What the regulator publishes about health insurance claims.
IRDAI and the Council for Insurance Ombudsmen publish claim and complaint figures every year. This page reproduces them with the source named against each number. It does not rank insurers, rate policies or recommend anything.
What the regulator publishes
IRDAI annual report, extract
CLAIMS PAID : as reported by insurer CLAIMS REPUDIATED : as reported by insurer AVG SETTLEMENT TIME GRIEVANCES REGISTERED / RESOLVED NO FIELD FOR: reason for deduction NO FIELD FOR: partial short-payment NO FIELD FOR: hospital-side cause
What it lets you say, and not say
The published data covers repudiation, not reduction. A claim paid at sixty per cent counts as paid.
Everything here is public and cited. Drapto does not rank insurers, and does not publish an opinion about one.
Claim settlement, by insurer
As reported to IRDAI for the financial year. A settlement ratio is a count of claims settled against claims processed. It says nothing about claim size, complexity, or whether any individual decision was correct.
| Insurer | Claims settled | Claims repudiated | Settlement ratio | Avg days to settle |
|---|---|---|---|---|
| Star Health | — | — | — | — |
| Niva Bupa | — | — | — | — |
| Care Health | — | — | — | — |
| HDFC ERGO | — | — | — | — |
| ICICI Lombard | — | — | — | — |
| Bajaj Allianz | — | — | — | — |
| Tata AIG | — | — | — | — |
| New India Assurance | — | — | — | — |
| United India | — | — | — | — |
| National Insurance | — | — | — | — |
| Oriental Insurance | — | — | — | — |
| SBI General | — | — | — | — |
| Reliance General | — | — | — | — |
| Aditya Birla Health | — | — | — | — |
| ManipalCigna | — | — | — | — |
| Future Generali | — | — | — | — |
Source: IRDAI Annual Report, health insurance claims data. Fill from the current published table and cite the year against the heading.
Complaints, and what they were about
The Council for Insurance Ombudsmen publishes complaint volumes and disposal by category. This is the more useful table for a hospital, because it is organised by ground rather than by company.
| Ground of complaint | Complaints | Share | Disposed in favour |
|---|---|---|---|
| Repudiation of claim | — | — | — |
| Partial settlement | — | — | — |
| Delay in settlement | — | — | — |
| Policy terms and conditions | — | — | — |
| Premium and proposal | — | — | — |
Source: Council for Insurance Ombudsmen Annual Report, cioins.co.in.
What a settlement ratio does not tell you
Why this page has no rankings
Comparing insurers and steering people toward policies is regulated intermediation in India, and it requires an IRDAI licence. Aggregators who publish comparisons hold one. We do not, so we reproduce published figures with sources named and stop there.
That constraint turns out to suit the audience. A hospital billing manager does not need to know which insurer is “best”. They need to know which grounds recur in their own settlements, and what the record shows on those grounds — which is what the grounds pages cover.
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