The Aditya Birla Health Insurance claim settlement ratio sat between 95.64% and 95.88% for FY 2024-25, depending on the source, placing the insurer in the upper-middle tier of Indian health insurers and above the broad industry benchmark of 95%. On a related IRDAI measure, 100% of ABHI’s claims were paid within three months during the same year.
ABHI’s Claim Settlement Ratio Year by Year
The claim settlement ratio is simply the share of claims an insurer settles out of the total it receives in a period. For ABHI, the trend has climbed gradually:
- FY 2021-22: 93.7%
- FY 2022-23: 95.95%
- FY 2023-24: 94.51% to 95.61%
- FY 2024-25: 95.64% to 95.88%
The small gaps between sources come from differences in methodology and timing. One aggregator pins the three-year average for 2022–2025 at 95.81%; another lists the FY 2024-25 figure at 95.64%. ABHI’s own website reports a higher 97% ratio for FY 2025-26, drawn from 29 lakh claims settled.
How ABHI Compares to Other Health Insurers
A PolicyX comparison for FY 2024-25 placed ABHI tenth among major players:
- Star Health: 99.06%
- Acko General: 97.68%
- Care Health: 96.74%
- HDFC ERGO: 96.71%
- Aditya Birla Health: 95.64%
- Niva Bupa: 92.39%
- ManipalCigna: 88.64%
Anything above 95% is generally treated as good in the health segment, so ABHI clears the bar without leading it.
On the IRDAI’s separate measure of claims paid within three months, ABHI did lead. It was one of four standalone health insurers to report 100% for FY 2024-25, alongside Niva Bupa, Galaxy Health, and Narayana Health. The industry average on that metric was 99.93% for standalone health insurers and 94.03% for general insurers.
What the Ratio Doesn’t Tell You
The CSR counts whether a claim was settled. It does not say how much was paid against what was claimed, and it does not say how long settlement took. An insurer can post a high CSR while routinely paying less than the amount submitted.
That gap is why the incurred claims ratio (ICR) matters alongside the CSR. The ICR compares the value of claims paid to premiums collected, which reads closer to financial behavior than approval behavior. ABHI’s ICR for FY 2023-24 was 68.31%, according to data cited by Beshak. Industry observers have noted that the IRDAI has been shifting weight toward ICR as a companion figure.
The CSR itself is also under review. A May 2025 report in the Economic Times noted that insurers use inconsistent definitions: some count a claim as settled at “first instance,” others only after liability is established, and some even classify rejected or document-deficient claims as settled. Former IRDAI member KK Srinivasan was quoted saying “a claim can be treated as settled only if the client confirms that it is settled.” As of mid-2026, the IRDAI is working to standardize the calculation, which means current CSR figures across insurers aren’t strictly comparable.
How Fast Does ABHI Settle Claims?
For cashless treatment at network hospitals, ABHI targets pre-authorization within one hour and discharge approval within three hours. Reimbursement claims are typically settled within 7 to 15 working days once complete documentation is in, against the IRDAI regulatory ceiling of 30 days.
If an insurer fails to settle within 45 days of receiving the last document, IRDAI rules require it to pay interest at 2% above the bank rate, counted from the date of document receipt.
Complaints and Consumer Court Outcomes
A high settlement ratio does not rule out disputes, and ABHI has its share. The insurer received 2,354 complaints to the Insurance Ombudsman in FY 2024-25, or roughly 12 per lakh (100,000) policyholders. That rate is lower than Star Health (51), Niva Bupa (18), and Care Health (17), and higher than HDFC ERGO (10) and ICICI Lombard (2). Ditto’s assessment flagged “room for improvement in customer experience,” citing 18.67 complaints per 10,000 claims.
Consumer courts have ruled against ABHI in several individual disputes. In February 2025, the Chandigarh consumer commission ordered the insurer to pay ₹54,228 in medical reimbursement plus ₹15,000 in compensation after it denied a hospitalization claim on the grounds that the admission was unnecessary. The commission stated that “the treating physician is the sole authority to determine the necessity of a patient’s admission” and observed that insurers commonly “invent all sorts of excuses to deny” claims after selling policies on attractive terms.
In Bengaluru, a consumer commission ordered ABHI to pay ₹2.6 lakh plus interest after it denied a reimbursement claim for an accident victim, citing hospital paperwork delays. The commission held that “delay in paperwork on the part of the treating hospital cannot be a ground to deny a genuine claim.” An Ernakulam consumer commission separately found ABHI liable for “deficiency in service and unfair trade practice” after it repudiated both cashless and reimbursement claims following an accidental injury. Individual rulings don’t define overall practice, but they show the kind of friction a 95%-plus CSR can still leave in.
Why ABHI Claims Get Rejected
ABHI does not publicly disclose the share of claims it rejects or repudiates. Its parent, Aditya Birla Capital, lists the common reasons claims are denied:
- Late notification: not informing the insurer before a planned hospitalization or within 24 hours of an emergency admission.
- Excluded treatments: claims for procedures the policy doesn’t cover, such as cosmetic surgery or dental care.
- Waiting period violations: filing during the mandatory waiting period for pre-existing conditions, which typically runs two to four years.
- Exceeding the sum insured: claims above the policy’s annual coverage limit.
- Non-disclosure or inaccurate information: errors or omissions about medical history, age, or other personal details at the time of purchase.
Most of these sit on the policyholder’s side at the point of purchase or admission, which is where the strongest protection against a denial is built.
Reading the Number in Context
ABHI’s claim settlement ratio of roughly 95.64% to 95.88% for FY 2024-25 is a reasonable, mid-pack figure that has trended up over four years. Paired with the 100% within-three-months rate, it suggests claims that get approved get paid promptly. The ICR of 68.31% for FY 2023-24, the Ombudsman complaint volume, and the pending IRDAI standardization work are the three qualifiers worth holding alongside the headline number before treating it as the final word on how an insurer behaves.