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Claim Settlement Ratio

The Claim Settlement Ratio (CSR) indicates an insurance company's reliability by showing the percentage of claims it has paid out. A higher percent of CSR suggests the company is more dependable in paying claims. ...Read More

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Francis Rodrigues Francis Rodrigues

Francis Rodrigues has a decade long experience in the insurance sector, and as SVP, E-Commerce and Digital Marketing, HDFC Life, manages the online sales channel, as well as digital and performance marketing. He has had hands-on experience in setting up sales channels and functional teams from scratch over a career spanning 2 decades.

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What is the Claim Settlement Ratio?

image-star image-star image-star image-star image-star image-star image-cloud image-cloud image-cloud moon What is the Claim Settlement Ratio?

Claim settlement ratio (CSR) is defined as the percentage of claims an insurance company has fulfilled of the total received claims during a financial year. Hence, this ratio indicates the credibility of an insurer. It also assures you of settling your insurance claim on time. The higher an insurer’s claim settlement ratio, the more you can rely on it.

If a life insurance company has a very high claim settlement ratio, it is very likely to honour claims filed by the beneficiaries of a term plan. The number indicates the insurer's trustworthiness, credibility, reliability and quality of service.

The claim settlement ratios of life insurance companies are published on the official portal of IRDAI (Insurance Regulatory and Development Authority of India) under the Annual Reports section. 

How Is Claim Settlement Ratio Calculated?

Calculating the claim settlement ratio is straightforward. Here's a simple formula you can use:

Claim Settlement Ratio (CSR) = (Number of Claims Settled / Number of Claims Received) × 100

For example:
Imagine a life insurance company receives 1,000 insurance claims over the year and manages to pay out on 996 of them. To find out how well they’re doing, you can use this formula:

Claim Settlement Ratio = (Claims Settled ÷ Total Claims) × 100

Here, it would be:
Claim Settlement Ratio = (996 ÷ 1,000) × 100 = 99.6%
So, the company successfully pays out on 99.6% of the claims it gets.

What Is a Good Claim Settlement Ratio?

For a provider of a term life insurance plan, a claim settlement ratio of 90% or above is considered good. This is so because 90 percent indicates that the insurance provider has successfully settled 90 out of 100 claims during the financial year.

The claim settlement ratio keeps on changing each year, depending on the number of claims the insurer has successfully settled. An insurance company completing claims above 95 per cent, an insurance buyer can stay assured that the company is secured financially. HDFC Life has a claim settlement ratio of 99.50% for FY 2023-2024 with it, your nominees are assured of minimum hassles and fast claim processing.

However, before selecting an insurance policy, it is necessary to consider other factors including the turnaround time of claims, online review of the insurer, sum assured offered and premium amount. 

Types of Insurance Claims

There are two types of claims under life insurance policy i.e., death claims and maturity claims.

Maturity Claims

Maturity Claims

Maturity claims can be received once your policy matures. This amount however can be fixed or market-linked, depending on the type of your policy. Several life insurance policies such as retirement plans, ULIPs, savings plans, and endowment plans offer attractive maturity benefits. At the end of your policy tenure, you can get a lump sum amount after submitting all necessary documents as required by the insurance company.

Death Claims

Death Claims

Death claims are paid out if the policyholder dies during the policy term. It is paid to the policyholder's nominee either as a regular income or a lump sum as chosen when buying the policy. However, the nominee must produce all necessary documents such as a doctor's certificate, proof of death, death certificate and more.
Death benefit claims ensure that the policyholder’s family is capable of sustaining themselves financially in your absence. 

Why is Claim Settlement Ratio Important?

While purchasing a life insurance policy, there are several factors you must look into including the sum assured value, customer reviews and so on. However, it is crucial to consider the claim settlement ratio when you are researching for any life insurance provider.

Here are the most important benefits of choosing a life insurance provider with a high claim settlement ratio:

Assures Financial Security

Assures Financial Security

In case of a policyholder's sudden death, the amount his/her family receives from a life insurance policy provides them essential financial security. Often, when the breadwinner of a family passes away, the family members get overwhelmed with financial responsibilities. It can also be difficult for them to meet obligations like loan payments.

In such a situation, a policy from an insurer with a high claim ratio ensures your family can support themselves financially. A high claim settlement ratio is one of the benefits of term insurance.

Depicts the Insurer’s Reliability

Depicts the Insurer’s Reliability

To rely on an insurance company, it is crucial to look into whether it maintains a high claim settlement ratio. A high claim settlement ratio indicates the life insurance company is capable of providing the sum assured to the policyholder's nominee, after the policyholder’s sudden demise. Hence, if a life insurance company holds the highest claim ratio throughout, the insured person can easily rely on the company to look after his/her family.

Co-operation from the Insurer

Co-operation from the Insurer

An insurance company’s high claim settlement ratio shows its concern for its policyholders and how much it cooperates with claimants. At the same time, policyholders get peace of mind that the insurer will settle their loved one’s claims quickly without hassles.

Considering all of these benefits, make sure to go through the claim settlement ratio before you proceed to choose a provider for a life insurance plan.

How Long Does it Take to Get the Claim Payout?

The time taken to get the claim payout varies among the insurance companies and the type of insurance. As per the IRDAI, all claims should be settled within 30 days1 from the date of receipt of all relevant documents. During this period, the insurance company scrutinises the application, assesses the damage/loss, raises queries for additional information or documentation, and decides upon the approvals and rejections thereof.

Why is HDFC Life Claim Settlement easy and Hassle-Free?

HDFC Life Insurance has an easy and hassle-free claim settlement process. It is noteworthy that the HDFC Life Claim Settlement Ratio set a remarkable benchmark of 99.50% for FY 2023-2024. The claim can be lodged in the branch of the company as well as online whereby the policyholders can conveniently lodge their claims and solve out the queries if any.


Apart from such hassle-free and faster claim settlement, HDFC Life also provides for 1-day claim settlement. Here, the policyholder can receive the claim settlement amount within 24 hours of lodging the claim and submission of documents. Following are the conditions subject to which the policyholders can receive claim settlement within 24 hours:

  • The policy should have been purchased online
  • The insurance claim should not require field investigation to be undertaken
  • The cumulative claim amount should not exceed Rs, 2 crores2
  • All the claim documents shall be submitted by 3 pm on a working day.

HDFC Life holds complete accountability and responsibility to settle the claim within 24 hours on working days. In case the claim does not get settled, then HDFC Life will pay interest at the rate of 2% per annum above the bank rate for each additional day that the claim gets delayed.

What is the Process for Processing a Claim?

HDFC Life provides three different modes for claim intimation. These are:

1. Online submission of claims

2. Whatsapp users can simply scan the QR code or directly message ‘Death Claim’ on +91 82918 90569 in order to begin the process.

QR Code

3. You can physically visit the branch for claim intimation with the claim form. The claim form can be downloaded from https://www.hdfclife.com/claims

The lodging and processing of the claim is a 3-step easy process with HDFC Life Insurance.

Reasons Why Our Claims Settlement Process Is Unique?

A high claim settlement ratio means a high rate of settling the received claims. Thus, the insurance company appears trustworthy to the insured person. HDFC Life’s claim settlement process is unique as we ensure a hassle-free claim filing process and immediate fulfilment of requests. Here are some of its features:

Ease

Ease

HDFC's Claim Centre provides all the necessary information. In your absence, your nominee can choose either to download the claim form from the website or visit the nearest branch office to file a claim. 

Speed

Speed

You can claim for your eligible amount under ClaimSecure maintaining the following conditions:
a) You can avail 1-day claim settlement exclusively for all online purchased policies.
b) Cumulative claim amount applicable for all policies up to Rs. 2 crore.
c) There is no need for a field investigation for the claim.
d) Submit all the necessary documents at any nearest office from Monday to Friday before 3 PM. Any document submission after 3 PM will be considered on the next business day.
e) HDFC Life offers interest on your amount death claim amount if there is a delay beyond one working day.

Appointment of Dedicated Officers

Appointment of Dedicated Officers

On the very next day of claim submission, a dedicated Claims Relationship Officer (CRO) is appointed to provide any personalised services. Having a CRO is very helpful during the settlement of a death claim. The nominee gets assistance and can avail the benefits of insurance claims on time.

Trust

Trust

HDFC Life has a claim settlement ratio of 99.50% over the fiscal year 2023-2024.This is by far the highest number that HDFC Life Insurance has achieved to date when compared with previous years.

Support

Support

The customer support services provide constant and speedy support to all queries and grievances of customers. They are ready to serve the customers anytime and anywhere they need.

Claim Settlement Ratio is Published Annually

HDFC Life has a claim settlement ratio of 99.50% over the fiscal year 2023-2024. During the fiscal year 2022-23, the claim settlement ratio of HDFC Life Insurance was 99.39%. This percentage is computed based on individual claims over total individual claims during the financial year. For further details, visit the annual report section for the fiscal year 2021-22.

Why is full disclosure important for a better claim settlement ratio?

As any form of 'misstatement' or 'non-disclosure' of facts can lead to your claim getting rejected upon investigation, it is crucial to have full disclosure in the case of term insurance plans. Firstly, non-disclosure refers to the scenario when a fact that directly affects the insurance policy's issuance turns out not to be disclosed in the proposal. As far as misstatement is concerned, it refers to the situation in which there has been withholding of information, or incorrect information has been provided while answering questions in the policy's proposal form. Both scenarios emphasize the importance of correct disclosure for your insurance policy's claim acceptance. 

Consistency in Claim Settlement Ratio is Crucial

IRDAI's Annual Report publishes claim settlement ratios for all life insurance companies. The claim settlement ratio calculation is done based on the total volume of settled claims. At HDFC Life, we have maintained a consistency in claim settlement ratio over the last five years. By now, our ratio is holding a prominent figure in the entire industry.
 

Here are our claim settlement ratios for the last 6 years:

 

Financial Year

Claim Settlement Ratio

2018-19

99.03%

2019-20

99.07%

2020-21

98.01%

2021-22

98.66%

2022-23

99.39%

2023-24

99.50%

Documents Required for Claim Settlement

Claim settlement involves the submission of certain documents in order for the company to verify the details of the claim. Mandatory Documents required for claims:
  • Key

    Death claim form (including NEFT)

  • Key

    Death certificate issued by the government or local municipality authority

  • Key

    Original policy document, (where applicable)

  • Key

    Claimant’s PAN details

  • Key

    Claimant’s ID proof

  • Key

    Claimant’s address proof

  • Key

    Personalized cancelled cheque or Bank passbook(Printed account number, name of the account holder and IFSC code)

  • Key

    Based on the type of claim, additional documents required as mentioned below:

Documents Required for Claim Settlement

Type of Claim

Documents Required

Natural Death Claim

The medical cause of death certificate

Medical records and associated documents

Unnatural Death Claim (Accidental Death / Suicide / Murder)

Post mortem report

First Information Report

Panchnama

Police inquest report

Annuity claim documents

Natural Calamities / Disaster Claims

Death certificate issued by the government or local municipality authority

Death claim form (including NEFT)

Claimant’s PAN card

Claimant’s address proof

Original policy document

Bank passbook or cancelled cheque

Critical Illness Claim

Critical illness claim form

Medical records (current & past) for instance, hospital records

Diagnostic tests reports

Key Considerations While Checking Life Insurance Claim Settlement Ratio

Insurance companies may reject your claim applications if they find inconsistencies in the details you have filed. Otherwise, they must compensate you if they do not have sufficient information to reject your claim.

Following are the key considerations you should consider while checking life insurance claim settlement ratio:

1
1

Filling Out the Nomination Form Correctly

It is crucial to fill out the nomination form with the correct details. In your absence, the nominee will ultimately claim for the insurance.

...Read More

2
2

Providing Right Information

Make sure to include all updated information accurately. This might include your medical history, smoking and drinking habits, employment profile, history of insurance policies, lifestyle and more.

Providing accurate information on your medical history might increase your premium amount. However, it will ensure that the insurer cannot deny your claims. 

...Read More

3
3

Paying Unpaid Premiums

Before getting a claim settlement, make sure your unpaid premiums are paid on time. This will enable you to receive life insurance coverage for your entire family. However, in cases, if you miss out on any premium, you can opt for policy revival and grace period. This will activate your policy and you can continue with life insurance coverage. 

...Read More

FAQs on Claim Settlement Ratio

1 What is the meaning of term insurance claim settlement ratio?

The claim settlement ratio of a term insurance company is the percentage of settled term insurance claims divided by the total claims received during a financial year. 

2 What is the formula for the claims ratio?

You can represent the formula for the claim settlement ratio as:

Claim Settlement Ratio (CSR) = (Total number of settled claims / Total number of received claims) *100

3 How do you calculate the claim settlement ratio?

The claim settlement ratio is calculated by dividing the total settled claims by the total received claims volume. 

4 Why is proper disclosure critical for a better claim settlement ratio?

Improper disclosure or non-disclosure means failing to reveal any fact that is creating an impact on the policy issuance decision in the proposal. Non-disclosure also leads to denial of the claim. Hence, it is recommended to provide proper disclosure to create a positive effect on the claim settlement ratio. 

5 What is the timeframe for reporting a claim?

There is no particular timeframe for reporting a claim. However, reporting a claim as soon as possible helps in faster processing. For disability claims, you need to report within 120 days from the date of disability. Moreover, it is essential to report the claim within 60 days for any surgery or critical illness. 

6 Who qualifies to receive the claim benefit?

The following individuals qualify to receive the claim benefits of a life insurance plan:

  • Proposer, if you are not the life-assured
  • Nominee, if you are the life-assured
  • Individual to whom the policy is assigned at the time of purchase
  • Life assured, if you are alive and enjoying all the benefit claims including any major illness, claims under disability and major surgery

7 What makes the claim settlement ratio important?

A claim settlement ratio shows an insurance company's ability to pay the claimed sum assured to you or the nominee. In case an insurer has a high claim settlement ratio, it indicates that there is less likelihood of default on payment of the sum assured. On the other hand, a low claim settlement ratio (CSR) indicates a higher chance of your claim getting rejected.

8 How do you check the claim settlement ratio?

You can check any insurer's claim settlement ratio through this formula: (Total number of claims settled in a year divided by total number of claims in a year), multiplied by 100. For example, if an insurance company has in the last year settled 9,700 out of 10,000 claims that it received, its claim settlement ratio turns out to be 97%.

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In a Nutshell


Claim settlement ratio is an important criterion that every policyholder should look into before buying their policy. Also, the prospective policyholders shall maintain transparency when it comes to an insurance policy because incorrect or false information could lead to rejection of the claim in the future. This defeats the very purpose of the insurance. Thus, going with an insurer who has a proven track record for faster and higher claim settlements can help policyholders meet their objectives. With an Insurance Claim Settlement Ratio that is one of the highest in the country, HDFC Life has been consistently protecting the policyholders whenever things went south.  

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Disclaimer

  1. 30 days for non-investigation cases and additional 90 days for investigated cases
  2. This is subject to claim assessment and if no further investigation is required.

#Provided we have received all the relevant and required documents and no further investigation is required. Claim settlement process would be completed within stipulated timelines once the claim request is approved

##Individual death claim settlement ratio by number of policies as per audited annual statistics for FY 2023-24.

***Online Premium for Life Option for HDFC Life Click 2 Protect Super (UIN: 101N145V04), Male Life Assured, Non-Smoker, 20 years of age, Policy term of 25 years, Regular pay, Annual frequency, exclusive of taxes and levies as applicable. (Monthly Premium of 622/30=20.7).

**7% online discount available on 1st year premium only

~Tax benefits of ₹ 54,600 (₹ 46,800 u/s 80C & ₹ 7,800 u/s 80D) is calculated at highest tax slab rate of 30% on life insurance premium u/s 80C of ₹ 1,50,000 and health premium (Critical illness rider) u/s 80D of ₹ 25,000. Tax benefits are subject to conditions under section 80C, 80D, 10(10D) as per Income Tax Act, 1961. Please consult your tax advisor for more information.

ARN -  INT/ED/02/24/8918

 

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