Where an insurer's operating promises are kept or broken

Nilakhya settled about 9.6 lakh health claims in 2025–26, 68 per cent of them cashless. A cashless claim involves three parties in real time: the hospital's insurance desk, our medical officers and a patient waiting to be admitted or discharged. Since 2023 retail health authorisations have been decided in our Chennai hub, which has 58 doctors and about 470 claims staff, against package rates and tariffs agreed with our 12,600 network hospitals. I measure the hub on the median and ninetieth-percentile time to decide, the share of approvals revised at discharge and the number of deductions a patient could not have predicted from the policy wording. The regulator's 2024 health master circular set expectations measured in hours for cashless decisions and discharge, and we built our rosters around them: night and weekend cover, medical officers grouped by speciality, and a direct line for hospitals with a dispute rather than a ticket queue.

Motor own-damage claims are our largest volume after health: about 5.1 lakh in 2025–26, repaired through 5,200 cashless garages and assessed by 1,350 empanelled surveyors who hold the licences the regulator requires. Most of my work here is in the plumbing customers never see: how a claim is allocated to a surveyor, how many visits a garage waits for, when a vehicle is treated as a constructive total loss because repair would cost more than three-quarters of its insured declared value, and how salvage is sold. Third-party injury and death claims are decided by Motor Accident Claims Tribunals, so our legal team and a panel of advocates handle them, but operations owns the records and the timeliness of our responses. Median own-damage settlement fell from nineteen days in 2016 to eleven by 2021 and eight by 2025–26, mainly because surveyors now assess routine damage from photographs and video and keep physical inspections for claims that need them.

Cyclones and floods arrive with a few days' warning and leave months of work. I have run claims through Cyclone Hudhud in Visakhapatnam in 2014, the Chennai floods of 2015 and 2023, the Kerala floods of 2018 and Cyclone Fani in Odisha in 2019. The pattern repeats: ten days bring the claims of a normal quarter, surveyors and garages are themselves affected, and every week of delay costs a family its vehicle, its shop stock or its savings. Our protocol now starts when the India Meteorological Department issues its cyclone warnings. We pre-position surveyors from other zones, open temporary salvage yards and switch on simplified intimation by phone and messaging. During the event we pay routine claims on remote assessment and audit a sample afterwards. Before each monsoon I run a rehearsal with the claims hubs, the reinsurance team and the contact centre, because a protocol nobody has practised is only a document.

Nilakhya serves farmers in clusters of districts allotted to us by Maharashtra, Odisha and Madhya Pradesh under the Pradhan Mantri Fasal Bima Yojana, the government's crop insurance scheme. Premium in 2025–26 was ₹1,320 crore, most of it subsidised by the central and state governments, and about 18 lakh farmers received claim payments. Crop operations differ from every other line we run. Widespread yield losses are calculated by area from yields the states measure through crop-cutting experiments and, increasingly, technology-based estimates, so our work is to check the data and pay on time. Localised losses from hailstorms, inundation or landslides, and some losses after harvest, are reported by individual farmers within seventy-two hours under the scheme's guidelines and assessed in the field. Payments go directly to farmers' bank accounts. The commonest failure is not the assessment but the payment: a mistyped account number can leave a farmer unpaid for months, so we now hold district camps to correct records before each season's claims fall due.

Fraud in Indian general insurance is rarely a lone forger. More often it is an arrangement: a hospital that admits patients for care they did not need, a garage that adds old damage to a new claim, a set of documents for an accident that never happened. When I joined Nilakhya there was no investigation function; claims staff referred suspicions to an outside agency and rarely heard back. We now have 64 investigators, an analytics team that scores every health and motor claim before payment, and a rule that a suspicion must be resolved within thirty days, by evidence or by payment. I am careful about the second half of that rule. A fraud unit that holds honest claims for weeks has simply moved its cost onto the customer. We report internally how many referred claims were finally paid in full, and when that share rises, I ask whether our scoring has become careless.

Policy servicing is the quiet majority of operations work: renewals, endorsements, nominee changes, portability requests from customers moving their health cover between insurers, and refunds on cancellation. Many complaints begin there rather than in claims. Since 2022 our grievance team has reported to me separately from the claims function, with a review panel of senior doctors and claims managers who had no part in the original decision and may revise it. We answer most grievances well inside the regulator's timelines, and we treat every complaint that reaches the Insurance Ombudsman as a failure of our own process rather than a legal matter. The measure I watch most closely is repeat contact: the share of customers who had to write or call a second time about the same issue. It fell from 23 per cent in 2021–22 to 11 per cent in 2025–26, and it tells me more about our servicing than any satisfaction survey.