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.

This metric has been updated.

Please click here to see the most up-to-date version and refer to Metric History for details on the changes.

Calculation:

$\frac{\href{/metric/4.0/PI3383}{\text{Claims Rejected (PI3383)}}}{\href{/metric/4.0/PI8018}{\text{Claims Submitted (PI8018)}}}$

Reporting Format Decimal
Metric Type Metric
Metric Level Product/Service, Organization
IRIS Metric Citation IRIS, 2021. Claims Rejection Ratio (PI7902). v5.2.

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/).

Impact Categories & Themes

SDG Goals & Targets

Metric History

April 2021 - IRIS+ v5.2 Released

No change.
December 2019 - IRIS+ v5.1 Released

No change.
April 2019 - IRIS+ v5.0 Released

No change.
February 2016 - IRIS+ v4.0 Released

Immaterial change. Minor revision to definition language for clarity.
February 2014 - IRIS+ v3.0 Released

Immaterial change. Minor revision to definition language for clarity.
October 2011 - IRIS+ v2.2 Released

New metric. Claims Rejection Ratio (PI7902) developed via IRIS Taxonomy Development Group.