Claim Settlement Ratio vs Incurred Claim Ratio
Two different metrics get called "claim ratio" in health insurance, and they measure different things. Before you read either table below, know which one you're looking at:
- Claim Settlement Ratio (CSR): The percentage of claims settled out of all claims received, by count. It answers: when a policyholder files a claim, how often does the insurer actually pay it (versus reject or leave pending)?
- Incurred Claim Ratio (ICR): Total claims paid divided by total premium collected, by value, for a financial year. An ICR above 100% means the insurer paid out more in claims than it collected in premium for that year. ICR reflects pricing and portfolio mix as much as claims behaviour — a lower ICR is not automatically a bad sign.
💡 A high CSR with a moderate ICR (common among standalone health insurers below) usually means: they settle most claims they receive, and price conservatively enough to stay profitable. Neither number alone tells the full story — read both.
Claim Settlement Ratio by Insurer (Count-Based, 3-Year Weighted Average)
Percentage of claims settled out of claims received, highest to lowest.
| Insurer | Type | Claim Settlement Ratio |
|---|
Three-year weighted average as of March 2026, compiled from IRDAI-published data. Figures change with each annual release — always verify the latest before buying.
Incurred Claim Ratio by Insurer (FY2024-25)
Claims paid as a percentage of premium collected in FY2024-25, per IRDAI's Annual Report.
Standalone Health Insurers
| Insurer | Incurred Claim Ratio |
|---|
Public Sector General Insurers (Health Segment)
| Insurer | Incurred Claim Ratio |
|---|
Private General Insurers (Health Segment)
| Insurer | Incurred Claim Ratio |
|---|
FY2024-25, provisional figures per IRDAI's Annual Report 2024-25. General insurers underwrite health alongside motor, fire and other lines — this is their health segment alone.
What to Do With This Data
1. Don't buy on ratio alone
Network hospital density near you, room-rent sub-limits, co-payment clauses and waiting periods usually matter more to your actual payout than a 5-10 point difference in either ratio. Use these tables to screen out obvious laggards, not to pick a winner outright.
2. Weight CSR more heavily for claim-paying behaviour
If your priority is "will they actually pay when I claim," CSR is the more direct signal — it's literally the share of claims that got settled. ICR is more useful for judging an insurer's pricing discipline and long-term stability.
3. Re-check before you buy
These are FY2024-25 figures. IRDAI publishes fresh data annually — always pull the latest Annual Report or ask your advisor to confirm current numbers before finalising a plan.
Frequently Asked Questions
Which health insurer has the best claim settlement ratio in India?
On claim settlement ratio (count-based, 3-year average), Go Digit, Narayana Health, HDFC ERGO and SBI General currently lead at 96-99%. On incurred claim ratio, Oriental Insurance, New India Assurance and Navi General report the highest FY2024-25 figures. The "best" insurer depends on which metric matters more to you — see the explainer above.
Do standalone health insurers have better claim ratios than general insurers?
Not necessarily. Standalone health insurers like Star Health and Care Health report relatively low incurred claim ratios (64-71%) but reasonably high claim settlement ratios (89-96%) — they settle most claims they receive, even though the ratio of claims paid to premium collected runs lower. General insurers show more spread across both metrics.
Why does the same insurer show different numbers in the two tables?
Because CSR and ICR measure different things — one counts claims, the other measures money. An insurer can settle 95% of the claims it receives (high CSR) while still paying out only 70% of premium collected in claims (moderate ICR), simply because it prices and reserves conservatively.
Where does this data come from?
Incurred claim ratio figures are from IRDAI's Annual Report for FY2024-25. Claim settlement ratio figures are a three-year weighted average compiled from IRDAI-published data. Sources are linked at the bottom of this page.
Not Sure Which Plan Actually Fits You?
Ratios are a starting point, not the whole picture. Talk to a Policy Aid advisor for a plan matched to your city, hospital preference and budget.
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