How to check the claim settlement record of a health insurer in 2026

The official claim record of health insurers is in the IRDAI Annual Report and in each insurer's Form NL-37. A 99 percent settlement figure usually counts claims and ignores the rupee value. Learn how to check health insurance claim settlement ratio and work out the rejection rate yourself.

By Qrates research desk · 2026-11-01

You can find the official claim record of health insurers in two places: the IRDAI Annual Report and each insurer's public disclosures on its own website. The Annual Report gives sector-wide claim numbers and each insurer's Incurred Claim Ratio. The claim counts for one insurer are in its Form NL-37. For waiting periods, cover and benefits of a policy, see the Qrates health insurance directory.

Quick answer

The IRDAI Annual Report shows sector-wide health claims and each insurer's Incurred Claim Ratio. Form NL-37 on the insurer's website shows its own claim numbers.
A figure like 99 percent usually counts the number of claims and ignores the rupee value. In 2024-25, general and health insurers paid 87.50 percent of health claims by number but 71.14 percent by amount.
To see the rejection numbers for one insurer, open its latest Form NL-37 and read the Claims Repudiated row in the Health column.

What you need before you start

A phone or computer with a PDF reader installed.
An internet connection to download a large file.
The exact registered name of the health insurance company you want to check.

How to check the claim settlement ratio on the IRDAI website

Step 1: Download the IRDAI Annual Report

Go to the official IRDAI website at irdai.gov.in.
Open Reports & Statistics, then Annual Reports. Menu names can change.
Download the PDF for the most recent financial year. The latest listed now is 2024-25, dated 30 December 2025.

Step 2: Find the health insurance claims table

Open the PDF and search for "Status of Claims under Health Insurance of General and Health Insurers". It is Table I.29 in the 2024-25 report.
This table shows totals for all general and health insurers, not one company. For 2024-25, 71.14 percent of the claim amount was paid, 13.98 percent was disallowed, 8.61 percent was repudiated and 6.27 percent was outstanding.
For your own insurer, go to Statement 10, "Incurred Claims Ratio of General and Health Insurers", and read the Health column.

Step 3: Calculate the rejection rate for your insurer

Open the public disclosures section on the insurer's website and find the latest Form NL-37, Claims Data. Use the form for the quarter ending in March to see the full year.
In the Health column, find Claims Settled and Claims Repudiated. Form NL-37's notes say repudiated means rejected, or partly rejected on account of policy terms and conditions.
The form gives the number of claims and usually a second table in rupees. Divide the repudiated figure by the total of paid and repudiated to get a rough rejection rate.

How long it takes and what it costs

This process takes about 10 minutes once you know where to look.
Downloading the report from the IRDAI website is completely free.
You do not need to create an account or share your phone number.

Difference between Incurred Claim Ratio and Claim Settlement Ratio

The Claim Settlement Ratio shows claims paid as a share of claims handled. IRDAI's table counts paid claims against all claims on the books in the year, including those still outstanding. Other sources may leave out outstanding claims, so check what the number is divided by. The Incurred Claim Ratio is net incurred claims divided by net earned premium. A high Claim Settlement Ratio by number can still hide large claims being rejected, and in IRDAI's 2024-25 data the share by amount was lower than the share by number.

The Incurred Claim Ratio shows how much of its premium an insurer spends on claims. It does not tell you how any one claim was treated. An Incurred Claim Ratio over 100 percent means net claims were more than the premium earned that year.

Feature	Claim Settlement Ratio (CSR)	Incurred Claim Ratio (ICR)
What it measures	Number of claims settled	Money paid out versus money collected
Formula	Claims paid divided by claims handled (check whether outstanding claims are included)	Net claims incurred divided by net earned premium
What it hides	The rupee value of rejected claims	The exact number of people whose claims were rejected
What a high number means	Most claims get paid	The insurer is paying out a large portion of its collected premiums

If it does not work

The IRDAI website can sometimes be slow or down for maintenance.
If you cannot download the Annual Report, visit the public disclosures section on the insurer's own website.
General and health insurers publish claim data in a standard format called Form NL-37. Insurer sites list it with their quarterly disclosures.
Life insurance companies publish claim data in Form L-40 and the age of claims in Form L-39.

FAQs

What is a good claim settlement ratio for health insurance?

The IRDAI Annual Report does not name a good number. As a reference, general and health insurers paid 87.50 percent of health claims by number in 2024-25, and 71.14 percent by amount. Compare your insurer with these figures, and check the amount as well as the count.

Is the 99 percent claim settlement ratio real?

It can be, but a 99 percent figure usually counts the number of claims and ignores the rupee value. Ask what period it covers and what it is divided by. IRDAI's claim figures include both cashless health insurance claims and reimbursement claims. A high percentage by number can hide the rejection of large hospital bills. Before buying, it is also wise to read your health insurance policy document clauses to understand how deductions like room rent limits affect your final payout.

Where to check health insurance complaints?

The IRDAI Annual Report gives grievance totals for groups of insurers, not for each company. In 2024-25, 1,37,361 grievances were reported against general and health insurers on the Bima Bharosa portal. For one insurer, look for Form NL-45, Grievance Disposal, in its public disclosures. If you are struggling with a claim, you can also learn how to complain to IRDAI Bima Bharosa about a rejected claim.

The short version

The IRDAI Annual Report has sector-wide health claim data and each insurer's Incurred Claim Ratio.
The Claim Settlement Ratio shows claims paid as a share of claims handled. Check what it is divided by.
The Claims Repudiated row in Form NL-37 shows rejected claims for one insurer.
The Incurred Claim Ratio compares net incurred claims with net earned premium.
You can find claim data on the insurer's website in Form NL-37, or Form L-40 for life insurers.