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Question regarding Claim Settlement ratio

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26 Aug, 2021 by  harivansh agrawal

I am Considering the SBI General Arorgy Supreme policy as it has a built-in Critical illness option (i.e they pay to lumpsum of 25 lac if you are diagnosed with any listed critical illness ) plus 200% NCB plus 2X sum insured in case of an accident, full reinstatement of sum insured for same illness and a lot more optional cover so you can customize to your own need

And also 10lac deductible 50 lac super top-up has a very low premium of rupee 300 within the same company

I know the Claim Settlement ratio does not matter, what matter is your Proposal Disclosure as you and your expert said it 100 times but just to know SBI General have the lowest claim 70% settlement ratio among insure and a higher Calim rejection rate close to 30% according to insure public disclosure(Quantitative and Qualitative parameter) which they release on their website

Do you think I should Ignore the SBI General as a company?


Higher claim rejection happen due to non-filling of proposal form properly by an agent as I know most of Sbi general health insurance is sold by Bank Representative who fill the proposal form for their client make mistake for commission

So Should I completely ignore the fact that SBI have a lower claim settlement ratio and go with it or Search for other company

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Health Insurance

2 Answer

27 Aug, 2021
Co-founder, SureClaim

Hi Harivansh,

I would not dig into reasons for low or high ICR or CSR. As you rightly observed, as a customer, your job is to ensure your disclosure is proper and complete and that you fill the form yourself. Never leave it to agent, banker or tele-sales person to do it for you. There is bound to be some leakage of information there that can potentially ruin your claim experience in future.

I would suggest that you make your choice of insurance plan purely on the merit of the product and whether it matches your requirements or not. Don't worry about rest of the things. Those are all external factors and beyond anyone's control. Infact a company-level observation has little bearing on experience of an individual customer, except when it comes to whether an insurer processes claims in-house or it outsources them to a TPA.

My recommendation is always to go for an insurer who processes claims in-house. And yet, this is just a reco and not a mandatory advice.

Anuj Jindal



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27 Aug, 2021
harivansh agrawal
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27 Aug, 2021
Co-founder, SureClaim
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07 Sep, 2021

Claim settlement is the number of claims paid by an insurance company filed in a year. If an insurer holds a higher claim ratio means they have settled a higher number of claims. And, the company with a higher claim settlement rate seems to be the trustable insurance company. Therefore, it is advisable to check the insurance company's claim settlement ratio before buying an insurance policy.

Insurance Regulatory and Development Authority (IRDAI) releases insurer's claim settlement ratios every year. The claim settlement ratio reflects the pattern of resolution of claims by an insurer. You must compare the claim settlement ratio of different insurers to choose the suitable one.

The types of claim settlement - You can get your claim settled in two ways-

Reimbursement claim: In case you get your car repaired at a non-authorised garage network, you can make a reimbursement claim. In this situation, the policyholder pays off the repairing cost first and then get reimbursed from the insurer later. After analysing the applicable deductibles, the compulsory or voluntary insurer reimburses the claim amount.

Cashless claim: When you get your car repaired by an authorised garage by an insurer, you entered into a cashless claim settlement process. Here, the policyholder doesn't have to pay any money for the repair, the insurer makes the payment.

In final words, now you have a brief idea about the claim settlement ratio for insurance companies. Hence, always choose your insurer with a high claim settlement ratio wisely. 

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