Claim Settlement Ratio for Life Insurance

The Claim Settlement Ratio is calculated using the following formula:

CSR = (Number of Claims Settled/Number of Claims Received)×100

Latest Claim Settlement Ratio (CSR) Data: FY 2023–24

As per the IRDAI Handbook on Indian Insurance Statistics (FY 2023–24), the latest data offers valuable insights into how efficiently life insurance companies in India settle individual death claims. The performance has been particularly noteworthy in terms of claims settled within 30 days, which is a critical benchmark of customer service and operational effectiveness. 

1. Overall Industry CSR (30 Days): 96.82% 

1. Private Insurers’ Average CSR (30 Days): 99% 

The above data can be interpreted in the following ways: 

1. High Efficiency Among Private Insurers: Private companies, such as HDFC Life and Axis Max Life, consistently deliver over 99% CSR, particularly within the 30‑day settlement window, underscoring operational excellence. 

1. Public Sector Entity (LIC): While LIC handles a significantly larger volume, its CSR of 96.42% (number of policies) remains respectable. 

1. Full Compliance by Select Insurers: Companies like Kotak Mahindra, Ageas Federal, Future Generali, and Aviva achieved perfect CSR, demonstrating seamless processes. 

1. Financial Efficiency (Benefit Amount): HDFC Life and Axis Max Life lead here, paying almost the entire claim amount within 30 days. 

Best Practices to Avoid Claim Denial 

1. Disclose all relevant details accurately, such as medical history and lifestyle factors, at application stage. 

1. Complete the application yourself; do not rely solely on the agent’s inputs. 

1. Utilise the free‑look period wisely, review policy terms and return it if unsatisfactory. 

1. Inform your nominees and ensure they understand the claim‑filing procedure. 

Types of Life Insurance Claims 

Life insurance claims are of two types. They are mentioned briefly below - 

1. Maturity claims - Payment for maturity claims is made when the life insurance policy matures. This essentially indicates that a specific amount will be paid to the life guaranteed if the policy period finishes and they outlive the whole policy term. In order to receive a maturity claim, the life assured must fill out a fully completed and signed discharge application. The amount that the maturity claims brought in is free of tax as per the ITA, 1961. 

2. Death Claims - In this, in the event of the policyholder's passing, the claimant may ask for death benefits. This only indicates that, in the event of the policyholder's passing, a sum insured amount is paid to the nominee. Notifying the insurance company of the death is necessary. According to ITA, 1961 § 10(10D), the amount received as the death claim benefit is free of taxes. 

Why is Claim Settlement Ratio Considered Important? 

1. The Claim Settlement Ratio (CSR) is a crucial metric that reflects how reliably an insurer honours its promise of financial protection. It indicates the percentage of claims settled by an insurance company against the total claims received in a financial year. 

1. A higher CSR implies greater dependability and trustworthiness in settling claims, especially during the most critical moments for policyholders or their beneficiaries. 

1. Since life insurance is often taken to secure the financial future of one’s family, it is vital to choose an insurer with a strong claim settlement record. 

A few reasons why CSR matters: 

1. It serves as a transparent measure of the insurer’s performance. 

1. It reflects the insurer's internal processes and customer commitment. 

1. It helps customers compare insurers objectively, especially when other product features like premiums and benefits are similar. 

1. A consistently high CSR builds long-term trust in the brand. 

While CSR is important, also ensure full and accurate disclosure of personal, medical, and lifestyle details during the policy application. Many claims are rejected due to non-disclosure. 

The maturity claim process is applicable when the policyholder survives the term of the policy and is eligible to receive the sum assured plus any applicable bonuses. 

• Notification to the Insurer: The policyholder must inform the insurance company about the policy’s maturity at least 15 to 30 days before the maturity date. 

• Document Submission: The following documents are typically required: 

1. Original policy bond 

1. Maturity claim form or discharge voucher 

1. A valid ID and address proof 

1. Bank account details (cancelled cheque or passbook copy) 

• Verification and Processing: Once submitted, the insurer verifies the details and processes the maturity payout, usually within seven to ten working days. 

The process is generally straightforward if the policy is in force, and all dues are cleared. These documents are required for death claims, not maturity claims. 

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