The health insurance claim settlement ratio tells you how many claims an insurer paid out of the claims it handled. Indian buyers often use it as a quick trust score, and insurers advertise it heavily. But the number is easy to misread, and it says little about whether your own claim will be paid.
What Is the Health Insurance Claim Settlement Ratio?
The claim settlement ratio (CSR) is the share of claims an insurer settled, shown as a percentage. If an insurer pays 96 of every 100 claims it decides, its ratio is 96%.
Formulas differ across sources. Some divide settled claims by claims decided (paid plus rejected). Others divide by all claims registered, which includes pending ones. Always check which one a website uses.
| Term | Simple meaning |
|---|---|
| Settled claim | A claim the insurer paid, in full or in part |
| Repudiated claim | A claim the insurer rejected |
| Pending claim | A claim still undecided at year end |
A Simple Example
This is a made-up example, not any real insurer’s data.
An insurer receives 1,000 claims in a year. It settles 880, rejects 70, and 50 are still pending.
- Settled ÷ (settled + rejected) = 880 ÷ 950 = 92.6%
- Settled ÷ registered = 880 ÷ 1,000 = 88.0%
Same insurer, two different percentages. That is why comparing figures from different sources can mislead you.
What the Industry Data Shows
IRDAI’s annual report for 2024-25, released in December 2025, covers the whole industry. As reported by Asia Insurance Review and other outlets:
| Measure (2024-25) | Figure |
|---|---|
| Health claims handled | About 3.26 crore |
| Settled (by number) | About 87% |
| Repudiated (by number) | About 8% |
| Pending at year end | About 5% |
| Average amount paid per claim | About ₹28,910 |
| Claims settled cashless | About 58% |
Two points are worth remembering. First, by value the picture is lower. One summary of the report puts the amount paid at about 71% of the claimed amount, which suggests many claims are paid only in part. Second, I could not find an insurer-wise settlement ratio in the annual report itself. A review of the report says it gives health settlement data for the whole industry, and insurer-wise ratios come from insurers’ own public disclosures.
Insurer-Wise Health Insurance Claim Settlement Ratio (2026)
The figures below were compiled by the comparison site nyvo, which says they are IRDAI-published data and a weighted average of the last three financial years, latest available as of March 2026. I could not confirm each number against the insurers’ own filings, so treat them as a starting point and check the latest disclosure on the insurer’s website.
| Insurer | Type | Claim settlement ratio | Complaints per 10,000 claims |
|---|---|---|---|
| HDFC Ergo | General | 97.8% | 8.3 |
| Aditya Birla Health | Health-only | 96.5% | 18.2 |
| Care Health | Health-only | 96.0% | 42.9 |
| Acko | General | 95.4% | 16.8 |
| Niva Bupa | Health-only | 93.3% | 35.4 |
| Galaxy Health | Health-only | 90.0% | 25.9 |
| Star Health | Health-only | 89.3% | 53.9 |
| ICICI Lombard | General | 87.6% | 16.6 |
| IndusInd General (formerly Reliance General) | General | 87.3% | 4.4 |
HDFC Ergo and Acko
The HDFC Ergo health insurance claim settlement ratio is listed at 97.8% in this compilation, and the Acko health insurance claim settlement ratio at 95.4%. Both are general insurers, so the number covers more than health claims.
Aditya Birla, Niva Bupa and Galaxy
The Aditya Birla health insurance claim settlement ratio is listed at 96.5%, the Niva Bupa health insurance claim settlement ratio at 93.3%, and the Galaxy health insurance claim settlement ratio at 90.0%. These three are standalone health insurers. For plan details, see our review of Aditya Birla Health Insurance.
ICICI Lombard
The ICICI Lombard health insurance claim settlement ratio is listed at 87.6%, so anyone searching for the ICICI health insurance claim settlement ratio should read that figure with the general-insurer caveat above.
Reliance Is Now IndusInd General
Many people still search for the Reliance health insurance claim settlement ratio. Reliance General Insurance has been renamed IndusInd General Insurance, according to the insurer’s own website and announcement in December 2025. The comparison site lists it at 87.3%. Policies continue under the new name.
Top 5 Health Insurance Claim Settlement Ratio
A fair top 5 health insurance claim settlement ratio list needs two views, because general insurers can look better or worse than health-only ones.
| Rank | All insurers on the list | Ratio | Health-only insurers | Ratio |
|---|---|---|---|---|
| 1 | Go Digit | 99.0% | Narayana Health Insurance | 98.5% |
| 2 | Narayana Health Insurance | 98.5% | Aditya Birla Health | 96.5% |
| 3 | HDFC Ergo | 97.8% | Care Health | 96.0% |
| 4 | SBI General | 96.8% | ManipalCigna | 93.7% |
| 5 | Bajaj General | 96.6% | Niva Bupa | 93.3% |
Why a High Ratio Does Not Guarantee Your Claim
The ratio is an average across all policies and customers. It cannot see your individual terms. Here is what it leaves out.
| What the ratio hides | Why it matters |
|---|---|
| Claim size | Small claims can lift the count while large ones are contested |
| Partial payments | A claim paid in part may still count as settled |
| Group policies | Employer plans can raise an insurer’s overall figure |
| Product mix | General insurers blend motor and travel claims |
| Speed | A paid claim can still take long |
| Your policy terms | Waiting periods, room rent limits, and co-payment decide your claim |
Complaints Tell a Different Story
In the same compilation, complaints per 10,000 claims range from about 4 to about 174, a far wider spread than settlement ratios. Reading both numbers together gives a better picture than either one alone.
Settlement Ratio Is Not the Incurred Claim Ratio
The incurred claim ratio compares claims paid with premiums earned. It is a financial measure of the insurer, not a promise about your claim. Do not mix the two.
Rules That Protect Your Claim
IRDAI’s Master Circular on Health Insurance Business, dated May 29, 2024, sets several rules:
- An insurer must decide a cashless request within one hour and give final approval at discharge within three hours (reported by Business Standard).
- After 60 continuous months of cover, a claim generally cannot be contested for non-disclosure, except in proven fraud (as summarized by secondary sources).
- Pre-existing disease waiting periods are capped at 36 months (as summarized by secondary sources).
- Reimbursement claims are generally expected within 30 days of the last document, with interest for delay, according to secondary summaries. Check your policy wording and IRDAI’s notification before relying on this.
How to Compare Health Insurance Plans Properly
When you compare health insurance plans, check these items beside the claim settlement ratio:
- Complaints per 10,000 claims and recent news about the insurer
- Waiting periods for pre-existing conditions and specific illnesses
- Room rent limits and co-payment, which can cut your payout
- Network hospitals near you for cashless care
- Sub-limits on treatments like cataract or maternity
- Deductible, if the plan has one. See what a deductible in insurance means.
- Claim process and tracking, for example how to follow a claim with a TPA such as Medi Assist
Common Mistakes to Avoid
- Picking an insurer only because of the highest percentage
- Comparing a general insurer with a health-only insurer directly
- Using old figures without checking the date
- Ignoring waiting periods and exclusions in the policy wording
- Hiding existing conditions when buying, which can lead to rejection
Conclusion
The health insurance claim settlement ratio is a useful first filter, but it is not a promise. It is an average across many policies, and formulas differ between sources. Read it beside complaint data, waiting periods, room rent limits, and network hospitals, and always check the latest figure on the insurer’s own disclosure.
Frequently Asked Questions
What is a good health insurance claim settlement ratio?
There is no official cut-off. One comparison site treats 93% or more as a working bar, but that is its own choice. Compare the ratio with complaints, waiting periods, and policy terms.
Which insurer has the highest ratio?
In the compilation used here, Go Digit is highest at 99.0%, followed by Narayana Health Insurance at 98.5%. Among health-only insurers, Narayana leads. Check each insurer’s latest disclosure before you decide.
Does IRDAI publish insurer-wise ratios?
IRDAI’s 2024-25 annual report gives industry-wide health claim data. I could not find an insurer-wise settlement ratio in it, so insurer-wise figures usually come from insurers’ public disclosures.
Is the ratio the same as the incurred claim ratio?
No. The settlement ratio shows how many claims were paid. The incurred claim ratio compares claims paid with premium earned. They answer different questions.
Can a claim be rejected even with a high ratio?
Yes. The ratio is an average. Your claim depends on your policy terms, such as waiting periods, exclusions, and accurate disclosure at purchase.
