How to Check an Insurer Claim Record

The real test of any insurance company is how it behaves when you make a claim. Premium prices and brochure benefits look similar across companies — what sets them apart is willingness to settle claims fairly and quickly. Fortunately, India has robust public data you can use to assess this before you commit.

What Data Is Available and Where

IRDAI (Insurance Regulatory and Development Authority of India) publishes an Annual Report every year that contains insurer-wise data on:

• Claim settlement ratio (claims settled as a percentage of claims received)
• Number of grievances per 10,000 claims
• Amount repudiated as a percentage of claims received
• Average time to settle claims

Download the report from the official IRDAI website (irdai.gov.in) — it is free and updated annually.

Step 1: Find the Right Ratio for Your Product Type

Life insurance data is reported separately from health and general insurance. Do not compare a life insurer''s settlement ratio with a health insurer''s — the product mechanics are different. For life insurance, look at death claim settlement ratios. For health insurance, look at claim settlement ratios by number and by value.

Step 2: Look at Five Years of Data, Not Just One

A single year''s good ratio can reflect timing anomalies or a change in business mix. An insurer that has maintained a high settlement ratio consistently over five years is far more reassuring than one that improved only recently. Download two or three years'' reports and build a simple comparison.

Step 3: Pay Attention to Grievances per 10,000 Claims

This metric is often more revealing than the raw settlement ratio. A high settlement ratio alongside a high grievance count suggests the insurer settles eventually but only after policyholders push back repeatedly. You want high settlement ratio AND low grievances.

Step 4: Read Consumer Forums and Aggregator Reviews

Platforms like the IRDAI Grievance portal, consumer court records, and insurance-specific forums carry real complaints from policyholders. Search for patterns — frequent complaints about specific claim types (e.g., critical illness, maternity, accident) reveal systematic issues that aggregate statistics may smooth over.

Step 5: Ask Your Agent About Their Claims Experience

A seasoned advisor who has helped clients through multiple claims with a given insurer is a valuable source of qualitative insight. Ask specifically: "Have any of your clients had a major claim with this insurer? How did it go?" Advisors who help clients regularly build a real-world perspective that no statistic captures.

Step 6: Check the Insurer''s Network and TPA Quality

For health insurance, the Third Party Administrator (TPA) handles cashless authorisations. Some insurers have switched to in-house claims processing, which typically speeds up the process. Check whether your shortlisted insurer uses a TPA or processes cashless claims directly — both can work well, but in-house processing is often faster.

Common Pitfalls to Avoid

• Relying on a single year''s data or a single source.
• Assuming a well-known brand name guarantees a good claim experience.
• Ignoring the value of claims settled versus only the number — an insurer can settle 98% of claims by number but dispute all high-value claims.

Conclusion

Checking an insurer''s claims record takes 30 minutes and is one of the most valuable steps in the buying process. TruePolicy advisors work with claim data regularly and can give you a realistic picture of what to expect from any insurer on your shortlist.