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What is the Claim settlement ratio?

Claim settlement ratio is a metric that prospective policyholders use to measure the credibility of the insurance provider. It is calculated as the percentage of claims a company has settled as against the number of claims received during a financial year. This allows the prospective insurance policyholders in making informed decisions regarding the selection of their insurer to ensure that they face minimum difficulties at the time of submission and approval of insurance claims. As a thumb rule, the higher the claims settlement ratio, the better the chances of your claim being approved and settled.

How is the Claim settlement ratio calculated?

Calculating the claim settlement ratio is easy. It can be calculated with the following formula:

Claim settlement ratio = (Total number of claims settled in a year / Total number of claims received in a year) * 100

For instance, suppose an insurance company received a total of 5000 claims in a financial year. Out of this, a total of 4900 claims were settled by the insurance company. Therefore, the claim settlement ratio will be 4900 / 5000 * 100 = 98%.

However, a key point to note here is that the claim settlement ratio is for the company as a whole and not plan or insurance category wise. Therefore, the above figure of 98% implies that across all the insurance categories taken together, a total of 98% of claims were approved. For instance, the term plan claim settlement ratio might be a little higher than the other ones. This offsets the claim settlement ratios of other products thus averaging out to 98%.

What is a Good Claim settlement ratio?

Policyholders always look for an insurance company with a good claim settlement ratio. However, a set benchmark is required to measure anything. In the case of the claim settlement ratio, while there is no set benchmark, a ratio of 90%-95% is considered good. It shows that there is a 90%-95% chance that the insurance company will approve your claim. However, an insurer with a claim settlement ratio of above 95% is more likely to get your insurance approved and offer a better claims experience in terms of the claims settlement process.

Why is the Claim settlement ratio Important?

The claim settlement ratio cannot be overlooked when searching for the right insurer. The following points depict the importance of a claim settlement ratio:

• Assures the financial security:

Claim settlement ratio depicts the percentage of claims settled. You pay a good number of premiums over the year to stay protected financially from the uncertainties. In case your claim gets rejected, it can create serious financial difficulties. If your insurer rejects your claim, then the whole purpose of getting your insurer gets defeated. On the other hand, if the insurer approves most of your claims, then it assures you and your family of financial security.

• Depicts the Insurer’s reliability:

A higher claim settlement ratio indicates the insurer’s capability and reliability to pay the claim amount whenever the claim is lodged. They are unlikely to default on their insurance claim settlement if they have consistently maintained a higher claim settlement ratio. Thus, a higher claim settlement ratio is seen as a positive indicator for the buyer of the insurance policy. Likewise, a lower claim settlement ratio creates a negative impact in the minds of the prospective policy holder.

• Co-operation from the insurer:

A higher claim settlement ratio depicts that the insurance company is concerned about its policyholders and co-operates to ensure that they are adequately compensated for their loss. It also creates an expectation in the minds of the policyholders that the company will ensure faster processing and settlement of claims. This is what the HDFC Life Insurance Claim Settlement Ratio conveys to the policyholders.

How Long Does it Take to Get the Claim Payout?

The time taken to get the claim payout varies among the insurance companies and the type of insurance. As per the IRDAI, all claims should be settled within 30 days1 from the date of receipt of all relevant documents. During this period, the insurance company scrutinises the application, assesses the damage/loss, raises queries for additional information or documentation, and decides upon the approvals and rejections thereof.

Why is HDFC Life Claim Settlement easy and Hassle-Free?

HDFC Life Insurance has an easy and hassle-free claim settlement process. It is noteworthy that the HDFC Life Claim Settlement Ratio set a remarkable benchmark of 99.39% for the FY 2022-23. The claim can be lodged in the branch of the company as well as online whereby the policyholders can conveniently lodge their claims and solve out the queries if any.

Apart from such hassle-free and faster claim settlement, HDFC Life also provides for 1-day claim settlement. Here, the policyholder can receive the claim settlement amount within 24 hours of lodging the claim and submission of documents. Following are the conditions subject to which the policyholders can receive claim settlement within 24 hours:

• The policy should have been purchased online

• The insurance claim should not require field investigation to be undertaken

• The cumulative claim amount should not exceed Rs, 2 crores2

• All the claim documents shall be submitted by 3 pm on a working day.

HDFC Life holds complete accountability and responsibility to settle the claim within 24 hours on working days. In case the claim does not get settled, then HDFC Life will pay interest at the rate of 2% per annum above the bank rate for each additional day that the claim gets delayed.

What is the Process for Processing a Claim?

HDFC Life provides three different modes for claim intimation. These are:

• Online submission of claims

• Whatsapp users can simply scan the QR code or directly message ‘Death Claim’ on +91 82918 90569 in order to begin the process.

• You can physically visit the branch for claim intimation with the claim form. The claim form can be downloaded from
https://www.hdfclife.com/claims

The lodging and processing of the claim is a 3-step easy process with HDFC Life Insurance.

Online Claim Lodging:

Online claim lodging is convenient, especially for the tech savvy people. It relieves them from going through the hassle of physically visiting the HDFC Life along with physical documents. It offers faster, seamless, paperless, and convenience in lodging the claim. If you wish to lodge the claim online, then follow the below-mentioned steps:

Step-1: Verify the Policy Details

You need to verify your policy details before lodging the claim. Through this, you can provide the necessary information from your policy viz. claim information, information about the claimant, information about the life insured, contact information of the claimant, etc.

Step-2: Submit the Details of Life Assured

The next step is to submit the details of the life assured including ID proofs, medical certificates, discharge receipt, and medical expense documents.

Step-3: Submit the Details of the Nominees

The details of the nominee as required in the claim settlement process shall be submitted.

Offline Claim Lodging:

In case you find online claim lodging inconvenient and an offline route is more preferable to you, then you can physically visit any one of our branches. Just follow the below mentioned steps:

Step-1: Submit the Claim Form

You can download the claim form from the website or visit a branch to acquire the same. You must fill in the necessary details before submitting the form. In case you require assistance, you can contact a representative at your nearest branch.

Step-2: Collect all the Required Supporting Claim Documents

Once you fill up the form, submit all the necessary supporting claim documents to the branch representative. This includes identity proofs of the life assured, discharge certificates, medical vouchers, medical reports, and other necessary documents.

Step-3: Submit Claim Form and Supporting Documents

Once the above two steps are completed, you can submit the claim form and supporting documents to our branch. To locate the branch in your city, you can use the branch locator from our website. By entering the state and city, the locator will show you the branches located in your city along with the address and office timings.

Documents Required for Claim Settlement

Claim settlement involves the submission of certain documents in order for the company to verify the details of the claim.

Mandatory Documents required for claims:

• Death claim form (including NEFT)

• Death certificate issued by the government or local municipality authority

• Original policy document, (where applicable)

• Claimant’s PAN details

• Claimant’s ID proof

• Personalized cancelled cheque or Bank passbook(Printed account number, name of the account holder and IFSC code)

Based on the type of claim, additional documents required as mentioned below:

 Type of Claim Documents Required Natural Death Claim The medical cause of death certificate Medical records and associated documents Unnatural Death Claim (Accidental Death / Suicide / Murder) Post mortem report First Information Report Panchnama Police inquest report Annuity claim documents Natural Calamities / Disaster Claims Death certificate issued by the government or local municipality authority Death claim form (including NEFT) Claimant’s PAN card Claimant’s address proof Original policy document Bank passbook or cancelled cheque Critical Illness Claim Critical illness claim form Medical records (current & past) for instance, hospital records Diagnostic tests reports

1 What is the resort in case the policy documents are not available with the nominee?

In lieu of the policy document, an indemnity bond shall be submitted. The indemnity bond shall be duly notarized and executed on a stamp paper. The value of stamp paper varies among the states.

2 What are the account proofs that can be submitted?

As account proofs, a cancelled cheque or bank statement with the pre-printed account number, IFSC, and beneficiary’s name shall be submitted.

3 What can be the reasons for the rejection of the claim?

Reasons could be many. However, some of the prominent reasons for claim rejection include:

Incorrect or incomplete information given in the application (Proposal) form: An incorrect or incomplete information in the application (Proposal) form could lead to claim rejection during the perusal of the documents. Therefore, do conceal any information especially for the existing diseases, occupation, habits etc.

Lapsed Policy: If the policy has lapsed, it is not bound to cover the risk. Most often, policies lapse when the premium is not paid on time. Therefore, ensure you pay all your premiums on time.

Death reason not covered in the policy: While buying the policy, you should ensure that all the terms and conditions, as well as the extent of coverage, are read by you thoroughly. In case you have not read the same, it might become the major reason for the rejection of your claim.

4 Whether claim settlement ratio can be the sole determinant when it comes to assessing the insurer’s credibility?

Claim settlement ratio cannot be the sole determinant when it comes to assessing the insurer’s credibility. This is because it shows the percentages but not the actual numbers. Secondly, the claim settlement ratio is for the company as a whole and not for individual products of the insurance company. Also the claim settlement depends on the genuine disclosure of all material facts by the life assured while applying for the policy. It is based on utmost good faith and hence, it is expected that, the life assured discloses all material facts.

In a Nutshell

Claim settlement ratio is an important criterion that every policyholder should look into before buying their policy. Also, the prospective policyholders shall maintain transparency when it comes to an insurance policy because incorrect or false information could lead to rejection of the claim in the future. This defeats the very purpose of the insurance. Thus, going with an insurer who has a proven track record for faster and higher claim settlements can help policyholders meet their objectives. With an Insurance Claim Settlement Ratio that is one of the highest in the country, HDFC Life has been consistently protecting the policyholders whenever things went south.

Disclaimer

1. 30 days for non-investigation cases and additional 90 days for investigated cases

2. This is subject to claim assessment and if no further investigation is required.

ARN: ED/02/22/27661