Enter a period’s claim counts to see the claim settlement ratio on a received-only basis and on a received-plus-opening-pending basis, with the repudiation ratio, the pending ratio and a check that the counts add up.
The claim settlement ratio is the share of claims an insurer or TPA paid out of the claims it had to deal with in a period, usually a financial year. It is counted in claims, not rupees. The catch is the denominator: some reports divide by claims received in the year, others by claims received plus those already pending at the start. On the same book, the two can differ by several points, which is why this calculator shows both side by side.
Let O be claims pending at the start, R claims received, P claims paid, X claims repudiated and E claims pending at the end.
| Measure | Formula |
|---|---|
| Settlement ratio, received basis | P ÷ R × 100 |
| Settlement ratio, received + opening pending | P ÷ (O + R) × 100 |
| Repudiation ratio | X ÷ (O + R) × 100 |
| Pending ratio | E ÷ (O + R) × 100 |
| Count check | O + R − P − X − E should be 0 |
| Value ratio (optional) | amount paid ÷ amount claimed on the paid claims × 100 |
On the received basis, the ratio can go above 100% in a year when a large opening backlog is cleared, because claims paid include claims that arrived the year before. The received-plus-opening basis cannot exceed 100% and, when the counts reconcile, the settlement, repudiation and pending ratios on that basis add up to exactly 100%. If the count check shows a gap, the usual reasons are claims withdrawn by the customer, duplicates closed without payment, or claims counted on a different date in two reports. Record those as their own line rather than forcing them into paid or repudiated.
Illustrative numbers only, not data from any insurer: a health claims team starts the year with 120 claims pending and receives 2,400. During the year it pays 2,180, repudiates 150 and ends with 190 pending. The counts reconcile, since 120 + 2,400 = 2,180 + 150 + 190 = 2,520.
The same year reads as 90.8% or 86.5% depending on the definition. When you report a ratio, state the formula next to it, and compare periods only on the same basis.
The Insurance Regulatory and Development Authority of India (IRDAI) publishes insurer-wise claims data, including settlement figures, in its Handbook on Indian Insurance Statistics, released each year. The handbook’s tables follow their own definitions and segments, for example individual and group business or claims settled within a time window, so a figure from this calculator will not match a published one unless you use the same definition and period. This page is illustrative; confirm definitions with the official source and your compliance team before reporting a ratio externally. It is meant for checking your own book, not for comparing insurers.
Pending claims often sit waiting for a document; see why claims stall on the second document request and how written claims triage rules keep simple claims moving.
The ratios above are only as good as the claim counts behind them, and AutoClaims, our claims triage software for insurers and their TPAs, records every claim from registration on WhatsApp or the portal through triage, document checks, approval and settlement, so paid, repudiated and pending are counted from one place. Payouts stay approved by people under maker-checker.
Divide the number of claims paid in a period by the number of claims to be dealt with and multiply by 100. Some reports use claims received in the year as the denominator; others add the claims pending at the start. State which one you use.
There is no single figure that fits every line of business and definition. Compare like with like: the same basis, the same line and the same period, and read the ratio together with the repudiation and pending ratios.
The claim settlement ratio counts claims paid against claims to be dealt with. The incurred claim ratio is a money measure: claims incurred in a period against premium earned. One tells you how many claims were paid; the other tells you how much of the premium went to claims.
IRDAI publishes insurer-wise claims data in its Handbook on Indian Insurance Statistics on irdai.gov.in. Use the handbook’s own definitions when you compare a figure with it.
See it on your own data. AutoClaims — Claims without the status calls. Book a 30-minute working session with an engineer.
