Once a year, ask your insurer (or broker) for the scheme's claims experience: total claims paid against premium, claim counts by category, and utilisation of benefits like the digital GP. It's anonymised — you see patterns, never identities. Use it three ways: target wellbeing spend at what's actually claiming (MSK and mental health drive 41% of long-term absence between them), challenge your renewal price, and drop benefits nobody uses.
- ✓Insurers report anonymised patterns — claim types, spend, utilisation — never who claimed for what.
- ✓MSK and mental health claim patterns point directly at wellbeing actions that pay back.
- ✓A claims ratio below your premium is renewal-negotiation ammunition; bring it in writing.
What insurers will actually give you
Every group scheme generates a claims experience report, and for mid-sized schemes your insurer or broker will typically provide one annually — usually in the run-up to renewal. Expect some or all of: total claims paid vs premium (the claims ratio, or loss ratio), claim counts and spend by category (musculoskeletal, mental health, cancer, cardiac, diagnostics and so on), in-patient vs out-patient split, and utilisation figures for services like the digital GP, physio pathways or an attached EAP.
If you've never seen a report, just ask — it's your scheme's data and a routine request. Brokers will usually obtain and interpret it as part of their service. For very small schemes the insurer may only share limited or banded information, for reasons we'll come to.
Reading the patterns: MSK, mental health and what they're telling you
The two categories that dominate most schemes' claims are the same two that dominate national absence: musculoskeletal problems and mental health, which together account for the majority of long-term sickness absence (mental ill health alone is 41%). Your scheme's split between them is a diagnostic of your workplace, and each pattern has actions attached:
- MSK-heavy claims. Backs, necks, shoulders and knees suggest desk-setup and manual-handling issues. Actions: workstation assessments, equipment budget, promoting the scheme's physio pathway earlier so niggles are treated before they become surgery-sized claims.
- Mental-health-heavy claims. Rising therapy and psychiatry claims are a signal about workload, management or a tough year. Actions: manager training, workload review, promoting the EAP so the £2-a-head layer catches what's currently arriving as insurance claims — see our workplace mental health strategy guide.
- Low digital GP or EAP utilisation. Usually a communication failure, not a demand failure. Re-launch the benefit; utilisation is the cheapest number on the report to improve.
- One or two very large claims. Usually noise, not signal — a single cancer claim says nothing about your workplace. Don't build strategy on it, and don't let an insurer price your renewal as if it's a trend.
The point of this reading is that wellbeing budgets are usually spent on guesswork. Claims data replaces the guesswork: it's a ranked list of what your workforce's bodies and minds are actually costing, and therefore of where prevention pays.
Turning the data into renewal ammunition
The second use of the report is money. Group renewal pricing leans heavily on your claims experience, and an informed employer negotiates very differently from one who just receives the renewal letter. The core number is the claims ratio — claims paid as a share of premium. If your scheme paid £20,000 in premium and claimed £9,000, a steep percentage increase deserves a written challenge; you're a profitable scheme and the market will happily quote to prove it.
| What the data shows | What to do at renewal |
|---|---|
| Claims ratio well below premium | Challenge any big increase in writing; tender the market with your data |
| Ratio inflated by one large claim | Argue it's non-recurring — one claim is not a trend |
| Persistently high claims category | Consider excess or benefit-design changes targeting that category, plus prevention |
| Unused benefits (low utilisation) | Trim options nobody uses, or trade them for cover people want |
| No data provided at all | Ask; if refused, that's a point for the tender — and for using a broker |
Bring the report, not vibes: "our claims ratio was 45% and you've quoted +18%" is a negotiation; "that seems like a lot" isn't. A good broker runs exactly this argument for you and knows each insurer's appetite — our renewal negotiation checklist sets out the full sequence and timeline.
Take your claims data to market
Small-scheme honesty, and the annual checklist
Now the honest caveat: below roughly 20–30 employees, claims data is statistically thin. One employee's surgery can double your claims ratio; a quiet year proves nothing either. Insurers know this — small schemes are largely priced on pooled book-wide experience rather than your own — and they may share only limited data, partly because in a five-person firm even "one mental health claim" narrows identities uncomfortably. Use small-scheme data for benefit-utilisation checks and gentle signals, not statistical conclusions, and expect your renewal to move with the insurer's book more than with your claims.
- Request the report 6–8 weeks before renewal (or ask your broker to).
- Check the claims ratio against premium, flagging any single large claim distorting it.
- Rank claim categories and compare with last year — what's growing?
- Check utilisation of digital GP, physio pathways and EAP; re-communicate anything under-used.
- Pick one wellbeing action the data supports — workstation audit, manager training, physio promotion.
- Write the renewal case — ratio, trend, actions taken — and put it to the insurer or tender.
An hour a year, in other words. Pair it with our benefit utilisation guide to fix the usage side, and absence management guide to connect claims patterns to your absence records — the two datasets explain each other.
Frequently asked questions
What claims data will my health insurer share with my business?
Typically an annual anonymised claims experience report: total claims paid versus premium (the claims ratio), claim counts and spend by category such as MSK and mental health, in-patient/out-patient split, and utilisation of services like the digital GP. You see aggregated patterns — never which employee claimed for what.
Can my employer's insurer tell us which employees made claims?
No — claims reports are anonymised and aggregated, and insurers won't identify claimants to the employer. Medical confidentiality survives the corporate policy. Employers shouldn't try to infer identities either, and telling staff the data is anonymous is worth doing: people claim more readily when they trust the confidentiality.
How do I get a claims report for our group health scheme?
Ask your insurer's account team or your broker — it's a routine request, usually fulfilled in the weeks before renewal. Brokers typically obtain and interpret the report as part of their service. Very small schemes may receive limited or banded data because small numbers risk identifying individuals.
What is a claims ratio on a business health scheme?
Claims paid as a percentage of premium: a scheme paying £20,000 in premium with £9,000 of claims ran a 45% ratio. It's the single number renewal pricing leans on most — a low ratio is your case against a big increase, while a ratio over 100% means an increase is likely coming regardless of negotiation.
How can claims data reduce our renewal increase?
By replacing vibes with evidence. A written case — claims ratio, whether a single large claim distorts it, the prevention actions you've taken — either wins a better renewal from the incumbent or arms a market tender that does. Insurers price uncertainty pessimistically; documented data removes uncertainty.
What do lots of musculoskeletal claims on our scheme mean?
Usually that desks, manual handling or activity patterns are generating back, neck, shoulder and knee problems — MSK is one of the two biggest claim drivers nationally. The paybacks: workstation assessments, equipment fixes, and promoting your scheme's physio pathway early so niggles get treated before they become surgical claims.
What should we do if mental health claims on our scheme are rising?
Treat it as a signal, not just an insurance cost. Rising therapy and psychiatry claims point at workload, management or a hard year — respond with manager training and an EAP promoted well enough that early counselling catches problems before they become clinical claims. Mental ill health drives 41% of long-term absence, so this pattern deserves the fastest response.
Is claims data meaningful for a small scheme of five or ten employees?
Only loosely, and honesty matters here: one operation can double a small scheme's claims ratio, so a single year proves little, and insurers price small schemes mostly on their pooled book anyway. Use small-scheme data for utilisation checks and persistent multi-year patterns — not for redesigning benefits after one noisy year.
How often should we review our scheme's claims data?
Annually, timed 6–8 weeks before renewal so the findings feed straight into negotiation — plus a mid-year glance at utilisation figures if your insurer's portal offers them. The annual pass takes about an hour: check the ratio, rank the categories, check utilisation, pick one wellbeing action, write the renewal case.
Does low utilisation of the digital GP or EAP matter?
Yes — it usually means employees have forgotten these benefits exist, so you're paying for value nobody collects and losing the early-intervention effect that keeps bigger claims down. Utilisation is the easiest metric to improve: re-launch the benefit, mention it in onboarding and after absences, and repeat a couple of times a year.