Claim Denial Rate KPI Benchmark (Life Insurance)

Claim Denial Rate KPI Benchmark (Life Insurance)

KPI Details

Claims Denial Rate measures the percentage of claims submitted by insurance policyholders that are denied. A higher than desired rate of denied claims may lead to costly disputes with claimants and may also be a lagging indicator of poor underwriting practices. While a low value is typically desired for Claim Denial Rate, an excessively low value compared to internal or external benchmarks could be an indicator of claims leakage.

KPI Definition

This chart displays the performance of each company within the observed sample for this particular metric, or Key Performance Indicator (KPI). Values are ordered based on performance; high performers on the far left, to low on the far right side of the chart.

KPI Calculation Instructions Claim Denial Rate KPI Benchmark (Life Insurance)?

Two numbers are used to calculate this KPI: (1) the number of reviewed claims that are denied payment, and (2) the total number of claims adjudicated over the same time period. A claim denial should be considered as any instance in which the company does not pay out a claim that is requested by an individual. The denominator should include all claims submitted to the company. Do not include NIGO claim submissions that were denied for missing or inaccurate data in the numerator of this calculation.

KPI Formula :

(Number of Life Insurance Claim Denials / Total Number of Life Insurance Claims Adjudicated)