A recent report by the Insurance Brokers Association of India (IBAI) has revealed that the claim-to-settlement ratio for general insurance in India has decreased to 86% in 2022-23, down from 87% in the previous fiscal year. This means that 14% of claims were rejected by insurance companies. The report also found that the claims repudiation ratio, which is the proportion of claims rejected by insurers, rose to 6% for general insurance, including motor, health, fire, and marine cargo.
The report analyzed data from various insurance companies and found that public sector insurer New India Assurance had the lowest claims repudiation ratio of 0.2%. Other private insurers with lower rates of claims rejection include HDFC Ergo, Future Generali, Aditya Birla Health, and Shriram. The Insurance Regulatory and Development Authority of India (IRDAI) makes it mandatory for insurance companies to publish settlement and rejection data on their websites, which helps policyholders make informed choices.
The report categorized general insurers into four categories: public sector general insurers, large private sector general insurers, other private sector insurers, and standalone health insurers. In the health insurance category, New India Assurance had a claim-settlement ratio of 95%, followed by Aditya Birla Health with a ratio of 95%. Iffco Tokio and Bajaj Allianz were among the top large private sector general insurers with a claims-to-settlement ratio of 90% or more.
However, experts point out that the data is combined for group and individual policies, and claim-rejection rates are historically lower for corporate policies. They argue that separate claim-settlement data for individual health insurance policies is needed to get a true picture. Incomplete or false disclosure at the time of policy purchase also contributes to claim rejections.
The report also highlighted the low insurance penetration in India, which is at 30%, compared to developed countries like the US, where it is over 90%. The high 18% tax on insurance premiums is also a concern, as it makes insurance unaffordable for many people. Experts suggest that reform measures are needed to reduce taxes and provide segregated data on claim-settlement ratios to help people make informed choices. Additionally, there is a need for better infrastructure and social security nets to support the growth of the insurance industry and provide relief to policyholders.