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Claims Rejection Ratio (PI7902)

Percentage of claims made by clients of the organization that were rejected during the reporting period relative to the total claims submitted to the organization during the reporting period.
Calculation:
Reporting format
Decimal
Metric type
Flow
Metric level
Product/Service, Organization
IRIS metric citation
IRIS, 2016. Claims Rejection Ratio (PI7902). v4.0.

Footnote

Organizations should footnote all assumptions used.

Usage Guidance

  • This metric is applicable to organizations in the insurance industry and can be used to examine the proportion of claims that were disqualified for benefit payment (rejected) for whatever reason. As an example, a 10 percent claims rejection ratio means that for every 100 claims reported, 90 result in a benefit payment while the other 10 are denied.
  • For more detail on the ratio and for guidance on interpretation, see the Microinsurance Network's Social Performance Indicators for Microinsurance, p. 25 (http://www.microfact.org/social-performance/).