Health Insurance Claims Worth Rs26,037.65 Crore Rejected by Insurers in FY23-24: Govt
Moneylife Digital Team 07 February 2025
While reiterating that insurance companies process the claims as per the terms and conditions of the policy, the Union government says that, during FY23-24, insurers rejected claims worth Rs26,037.65 crore. It includes claims worth Rs15,100.14 crore disallowed as per terms and conditions (T&C) of policy and claims of Rs10,937.17 crore repudiated by health insurance companies. 
 
Responding to a question in the Lok Sabha, Pankaj Chaudhary, Union minister of state for finance, says during FY23-24, public sector insurer The New India Assurance Co Ltd tops the list, rejecting claims worth Rs7,038.04 crore. It is followed by ICICI Lombard General Insurance Co Ltd, which, according to the data shared by the insurance regulatory and development authority of India (IRDAI), rejected health insurance claims worth Rs2,016.81 crore.
 
Balashowry Vallabhaneni and advocate Dean Kuriakose, the members of Parliament (MP) have asked for details of health insurance claims rejected during FY23-24. 
 
According to the minister, IRDAI has mandated a few rules for insurers to ensure that customers are fully aware of the policy's T&C and prevent mis-selling. It includes providing a customer information sheet (CIS) to each policyholder, using a minimum 11-size font in the policy documents, put in place a framework to correctly inform features and benefits with T&C of insurance policy to the buyer, among others.
 
  
Data shared by the government shows that public sector insurers are paid Rs10,122 as a claim during FY23-24 for every Rs10,000 collected as a premium for the insurance policy. While private sector general insurers paid Rs7,077, stand-alone health insurers (SAHI) paid just Rs5,463 as claim amount against a premium of Rs10,000. 
 
 
However, when it comes to settling claims, for every 10,000 claims received in FY23-24, private sector general insurers and SAHI have an edge. IRDAI's annual report shows that while public sector insurers paid Rs7,984 for claims of every Rs10,000. Private sector general insurers and SAHI paid Rs8,639 and Rs8,635 for the same. 
 
 
The MPs also asked for information about state-wise health insurance paid by policyholders from across the country. This excludes premiums collected for travel and personal accident business. 
 
As per information shared in the lower house, Maharashtra tops the list with Rs31,258 crore collected during FY23-24 as health insurance premiums. Karnataka is in a distant second position with a collection of Rs12,017 crore, followed by Tamil Nadu at Rs9,738 crore.
 
During the past three financial years, policyholders paid Rs73,052 crore, Rs89,432 crore and Rs1.07 lakh crore for FY21-22, FY22-23 and FY23-24, respectively, as health insurance premiums. 
 
IRDAI has further advised the insurance companies to take various measures to improve the customer claim settlement experience, Mr Chaudhary says.
 
Here are some of the measures suggested by IRDAI...
1. No claim shall be repudiated without the approval of the insurer's product management committee (PMC) or a three-member sub-group of PMC called the claims review committee (CRC).
 
2. In case the claim is repudiated or rejected or disallowed partially, details shall be communicated to the claimant along with full details giving reference to the specific terms and conditions of the policy document.
 
3. If a customer is not satisfied with the decision of the insurer on the claim, he/she may lodge a complaint with the grievance redressal officer of the insurer. The policyholders have the right to approach the insurance ombudsman without any charges. Insurers must comply with the ombudsman's decision within 30 days, or they need to pay penal charges of Rs5,000 per day for each day of delay.
 
4. Shorter timelines for processing and settlement of claims have been introduced for reimbursement/ cashless claim settlement and for pre-authorisation.
 
5. Suo-moto payment of interest at bank rate plus 2% in the event of a delay beyond specified timelines.
Comments
madhavmenaria126
2 weeks ago
Gentelmen,
Absolutely needed matter raised by MP.Insurers r looting and emotionally blackmailing.Only improve need in this dirty insurance system is
1. to cut in luxury facility attraction to insured and payment against medicine and medical labour only to be paid
2 A huge unnecessarily pay and perks to insurance companies staff to be cut latest honourable court shown eye to care health insurance false payment made to a female authority
3 five star facility advertisement air taxi ac room ac toilet tv sofa bed and bedsheets facility to be banned by irdai
Only medicine and medical labour should be covered by insurer
They r cheating looting robbingon the name of five star facility and 90 % of looted cheated amount is either westing on the luxury ugly purpose

At the last health insurance means insurance of body so exclussion and permanent exclussion words to be removed from terms and conditions of policy
Exclussion and permanent exclussions r hidden agenda of insurance companies for rejection of claim
tejinder1962
2 weeks ago
IRDAI is turning nelson eye on the arbitrary rejection claims by insurance company including short settled claims by hiding behind the curtain of reasonable and customary charges. A total misuse of this clause which should be abolished in toto. They are not honouring the judgement passed earlier by consumer forum for similar matter. Total dadagiri and injustice.
jklalwani22
2 weeks ago
Abhi bhi darty ma ka hi padkop hai ye ki khatre main Charkop hai .star bhupa all in soupa
jklalwani22
2 weeks ago
Abhi bhi darty ma ka hi padkop hai ye ki khatre main Charkop hai .star bhupa all in soupa
narenwagle34
2 weeks ago
I have a "Gold Plan" for "super senior" citizens. Just three years ago, the annual premium was Rs 35000 for Rs 4.5L [my wife & I]. In 2020, this was hiked 300% as "Covid" effect. I was admitted to a reputed hospital for treatment of pneumonia. My bill for about Rs 1.25L was partly repudiated for room rent [although within allowable limit], disinfectant charges [despite pandemic period] and "others" unexplained. The PSU company [United India] nominated an agent on policy document who is a fossilised bureaucrat. No clarification given to me by higher echelons in UIICo. who claims U before I but reverse in reality. At 90+, I have no choice being with this insurer since 1996 with three claims since 2013. Who cares for a person paying tax on earnings for >65 years. This is the plight of a middle class tax payer for whom the FM shed copious tears on Saturday last.
mohansiroya
Replied to narenwagle34 comment 2 weeks ago
Totally agreed.
kishored13
2 weeks ago
CARE INSURANCE IS CHEATING OPENLY AND WHAT IS THE IRDAI DOING? WHAT IS THE GOVERNMENT DOING ABOUT THIS? FROM THE DATA SHARED ALL INSURANCE COMPANIES ARE CHEATING WITH A REASON CALLED REPUDIATE. WHEN THE GOVERNMENT IS ACTIVE IN COLLECTING GST ON HEALTH INSURANCE THEY SHOULD ALSO BE ACCOUNTABLE FOR GETTING THE INSURANCE CLAIMS SETTLED IN A FAIR MANNER.
reach.biz.sn
2 weeks ago
ICICI Lombard froze my renewal terms at time of renewal so that I cannot increase my Sum Insured or change add-ins. Their website didn't even show add-ins which were part of my policy which would provide additional bonus and help increase my sum insured. The premiums charged are y-o-y higher and higher than new customers with double the sum insured and extended benefits. Premium charged to me was higher than what was being shown on the website because I was at the mercy of their customer service agent for renewal due to above mentioned issues. Even after calling multiple times a day, emailing to customer service, renewal team, grievance cell they didn't solve anything. They would not even give in writing why they froze everything for me or explanation of high premiums. They did same for my accident insurance policy and forced me to renew both my Health Insurance and Accident Insurance at their unilateral terms. Even the policy document they issued has errors and for bonus which does not reduce as per their policy wordings they have said bonus will reduce and despite sharing snapshots their grievance cell still write bonus will reduce. Their harassment is next level. Last year even for my claims they just gave part claim and even though I had submitted all documents with page numbers they said documents missing and were not paying. Same happened when few years ago I tried raising sum insured. @IRDA please note and take strict actions against them and bring strict rules for policy renewal for younger population too not just senior citizens as the moment we have claims the insurer like ICICI Lombard harasses us and
abhay1955
2 weeks ago
I thank the MPs who raised this burning issue in Lok Sabha. The data provided in LS needs to be analyzed since it does not give sufficiently clear picture. While 57.69% claims were rejected based on T&C, as high as 42.31% claims were repudiated. The legal definition of this term as per Merriam-Webster dictionary is "rejection or renunciation of a duty or obligation." Reason wise data for repudiation is required. Unreasonable charges, linking some old disease to the present illness, raising objection on the method of surgery or other treatment, are some of the common reasons. Data of repudiation of claims on these grounds should be published. Also required is the data as to how much suo moto interest was paid by the insurers. This years old rate should be hiked substantially to keep some check on the insurers. I think this clause is applicable not only for delay in payment but also for wrongful rejection of claim.
mirjavaid52
Replied to abhay1955 comment 2 weeks ago
Exactly...all insurance companies wait for renewal and talk in sober nature but after paying your premium they treat citizens as inhuman at the time of claim.govt should take cognizance
sbrghsh29
2 weeks ago
Star health insurance company suddenly raised my premium from 36000 to 51000 citing the reason that I have attained 66 years on a coverage of 3 lac. This is blow to ar citizen. I did not made any claim for the last 9 years. But this year they did not pay teh amount I claimed for cataract operation.
SPGadiyar
Replied to sbrghsh29 comment 2 weeks ago
Sir, every company has age band for premium. Normally of five years. Your premium will increase again at age 71.

kishored13
2 weeks ago
CARE INSURANCE IS CHEATING OPENLY AND WHAT IS THE IRDAI DOING? WHAT IS THE GOVERNMENT DOING ABOUT THIS? FROM THE DATA SHARED ALL INSURANCE COMPANIES ARE CHEATING WITH A REASON CALLED REPUDIATE. WHEN THE GOVERNMENT IS ACTIVE IN COLLECTING GST ON HEALTH INSURANCE THEY SHOULD ALSO BE ACCOUNTABLE FOR GETTING THE INSURANCE CLAIMS SETTLED IN A FAIR MANNER.
mrsanjaybathia
2 weeks ago
Guys don't buy care health insurance and don't trust policy bazaar also they too involved in this scam they will ask u to port ur old genuin no waiting period policy in care health and then will not give u any claim they are rejecting claim for non discloser reason .why irda is not taking any action against this big scam
sandeep.act
Replied to mrsanjaybathia comment 2 weeks ago
Same here, Care insurance has played fraud
gondaliya.kp
Replied to mrsanjaybathia comment 2 weeks ago
Sab mile hue he
You go to consumer court believe me you will get justice.
I got my money through consumer court. Care health insurance is a very big fraud company.always buy policy from public sector company.
mirjavaid52
2 weeks ago
Most of the insurance companies decieved customers.i have decieved by Niva bupa in recent past on behest of pre existing disease.Hell with these insurance companies..I am fed up.policybazar is also involved in this deception and cheating common people.
vikasyadavvy9696
2 weeks ago
Please guys don't purchase CARE HEALTH INSURANCE. They are doing scam..
I admitted in hospital on 14/11/2024 at that time i applied for cashless claim for only 30000/- they denied said apply for reimbursement..
After discharge from hospital i apply same in reimbursement process they again denied giving some bullshit reasons THAT DOCTOR HANDWRITING IS STEREOTYPE AND IN SINGLE STRETCH.
after that i registered my complaint with IRDA after 8 days i got response from insurer asking me to provide pre hospitalization reports... I suffered with some infection in my lower abdomen with serious pain in midnight of 13/11/2024 and on 14/11/2024 early around 1:30 AM i admitted.
HOW CAN I PROVIDE MY PRE HOSPITALIZATION REPORTS?
They are doing scam with patients
In their customer care all employes are uneducated they don't know how to talk with patients.
And communication of upper management is very slow. They tak 8-10 days for a single mail reply..

CARE HEALTH INSURANCE
SCAM COMPANY
#CAREHEALTHSCAM
gondaliya.kp
Replied to vikasyadavvy9696 comment 2 weeks ago
Care ka pura naam he DOESN'T CARE. they are harassing me since four months.Sab mile hue he
You go to consumer court believe me you will get justice.
I got my money through consumer court. Care health insurance is a very big fraud company.always buy policy from public sector company.
mohansiroya
2 weeks ago
I think almost similar has been the situation in 11 years since BJP is in power. The Govt. is pro- insurance or industry. No concern for the declining health of the people. This year union budget tom toms that up to 12 lakhs rupees there is no Tx. But the suffering person asks "Give us the income then question of tax will arise
;give us the
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