| What is ICICI Lombard Health Insurance’s Claim Settlement Ratio? The ICICI Lombard Health Insurance Claim Settlement Ratio averaged 85% over the three-year period from FY 2021 to 2024, as per data from public disclosures. This figure represents the proportion of claims settled by the insurer out of the total claims received. |
When you're buying health insurance, one of the first things you will hear about is the Claim Settlement Ratio (CSR) and for good reason. It tells you how often an insurer actually pays out claims. For a company as prominent as ICICI Lombard, this number can make or break trust. ICICI Lombard’s Health Insurance Claim Settlement Ratio, averaging 85% over the past three years (2021–2024), is passable but not particularly reassuring when compared to top insurers that consistently exceed 90%.
So how does it hold up? When benchmarked against leading players in the industry, many of whom maintain settlement ratios in the 90–98% range, ICICI Lombard’s numbers suggest room for improvement. It raises questions about consistency and reliability, especially in a category where claim approval can make or break customer trust.
In this article, we break down what CSR really means, why it’s important (but not everything), and how ICICI Lombard stacks up when compared to competitors on other key metrics. If you’re considering a policy with ICICI Lombard, this guide will help you understand not just the numbers but the full picture.
Finding the right health insurance policy doesn’t have to be mind-boggling. With Ditto’s expert advisors by your side, you’ll get clear, personalised guidance to help you understand what truly matters and choose a policy that actually fits your needs. Book your free call today!
ICICI Lombard Health Insurance - An Overview
ICICI Lombard General Insurance is one of India’s leading private general insurers with a market cap of over ₹90,000 crore. The insurer offers a wide range of insurance products, including health, motor, travel, home, and business, serving both individuals and corporations. More recently, its retail health insurance market share rose to 3.3% in FY2025, up from 3.0% in FY2024, reflecting its growing focus on retail health products.
The ICICI Lombard Health Insurance Claim Settlement Ratio, while consistent, remains relatively lower than some top competitors, and its hospital network isn’t the most extensive. That said, the insurer maintains a solid track record when it comes to incurred claim ratio and a lower-than-average complaint volume.
Top 10 Health Insurance Companies Based on Claim Settlement Ratio 2025
When comparing insurers, a Claim Settlement Ratio (CSR) above 90% is generally considered ideal. It reflects an insurer's reliability in processing and settling health insurance claims. Here's a look at the top performers in 2025:
| Rank | Health Insurance Company | CSR 2021–2022 (%) | CSR 2022–2023 (%) | CSR 2023–2024 (%) | Average CSR (%) |
|---|---|---|---|---|---|
| 1 | HDFC ERGO | 100 | 95 | 97 | 98 |
| 2 | SBI General | 97 | 94 | 98 | 97 |
| 3 | Aditya Birla | 94 | 96 | 96 | 95 |
| 3 | Bajaj Allianz | 91 | 97 | 96 | 95 |
| 3 | IFFCO Tokio | 96 | 95 | 93 | 95 |
| 6 | Niva Bupa | 91 | 91 | 92 | 91 |
| 6 | Zurich Kotak | 91 | 93 | 89 | 91 |
| 8 | Care Health | 87 | 90 | 93 | 90 |
| 9 | ICICI Lombard | 86 | 85 | 85 | 85 |
| 10 | Star Health | 82 | 80 | 86 | 83 |
Compared to others, the Claim Settlement Ratio of ICICI Lombard Health Insurance is on the lower side. While 85 percent is decent, it trails behind other insurers that consistently report ratios near or above 90 percent which is also the industry average.
ICICI Lombard Health Insurance Claim Settlement Ratio Vs Other Health Insurance Companies: Key Insight
When assessing the ICICI Lombard Health Insurance Claim Settlement Ratio 2025, it’s clear that the company’s CSR is lower than many competitors. Insurers like HDFC Ergo, SBI General, and Aditya Birla report near-perfect settlement ratios, which may reflect faster claim processing & broader policy coverage. ICICI Lombard processes claims in-house, which often leads to faster resolutions compared to companies that solely rely on third-party administrators (TPAs) to settle their individual policy claims. Still, their CSR suggests there’s room for improvement in efficiency or policyholder communication.
For a broader view, you can explore our list of the best health insurance plans in India 2025 to compare features, benefits, and value across top insurers.
How We Calculate the ICICI Lombard Health Insurance Claim Settlement Ratio
Before we dive into how we calculate CSR, let’s quickly understand what it actually means. The Claim Settlement Ratio (CSR) is a crucial metric in evaluating any health insurance provider. It represents the percentage of claims an insurer has successfully settled out of the total claims received (excluding those closed without payment). For example, the ICICI Lombard Health Insurance Claim Settlement Ratio for FY 2023 to 2024 is 85 percent, which means 85 out of every 100 eligible claims were paid by the insurer.
Now, when it comes to calculating this number, it's important to note that IRDAI does not prescribe a standard formula for CSR in health insurance. So at Ditto, we follow a consistent, outcome-focused method that aims to reflect how many valid claims are actually paid that would provide a fair basis for evaluating insurers like ICICI Lombard.
Our Formula: CSR = (Total number of claims settled / Total number of claims available to settle) × 100
Where:
Total number of claims available to settle = (Claims Outstanding at the start of the year + Claims Reported during the year −Claims Closed without Payment −Claims Outstanding at the end of the year)
We exclude claims closed without payment, as many of these aren't rejections but cases where the policyholder didn’t complete the process. Including them would skew the data.
To ensure fairness, we average the CSR over three years. This smooths out any unusually high or low years, offering a more accurate picture of how consistently an insurer like ICICI Lombard settles claims.
All figures are sourced from the insurer’s official public disclosure Q4 NL-37 Claims Data Report.
Now that you know how we calculate the ICICI Lombard Health Insurance Claim Settlement Ratio, let’s see how ICICI Lombard up against other top players in the industry not just on CSR, but across all key performance metrics that matter when choosing the right health insurance policy.
ICICI Lombard Health Insurance Metrics Compared to Top Players in India
| Insurer | CSR (%)(Avg. of 2021–24) | Network Hospitals | Avg Complaints(per 10,000 claims)(Avg. of 2021-24) | ICR (%)(Avg. of 2021–24) | Annual Business Volumes (₹ Cr)(Avg. of 2021–24) | Track Record |
|---|---|---|---|---|---|---|
| ICICI Lombard | 85% | 10,200+ | 9 | 83% | ₹4,814 | 24+ years |
| Bajaj Allianz | 95% | 12,000+ | 3 | 83% | ₹4,203 | 23+ years |
| Star Health | 83% | 14,000+ | 46 | 73% | ₹13,029 | 19+ years |
| HDFC Ergo | 98% | 13,000+ | 7 | 86% | ₹5,120 | 23+ years |
| Care Health | 90% | 11,400+ | 36 | 59% | ₹4,890 | 13+ years |
| Aditya Birla | 95% | 12,000+ | 22 | 68% | ₹2,498 | 9+ years |
| Niva Bupa | 91% | 10,000+ | 43 | 58% | ₹4,077 | 17+ years |
Key Insight:
ICICI Lombard stands out as one of the more experienced insurers with 24+ years in the industry and a strong premium base of ₹4,814 Cr. However, its Claim Settlement Ratio (85%) is notably lower than top performers like HDFC Ergo (98%) and Bajaj Allianz (95%), and its network hospital count (10,800+) is decent but not market-leading.
On the plus side, it fares well on customer complaint volume, averaging just 9 complaints per 10,000 claims across FY 2021 to FY 2024, which is significantly better than players like Star Health and Niva Bupa. In addition, ICICI Lombard pays out over 80% of the premiums it collects in claims, a number that is broadly in line with competitors like Bajaj Allianz and HDFC Ergo.
Ditto’s Take on ICICI Lombard Health Insurance Claim Settlement Ratio
- ICICI Lombard offers some solid health plans with industry-first features, but its Claim Settlement Ratio averaging 85% over the last three years leaves us a bit underwhelmed, especially when competitors consistently hit the 90–98% range.
- Add to that a smaller hospital network compared to market leaders, and the overall experience can feel limited.
- While we don’t consider the CSR dangerously low, it’s not the most reassuring either. If you’re considering ICICI Lombard, make sure the features align with your needs and that you're comfortable with the trade-offs on claim performance and accessibility.
For a more in-depth look at the insurer’s features, benefits, and limitations, check out our full ICICI Lombard Health Insurance review.
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Final Thoughts
ICICI Lombard’s claim settlement ratio of 85% (average for FY 2021–2024) paints a mixed picture. That said, numbers alone don’t define an insurer. ICICI Lombard has launched strong retail products like Elevate and Activate Booster, both packing industry-first features and comprehensive coverage. This signals a clear intent to strengthen its position in the retail health insurance space.
After years of being a major general insurer, these launches mark a focused push into the individual health segment. But for this intent to truly deliver value, we’d like to see improvements in key performance indicators like claim settlement and service consistency. For now, it’s a wait-and-watch for us.
In the end, a good health insurance plan isn’t just about what’s on paper rather it’s about how it performs when you actually need it. So while ICICI Lombard has some compelling offerings, we would recommend weighing the pros and cons carefully before making a decision.
Finding the right health insurance policy doesn’t have to be mind-boggling. With Ditto’s expert advisors by your side, you’ll get clear, personalised guidance to help you understand what truly matters and choose a policy that actually fits your needs. Book your free call today!
FAQs
How has ICICI Lombard’s Claim Settlement Ratio changed over the last 3 years?
The ICICI Lombard Health Insurance Claim Settlement Ratio has seen modest improvement from around 83% to 85% over the last three years. While not drastic, it shows some consistency, though still below the ideal range of 90–100%.
Does ICICI Lombard process claims in-house or through a TPA?
ICICI Lombard settles individual (retail) policy claims in-house, while group health insurance claims are mostly handled via TPAs. This difference can impact both the speed and quality of service as in-house processes are generally faster and more controlled.
Can I track my ICICI Lombard health insurance claim status online?
Yes, ICICI Lombard offers a digital claim tracking tool. You can easily check your claim status online via their website or mobile app.
Does a high Claim Settlement Ratio guarantee my claim will be approved?
Not necessarily. While a good Claim Settlement Ratio, like ICICI Lombard’s 85%, is a useful indicator, it doesn’t guarantee approval. You should also consider the cashless hospital network, policy terms, and claim documentation process. For example, even with a solid CSR, your claim may be denied if the hospital isn’t in their network or if the treatment isn’t covered.
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