Insurance claim rejection statistics in India
How many insurance claims get rejected in India — the verified, source-linked figures, straight from the IRDAI Annual Report. Every number below is quotable and links to where you can check it.
In short: across FY24, Indian health insurers turned away about ₹15,100 crore of claims (~12.9% of the value claimed), and the number of rejections climbed about 19.1% year-on-year. Roughly 82.5% of health claims were settled, while standalone health insurers paid only about 64.7% by value. In FY25, policyholders raised 2.57 lakh grievances on Bima Bharosa, nearly half of them about claims. Each figure links to its source below.
Health claim rejection & settlement
What the IRDAI Annual Report shows about how much of India's health-insurance claim value is disallowed, delayed, or left unpaid.
In FY24, health insurers in India declined about ₹15,100 crore of claims — close to 12.9% of the total value that policyholders put in.
The count of rejected health-insurance claims grew roughly 19.1% in FY24 compared with the year before.
Source: IRDAI Annual Report 2023-24 (reported by Business Standard)
Standalone health insurers paid out only about 64.7% of claim value in FY24, so close to a third of what was claimed went unpaid.
Of roughly 3.26 crore health-insurance claims raised in FY24, about 82.5% were settled — the rest were delayed, denied, or only partly met.
Grievances & complaints
How many insurance complaints Indians file each year, and how many of them are about claims.
Indian policyholders lodged about 2.57 lakh insurance grievances on IRDAI's Bima Bharosa portal during FY25.
Around 1.22 lakh of those FY25 grievances were about claims — the largest single category, close to half of the total.
BimaHaq will publish its own anonymized aggregate outcomes (e.g. appeal-reversal rate and average recovery) here as the case base grows.
Why are health claims rejected?
The leading reasons insurers cite, from Policybazaar's analysis of claims filed April–September 2023. Many are avoidable — and several are challengeable.
| Reason for rejection | Share | What it means |
|---|---|---|
| Non-disclosure of a pre-existing condition | ~25% | A prior condition such as diabetes or high blood pressure that was not declared when buying the policy — the most common avoidable ground for refusal. |
| Claim outside policy coverage | ~25% | The treatment sits outside what the plan pays for — an excluded ailment (about 16%) or a non-payable OPD/day-care claim (about 9%). |
| Incomplete waiting period | >18% | The claim was raised before the applicable waiting period — initial, disease-specific, or for pre-existing conditions — had run out. |
| Unanswered insurer queries | >16% | The insurer asked for extra details to assess the claim and never received the policyholder's reply. |
| Unjustified hospitalisation | ~4.9% | An admission the insurer judged did not meet the policy's conditions for a payable hospital stay. |
| Wrongly filed claims | ~4.5% | Mistakes or the wrong procedure in the way the claim itself was submitted. |
| Exhausted limits | ~2.1% | The sum insured, or a sub-limit that applies to that treatment, had already been used up. |
Shares are the leading rejection categories and overlap; they do not sum to 100%.
Behind every one of these numbers is a policyholder whose claim was rejected, delayed, or underpaid — but a rejection is not the end of the road. If yours was one of them, see exactly what to do when a claim is rejected — the free, regulator-backed escalation ladder from the insurer's grievance officer to IRDAI and the Insurance Ombudsman.
Common questions
How many insurance claims are rejected in India?
In FY24, Indian health insurers declined about ₹15,100 crore of claims — roughly 12.9% of the amount claimed — and only around 82.5% of the roughly 3.26 crore health-insurance claims raised that year were settled, going by the IRDAI Annual Report 2023-24.
Are insurance claim rejections rising in India?
They are — the count of rejected health-insurance claims grew about 19.1% in FY24 over the previous year, per the IRDAI Annual Report 2023-24.
What percentage of health insurance claims are settled in India?
About 82.5% of health-insurance claims were settled in FY24. Standalone health insurers, though, paid out only around 64.7% by value that year — close to a third of what was claimed went unpaid — according to the IRDAI Annual Report 2023-24.
How many insurance complaints are filed in India each year?
In FY25, policyholders raised about 2.57 lakh grievances through IRDAI's Bima Bharosa portal, and roughly 1.22 lakh of them — near half — were about claims, the biggest single category (IRDAI Annual Report 2024-25).
Why are health insurance claims rejected in India?
By a Policybazaar review of claims from April to September 2023, the top grounds were an undeclared pre-existing condition (~25%), treatment outside the policy's cover (~25%), a waiting period that had not yet finished (>18%), and insurer queries the policyholder never answered (>16%); smaller shares involved unjustified hospitalisation, wrongly filed claims, and exhausted limits.
This guide is general information about the insurance-grievance process in India, not legal advice, and figures (timelines, monetary limits, jurisdiction) can change — verify against the official sources linked above before you rely on them.