Health insurance CSR.
When choosing a health insurance provider, you may come across a number called the Claim Settlement Ratio (CSR). Simply put, it tells you what proportion of claims an insurer has settled during a given period. So, a CSR of 95% broadly means that 95 out of every 100 claims considered in the calculation were settled.
The numbers used to understand an insurer's claims record come from disclosures published in line with Insurance Regulatory and Development Authority of India (IRDAI) requirements.
For general insurers, the underlying claims information comes from Form NL-37 - Claims Data, published as part of insurers' public disclosures. The form provides details on:
When looking at health insurance claims, these figures become more useful when you consider both the number of claims settled and the amount paid towards them.
Using the data disclosed in Form NL-37, a count-based CSR can be calculated as:
CSR = Claims paid ÷ (Opening claims + Claims reported â Claims closed â Closing claims) à 100
Essentially, it measures how many eligible claims were settled during the period.
For example, suppose an insurer had 10,000 claims available for settlement and settled 9,500. Its count-based CSR would be 95%.
But that does not mean 95% of the total amount claimed was paid. Some of those 9,500 settled claims may have been for smaller amounts, while a few high-value claims may still be pending or may have been closed or repudiated. Since every claim count as one, regardless of its value, it is important to look at both the number and value of claims when assessing an insurer's claims record.
A claim settlement figure can be looked at in two ways:
The difference is important, especially when comparing health insurers.
A count-based ratio focuses on the number of claims settled, regardless of how much each claim is worth. For example, if an insurer has 100 claims and settles 95 of them, its count-based CSR would be 95%. It does not matter whether those settled claims were worth Rs 10,000 or Rs 10 lakh each. Every settled claim is counted as one.
Claims settled by value focus on the amount involved. For example, suppose those 100 claims are worth Rs 1 crore in total. If the claims settled by the insurer account for Rs 75 lakh, the settlement picture by value would be 75% of the total claim value in this scenario.
This matters in health insurance, where the cost of treatment can differ greatly. A smaller hospital bill and a much larger claim for major surgery would still count as one claim each in a count-based ratio.
That is why a high CSR should not automatically be read as the percentage of the total claimed amount that an insurer has paid. Claims by count tell you how many claims were settled, while claims by value help put the amount involved into perspective. Looking at both can give a more complete picture of an insurer's claims experience.
The following figures are calculated from FY 2025-26 Form NL-37 disclosures and represent health claim settlement ratios based on the number of claims.
|
General insurer |
Health CSR FY 2025-26 |
Popular Health Insurance Plan |
|
Go Digit General Insurance |
99.21% |
Digit Health Insurance - Infinity Wallet Plan |
|
HDFC ERGO General Insurance |
98.19% |
my:Optima Secure |
|
ACKO General Insurance |
94.86% |
ACKO Platinum Health Insurance Plan |
|
SBI General Insurance |
93.62% |
SBI General Health Alpha |
|
Bajaj General Insurance |
93.40% |
Health Guard |
|
ICICI Lombard General Insurance |
91.96% |
Elevate Health Insurance |
|
Tata AIG General Insurance |
89.30% |
Medicare Premier |
Note: The claim settlement ratios are based on publicly available FY 2025-26 Form NL-37 disclosures and reflect the number of claims settled. Since claim settlement ratios can change from year to year, it is advisable to consider them along with other factors when comparing insurers.
It can be tempting to choose the insurer with the highest percentage in the table above. But that misses an important part of how general insurance works.
A higher CSR could look better at first, but the number can be influenced by the kind of claims an insurer handles.
For example, one insurer may settle a large number of smaller motor claims, while another may handle health claims involving hospitalisation, medical documents, pre-authorisation and higher treatment costs. Both count as claims, but they may be very different in terms of the time and assessment involved.
This means an insurer can have a higher count-based CSR without necessarily offering a better claims experience.
It is also why looking at an insurer's overall CSR can be misleading. General insurers deal with different types of insurance, including motor, health and travel. So, if you are comparing health insurance providers, looking specifically at their health claims data can give you a more relevant picture.
A high CSR is useful information, but it cannot tell you:
A high CSR should therefore be treated as one indicator rather than a final verdict on an insurer.
For someone choosing health insurance, the insurer's claims record can be read alongside factors such as:
CSR is more useful when considered alongside other indicators of an insurer's claims experience. One such indicator is the number of claim-related complaints.
Insurers disclose grievance information through their regulatory public disclosures. Since insurers handle different volumes of claims, looking only at the total number of complaints may not give a fair comparison. Measuring complaints per 10,000 claims helps put the figure in context.
For SBI General Insurance, this number has declined consistently over the past three financial years:
|
Financial year |
Claim complaints per 10,000 claims |
|
FY 2023-24 |
23.28 |
|
FY 2024-25 |
14.66 |
|
FY 2025-26 |
4.17 |
This represents a decline of around 82% in claim complaints per 10,000 claims between FY 2023-24 and FY 2025-26.
When considered alongside SBI General Insurance's 93.62% count-based health CSR for FY 2025-26, the decline in its complaint ratio adds useful context to its recent claims record. While these figures cannot predict the outcome of an individual claim, the trend provides another way to understand how the insurer's claims experience has evolved.
The support available at the time of a claim is equally important. SBI General Insurance has a network of 18,000+ hospitals, giving policyholders wider access to cashless treatment at network hospitals. Claims can also be intimated through the website, mobile app, email or toll-free numbers, with 24x7 customer support available for assistance during the process. Together, these factors make it easier for policyholders to access the claims support they may need, rather than relying on the settlement ratio alone.
A high claim settlement ratio can be reassuring. However, it should not be the only reason you choose a health insurance policy. The number tells you about an insurer's past claims record, not what your individual claims experience will look like.
Consider factors that could matter when you actually need to use the policy. Is your preferred hospital part of the insurer's cashless network? Is the claims process easy to understand? Can you reach the insurer when you need help? It is equally important to check the policy coverage, waiting periods, exclusions, room rent limits, co-payments and other conditions that could affect a future claim.
Complaint trends can add another layer of context. SBI General Insurance is a useful example. While its count-based health CSR stood at 93.62% in FY 2025-26, its claim complaints per 10,000 claims fell from 23.28 in FY 2023-24 to 4.17 in FY 2025-26, a decline of around 82% in two years. This improvement may not be visible if CSR is viewed in isolation, but it adds useful context to how the insurer's recent claims record has evolved.
So, it is wise to use CSR as a starting point, not the final deciding factor. A policy that suits your healthcare needs, offers the right coverage and gives you convenient access to claims support may ultimately matter more than choosing an insurer only because it has the highest ratio.
The Claim Settlement Ratio can offer valuable information about an insurer's past claims record. But the highest percentage does not necessarily tell the complete story. How the ratio is calculated, the type of claims being handled and the number of complaints can all add important context.
When comparing health insurance providers, individuals should look beyond a single figure. Consider the insurer's claims record along with its complaint trends, cashless hospital network, policy coverage and the support available during a claim. This can help you make a more informed decision based on what may actually matter when you need to use your policy.
Disclaimer: Claim settlement and complaint figures are based on publicly available insurer disclosures and calculations using those disclosures. Historical claim statistics do not guarantee settlement of future claims. Claims are assessed according to the applicable policy terms and conditions.
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