Claims Repudiation Rate
Percentage of submitted claims declined or denied by the insurer
What is Claims Repudiation Rate?
Claims repudiation rate is the percentage of submitted claims that an insurer declines. It shows how often claims are refused.
The rate has to be watched carefully: too high can signal unfair handling or unclear policies, while too low may mean weak checks.
How this KPI is measured
- Function
- Operations & Supply Chain
- Sub-function
- Claims Management
- Industry
- Insurance
- Type
- Lagging
- Impact
- Quality
- Unit
- %
- Measurement frequency
- Monthly
- Formula
- (Claims declined / Total claims submitted) × 100
How to calculate it
Divide claims declined by total claims submitted, and multiply by 100.
For example, if 1,000 claims were submitted and 80 were declined, the rate is 8%.
Record the reasons for declining, such as exclusions or fraud, and look at how many decisions are later reversed on complaint or appeal.
Where it is used
Monitoring fairness
Check decisions are consistent.
Improving policy clarity
Find confusing terms.
Managing fraud
Balance checks and speed.
How to improve it
Tips and common mistakes
- Customers and regulators expect fair outcomes, not just a low rate.
- Look at complaints upheld.
- Do not set targets that encourage declining claims.
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