Traditional measurements of disability claims success – such as cases closed, keystrokes, and return-to-work percentages – are being surpassed by metrics that take into account increasing case complexity and a focus on quality, sustainable results.
On a snowy afternoon, two motorists are injured in separate car accidents. The different paths their disability claims take underscore the challenge faced by insurance executives: What metrics best measure disability claims success today?
On the surface, the two motorists’ disability claims appear nearly identical. Both are injured, both are unable to work, and both are seeking support from their insurance carrier. But as their cases unfold, the differences become stark.
The first claimant suffers a fractured wrist. An X-ray confirms the injury, and the treatment plan is straightforward – a cast and six weeks of recovery. The claims examiner reviews the records, verifies eligibility, and approves short-term disability benefits. The claimant returns to work as expected, and the claim closes quickly. During the week this claim landed on her desk, the examiner approved 20 other similar, straightforward cases.
The second claimant also suffers a fractured wrist. He develops chronic pain that prevents him from coaching winter workouts for his son’s baseball team. He is forced to withdraw from his pickleball league, and his sleep is frequently disrupted by pain. Depression sets in. The claims examiner sifts through hundreds of pages of medical data from multiple specialists – orthopedic, pain management, and mental health. The records are extensive and sometimes conflicting. The examiner must coordinate with clinical and vocational experts, assessing whether the claimant can perform any occupation. Independent medical exams and legal consultations follow. During the week this case hits her desk, the examiner works on few other cases. Ultimately, the claim closes with no appeal or lawsuit and, more importantly to the claimant, he is able to coach his son’s baseball team that summer.
Both examiners have performed a valuable service for their companies. But which was more valuable to the insurer?
The answer varies among insurance executives. Some would give greater weight to the first examiner’s volume of closed cases. Others would say the second examiner’s successful handling of one complicated case provides nearly immeasurable business value.
The issue of how to measure success in modern-day disability claims was one of several addressed during a roundtable at the 2025 International Claims Association (ICA) Annual Education Conference. The goal of this roundtable, which featured the authors of this article, was to help move the industry closer to a best practices model. This article examines some of those best practices.
The COVID-19 pandemic ignited the smoldering embers of a hot topic in disability claims management: What exactly does success look like?
Return-to-work rate, which had long been the gold standard for disability claims departments, was proving less than ideal. Getting someone back to work did not necessarily reflect a quality decision – and sometimes did not prove sustainable.
With examiners suddenly working from home and away from supervisory eyes, some companies turned to keystroke monitors to judge productivity. This proved insufficient. Because disability claims involve so much analysis and investigation, the number of keystrokes did not accurately reflect the work being accomplished.
Measuring productivity by volume was also ineffective. The sheer number of decisions made did not accurately reflect the growing complexity of disability claims, which today include more information from more sources than ever before.
In short, the old ways to measure success were insufficient. Claims had grown more complex, with mental health and layered medical issues requiring specialized handling. That meant caseload counts and keystrokes were no longer reliable measures. Increased remote work and new technology further exposed those flaws.
Forward-thinking claims departments are adding increasing consideration to a more sophisticated set of metrics that focus on outcomes, quality, and continuous improvement.
More departments are segmenting their examiners to handle specific tasks such as financial calculations, change in definition decisions, and management of the permanently disabled claim block. Such specialization drives efficiency and expertise without increasing costs. Beyond that, the real gains are seen in higher-quality decisions based on deeper knowledge.
Quality, not quantity, is becoming the modern metric for success. Departments are embedding quality assurance into their workflows, with auditors who understand the nuances of disability adjudication.
In this model, the expectation for a certain number of decisions per week or month is replaced by an expectation for meaningful decisions that stand up to scrutiny.
Increasingly, disability claims departments are incorporating behavioral science into their workflows and empowering their teams to collaborate with claimants to discover their motivations and barriers. The true measure is not the answer to “Are you still disabled?” but rather lies in the more meaningful question: “What is it that you did before this claim occurred that you want to do again?” Building this type of rapport takes time, but as RGA research has shown, it is time well spent to help more efficiently and effectively address the return-to-work question.1
When looking to modernize disability claims metrics, consider the following options:
A claims examiner can build a successful career by efficiently processing 100 straightforward claims. Higher value lies in expertly managing the complex cases that require deep analysis and compassion. Success is not just about volume. It is about making a difference where it matters most, for both the company and the claimant.
To promote that environment, insurance executives should consider updating the success metrics for their examiners and departments. The most effective method is to work with a neutral third party who can review existing metrics and workflows before recommending new ones that more accurately reflect the department’s true success story.
Contact RGA today to learn how to incorporate behavioral science insights into your disability claims department and to explore other avenues to modernize your workflows.
