Insurance claim rejection statistics in India
How many insurance claims get rejected in India — the figures, straight from the IRDAI Annual Report 2024-25. Every number in the table below is quotable and links to the report you can check it in. The rejection-reason breakdown further down is a distributor's analysis, not an IRDAI statistic, and is marked as indicative.
In short: in FY25 general and health insurers paid 87.5% of health claims by number, but only 71.1% of the money claimed. They repudiated 29.51 lakh claims outright, and disallowed a further ₹18,521 crore under policy terms — deductions taken from claims that were otherwise paid. Policyholders lodged 2,57,790 grievances on Bima Bharosa, 1,22,121 of them about claims. Every figure links to the IRDAI Annual Report 2024-25 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 FY25, general and health insurers paid 3.26 crore of the 3.73 crore health insurance claims on their books — 87.5% by number.
Insurers repudiated 29.51 lakh health insurance claims in FY25 — 7.9% of every claim on their books — and a further 4.6% were still unsettled when the year closed.
Measured in money rather than claim count, only 71.1% of the ₹1.32 lakh crore claimed under health policies in FY25 was actually paid out.
₹18,521 crore of health claims was disallowed in FY25 under policy terms and conditions — 14.0% of everything claimed. These are deductions taken from claims that were otherwise paid, not refusals.
Grievances & complaints
How many insurance complaints Indians file each year, and how many of them are about claims.
A further ₹11,412 crore of health claims was repudiated outright in FY25 — 8.6% of the total amount claimed.
The average health insurance claim paid in FY25 was ₹28,910, across 3.26 crore settled claims totalling ₹94,248 crore.
Policyholders lodged 2,57,790 grievances on IRDAI's Bima Bharosa portal during FY25 — 1,20,429 against life insurers and 1,37,361 against general and health insurers.
Source: IRDAI Annual Report 2024-25, para II.6.7 and Table II.15
Of those, 1,22,121 grievances were about claims — 33,280 in life and 88,841 in general and health insurance, close to half of everything lodged.
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%.
Source: Indicative only — a distributor's analysis of health claims filed Apr-Sep 2023, not an IRDAI statistic
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 FY25, general and health insurers repudiated 29.51 lakh health insurance claims — 7.9% of every claim on their books — while 4.6% were still unsettled at year end. Measured in money the gap is wider: of the ₹1.32 lakh crore claimed, only 71.1% was paid (IRDAI Annual Report 2024-25, Table I.29).
Are insurance claim rejections rising in India?
The IRDAI Annual Report 2024-25 does not publish a year-on-year change in rejections, so we do not state one. What it does show for FY25 is the standing position: 87.5% of health claims paid by number, 7.9% repudiated, and 4.6% unsettled at year end (Table I.29).
What percentage of health insurance claims are settled in India?
87.5% by number in FY25. By value it is 71.1%, and the difference is worth understanding: ₹18,521 crore — 14.0% of everything claimed — was disallowed under policy terms and conditions, which are deductions applied to claims that were otherwise paid, and a further ₹11,412 crore was repudiated outright (IRDAI Annual Report 2024-25, Table I.29).
How many insurance complaints are filed in India each year?
2,57,790 in FY25 on IRDAI's Bima Bharosa portal — 1,20,429 against life insurers and 1,37,361 against general and health insurers. Of those, 1,22,121 were about claims: 33,280 in life and 88,841 in general and health, close to half of everything lodged (IRDAI Annual Report 2024-25, paras II.6.7 and II.6.9).
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.