The insurance industry in India is witnessing notable shifts in claims patterns across health, motor, and term insurance sectors, according to Policybazaar’s latest research.
The study pointed to rising costs and evolving consumer behaviour as factors shaping the landscape.
The report showed that claims in the health insurance sector are increasingly driven by seasonal illnesses such as fever and chronic conditions including diabetes, cancer, and heart disease.
These trends highlight the dual impact of short-term disease outbreaks and the growing burden of lifestyle-related health issues.
Data indicated a steady rise in average claim payouts, growing from ₹62,014 in FY23 to a projected ₹81,025 by FY25, an increase of about 30%.
Policybazaar said the rising payouts underscore escalating healthcare costs and greater reliance on insurance to meet medical needs as medical inflation outpaces overall inflation rates.
Maharashtra contributed 14.5% of all health insurance claims, with an average claim size of ₹86,402, while Delhi, representing 10.2% of claims, recorded higher average payouts of ₹100,600.
These variations are tied to the availability of advanced medical infrastructure and the cost of healthcare services in urban regions.
The frequency of health insurance claims has grown from 4.9% in FY23 to 6.39% in FY25. This rise may be attributed to improved awareness, increased healthcare access, and a proactive approach to health management by policyholders.
Policyholders aged 18 to 35 accounted for 38.2% of health claims, reflecting the impact of seasonal illnesses and early diagnoses of chronic conditions among younger demographics.
The data also showed a skewed gender distribution, with men making 86% of claims, which could be due to higher insurance penetration among males.
Motor insurance claims are heavily influenced by accidents, natural disasters, and theft, with significant regional and vehicle-type variations.
Accidents and total loss claims dominate motor insurance, with a 40% spike in claims during the rainy season. Cities experiencing heavy monsoons see increased rates of accidents and flood-related vehicle damage.
Hatchbacks account for 54% of motor insurance claim volumes, reflecting their dominance in the vehicle market, with average claims ranging from ₹20,000 to ₹25,000.
SUVs, representing 26% of claims, incur higher repair costs, with claims typically between ₹30,000 and ₹35,000.
States like Tamil Nadu and Andhra Pradesh report higher claims linked to cyclonic activity, while Delhi NCR and Maharashtra see more accident-related claims.
An increasing number of policyholders are opting for add-ons such as zero depreciation and engine protection coverage, reflecting a shift toward more comprehensive policies, even for vehicles older than five years.
In term insurance, claims are largely influenced by heart diseases and natural causes, with regional differences highlighting the role of urbanisation and awaeness.
Heart-related issues account for 25% to 30% of claims, while natural causes represent 30% to 35%. Accident claims contribute 15% to 20% to the total.
The residual impact of the COVID-19 pandemic is still visible in claim patterns.
Male policyholders make up 90% to 92% of claims, a trend attributed to higher term insurance penetration among men and their generally higher mortality rates.
Claims are concentrated in urban areas, with states like Maharashtra, Uttar Pradesh, and Delhi reporting higher volumes. This is linked to greater awareness and access to insurance products in urbanised and industrialised states.
Around 35% to 40% of term policyholders are including riders such as critical illness and accidental death benefits, indicating a growing preference for added layers of financial protection.
