Choosing a health insurer based on premium alone is like choosing a restaurant based on menu prices without checking the food reviews. What matters is what happens when you file a claim. Using IRDAI's FY2024-25 published data, we constructed a composite Claims Difficulty Score (CDS) that combines three metrics: claim rejection rate (weight: 40 per cent), average settlement turnaround time (weight: 30 per cent), and grievance ratio per 10,000 policies (weight: 30 per cent). A higher CDS means a harder claims experience.
Methodology
Each metric was normalised to a 0-100 scale across all 29 health and general insurers offering individual health products in India. The normalised scores were then combined using the weights above. We excluded group health insurance data because the claims experience for employer-sponsored policies is structurally different from individual retail policies. The data source is IRDAI's annual statistical publication and the Insurance Ombudsman's annual report, both covering the period April 2024 to March 2025.
The Five Hardest Insurers for Claims
At position five is Cholamandalam MS General Insurance, with a CDS of 62.4. Their claim rejection rate of 16.8 per cent is above the industry average of 11.4 per cent, and their average reimbursement turnaround of 22 working days is nearly double the industry median. The grievance ratio at 134 per 10,000 policies is moderate but still above average.
Position four goes to Reliance General Insurance with a CDS of 65.1. Reliance's rejection rate of 14.2 per cent is above average, but the real concern is the turnaround time: an average of 26 working days for reimbursement claims, the second longest among all insurers. Their grievance ratio of 156 per 10,000 policies indicates persistent policyholder dissatisfaction.
At position three is Bajaj Allianz General Insurance, CDS 67.8. Despite being one of the largest general insurers, Bajaj Allianz's claim rejection rate of 15.6 per cent is a concern. Their turnaround time of 18 working days is average, but the grievance ratio of 168 per 10,000 policies is significantly above the industry mean, suggesting that many policyholders who get their claims settled still find the process frustrating.
Position two: Tata AIG General Insurance at CDS 69.3. Tata AIG has a rejection rate of 17.4 per cent, the third highest in the industry. The turnaround time of 21 working days is above average, and the grievance ratio of 149 per 10,000 policies rounds out a consistently below-par claims experience. It is worth noting that Tata AIG's motor insurance claims experience is significantly better, suggesting the difficulty is concentrated in their health portfolio.
The highest Claims Difficulty Score of 72.6 goes to National Insurance Company, one of the four public-sector general insurers. Their claim rejection rate of 19.2 per cent is the highest among all insurers, the turnaround time of 31 working days is by far the longest, and the grievance ratio of 204 per 10,000 policies is nearly double the industry average. Public-sector insurers have historically struggled with technology adoption and process efficiency in health claims.
Who Scores Best?
For context, the three insurers with the lowest CDS (easiest claims experience) are Niva Bupa (CDS 28.4), ManipalCigna (CDS 31.2), and HDFC ERGO (CDS 34.7). All three are private-sector players that have invested heavily in digital claims infrastructure.
What This Means for You
A low premium from a high-CDS insurer is a false economy. If your claim gets rejected or takes a month to settle, the Rs 2,000-3,000 you saved on premium becomes irrelevant. When comparing health insurance options, weigh the insurer's claims track record at least as heavily as the premium. Use a claim estimator to understand what you might receive from your current insurer based on typical settlement patterns, and consider switching at renewal if your insurer scores poorly on these metrics.
Source
IRDAI Annual Report FY2024-25; Insurance Ombudsman Annual Report FY2024-25; insurer public disclosures