Buying health insurance? You must check track record of claims and complaints

For insurance companies offering health covers, a higher claim settlement ratio reflects a stronger track record of paying claims, while a lower complaint rate indicates better customer experience and claims handling. The insurance advisory platform, Ditto Insurance, compares insurers on two key metrics: three-year average claim settlement ratio (by policy count) and number of complaints per 10,000 claims. Prospective buyers also need to take into account an insurer’s scale, track record, product portfolio and hospital network, among other factors.

Claim settlement ratio

Complaint rate

*Mainly personal accident, not health. #Galaxy Health and Narayana Health have limited operational history. Hence, data is limited.

Notes: Claim settlement ratio by policy count; Ditto Insurance is an Irdai-licenced corporate agent across insurers; Complaint data is reproduced as shown by Ditto; some insurers’ complaint data may cover broader/general insurance business rather than health-only data, depending on their disclosures; in some cases, high initial CSR can reflect a very small volume of early claims for new insurers; The data represents the total health insurance segment for a non-life insurer, including health, travel, and personal accident insurance products. It covers both group and retail segments. CSR formula: [Claims paid /(opening claims + claims reported − claims closed − closing claims)] x 100

Source: Ditto Insurance; CSR source: Insurers’ public disclosures, Form NL37, Q4 filing; Complaints source: Insurer public disclosures, NL-45, grievance disposal, Irdai annual report; Complaints metric: Formal grievances per 10,000 claims.