Stop Buying Health Insurance Based Only on Claim Settlement Ratio (CSR). The Data Tells a Very Different Story.
One metric is repeatedly used by insurers and YouTube influencers to sell health insurance: Claim Settlement Ratio (CSR).
It sounds reassuring. “97–98% claims settled.” But CSR alone tells you very little about how an insurer behaves when a claim becomes disputed.
After looking at publicly available IRDAI and Ombudsman data, here’s what stood out.
- A high CSR does NOT necessarily mean smooth claims.
- For example:
- HDFC ERGO reports a very high CSR, yet lower CSR(Absolute Amount) indicating that they reject tiger value claims and pass lower value claims to keep their CSR High and has one of the higher complaint rates among general insurers and more than half of Ombudsman decisions reportedly went in favour of customers in the referenced data.
Care Health
Niva Bupa
Star Health
These insurers also rank relatively high in complaint rates or customer success rates before the Ombudsman in the charts shared. That does not mean every claim is handled poorly. It does mean that CSR alone doesn’t tell the whole story.
Complaint ratio matters.
Ask yourself:
How many customers actually had to complain?
Complaint ratio (complaints per 10,000 policies) reflects how often policyholders felt something went wrong.
In the charts:
Star Health
Niva Bupa
Care
HDFC ERGO
all appear toward the higher end of complaint frequency compared with several peers.
If an insurer settles most claims but generates significantly more complaints than competitors, that is worth examining.Ombudsman data is even more interesting.
If an unusually large proportion of Ombudsman decisions end in favour of policyholders, it suggests that, in those disputed cases, the insurer’s position was not upheld.
Again, this does not prove misconduct by any insurer. But it is a useful indicator of how disputes are ultimately resolved.Who looks stronger from these datasets?
Looking only at the charts shared:
New India Assurance appears to have: relatively low complaint ratios, comparatively fewer Ombudsman outcomes favouring customers than several peers, respectable settlement performance
Bajaj Allianz also appears comparatively balanced across: CSR, complaint rate, Ombudsman outcomes
No insurer is perfect.
But based on these datasets, they appear more consistent than some of the more aggressively marketed brands.
- My takeaway
When choosing health insurance, don’t ask only:
“What’s the Claim Settlement Ratio?”
Also ask:
Complaint ratio
Ombudsman outcomes
Average settlement amount
Cashless network quality
Policy wording
PED clauses
Customer experience during disputes
A company can have a 97–98% CSR while still generating a relatively high number of complaints or losing a substantial share of disputed cases before the Ombudsman, indicating that they weren't useful at the exact time when they were expected to support, an emergency Hospitalisation.
CSR measures how many claims were settled.
It does not tell you:
1. how many policyholders had to fight,
2. how many claims were initially disputed,
3. how many were settled only after escalation,
4. how difficult the claims process was.
Use multiple metrics before choosing an insurer, not CSR alone.
Infographics source: Beshak Insurance, Ditto Insurance by Zerodha.
Data source: Publicly available IRDAI disclosures, Insurance Ombudsman Annual Report, and insurer complaint statistics reflected in the attached charts. These observations are based on those published datasets and should not be interpreted as findings of misconduct by any insurer.
