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Claim Settlement Ratio of Insurance Companies

Team AckoMar 24, 2021

Picking the right car, bike, or health insurance policy isn’t easy. There are different features, coverage, ease of purchase, and claims services to compare. Price is important to us all, but arguably the most important thing is to have the comfort that when you make a claim, the insurance company will be there to help you.

It is impossible to know what the future holds. And when it is impossible to see the future, one must look back in history. This is where the Claim Settlement Ratio comes to help.

Claim Settlement Ratio - Formula

What is Claim Settlement Ratio?

Claim Settlement Ratio (CSR) is the ratio of the total number of claims settled by an insurance company against the total number of claims available for processing for a financial year.

CSR = Total claims settled in a year / Total claims received in a year x 100

CSR Formula

CSR is a good indicator of the claim settlement rate of an insurance company.

Example: If a company has a Claim settlement ratio of 99%. It means that the insurance company has successfully settled 99% of the claims it received. It should give some comfort to you as to how your claim will get handled in the future.

Importance of Claim Settlement Ratio in Insurance

Insurance is essentially a promise to help when you incur a financial loss. It’s only natural to verify whether the insurance company will honour that promise or not.

Claim Settlement Ratio (CSR) gives you confirmation that the insurance company has every intent to settle your claim.

Shortcomings of Claim Settlement Ratio

As an important metric, CSR is to gauge the intent of an insurance company towards settling your claim, it is not without its shortcomings:

Relies on the number, not the amount:

CSR only tells you about the percentage of claims settled by an insurance company. It doesn’t tell the complete story around the amount settled in claims.

Example: If a customer raised a claim against damages to his car, with the cost of repairs coming to Rs. 30,000. If the insurance company pays only Rs. 10,000 in partial claim settlement, it’ll still show up under ‘settled claims’ when you look at the CSR.

Doesn’t measure efficiency:

It could be that an insurance company has a high CSR but has a tedious process of claim reimbursement. Since the claim eventually gets settled, the CSR will look good. But the customer might regret buying a policy through them because they didn’t get help when they needed it the most.

Hence, it is important not to ignore other aspects like the efficiency of claim services and reviews on social media to know more about an insurance company beyond their Claim Settlement Ratio. CSR is one of the important metrics to look at, but it is not the only one you should consider.

ACKO Claim Settlement Ratio FY19-20:

At ACKO, our intent is never to find a reason to reject a claim but to find ways to approve them fast, and it shows in our Claim Settlement Ratio as well. We believe that our best practices should be known to our customers. Hence, our effort is to continuously and proactively enable and make visible all such information to both our policyholders and prospective customers on our website and refresh the data with the latest updates from time to time as applicable.

For claim settlement ratio or for an answer to any of your queries or to know about our public disclosures or to know anything about the company, the only source that you should trust and rely upon is our website www.acko.com.

We believe that we should provide and publish accurate and authentic data about our performances like CSR (Claim Settlement Ratio), ICR (Incurred Claim Ratio) and GWP (Gross Written Premium) for our customers to know how we are performing. 

Refer to the table below for the claim settlement ratio of ACKO General insurance:

Category Claim Settlement Ratio
Motor OD 97%

##The Claim Settlement Ratio for ACKO’s Own Damage Cover (part of Motor Insurance) was 97.22%.  The rejection ratio was 1.33%.

What this means is that out of every 100 claims received by us (ACKO), we have settled ~97 claims & rejected ~2 claims. The remaining ~1 remains outstanding as it is still awaiting some mandatory documents from the customer.

** ACKO’s Group Medical Health Insurance plan did not receive any claims in FY 2019-20. Its data will get updated at the end of FY 2020-21.

Reasons for Claim Rejection:

Each claim is different and more often than not, the insurance companies have a good reason for rejecting any claim. If CSR is not 100%, it doesn’t mean that the insurance company is not treating every claim fairly. 

Here are some of the reasons that can lead to a rejection of a claim:

  • Claim raised after the insurance policy has lapsed.

  • Claim raised against a disease/damage that is not covered by the insurance policy.

  • Misrepresentation or wrong information in the claim form.

  • Non-disclosure of any information such as pre-existing diseases in health insurance and modifications done to the vehicle in case of car/bike insurance.

  • Unreasonable delay in raising the claim request.

  • Claim raised for coverage that is not covered by the insurance policy.

  • A false claim made with untruthful information. Such claims are known as fraudulent claims.

Claim Settlement Ratio For Car Insurance:

Car insurance is nothing but the legal contract between you and ACKO. A car is prone to damages, and you will end up applying for a claim if your car suffers an accident. Therefore, it is crucial to check the CSR before making the purchase decision. For more information, you can read about the Car Insurance Claim Settlement Ratio.

Claim Settlement Ratio For Bike/Two-Wheeler Insurance:

A two-wheeler insurance policy provides coverage against legal and financial liabilities in case of an accident. The bike insurance plan compensates for the repair bill if your motorcycle/scooter is damaged. To get compensation from the insurer, you need to apply for a claim. That’s why it is important to check the Bike Insurance Claim Settlement Ratio before you purchase a two-wheeler insurance policy.

Claim Settlement Ratio For Health Insurance:

Buying a health insurance policy is not a luxury anymore. It has become a necessity, especially amidst the ongoing pandemic. You buy health insurance to get compensated for the medical expenses incurred due to various health disorders, which are covered by the policy. Before buying a health insurance policy, go through the insurer's after-sales service policies, claim settlement ratio, and also the Incurred claims ratio (ICR). For more information, you can read about the Incurred Claims Ratio for Health Insurance

Claim Settlement Ratio: Frequently Asked Questions

If you are someone who is purchasing an insurance policy for the very first time, then you will find it confusing to choose the right insurance provider. Below are the most commonly asked questions related to insurance claims and claim settlement ratio.

Claim Process

1. What is a claim number in an insurance claim?

After registering the claim, you will be given a number, which is called a claim number. You can use the claim number as a reference number for future enquiries and claim settlement.

2. How do I apply for an insurance claim?

You need to intimate us to raise a claim. ACKO customers can log in here to initiate a claim or download our mobile app.

3. What is the first step in processing an insurance claim?

The first step in processing an insurance claim is to intimate ACKO and apply for a claim online or by downloading the mobile app.  

4. What are the two most common mistakes made while submitting a claim?

Incorrect/Incomplete claim form and claiming the exclusions are the two common mistakes made while filing a claim.

Documentation

1. What all documents do I need to submit to file a claim with the insurance company?

The need for documents differs for the type of claim and processes of an insurance company. Some of the commonly required documents are:

  • A medical certificate, discharge summary, diagnostic reports and original hospital bills (For health insurance claim).

  • Vehicle registration certificate,driving license and FIR if required (For car/bike insurance claim).

2. From where can I get the claim form and list of documents required to file a claim?

Normally, the claim process is cumbersome and lengthy. However, ACKO aims to make this process simple and faster. The entire process is digital, to enable ACKO’s customers to file claims anytime and anywhere. ACKO customers can file a claim online on this link.

Claim Settlement

1. Why does the insurance company reject the claim?

ACKO will reject the claim because of the following reasons:

  • Incomplete claim form/Claim form with wrong information

  • Claim raised against exclusions of the policy.

  • Claim raised with untruthful information

  • Claim raised after the expiry of the insurance policy

  • A fraudulent claim

2. What is a settlement letter in an insurance claim?

A settlement letter is nothing but the request letter to settle the claim. You need to submit the claim settlement letter to ACKO while applying for a claim.

3. What is a cashless claim settlement in an insurance claim?

Cashless claim settlement is a facility offered by ACKO wherein ACKOsettles the claim directly with the network hospitals (health insurance claims)/network garages (motor insurance claims). This means you don’t have to pay anything except for the deductibles as per the policy document.

4. How to submit the claim settlement documents to the insurance company?

You can upload the soft copies of the document on the ACKO’s website/app.

Terminologies

1. How is the insurance claim settlement ratio calculated?

The insurance claim settlement ratio is calculated by dividing the number of settled claims by the total number of claims available for processing in a year.

2. What is the difference between the incurred claim ratio and claim settlement ratio?

Incurred Claim Ratio is the ratio between the total paid claims and the total premium earned by the insurer in a year. Whereas, the claim settlement ratio is the ratio between the settled claims and the received claims in a particular period.

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