In India, the health insurance claims scenario has witnessed a notable transformation. Policybazaar reports a 30% hike in payouts over three years, with the average claim amount rising from ₹62,014 in FY23 to ₹81,025 in FY 2025. This upward trajectory is a clear indication of the mounting healthcare costs. Chronic conditions such as heart disease, diabetes, and cancer, along with seasonal ailments like fever and viral infections, are the main culprits behind this surge. Interestingly, younger adults aged 18 to 35 contribute 38.2% of the payouts, signifying a concerning trend of increased chronic condition diagnoses at an earlier age. Geographically, Maharashtra and Delhi top the charts in claim volumes, accounting for 14.5% and 10.2% respectively, and their average payouts exceed ₹85,000 due to the higher cost of healthcare in urban centers. The claims frequency has also been on a steady climb, from 4.9% in FY23 to 6.39% in FY25, highlighting a greater utilization of insurance coverage.
When it comes to motor insurance claims, accidents, thefts, and natural events remain the predominant triggers. The monsoon season has led to a 40% spike in claims, attributed to flooding and slippery road conditions. Hatchbacks make up 54% of claims, with average payouts ranging from ₹20,000 to ₹25,000, while SUVs, though fewer in claim volume, have higher payouts of ₹30,000 to ₹35,000, owing to their costlier repair requirements. Tamil Nadu and Andhra Pradesh report significant claims during cyclones, and Delhi NCR sees more accident-related claims. The increasing popularity of add-ons like zero depreciation and engine protectors points towards a shift towards more comprehensive motor insurance coverage.
In the realm of term insurance claims, heart disease and natural deaths account for 55% to 65% of them, underlining the health risks and the impact of an ageing population. Men dominate the claim statistics, representing 90% to 92% of claims, which reflects higher insurance penetration and mortality rates among male policyholders. Urban states such as Maharashtra and Delhi lead in claim volumes, a result of better access to insurance services. The choice of critical illness and accidental death riders by 35% to 40% of policyholders indicates a growing preference for enhanced protection in the term insurance segment.
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