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DownloadTip: Compare count-based and value-based ratios. If value is significantly lower, large claims are being rejected at higher rates.
CSR (Count) = (Claims Settled / Total Claims Received) x 100
CSR (Value) = (Claims Settled Amount / Total Claims Amount) x 100
Example: 9,500 settled out of 10,000 = 95.0% CSR. Rs 80 Cr settled out of Rs 90 Cr claimed = 88.9% value CSR.
Life Insurance Death Claims:
Health Insurance:
General Insurance:
Source: IRDAI Annual Report 2023-24.
1. Aggregator Visibility: PolicyBazaar displays ratios next to quotes. 95%+ products convert better even at 10-15% higher prices.
2. SEO Traffic: “Best health insurance India” and “highest claim settlement ratio” are high-volume queries. Claims comparison content captures massive organic traffic.
3. Renewal Economics: Positive claims experience drives 85-95% renewal vs 30-50% for negative. Claims experience is the biggest LTV driver.
4. Referral Engine: One rejected claim generates 10-15 negative reviews. Smooth settlements drive referrals. Claims experience IS the marketing.
Quick Wins (1-3 months):
Structural (3-12 months):
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FAQs about Claims Settlement Ratio
CSR is the percentage of claims an insurer settles out of total claims received. A 95% CSR means 95 out of 100 claims were paid. IRDAI publishes this for every registered insurer annually.
Life: LIC at 98.6%. Private life: Max Life (99.5%), HDFC Life (99.1%), ICICI Pru (98.5%). Health: Star Health and New India Assurance lead their segments.
Non-disclosure of pre-existing conditions, policy exclusions, lapsed policies, incomplete documentation, claims outside coverage period, and fraud. Over 60% of rejections are preventable with better point-of-sale communication.
Count-based = number settled / received. Value-based = amount settled / claimed. An insurer could show 95% count but 80% value if they settle small claims but reject large ones. Both together reveal the full picture.
PolicyBazaar and other aggregators display ratios prominently. High-ratio products convert significantly better. Recommending high-CSR products builds trust, reduces complaints, and improves renewal rates.
No. Also check: settlement time, IRDAI complaint ratio, solvency ratio (financial strength), persistency ratio for life insurance, incurred claims ratio (value), and customer reviews.
Improve point-of-sale disclosure, implement AI claims triage for faster processing, reduce documentation burden, train agents on policy terms, create pre-claim assistance, and audit rejections for fairness. Most rejections are process failures.
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