# Health Insurance Claim Settlement Ratio by Insurer (2026)

> FY 2024-25 health claim settlement ratios for 22 Indian insurers, computed from IRDAI data and insurer NL-37 filings, with complaints and ICR.
- **Published**: 2026-08-16
- **Modified**: 2026-10-18
- **Category**: health-insurance
- **URL**: https://www.tldr.money/articles/health-insurance/top-claim-settlement-ratio-companies

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Use this with the full [health insurance in India](/health-insurance) guide and the [all health insurance companies](/health-insurance/insurers) page. Every number below comes from an IRDAI publication or the insurer's own statutory filing, linked in the sources.

## What claim settlement ratio measures

Claim settlement ratio (CSR) is the share of claims an insurer paid out of the claims it had to decide in a year. We compute it the same way for every insurer, by number of claims:

**CSR = claims paid / (outstanding at start + reported − closed without payment − outstanding at end)**

A high, stable CSR is a sensible first filter. It does not tell you how much of each bill was paid, how fast, or how disputes were handled, so read it with the complaint and amount figures further down.

## Health claim settlement ratio by insurer, FY 2024-25

| Insurer | Type | Claims settled, FY 2024-25 | Repudiated | 3-year average | Health ICR FY 2024-25 | Complaints per 10k claims* | Source |
|---|---|---|---|---|---|---|---|
| [Digit](/health-insurance/digit) | Private general | 98.90% | 1.10% | - | 90.1% | 24.2 | Form NL-37 |
| [New India Assurance](/health-insurance/new-india-assurance) | Public sector | 98.38% | 1.62% | - | 101.3% | 6.2 | Form NL-37 |
| [HDFC Ergo](/health-insurance/hdfc-ergo) | Private general | 97.47% | 2.53% | - | 87.0% | 22.6 | Form NL-37 |
| [Bajaj General](/health-insurance/bajaj-general) | Private general | 97.39% | 2.61% | - | 90.0% | 5.6 | Form NL-37 |
| [Care Health](/health-insurance/care-health) | Standalone health | 96.85% | 3.15% | 93.38% | 65.1% | 69.2 | IRDAI Table 53 |
| [Aditya Birla](/health-insurance/aditya-birla) | Standalone health | 95.94% | 4.06% | 95.85% | 76.0% | 22.1 | IRDAI Table 53 |
| [ACKO](/health-insurance/acko) | Private general | 95.61% | 4.39% | - | 58.5% | 33.5 | Form NL-37 |
| [National Insurance](/health-insurance/national-insurance) | Public sector | 93.91% | 6.09% | - | 95.8% | 47.7 | Form NL-37 |
| [Manipal Cigna](/health-insurance/manipal-cigna) | Standalone health | 93.71% | 6.29% | 90.88% | 73.3% | 41.8 | IRDAI Table 53 |
| [Niva Bupa](/health-insurance/niva-bupa) | Standalone health | 92.55% | 7.45% | 91.74% | 61.6% | 77.8 | IRDAI Table 53 |
| [Tata AIG](/health-insurance/tata-aig) | Private general | 88.36% | 11.64% | - | 80.7% | 15.5 | Form NL-37 |
| [IndusInd General](/health-insurance/reliance) | Private general | 87.45% | 12.55% | - | 97.1% | 7.9 | Form NL-37 |
| [Star Health](/health-insurance/star-health) | Standalone health | 86.42% | 13.58% | 84.06% | 70.5% | 86.5 | IRDAI Table 53 |
| [IFFCO Tokio](/health-insurance/iffco-tokio) | Private general | 86.28% | 13.72% | - | 85.3% | 46.2 | Form NL-37 |
| [ICICI Lombard](/health-insurance/icici-lombard) | Private general | 85.43% | 14.57% | - | 85.5% | 23.8 | Form NL-37 |

\* Complaints reported to the insurer in FY 2024-25 (IRDAI Handbook Table 56) per 10,000 claims intimated (Table 53). Both tables cover **all lines of business**, so for general insurers this includes motor and other complaints. Our benchmarks are under 20 for general insurers and under 40 for standalone health insurers.

How to read the table:

- **Standalone health insurers** (Care, Aditya Birla, Manipal Cigna, Niva Bupa, Star) come from IRDAI's Handbook Table 53, which covers their whole book, including personal accident and travel. Three years are available, so we show a three-year average too.
- **General insurers** come from the Health column of their own Form NL-37, which excludes personal accident and travel. We have verified FY 2024-25 only.
- **New India Assurance** handled over 1.15 crore health claims, most of them group and government-scheme claims, so its ratio says little about a retail policy.
- **Galaxy Health** and **Narayana Health** settled 50 and 11 claims respectively in FY 2024-25. That is too few to compare, so we leave them out of the ranking.

### Insurers without a verified ratio yet

| Insurer | Type | Why no settlement ratio yet | Health ICR FY 2024-25 | Complaints per 10k claims* |
|---|---|---|---|---|
| [Oriental Insurance](/health-insurance/oriental-insurance) | Public sector | NL-37 not retrievable | 103.8% | 29.6 |
| [United India](/health-insurance/united-india) | Public sector | NL-37 not retrievable | 100.1% | 25.7 |
| [Navi](/health-insurance/navi) | Private general | NL-37 not retrievable | 106.1% | 387.6 |
| [Royal Sundaram](/health-insurance/royal-sundaram) | Private general | NL-37 not retrievable | 97.2% | 28.4 |
| [SBI General](/health-insurance/sbi) | Private general | NL-37 not retrievable | 94.2% | 28.0 |
| [Universal Sompo](/health-insurance/universal-sompo) | Private general | FY 2024-25 NL-37 not located | 96.4% | 7.6 |
| [Zuno](/health-insurance/zuno) | Private general | FY 2024-25 NL-37 does not reconcile | 96.1% | 40.6 |

We would rather show a gap than an estimate. If you hold one of these policies, the insurer's public disclosures page carries the latest Form NL-37.

## Claim settlement ratio vs amount settled

IRDAI's Annual Report 2024-25 (Table I.29) gives the industry picture for health claims in FY 2024-25:

| Measure | By number | By amount |
|---|---|---|
| Paid | 87.50% | 71.14% |
| Disallowed under policy terms | 0% | 13.98% |
| Repudiated | 7.92% | 8.61% |
| Outstanding at year end | 4.58% | 6.27% |

These shares use all claims handled as the base, so they run a little lower than the per-insurer CSR above. The big gap is in rupees: about 14% of the money claimed was cut under policy terms, which is where [room-rent limits and proportionate deductions](/articles/health-insurance/room-rent-capping-proportionate-deduction), sub-limits and non-payable items show up.

In an interview with BusinessLine published on 11 October 2026, IRDAI chairman Ajay Seth said: "Headline settlement ratios are not enough; what matters is how much is actually paid. And we are actively monitoring that."

### What is changing

- **A Public Insurance Registry** will make insurers' claims and premium records visible, Seth said. It is being rolled out in phases alongside [Bima Sugam](/articles/health-insurance/bima-sugam-explained).
- **Claims Review Committees.** No claim can be rejected without the approval of the insurer's Claims Review Committee, a rule already in IRDAI's 2024 health master circular. See [why health claims get rejected](/articles/health-insurance/health-insurance-claim-rejection-reasons) for how to appeal.
- **Claims reforms** are planned for 2027-28, and Insurance Reporter reported on 16 October 2026 that IRDAI will issue a consultation paper on hospital billing and claims. No date has been given.

## How to use CSR properly

1. Shortlist insurers at or above 90%, and prefer those that stay there across years.
2. Check complaints per 10,000 claims. A high CSR with heavy complaints often means partial payments and disputes.
3. Confirm your hospitals are in the cashless network. See [cashless vs reimbursement](/articles/health-insurance/cashless-vs-reimbursement).
4. Read the plan wording for room-rent caps, co-pay and sub-limits.
5. Then compare premium against the actual cover, using the [best health insurance plans](/articles/health-insurance/best-health-insurance-plans-india) shortlist.

Our [methodology](/about/methodology#claim-settlement-ratio) explains the formula, benchmarks and why our Claim Settlement scores are still provisional.

## Sources

- IRDAI, Handbook on Indian Insurance Statistics 2024-25 (published 3 Feb 2026), Part II Table 53 (status of claims), Table 56 (grievances), Part III Table 62 (health ICR): https://irdai.gov.in/en/document-detail?documentId=8658868
- IRDAI, Annual Report 2024-25, Table I.29 (status of health insurance claims): https://irdai.gov.in/annual-reports
- Insurer Form NL-37 (Claims Data), Q4 FY 2024-25: [HDFC ERGO](https://www.hdfcergo.com/docs/default-source/public-disclosure/financial/financial_2024-25_q4_annexure-iv/nl-37-claims-data.pdf?sfvrsn=34684bff_2), [ICICI Lombard](https://www.icicilombard.com/docs/default-source/public-disclosures/2024-25/q4-2025/nl-37.pdf), [Bajaj General](https://www.bajajgeneralinsurance.com/download-documents/financialinformation_general/2024-25q4/NL-37.pdf), [Digit](https://www.godigit.com/content/dam/godigit/general/financials/public-disclosure/2024-2025/nl-37-claims-data.pdf), [Tata AIG](https://www.tataaig.com/s3/NL_37_ad5b0fc01a.pdf), [ACKO](https://acko-cms.ackoassets.com/Public_Disclosure_Q4_2024_25_b9e980b08e.pdf) (p.42), [IndusInd General](https://www.indusindinsurance.com/downloads/pd-q4-24-25) (p.42), [New India Assurance](https://www.newindia.co.in/assets/docs/public-disclosure/Public%20Disclosure%20March_2025.pdf) (p.39), [IFFCO Tokio](https://www.iffcotokio.co.in/content/dam/iffcotokio/iffco-pdf/public-disclosure-march-2025.pdf) (p.74), [National Insurance](https://nationalinsurance.nic.co.in/sites/default/files/Public%20Disclosures_Q4_2024-25.zip)
- BusinessLine, interview with IRDAI chairman Ajay Seth, 11 Oct 2026: https://www.thehindubusinessline.com/economy/focus-on-actual-payouts-not-just-claim-settlement-ratios-irdai-chairman/article71570532.ece
- Insurance Reporter, IRDAI to review hospital bills and claim payouts, 16 Oct 2026: https://theinsurancereporter.com/irdai-to-review-hospital-bills-and-claim-payouts/
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