The most common conditions leading to claims include fever (seasonal diseases), gastritis, heart disease, diabetes and cancer; the share of claims of younger adults has been higher
Seasonal and chronic conditions are driving up health insurance claims. The most common conditions leading to claims include fever (seasonal diseases), gastritis, heart disease, diabetes and cancer. Seasonal diseases like fever typically drive a surge in claims during specific months, particularly during monsoon and winter. Meanwhile, conditions like heart disease, diabetes, and cancer reflect long-term health trends, indicating increasing prevalence of chronic diseases among Indians.
Rapid rise in claims
The 30% rise in average payouts over three years suggests healthcare costs are rising, and policyholders are claiming higher amounts for medical treatments. This trend also indicates insurance is becoming a more essential tool for managing medical expenses as medical inflation outpaces general inflation.
Maharashtra, Delhi
States like Maharashtra and Delhi report higher claim payouts despite having a similar proportion of total claims. This can bedue to the higher cost of healthcare in urban centers and more advanced medical facilities available.
Claims frequency
Clam frequency has steadily increased over the last three years. It means more policyholders are utilising health insurance benefits. This could be due to improved access to healthcare services, a greater awareness of health insurance coverage, and a proactive approach to managing personal health.
Young adult claims up
The higher share of claims from younger adults (18-35) reflects a combination of seasonal illnesses (fever, viral infections) and rising claims for chronic conditions like diabetes, which are increasingly diagnosed at younger ages. This trend underscores the need to buy health insurance when young and healthy. The gender distribution (86% male) is typical of health insurance claims, as men tend to file claims more frequently, possibly due to a higher penetration of insurance among males.
Motor insurance
The leading causes of motor insurance claims are primarily accidents, theft, and damage from natural events. The prevalence of accidents and total loss claims reflects the importance of having robust motor insurance to protect against collisions and theft
Claim amount basis
The higher claim amounts for SUVs reflect their greater value and more complex repair costs compared to smaller vehicles like hatchbacks. The higher claim volumes from hatchbacks are due to their higher market share in the overall vehicle population.
Monsoon claim surge
There is a notable spike in motor insurance claims during the monsoon season, with a 40% rise in claims during rainy months in cities which are more prone to heavy rains. Factors like heavy rains, flooding and slippery road conditions contribute to higher total loss claims, higher accident rates and damage to vehicles, especially in regions prone to monsoon weather.
Popularity of add-ons
Policyholders are increasingly choosing add-ons like zero depreciation, engine protectors, and cost of consumablesas part of motor insurance plans for their car as old as up to 10 years. This indicates a growing trend towards enhanced protection and a desire for comprehensive coverage in the event of a claim.
South and Delhi-NCR
Regions such as Tamil Nadu, Karnataka, and Andhra Pradesh report higher total loss motor claims due to cyclones, while States like Delhi NCR, Maharasthra experience more accidental claims.
Heart issues
Heart disease and natural causes remain the most prevalent reasons for term insurance claims, which is consistent with the overall ageing population and the growing awareness of health risks. COVID-19 claims also reflect the impact of the pandemic on life insurance needs even after three years.
Male policyholders
The majority of term insurance claims are made by male policyholders (90-92%). This is mainly due to the high penetration of term insurance among males. Men also generally have higher mortality rates and may be more likely to take term life cover resulting in a higher percentage of claims from them.
Regions with higher urban population leading in claims. The top regions for term insurance claims include Maharashtra, Uttar Pradesh, Delhi, Karnataka, and Gujarat. These areas see higher claim volumes due to a combination of larger populations and greater awareness of the importance of life insurance. Regions with higher urban populations and greater access to financial services see more claims because policyholders are more likely to engage with life insurance products.
Riders gain popularity
Approximately 35-40% of term insurance policyholders are opting for riders likecritical illness and accidental death benefits, indicating a growing desire for comprehensive protection, particularly among those concerned about critical illnesses or accidents.
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