Latest claim settlement ratio of health and general insurance companies released by IRDA in 2025, ET BFSI
In at the moment’s day and age, it is extremely difficult to bear the medical bills with out having a stable health insurance coverage in place if the invoice is on the upper facet. You get medical health insurance and pay common premiums in order that at any time when such a medical emergency or want arises in your loved ones, your well being insurer steps in and gives the much-needed monetary help. General insurance corporations additionally supply medical health insurance protection, whereas in addition they supply protection in your automobiles, dwelling, journey, and many others.
However how are you going to decide the effectiveness of your well being or basic insurer in the case of settling your claims on time? How are you going to discover out in case your well being or basic insurer is honest in the case of declare payouts or has a monitor document of delaying or denying declare funds? In any case, having a medical health insurance coverage wouldn’t be of a lot assist in case your insurer doesn’t honor your claims adequately, ideally within the shortest attainable time, i.e., in lower than 30 days.
Therefore, checking the claim settlement ratio, significantly inside 30 days of your declare intimation, of your basic or well being insurer is an effective approach to monitor this. Insurance coverage regulator IRDAI (Insurance coverage Regulatory and Growth Authority of India) releases a listing of declare settlements performed by all well being and basic insurers yearly, and it has launched the most recent information in 2025.
Verify the most recent well being and basic insurance coverage claims settlement ratio of well being and basic insurers in 2025
Declare settlement ratio refers back to the proportion or proportion of the variety of claims that an insurer pays, out of the overall variety of claims that it receives throughout a sure interval. So, say a well being insurer has a declare settlement ratio of 93%; it implies that it sometimes pays solely round 93 of each 100 claims it receives.Nonetheless, observe that whereas checking the declare settlement ratio is important, this could not type the only foundation of finalising your well being or basic insurance coverage firm. Have in mind the sum insured, the ready interval for varied diseases, and the community of hospitals supplied whereas taking a medical health insurance coverage.
STATUS OF CLAIMS OF GENERAL AND HEALTH INSURERS 2023-2024
Supply: IRDAI Handbook of Indian Insurance coverage Statistics, 2023-2024
# Demerger of basic insurance coverage enterprise of Bharti AXA Normal Insurance coverage Co.Ltd. to ICICI Lombard Normal Insurance coverage Co.Ltd. w.e.f April 01, 2021.
$ Previously referred to as Edelweiss Normal Insurance coverage Firm Restricted Notably, this 12 months, IRDAI has not given proportion information individually for claims settled by stand-alone well being insurers in lower than 30 days. Our mail to IRDAI in search of this information remained unanswered on the time of publishing this story.
To calculate the overall variety of claims on which the stand-alone well being insurers took motion throughout the 12 months FY2023-24, we added the claims excellent initially of the interval (A) and the claims that have been intimated/booked by the insurance coverage firm throughout the interval (B). From this determine, we subtracted all of the claims excellent with the insurer on the finish of the interval (D)
Therefore, the overall variety of claims on which a stand-alone medical health insurance firm took motion throughout the 12 months equals A+B-D.
This determine (A+B-D) was then divided by absolutely the variety of claims paid in lower than 30 days by the respective stand-alone well being insurer (F) and multiplied by 100 to reach on the closing determine.
Therefore, A+B-D/F X 100 = % of claims settled by stand-alone well being insurers in lower than 30 days.
Amongst all private general insurers, Acko Normal Insurance coverage took the lead with 99.91% claims paid inside 30 days in 2023-24. Navi Normal Insurance coverage Ltd additionally had a ratio of 99.97% for claims settled inside 30 days.
Amongst personal sector insurers, Zuno General Insurance Co. Ltd. (previously referred to as Edelweiss Normal Insurance coverage Firm Restricted) emerged with the bottom declare settlement ratio (paid out inside 30 days) of 83.12%. Amidst public insurers, The Oriental Insurance coverage Co. Ltd. was solely capable of settle 65.08% of its declare in a span of lower than 30 days.
Total, throughout 2023-24, basic insurers paid out a complete of 71,200,854 as claims throughout FY2023-24. Insurers (each private and non-private) paid out round 81.13% of complete claims inside 30 days of declare intimation, whereas 16.3% of the overall claims have been paid out between 3-6 months.
As for stand-alone well being insurers, Aditya Birla Health Insurance Firm had the best declare settlement ratio inside 30 days at 92.97%. It was adopted by Care Health Insurance with 92.77% and Niva Bupa Well being Insurance coverage with 92.02%.
Whereas Star Well being and Allied Insurance coverage Co. Ltd. had the bottom declare settlement ratio inside 30 days among the many standalone well being insurers, it paid out essentially the most claims (16,80,171) inside 30 days in FY2023-24. When it comes to variety of claims, it was adopted by Aditya Birla Well being Insurance coverage, which settled 12,24,376 claims in lower than 30 days.
