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Claim Settlement Ratio for Term Insurance by IRDA : 2017-2018

claim-settlement-ratio-irda-2015-2016
  • Author

    Amey Saxena

  • Date

    May 13, 2019

IRDA has announced the Claim Settlement Ratio for 2017-2018 in Dec 2018. This is valid as most recent till Dec 2019, when the next year’s data will be published by the Regulator. If you are looking for a term insurance plan, you MUST know the IRDA Claim Settlement Ratio (CSR) before making the decision. At this point, we must tell you that in spite of the fact that overall CSR is NOT the best way to decide on your term insurance plan, you cannot ignore it because it is one of the best available indicators as of today.

Definition / Formula of Claim Settlement Ratio

Claim Settlement Ratio = Total Claims Approved (paid to nominees) divided by Total Claims Received by the Company.

So Claim Settlement Ratio (or IRDA claim ratio) is the total number of death claims approved by an insurance company, divided by the total no. of death claims received by the insurance company. It is generally measured for a period of one financial year. It is measured for all products of the company put together (not term insurance plans alone).

To explain this, if an insurance company received 1000 death claims between Apr 1, 2017 and Mar 31, 2018, out of which it

  • paid 973 claims to the nominees of those dead,
  • rejected 16 claims, and
  • is yet to take a decision on the remaining (1000-973-16=) 11 claims,

then

  • the claim settlement ratio (or claims acceptance ratio or claims ratio) of the insurance company = 973/1000 = 97.3%
  • the claim repudiation ratio (or claims rejection ratio) of the company = 16/1000 = 1.6%
  • the claim pending ratio of the company = 11/1000 = 1.1%


All claims ratios are measured in percentages. And thanks to standardization done by the IRDA, the Insurance Regulator of India, it’s that simple to measure and it is therefore a great idea to use Claim Settlement Ratio for Term Insurance buying. IRDAI publishes this information annually. Claim Settlement Ratio 2017-2018 is not yet announced by IRDAI. The latest one available is published in 2017, for the period 2017-2018. This will be valid till Dec 2019, when the next report will get released by IRDA. Claim Settlement Ratio or Claim Clearance Ratio has a simple formula. Claims Settlement Ratio is defined as the ratio of claims paid to nominees by the insurance company and total claims received from customers. The balance claims are either rejected for impersonation, misrepresentation, fraud, etc. or pending for decision by the life insurance companies.

Now, it’s time to dive into the numbers.

Claim Settlement Ratio 2017-2018 Announced by IRDA

Overall, the claim settlement ratio for the life insurance industry stands at 97%, but a lot of it is because of LIC’s large base with very high CSR. A lot of private life insurance companies are now ‘matching up’ since the last 4-5 years. However, like we mentioned in the disclaimers above, it may not be an equal comparison. Here’s all the information on CSR that you will need. Let us see which are the best insurance companies on claims ratio. The ranking is based on the size of the company (New Business Premium generated) so that you get that perspective as well.

Life Insurance
Company
Annual New
Business Premium
Total Value of
Claims Settled
Total Value of
Claims Rejected
Claim
Settlement
Ratio **
Details
LIC Rs. 13,46,71.70 crores Rs. 10,747.53 crores Rs. 32 lakhs 98.04% View
Max Life Rs. 4,348.59 crores Rs. 353.39 crores Rs. 9.42 crores 98.26% View
HDFC Life Rs. 11,349.61 crores Rs. 482.78 crores Rs. 21.45 crores 97.80% View
ICICI Prudential Life Rs. 9,211.75 crores Rs. 715.11 crores Rs. 11 lakhs 97.88% View
Aegon Life Rs. 147.05 crores Rs. 97.68 crores Rs. 0 lakhs 95.67% View
SBI Life Rs. 10,966.14 crores Rs. 590.33 crores Rs. 15.37 crores 96.76% View
Tata AIA Life Rs. 1,488.42 crores Rs. 131.84 crores Rs. 3 lakhs 98% View
Exide Life Rs. 759.90 crores Rs. 77.26 crores Rs. 0 lakhs 96.81% View
Canara HSBC Life Rs. 1,227.74 crores Rs. 49.13 crores Rs. 1.25 crores 95.22% View
Birla Sunlife Rs. 2,662.80 crores Rs. 248.16 crores Rs. 85 lakhs 96.38% View
Reliance Life Rs. 915.62 crores Rs. 149.54 crores Rs. 44 lakhs 95.17% View
Edelweiss Tokio Life Rs. 342.46 crores Rs. 11.31 crores Rs. 0 lakhs 95.25% View
Bajaj Allianz Life Rs. 4,291.14 crores Rs. 311.59 crores Rs. 10.15 crores 92.04% View
Bharti Axa Life Rs. 730.86 crores Rs. 42.48 crores Rs. 43 lakhs 96.85% View
Kotak Life Rs. 3,404.21 crores Rs. 119.50 crores Rs. 9.52 crores 93.72% View
DHFL Pramerica Rs. 1,455.68 crores Rs. 23.51 crores Rs. 5.41 crores 96.62% View
Aviva Life Rs. 325.57 crores Rs. 97.68 crores Rs. 15 lakhs 94.45% View
Sahara Life Rs. 4.17 crores Rs. 5.41 crores Rs. 0 lakhs 82.74% View
Future Generali Life Rs. 582.35 crores Rs. 34.18 crores Rs. 2.98 crores 93.11% View
IDBI Federal Life Rs. 833.03 crores Rs. 45.15 crores Rs. 94 lakhs 91.99% View
PNB Metlife Rs. 1,427.08 crores Rs. 179.60 crores Rs. 2.91 crores 91.12% View
Star Union Dai-ichi Life Rs. 700.72 crores Rs. 43.42 crores Rs. 1.04 crores 92.26% View
IndiaFirst Life Rs. 1,496.97 crores Rs. 45.97 crores Rs. 17.69 crores 89.83% View
Shriram Life Rs. 810.33 crores Rs. 69.80 crores Rs. 5.92 crores 80.23% View

What should you look for in Comparison of Claims Ratios?

Based on the above data on Claims Ratio published in 2018, this is how you should interpret it.

  • Claim Settlement Ratio higher than 85% is good. Of course, very high CSR (more than 90%) is welcome if the life insurance company is also offering you a great value product. e.g. LIC, Max Life, Tata AIA Life, ICICI Prulife, Aegon Life, HDFC Life, Reliance Life, SBI Life, Canara HSBC Life, Bajaj Allianz Life, Sahara Life, Exide Life, Kotak Life, Bharti Axa Life, Aviva Life, Birla SunLife, IDBI, Edelwise Tokio and DHFL Pramerica.
  • Notice the variance in average value of claim paid. Higher the sales of term insurance (as % of overall portfolio), higher is the average value of claim paid. Also, lower is the CSR if the companies are newer.

Some Disclaimers on Claims Ratio

While claim settlement ratio is recommended as worthy of consideration at the time of buying a term insurance plan, the ratio is only indicative and not 100% perfect for this purpose. The reasons for which we are saying this, are as follows.

  1. The ratio is for all life insurance products put together and not just term insurance plans. So claim settlement ratio works in favor of life insurance companies with large non-term product customer base since such customers had bought a life insurance policy mainly with the aim of getting returns rather than as a protection tool in case of death.
  2. Frauds committed by customers cannot be blamed on the life insurance company. In such cases, it is only correct on the company’s part to deny the claim. Over time, when you eliminate fraud, you settle claims for only genuine cases and this can bring down the premiums for customers. So chasing fraudulent claims is indeed in the interest of good customers, even if it is at the cost of claim settlement ratio going down.
  3. Most of the claim denials happen in the first 2 years after issuance of the insurance policy. In life insurance industry parlance, they are called ‘early claims’. Newer companies will have many more early claims as a % compared to older companies. Claim settlement ratio of newer life insurance companies can come down for this reason.
  4. Some insurance companies which aggressively sell term insurance plans investigate all the suspicious and most of the large value claims before payout. So they may end up discovering more fraud cases, rejecting them (obviously) but deteriorating their claims ratio. We need to keep this perspective in mind when we look at some of the smaller companies with lower claim settlement ratio.

Having said this, life insurance companies who have managed a high claim settlement ratio in 2017-2018 have indeed done a fabulous job – no denying that.

Final Words on Claims Settlement Ratio when buying Term Insurance

In conclusion, you should definitely use Claim Settlement Ratio when buying a term insurance plan. In addition to that, if you buy a term plan online by filling the application form yourself, and if you declare everything honestly on the form as well as during the medical examination to the doctor, it will make sure that your chances of claim approval are very high indeed.

If you are looking to buy a Term Insurance Plan with a guarantee of getting the claim, these tips can help.

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