Metrics like lawsuit rates are often used within the industry to assess the quality of services or products. After all, these rates indicate how many legal proceedings an insurer had to initiate against its customers. However, the actual informative value of such metrics for service quality is disputed.
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Interpreting Lawsuit Rates: A Nuanced View
While high lawsuit rates can indeed point to a litigation-prone practice and low rates might suggest good customer service, not every lawsuit initiated by an insurer should be viewed negatively. Legal actions are also taken for the benefit of the collective policyholders—for example, to defend against unjustified claims. Justified claim denials also frequently lead to lawsuits.
Nevertheless, this data appears sensitive for the industry. Many private health insurance (PKV) companies remain tight-lipped and do not want their rates publicized. This context is crucial when reviewing the figures from the eleven companies presented below. While some rates are higher (and thus "worse") than others, all the data comes from those few PKV insurers who already distinguish themselves through their transparency.
The Data Source and Its Limitations
Thirty companies were contacted for the new PKV rating in the MAP Report (Number 927); only eleven were willing to provide their lawsuit rates. For this reason, it is impossible to assess what the average lawsuit rate for the entire PKV industry truly is. Instead, this only provides a picture of transparent PKV companies. Also note: The following presents average values for the years 2017 to 2021.
The 2023 Ranking of Transparent PKV Insurers
Here is the ranking based on the average number of lawsuits per 100,000 policyholders. Remember, a lower number is generally better, but context is key.
| Rank | PKV Insurer | Avg. Lawsuits per 100,000 Policyholders | Approx. Annual Lawsuits | Total PKV Policyholders |
|---|---|---|---|---|
| 1 | VGH Provinzial | 2.10 | 3 | 168,971 |
| 2 | Württembergische | 2.72 | 12 | 440,626 |
| 3 | R+V | 4.40 | 52 | 1,178,020 |
| 4 | Barmenia | 6.00 | 84 | 1,397,197 |
| 5 | Debeka | 6.70 | 283 | 4,219,488 |
| 6 | Concordia | 9.38 | 11 | 115,109 |
| 7 | Allianz | 12.05 | 327 | 2,710,965 |
| 8 | SDK | 14.06 | 89 | 634,445 |
| 9 | LVM | 14.96 | 58 | 384,988 |
| 10 | Signal Iduna | 16.20 | 409 | 2,525,349 |
| 11 | Alte Oldenburger | 21.75 | 35 | 159,998 |
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Important Context for the Ranking
The insurers presented may have unfavorable lawsuit rates, especially compared to the top performers. However, it should be remembered: These companies already distinguish themselves by publishing their rates. On one hand, it cannot be ruled out that other PKV companies have even worse rates. On the other hand, these companies handle their data transparently.
It should also be noted that small policyholder portfolios can produce outliers in the rates, as even a few additional lawsuits can have a large impact on the calculated ratio. This applies especially to Alte Oldenburger, which is among the smaller PKV insurers. With these caveats, ranks nine through eleven are presented.
Why This Data Matters for Your Insurance Choice
While not a definitive measure of quality, lawsuit rate transparency is a positive indicator. When choosing a private health insurance provider, consider this data alongside other crucial factors:
- Customer Service Ratings: Look for independent reviews and customer satisfaction surveys.
- Financial Stability: Ensure the insurer has strong financial ratings (e.g., from Assekurata or similar agencies).
- Coverage and Tariffs: The most important factor is whether the plan's benefits and exclusions meet your specific health needs and budget.
- Claims Processing: Research how efficiently and fairly the company handles claims.
An insurer with a slightly higher lawsuit rate but excellent coverage, financial strength, and overall service may be a better choice than one with a low lawsuit rate but poor benefits.
A US Comparison: Measuring Insurer Performance
American consumers also seek metrics to evaluate health insurance companies. While "lawsuit rates" are not commonly published, other transparency tools exist:
- NAIC Complaint Index: The National Association of Insurance Commissioners publishes a complaint index showing how many complaints a company receives relative to its market size.
- Medicare Star Ratings: For Medicare Advantage and Part D plans, CMS Star Ratings incorporate customer service measures, including complaints.
- State Department of Insurance Reports: Many state regulators publish data on market conduct examinations and consumer complaints.
The German MAP Report's focus on lawsuit rates highlights a unique, albeit imperfect, transparency effort. In both markets, the lesson is clear: informed consumers should look beyond premiums and seek out data on company behavior, customer treatment, and transparency. Consulting with an independent insurance advisor or broker can help you weigh all these factors to find the best PKV plan or US health insurance option for your situation.
Background: Once a year, the traditional MAP Report compiles facts and key figures from PKV sub-ratings into a large overall rating of PKV companies. The sub-areas relate to service, contract, and balance sheet indicators. The current "Rating Private Krankenversicherung" bears the number 927 and can be ordered for a fee. In addition to rating results and a description of the evaluation methodology, the experts again make a multitude of important key figures on private health insurance accessible.
Insurers and brokers are struggling in claims management with high backlogs, increasing claim frequencies, a shortage of skilled workers, and growing customer expectations. Manual processes are expensive and slow.