Claim Settlement Ratio vs Real Claim Experience — What Should You Trust?

When you compare insurance companies in India, one term keeps popping up — Claim Settlement Ratio (CSR). On the surface, it looks like a trustworthy metric. A company with a CSR of 98% sounds like a safe bet, right?
But here’s the truth: that number doesn’t always reflect how smooth your actual experience will be when you file a claim.
Let’s break it down and more importantly, help you decide what really matters when choosing an insurer.

What is Claim Settlement Ratio (CSR)?

Claim Settlement Ratio refers to the percentage of claims an insurance company approves in a given year.
For example, if an insurer received 10,000 claims in 2024–25 and approved 9,800 of them, their CSR would be 98%.
The IRDAI (Insurance Regulatory and Development Authority of India) publishes these numbers every year in their Annual Report.

But here’s what the CSR doesn’t tell you:

How long did the claim process take?
Was the claim settled fully or partially?
How difficult was the paperwork?
Did the customer have to run pillar to post?
Was there legal escalation involved?

That’s where real claim experience comes into the picture.

Real Claim Experience: The Hidden Reality

Time taken to process the claim
Communication clarity from the insurance company
Whether any documents were unfairly rejected
Whether the insurer delayed intentionally
Ease of customer support, and more

For example, a company may settle 9,800 out of 10,000 claims (high CSR), but:

Delay payouts beyond 60 days
Keep asking for unnecessary documents
Underpay compared to the actual eligible amount

In such cases, the experience can be frustrating — especially during a time of medical emergency or financial need.

Why CSR Can Be Misleading

Let’s say two companies have the same CSR of 97%.

Company A processes claims in 10–15 days, communicates clearly, and helps with documents.
Company B delays claims, doesn’t answer calls, and requires multiple visits.

On paper, they look equal — but in reality, Company A provides far better service.
Also, insurers may deny big claims and approve small ones quickly to maintain their high CSR. So if you’re filing for ₹5 lakh, your experience could be very different from someone filing for ₹50,000.

Check These Before Choosing an Insurance Company:

CSR for the last 3 years (not just one year)
Average Claim Settlement Time (many companies publish this)
Customer reviews on Google, Reddit, Quora, etc.
Number of complaints filed with IRDAI
Claim payout ratio (total claims paid ÷ total claims filed)
Ease of cashless hospital network or claim process

Also, ask your agent or advisor for real-life examples of how claims were handled.

Use IRDAI’s Grievance Data

Total complaints received against each insurer
Types of complaints (delay, denial, partial payment)
Time taken to resolve issues

You can visit: https://bimabharosa.irdai.gov.in to explore complaint trends.
This can be a more honest indicator of how an insurer treats customers.

Case

Ravi bought a health insurance policy from Insurer X because it had a 99.2% CSR. But when his father was hospitalized, they:

Denied cashless claim despite being on the hospital list
Asked for documents twice that he’d already submitted
Took 47 days to finally settle the bill after multiple emails

Meanwhile, his friend Meena had a much smoother experience with Insurer Y, which had only a 96.5% CSR — but excellent customer service. So it’s clear that Numbers don’t always tell the full story.