The Claim Settlement Ratio (CSR) is a vital metric for choosing an insurance provider as it informs buyers how likely an insurer is to honour claims when you make one. It simply measures the percentage of claims an insurer successfully pays out of the total claims received.
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Feb20 th, 2026 - Time 11.45Hrs
IRDAI’s latest FY 2024–25 data shows top general and health insurers such as Niva Bupa, ACKO, Aditya Birla, and Galaxy have reported high claim settlement percentages based on IRDAI’s published figures.
Using this ratio, consumers can identify which providers are efficient when it comes to the insurance claim process and have reliable claim assistance during times of need.
What is the Claim Settlement Ratio?
The claim settlement ratio is the percentage of claims an insurance company settles compared to the number of claims it receives over a certain period of time. If an insurance company has a 95% claim ratio, it means that 95 out of every 100 claims were resolved and paid. However, it does not relate to the value of those claims but rather the quantity of claims that were resolved and paid.
Mathematically:nClaim Settlement Ratio = (Total claims settled / Total claims received) x 100
A higher ratio generally suggests higher performance in rewarding valid claims under the medical claim reimbursement process.
Latest IRDAI Claim Settlement Ratio Data – % of Claims Settled Within 3 Months (FY 2024–25)
As per IRDAI’s official data released in February 2026, the figures below represent the percentage of claims settled within 3 months during FY 2024–25 for general and health insurers.
| Insurer Category | % of Claims Settled Within 3 Months |
| Niva Bupa Health Insurance Co. Ltd. | 100% |
| Galaxy Health Insurance Co. Ltd. | 100% |
| Narayana Health Insurance Co. Ltd. | 100% |
| Tata AIG General Insurance Co. Ltd. | 94.14% |
| Acko General Insurance Ltd. | 99.98% |
| Care Health Insurance Ltd. | 99.95% |
| ManipalCigna Health Insurance Co. Ltd. | 99.88% |
| Star Health and Allied Insurance Co. Ltd. | 99.81% |
| Zuno General Insurance Co. Ltd. | 98.13% |
| United India Insurance Co. Ltd. (Public Sector) | 95.26% |
| The New India Assurance Co. Ltd. | 91.75% |
| National Insurance Co. Ltd. | 91.79% |
| The Oriental Insurance Co. Ltd. | 90.17% |
Note: The above list highlights select general and health insurers based on IRDAI’s published data.
Why CSR Matters for Policyholders
Selecting a health insurance plan involves much more than what premiums will be paid to get medical care. The claim settlement ratio of an insurance plan could make a difference in whether or not your claim experience is good. The reason is:
- Measures Trustworthiness
A higher insurance claim settlement ratio may indicate an insurer has settled the majority of its valid claims, increasing trust.
- Demonstrates Operational Effectiveness
A high claim settlement ratio typically indicates that the health insurance claim process is efficient.
- Results in a More Satisfying Policyholder Experience
An insurer that can settle claims quickly is generally less stressful to deal with when applying for medical claim reimbursement during emergencies.
Things to Keep in Mind When Evaluating Claim Settlement Ratios
- CSR isn’t Everything: A high settlement ratio doesn’t guarantee zero disputes. Claim approval depends on policy terms, documentation accuracy, waiting periods, and exclusions.
- Check Incurred Claim Ratio (ICR): The percentage of claim amounts paid against premiums collected offers another perspective on how insurers manage claim payouts.
- Customer Experience Matters: Turnaround time, transparency in claim settlement, and customer service support are practical factors beyond ratios that influence overall satisfaction.
Health Insurance Claim Process Overview
When you know about the health insurance claims process, you will also know what to do before you file a claim. There are two methods to file a claim as follows:
- Cashless Claim Procedure
- Reimbursement Claim Procedure
For both methods, it is critical to have accurate documentation to support your claim and comply with your insurance company’s requirements so that your claim will be accepted.
Conclusion
The health insurance claim settlement ratio is one of the strongest first steps when evaluating which insurance companies are reliable. Data from the Insurance Regulatory and Development Authority of India (IRDAI) has shown that many insurance companies have achieved extremely high CSRs. Thus, increasing consumers’ confidence in the medical insurance claims process and reimbursement experience.
As such, it is always important to look at CSR in conjunction with all other policy features, the strength of hospitals in-network, and overall service quality when selecting the best medical coverage for your needs.
