Is Niva Bupa’s Claim Settlement Ratio Good?

Niva Bupa’s claim settlement ratio was 92.4% for the financial year 2024-25, meaning the company settled roughly 92 of every 100 claims it processed that year.¹ The ratio rose to 94.4% over the first nine months of FY 2025-26, through December 2025, suggesting the full-year figure will climb again.² That puts Niva Bupa slightly above the standalone health insurer average, though not at the top of the pack, and the headline number carries a couple of caveats worth understanding before you treat it as the final word.

The Trend Over Recent Years

The ratio has moved up each year the company has reported it on a comparable basis:

Within FY 2024-25, the January–March 2025 quarter alone came in at 93.2%, so the momentum was already building before the FY 2025-26 numbers arrived.¹ The company says its ratio has stayed above 90% for several consecutive years.³

How It Compares to Other Health Insurers

For FY 2024-25, Niva Bupa’s 92.4% sits a little above the standalone health insurer average of 91.22%, according to a Ditto Insurance comparison. Care Health Insurance came in higher at 93.13% over the FY 2022-25 period in the same comparison.⁴

A separate IRDAI metric reported by the Economic Times in February 2026 measures the percentage of claims paid within three months during FY 2024-25. On that metric, Niva Bupa scored 100%, one of only four standalone health insurers to do so, alongside Aditya Birla Health, Galaxy Health, and Narayana Health. Care Health was at 99.95% and Star Health at 99.81%.⁵

These are two different measurements. The 92.4% CSR tracks how many claims the company settles versus how many it receives, so rejections pull it down. The 100% figure tracks how quickly the insurer pays the claims it has already decided to approve. A company can turn down a meaningful share of claims and still pay the approved ones fast. Both are useful; neither alone tells you what you want to know.

What the Headline Ratio Doesn’t Capture

The 92.4% is counted claim by claim. A ₹5,000 claim and a ₹15 lakh claim each count as one. A Beshak page covering an earlier reporting period showed Niva Bupa’s CSR by number of claims at 90.64%, but its CSR by value of claims at only 74.32%.⁶ That gap points to a pattern where smaller claims are settled at a higher rate than larger ones. Niva Bupa’s own FY 2024-25 public disclosure reports settlement ratios only by count, not by value, so you cannot verify from the official document how the current ratio looks when weighted by rupees at stake.⁷

Speed of settlement is cleaner. For FY 2024-25, 99.95% of Niva Bupa’s claims were settled in under 30 days, matching Care Health for the period.⁷ The company says reimbursement claims are settled within 15 days of complete documentation, and cashless pre-authorization is targeted at 30 minutes.⁸

Why the Remaining Claims Don’t Get Settled

If 92.4% of claims are settled, the rest are rejected, withdrawn, or still pending. Niva Bupa’s own guidance identifies the common rejection causes, and most of them are things a policyholder can avoid:⁹

Incomplete or mismatched documents, such as missing bills, prescriptions, test reports, or discharge papers.
Pre-existing conditions that weren’t disclosed when the policy was bought.
Claims filed for a condition still inside the policy’s mandatory waiting period.
Treatments the policy explicitly excludes, like cosmetic procedures or self-inflicted injuries.
Late notification of hospitalization, or missed document submission deadlines.

Reimbursement claims are rejected more often than cashless ones because they’re assembled after treatment, which leaves more room for missing paperwork. The company says most rejections come from policyholders not knowing their policy terms rather than from anything intentional, and a rejected claim can be appealed or resubmitted with missing documents through the grievance process.⁹

Can the Company Actually Pay?

A settlement ratio only means something if the insurer has the money to back it. Niva Bupa reported gross written premiums of ₹6,762 crore for FY 2024-25, up 21% from the previous year, and profit after tax of ₹214 crore, up 161% from ₹82 crore.¹⁰ Its solvency ratio stood at 3.03 as of March 2025, well above the IRDAI minimum of 1.5. CARE Ratings reaffirmed the company’s subordinated debt rating at “CARE AA; Stable” in June 2025, citing liquidity of ₹7,195 crore in government securities and AAA-rated investments.¹¹

The incurred claim ratio, which shows claim costs as a share of premiums earned, was 61.22% for FY 2024-25, up from 59.09% the year before.¹² That rise is consistent with the company paying out more in claims relative to what it collects, which lines up with the rising settlement ratio.

Complaint Volumes Have Also Risen

A strong ratio doesn’t guarantee a smooth experience with every claim. Niva Bupa received 7,970 grievances in FY 2024-25, up from 5,165 the previous year, according to data presented to the Rajya Sabha.¹³ The Council of Insurance Ombudsman separately recorded 3,983 complaints involving Niva Bupa during the same year, or about 18 per lakh (100,000) policyholders. On that per-policyholder basis Niva Bupa sits close to Care Health (17 per lakh) and well below Star Health (51 per lakh).¹⁴ Complaint volumes rose across major health insurers that year, in part reflecting growing customer bases.

The Short Version

Niva Bupa’s claim settlement ratio is above the standalone health insurer average, has risen each year, and sits in a reasonable range relative to peers. The company is financially solid enough to back the claims it approves. Two things keep the picture from being purely positive: the ratio is counted claim by claim rather than weighted by amount, and older data has shown a meaningful gap between the two. If you’re buying or holding a Niva Bupa policy, the ratio is a useful signal, but your own experience will depend more on how carefully you disclose pre-existing conditions, respect waiting periods, and submit documents on time.

1
Niva Bupa Health Insurance. Investor Presentation Q4 FY2025
2
Niva Bupa Health Insurance. Earnings Presentation Q3 FY26
3
Niva Bupa Health Insurance. Annual Report FY 2024-25
4
Ditto Insurance. Niva Bupa vs Care Health Insurance
5
The Economic Times. Latest Claim Settlement Ratio of Health and General Insurers Released by IRDA in 2026
6
Beshak. Niva Bupa Health Insurance Claim Settlement Ratio
7
Niva Bupa Health Insurance. Public Disclosures on Quantitative and Qualitative Parameters FY 2024-25
8
Niva Bupa Health Insurance. Health Claim
9
Niva Bupa Health Insurance. Health Insurance Claim Rejection Reasons
10
Niva Bupa Health Insurance. Press Release Results March 2025
11
CARE Ratings. Niva Bupa Health Insurance Company Limited Rating
12
Niva Bupa Health Insurance. Financial Results March 2025
13
The Economic Times. Top Complaints of Policyholders Against Their Insurers
14
The Economic Times. Top 10 Insurers With Highest Number of Complaints in Handling Health Insurance