How many Health Insurance claims were settled and rejected by Companies? Check Data
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In today’s fast-paced world, health insurance is no longer a luxury—it has become a necessity. With rising medical costs, even a short hospital stay or a basic surgery can create a major financial burden. As a result, more and more people are turning to health insurance policies to protect themselves and their families during medical emergencies.
However, while awareness and demand for health insurance have grown, so has a major concern—claim settlement issues. Many policyholders find themselves in difficult situations when their insurance claims are delayed, partially paid, or even rejected. Let’s have a look at the health insurance data – how many claims were accepted and rejected.
As per IRDAI Master Circular on Health Insurance Business dated 29.05.2024, insurers are required to decide on the request for cashless authorization within 1 hour of receipt of such request and grant final authorization within 3 hours of the receipt of discharge authorization request from the hospital. However, the data related to the average time taken by insurance companies and third-party administrators (TPAs) for the claim settlement is not maintained by IRDAI.
IRDAI has informed that during FY 2023-24, 58.39% of total claims were settled through cashless mode in terms of count and 66.16% in terms of amount. As per the data provided by National Health Authority, the number of hospitals onboarded to National Health Claims Exchange (NHCX) is 450 as on 28.03.2025.
The data pertaining to paid and outstanding health claims for the last 5 Financial Years is furnished below:
| As on 31st March | Paid Claims (Number) | Paid Claims (Amount) | Outstanding Claims (Number) | Outstanding Claims (Amount) |
| 2024 | 2,68,59,974 | 83,493.17 | 20,72,978 | 7,584.57 |
| 2023 | 2,35,75,048 | 70,929.82 | 17,83,509 | 6,246.88 |
| 2022 | 2,18,52,201 | 69,498.48 | 20,05,686 | 5,978.44 |
| 2021 | 1,40,30,761 | 43,354.60 | 14,73,180 | 5,657.56 |
| 2020 | 1,67,71,266 | 40,025.59 | 16,05,724 | 4,221.79 |
| Total | 10,30,89,250 | 3,07,301.66 | 89,41,077 | 29,689.24 |
If you are unsatisfied with claim settlement by insurance company, then you can file complaint with insurance ombudsman. The Insurance Ombudsman is a Grievance Redressal forum setup with an aim to resolve grievances of aggrieved policyholders in a speedy and cost-effective manner. The Insurers must comply with the Ombudsman’s decision within 30 days, or they need to pay penal charges of Rs.5000 per day for each day of delay.