leaves your tenant.
ERISA §503Where applicable: reasoned determinations, full file, ABD-ready.
NAIC Model #672UCSPA: every Owl-assisted decision cited and auditable.
State DOI, IDI rulesPer-state IDI-specific regulations including own-occ definitions.
Surveillance, state lawPublic-place / consent rules tracked per state.
Reg AI / NYDFSBias testing, model documentation, human-in-the-loop.
External data lawful basisOwlSignal sources are public-records or publicly-available. FCRA-aware sourcing flag on every observation.
SOC 2 Type IIAnnual audit. Report available under NDA.
07Integrations

Lives where your Individual Disability files live.

Claim systems

FINEOS, Guidewire, DCS, in-house

Financial records

IRS 4506-T, state UI wage feeds, K-1 ingest

Document intake

Box, OnBase, Documentum, ImageRight

EHR / records

Epic, Cerner, MRO, Verisma, Ciox/Datavant

Surveillance vendors

Frame-level review across all major IDI vendors

Identity & SSO

Okta, Azure AD, PingFederate, SAML

08Get started

Bring us a closed IDI own-occ file. We’ll show you what the world said about that claimant.

Two-week pilot. Your records, your tenant, your own-occ definitions. We measure income reconstruction, own-occ defensibility, and decision quality against your own ground truth.