IRDA Claim Settlement Ratio in life insurance

Buying a life insurance policy is crucial as you can secure your family's financial future with it. This is why it's vital to choose your policy and the insurance company offering it wisely. One criteria for making such a choice is the IRDAI Claim Settlement Ratio (CSR). In this article, we help you understand IRDAI Claim Settlement Ratio in life insurance.

The IRDAI is the Indian insurance industry's governing body that issues licences to insurance companies, checks their policies and premiums against benchmarks, and settles disputes that policyholders and insurance companies may have. 

The IRDAI sets down the rules and regulations for the Indian insurance industry. These regulations streamline the industry's growth and safeguard policyholders' interests. Thanks to IRDAI, insurance is made affordable and available to all Indian citizens.

A life insurance Claims Settlement Ratio measures how many claim applications an insurance company settled against the total number of claims they received in a year. The resulting ratio is the percentage of claims that an insurance company settled in that year.

If an insurer has a high IRDAI Claim Settlement Ratio, it means that they have a higher capability to settle claims, and indicates their efficiency in handling and processing claims. In addition, a high CSR establishes that the insurance company can deliver on their promises to fulfil claims settlements smoothly.

When a policyholder chooses a Life Insurance Policy, they can base their choice on an IRDAI Claim Settlement Ratio. However, selecting an insurance company only according to it is not recommended as CSR is not the only important selection criteria. Potential policyholders should also research the insurance company's product offerings, customer service, social media handles, etc., among other criteria.

You can look at the insurer’s CSR to determine if the insurance company you are looking at is the right one for their family. Here’s how to calculate CSR.

If an insurance company settles 9,000 claims out of 10,000, the Claim Settlement Ratio is calculated by dividing claims settled against the total number of claims received. 

Claims Settled divided (÷) by Total Claims Received Times (×) 100 = CSR 

In this case, CSR is 90.

Claims settlements are executed in a structured process that insurance companies adhere to. Most insurance companies carry out claims settlements according to the following steps.

1. Reporting the claim 

A claim settlement process is initiated when the claim is reported to the respective insurance company. Reporting a claim can be done online, over the phone, by visiting the insurance company's office, or other methods the insurance company specifies.

2. Submitting the necessary documents 

The person who reports a claim should furnish the insurance company with the documents they require in order to substantiate and verify the claim. Although the type of documents needed will vary by insurance company, policy, nature of the claim, and death of the policyholder, most insurance companies require similar sets of documents. 

3. Assessment of claim 

After the required documents have been submitted by the beneficiary or claimant, the insurance company will begin to assess the claim and its legitimacy. The insurance company may appoint an assessor to investigate the claim in order to verify the details. This process is crucial in ascertaining the relationship between the claimant and policyholder, and if they are the beneficiary that the policyholder has stated in their life insurance policy document. 

4. Claim decision 

After the insurance company's assessor assesses the claim settlement application and verifies it, the insurance company will decide if they should accept or reject the claim. In case the details furnished were wrong, or if the beneficiary is not who the policyholder stated, then the claim will be rejected. 

On the other hand, if the beneficiary is the correct one, and all documentation is in place, then the claim is accepted. The insurance company will start the payment of the settlement amount based on the terms and conditions of the life insurance policy.

5. Settlement

After the claimant agrees to the settlement amount proposed by the insurance company, the insurance company will process the payment for the beneficiary. The claim settlement payment may be paid out via cheque, bank transfer, or electronic payment.

Claims settlements take days to weeks to process and do not happen overnight. According to the policyholder's death and circumstances surrounding it, and any challenges surrounding the policy, or issues in documentation, the process could extend further. Claimants must ensure they bring the necessary documents to finish the process quicker, and smoothly.

The person who applies for a claim will need to submit a set of necessary documents to the insurance company. These documents and types can vary by insurance company, policy, and cause of the policyholder's death. Generally, the following are the most common types of documents needed to settle a life insurance claim. 

The claimant should always find out more about the claims settlement process and the terms & conditions outlined, because these variables differ by insurance company and policies. The insurance company may require extra documents depending on the circumstances of the policyholder's death, or terms & conditions of the life insurance policy.

A special section of the Insurance Act known as Section 45 protects policyholders and their families in case Claims Settlement disputes that may arise after a certain period has passed. 

According to Section 45, if the insurance company suspects any foul play and has the evidence to support it, they have the authority to remove the life Insurance policy. Insurers can investigate suspicious Settlement Claims within 3 years of receiving the Claims requests. However, they do not have the right to reject claims made after 3 years, even if the claim might be a fraudulent one.

Disclaimer: The content on this page is generic and shared only for informational and explanatory purposes. It is based on industry experience and several secondary sources on the internet, and is subject to changes.