Life Insurance Claim Settlement Ratio 2024

The CSR in life insurance refers to the percentage of claims settled by an insurance company compared to the total number of claims received within a particular period, usually a year.

A high Claim Settlement Ratio indicates that the insurance company has a good track record of honoring claims promptly and accurately. It moreover instills confidence in policyholders that their nominees will receive the term insurance benefits without any delays or disputes. On the other hand, a low Claim Settlement Ratio signifies potential issues such as claim rejections or claim delays, which might leave your beneficiaries at financial risk when they need financial support the most.

Not only this, but a high CSR also reflects the insurance company’s financial stability and efficiency. It suggests that the company has enough resources to fulfill its obligations and manage the life insurance claims effectively.

Why is a Claim Settlement Ratio Important?

Following are several reasons why the CSR of a life insurance company is important:

• Assessing Financial Security: Term insurance is all about securing your family's financial future in case of your untimely demise. Hence, it's important to make sure that the insurer you choose is financially stable and capable of fulfilling its promises. By checking the Claim Settlement Ratio, you can gain insights into how dependable the insurer is in honoring claims. A higher ratio indicates greater financial stability and reliability.
• Comparative Analysis: Comparing the CSR of different insurers allows you to make better decisions when selecting a life insurance provider. By evaluating multiple insurers based on their claim settlement performance, you can identify the most reliable and trustworthy option that aligns with your needs and preferences.
• Market Reputation: A favourable Claim Settlement Ratio contributes to the insurer's positive reputation within the industry. It can attract more customers, enhance brand value, and strengthen competitiveness in the market. Alternatively, a low CSR may raise concerns among policyholders and affect the insurer's market reputation.
• Transparency and Trust: Opting for an insurer with a high Claim Settlement Ratio shows the insurer's transparency and trustworthiness in their operations. This transparency is essential for your peace of mind and helps you know that your family's financial needs will be met without any unnecessary complications or delays.
• Reducing Financial Risks: In the event of your death, your family will rely on the insurance payout to meet multiple financial obligations, such as loan payments, education expenses, and daily living costs. A high Claim Settlement Ratio ensures that the insurer is efficient in processing claims, reducing the risk of financial hardship for your nominees during tough times.

How is a Claim Settlement Ratio Calculated?

The calculation of Claim Settlement Ratio can be better understood with the help of the pointers below:

• Total Claims Received: The insurance company collects data on all the claims it receives during a specific period, particularly a year.
• Total Claims Settled: Among those claims received, the company processes and settles a certain number of them. This means they approve the claim and pay out the agreed-upon amount as per the policy terms.

Claim Settlement Ratio Calculation

To calculate the CSR, simply divide the total number of claims settled by the total number of claims received, and then multiply the result by 100 to get the answer in percentage:

Claim Settlement Ratio = (Total Claims Settled /Total Claims Received) × 100

For Example: if an insurance company received 1,000 claims in a year and settled 970 of them, then CSR will be calculated in the following way:

Claim Settlement Ratio = (970/1000) × 100

So, in this example, the Claim Settlement Ratio of the insurance company will be 97%.

The latest Claim Settlement Ratio or CSR of all the active life insurance companies in India are as follows:

The reasons mentioned below can affect the life insurance claim approval process:

• Hiding Information: Some people might not tell the whole truth to try and get their claim approved without providing all the necessary proof. However, doing this can make the insurance company suspicious. They could reject your claim if they investigate and find out you've been dishonest. This can even impact the insurance company's Claim Settlement Ratio adversely.
• Ignorance By the Policyholder: It's important to take the time to understand everything in your term insurance policy. If policyholders don't understand the policy exclusions, they might make a claim for something that isn't included. In such cases, the claim might get rejected and policyholders won't get any money.
• Not Disclosing Facts: As the policyholder, it's considered dishonest if you choose not to disclose crucial details that could affect your claim. This lack of transparency can affect the insurance company's ability to effectively settle your claim.
• Error In Updating Nominee: If something happens to you, your insurance company will give the death benefit to the chosen beneficiary. But if you don't keep your nominee's details accurate and updated, it might make it challenging for your insurance company to help your nominee get the death benefit.

Generally, 95% or above CSR is considered to be good. This percentage shows that out of 100 claims received in a given year, the insurer has successfully settled 90 of them.

Please note that the CSR of life insurance companies can fluctuate yearly based on the insurer's ability to handle claims. So, when purchasing a life insurance policy, it's important to look at the trend of the Claim Settlement Ratio over time rather than just one single figure. A consistently high ratio indicates reliability and customer satisfaction, while a declining ratio might signal potential issues with claim processing.

Life insurance claims come in two types which are included below:

• Maturity Claims: Maturity Claims are paid out when the life insurance policy reaches its maturity date. This happens when the policyholder completes the entire policy term and survives until the end.

To receive a maturity claim, the policyholder must fill out a discharge form. The amount received from a maturity claim is not taxed under the current Income Tax Act, 1961, provided that premiums have been paid on time.

• Death Claims: Death claims refer to the amount payable by an insurance company to the beneficiaries of a life insurance policy upon the death of the insured individual. When the policyholder passes away, the nominees named in the policy are entitled to receive the death benefit, which is the sum assured or the coverage amount specified in the policy contract. This benefit is paid out to provide financial support to the dependents or beneficiaries of the deceased policyholder.

To initiate a death claim, the beneficiary needs to inform the insurance company of the policyholder's death, including details such as the policy number, date and cause of death, and the policy term. The insurance company then investigates the claim. The death benefit amount is also tax-free under Section 10(10D) of the Income Tax Act, 1961.

Following is the list of some of the mandatory documents required for life insurance claims:

• Claim Forms (Duly signed and attested)
• Original Policy Documents
• Death Certificate attested by the local authorities
• Copy of FIR/Post Mortem Reports/Punchnama
• Medical Records (including hospital discharge summary)
• Claimant’s Photo ID Proof
• Claimant’s Address Proof
• Copy of Cancelled Cheque/Bank Statement/Bank Passbook

Claim Settlement Process of Life Insurers in India

Listed below is the process of life insurance claim settlement followed by most of the insurance companies. However, every insurance operates differently hence the claim settlement process for a life insurance claim can differ from insurer to insurer:

Step 1: Notification of Claim

Upon the insured individual's demise, the designated nominee must contact the respective insurance company promptly.

InsuranceDekho Support: We extend our assistance to the nominee or family members in initiating the claim process efficiently.

Step 2: Submission of Documentation

The nominee is required to furnish essential documents including the Policy Number, Death Certificate, and valid Government ID to the insurance provider. Depending on the circumstances surrounding the death, additional documentation such as an FIR Report or Postmortem Report may be necessary.

InsuranceDekho Support: InsuranceDekho helps the nominee or family members of the policyholder in handling the complexities associated with gathering and submitting required documents, and addressing queries.

Step 3: Review of Claim

After receiving the required documents, the insurance company will thoroughly assess the claim.

InsuranceDekho Support: InsuranceDekho ensures continuous communication with the nominee or family members throughout the claim review process by maintaining close collaboration with the insurance provider.

Step 4: Settlement of Claim

Upon approval, the claim proceeds to the settlement stage where the life insurance policy benefits are processed for disbursement.

InsuranceDekho Support: We strive to expedite and streamline the claim settlement process, ensuring a seamless experience for the nominee.

Note: If there is no nominated beneficiary or if the nominee is absent, the claim will be paid to the next legal heir with proper legal evidence.

How to Interpret the Claim Settlement Ratio?

Here is how you can interpret the Claim Settlement Ratio of any insurance company:

• Higher Ratio: A higher CSR generally indicates that the insurance company is more reliable and efficient in settling claims. It even implies that a larger percentage of claims filed by policyholders are being settled successfully by the life insurance company.
• Lower Ratio: A lower CSR might show that the insurer is facing challenges in efficiently processing and settling claims. It could moreover indicate potential issues such as delays, disputes, or rejections in claim settlements.
• Comparison: The Claim Settlement Ratio can be used to compare different insurance companies. Policyholders often use this ratio as one of the factors to evaluate and compare insurers when making decisions about purchasing life insurance policies. However, it's important to note that while a higher ratio is generally preferable, but it should not be the only factor considered while evaluating an insurer. Instead, other factors such as Sum Assured, Amount Settled, Solvency Ratio, etc, should also be taken into consideration.

Here are some common reasons for the rejection of life insurance claims:

• Mentioning false or inaccurate information in the life insurance proposal form
• Not paying premiums on the due date or during the grace period
• Causes of death that are not covered by the insurance policy such as suicide before the completion of the first policy term, accidental death caused by overconsumption of alcohol/drugs
• A fraudulent claim made by the beneficiary

Below mentioned are the events or instances that are not covered under a life insurance policy:

Life insurance policies often come with the following exclusions:

• Hazardous Activities: Engaging in dangerous activities like skydiving or racing typically voids coverage due to the high risk involved.
• Pre-existing Medical Conditions: If the insured doesn't disclose pre-existing medical conditions, claims related to them may be denied.
• Aviation Incidents: Private plane accidents may not be covered, but commercial flight incidents are usually covered under life insurance.
• Unlawful Activities: Participation in criminal or unlawful activities like theft or riots is considered an exclusion in a life insurance policy.
• Suicide: Life insurance policies don't cover suicide within the first year, providing only a partial refund of premiums.
• Misrepresented Information: Providing false information can lead to claim denials or term insurance policy cancellations.
• Natural Disasters: Life insurance policies exclude deaths caused by natural calamities such as earthquakes or hurricanes.
• Sexually Transmitted Diseases: Diseases like HIV/AIDS are typically not covered under life or term insurance policies.
• Drug/Alcohol Abuse: Deaths resulting from drug overdose or excessive alcohol consumption are not covered.

The Claim Settlement Ratio (CSR) is a vital factor in selecting a life insurance policy, reflecting an insurer's reliability in processing claims. A high CSR signifies timely and accurate claim settlements and even ensures financial security for beneficiaries. So, always make sure you opt for a life insurance provider with high CSR but remember to club this metric with other factors that play a significant role while choosing a good life insurance company.