Health insurance cos settled 71% claims in FY24

Health insurers paid out 71.3% of the Rs 1.2 lakh crore in registered and outstanding claims during FY 24, according to data from the Insurance Regulatory and Development Authority of India (IRDAI).

The insurance regulator's report indicates that insurers registered over 3 crore claims during the year, amounting to Rs 1.1 lakh crore. This also included 1.79 million claims worth Rs 6,290 crore carried forward from previous years. Insurers paid nearly 2.7 crore claims, totaling Rs 83,493 crore, representing 82% of the reported claims by volume and 71.3% by value.

Of the claims that were not paid, Rs 15,100 crore worth of claims were disallowed according to the terms and conditions of the policy contract. These claims do not appear in the records, and there are no numbers available for them, as they are not entertained upon submission because the insurer identifies that the claim does not meet specific criteria outlined in the policy. Additionally, 3.6 million claims worth Rs 10,937 crore were repudiated or rejected by insurance companies. The remaining 2 million claims, amounting to Rs 7,584 crore (6.4%), continue to remain outstanding on the books of the insured.

Disallowed claims are those that were never registered at all, while repudiated claims are those that were rejected after the scrutiny of documents. Against the Rs 83,493 crore in claims paid, insurers collected Rs 1.1 lakh crore through health insurance premiums. The highest amount was collected by public sector insurers, which raised Rs 40,993 crore, followed by private insurers at Rs 34,503 crore and standalone health insurers at Rs 32,180 crore.​