About the Indian Insurance industry:

The insurance industry of India has 57 insurance companies - 24 are in the life insurance
business, while 34 are non-life insurers. Among the life insurers, Life Insurance Corporation
(LIC) is the sole public sector company. There are six public sector insurers in the non-life
insurance segment. In addition to these, there is a sole national re-insurer, namely General
Insurance Corporation of India (GIC Re). Other stakeholders in the Indian Insurance market
include agents (individual and corporate), brokers, surveyors and third-party administrators
servicing health insurance claims. Apart from this, there are over 110 InsurTechs which are
concentrating on selling insurance policies and using tech for improving speed of issuing
policies and the speed & quality of underwriting.

Indian Life Insurance industry compared to Global peers

 In life insurance business, India is ranked tenth in the world. India's share in global
life insurance market was 2.73% during 2019-20. Compared to the previous year, the
life insurance premium in India increased by 9.63% whereas global life insurance
premium increased by 1.18%. 
 Globally, the share of life insurance business in total premium was 46.34% & the
share of non-life insurance premium was 53.66% during 2021. However, the share of
life insurance business for India was high at 74.94% while the share of non-life
insurance business was at 25.06%.

Insurance Penetration and Density

 Insurance penetration and density are two metrics, among others, often used to assess
the level of development of the insurance sector in a country. While insurance
penetration is measured as the percentage of insurance premiums to GDP, insurance
density is calculated as the ratio of premiums to population (per capita premium).

 Insurance penetration which was 2.71% in 2001 has steadily increased to 4.2% in
2020(Life 3.2% and Non-Life 1.0&). Insurance penetration in some of the emerging
economies in Asia, is in range of 5-7% in economies like Malaysia, Thailand &
China.

 The insurance density in India which was USD 11.5 in 2001, reached to USD 78 in
2020 (Life- USD 58 and Non-Life - USD 20). The comparative figures for Malaysia,
Thailand and China during the same period were USD 536, USD 389 and USD 430

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 respectively. Globally insurance penetration and density were 3.35% and USD 379
for the life segment and 3.88% and USD 439 for the non-life segment respectively in
2020. (Source: SwissRe Sigma).

Life Insurance Industry, market and its size

 Premiums from India’s life insurance industry is expected to reach Rs. 24 lakh crore
(US$ 317.98 billion) by FY31.

 According to S&P Global Market Intelligence data, India is the second-largest

insurance technology market in Asia-Pacific, accounting for 35% of the US$ 3.66
billion Insurtech-focused venture investments made in the country.

Indian Life Insurance Market and Premiums: Life insurance industry recorded a premium
income of ₹6.29 lakh crore during 2020-21 as against ₹5.73 lakh crore in the previous
financial year, registering growth of 9.74% and slated to grow at 12% CAGR till 2025.

Segment wise Life Insurance Premium: While renewal premium accounted for 55.67% of
the total premium received by the life insurers in 2020-21, new business premium contributed
the remaining 44.33%. During 2020-21, the growth in renewal premium was 11.60%.

Policies Issued by Life Insurers: During 2020-21, life insurers issued 281.27 lakh new
policies under individual business, out of which LIC issued 209.75 lakh policies (74.57%)
and the private life insurers issued 71.52 lakh policies (25.43%).

Claims of Life Insurers: The life insurance industry paid benefits of ₹3.99 lakh crore in
2020-21 (₹3.51 lakh crore in 2019-20) constitutes 63.42% of the gross premium underwritten
(61.35% in 2019-20). The benefits paid by the private insurers was ₹1.13 lakh crore
(₹98,706 crore in 2019-20) constituting 50.15% of the premium underwritten.

Death Claims

 In case of individual life insurance business, during the year 2020-21, out of the total
11.01 lakh claims, the life insurers paid 10.84 lakh claims, with a total benefit amount
of ₹26,422 crore. The number of claims repudiated was 9,527 for an amount of ₹865
crore and the number of claims rejected was 3,032 for an amount of ₹60 crore. The
claims pending at the end of the year was 3,055 for ₹623 crore.

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  The claim settlement ratio of LIC was 98.62% as at March 31, 2021 compared to
96.69% as at March 31, 2020 and the proportion of claims repudiated/rejected has
decreased to 1.0% in 2020-21 from 1.09% in the previous year. The claim settlement
ratio of private insurers was 97.02% during 2020-21 (97.18% during 2019-20) and the
proportion of repudiations came down to 2.0% in the year 2020-21 from 2.50% in
previous year.
 In case of group life insurance business, out of the total 11.07 lakh claims during
2020-21, life insurers paid 10.92 lakh claims. For detailed claims data, refer Annexure
1 at the end of the report.

Issues at hand w.r.t claims and settling claims in India

 Claim Settlement Ratio (CSR) is a ratio which provides the number of claims
processed against the number of claims received. It doesn’t provide one with
likelihood of claim settlement.
 The claim settlement ratio doesn’t take into account the value of claim settlement
either. Illustration below for FY21 shows that in percentage terms claims settled
higher but much lower in value terms [Claim settlement Ratio(val) < Claim
Settlement Ratio].
 The ratio also doesn’t provide the number of days, it takes to settle the claim. A ratio
of 97% doesn’t say the number of days taken is 30 days or 120 days.
 A high claim settlement ratio also means the processes to deal with claims difficult
and complex to understand for a layman.
 The total amount of repudiated claims in FY21 were over Rs. 18,000 crs which
includes both private and public insurers.

Who are we? What is Ensure.io?

 Ensure.io is an offshoot of an 8–10-year-old Insurtech company which is selling

policies online, is IRDAI approved insurance web aggregator.
 Ensure.io has a target audience for provides claim servicing to existing clients of
parent company. Apart from that our target audience will be individuals and retail
policy holders who could have bought this policy from another website, insurance
agent, bank or directly from the insurer.

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  We are the servicing arm of an established InsurTech player. The above service is
offered for a fee.
 As a company, we focus on Post Sales, Claim Servicing, Claim processing and
helping the clients also with Post Claim service.
 At Ensure.io, we want to make sure that once the dependant / beneficiary of the policy
has received their claim, even they buy the policy through us. Our target products for
post claims service will be to connect these clients through an API to a Wealth tech
solution provider once we have reached scale.
 Focus will be to help client invest in Guaranteed plans and other insurance products
along with a mix of debt portfolio through the partner Wealth tech provider. This will
eventually be a cross sell for Ensure.io which will help the parent get new clients for a
fee/commission.
 Client Acquisition costs: CAC will be relatively low as the target audience will be the
existing client base of the parent company. Apart from that, clients will be targeted
through Social Media advertising and other forms of promotional activities.
 “Claims Servicing” has an additional opportunity cost for insurance companies.
Insurers will resist the change of a post sales ‘Claim Servicing Company’ as they will
have to let go off additional funds vis-à-vis what they would have to.

The Problem we are trying to solve– Reason for Rejection for a

Death Claim
The main reasons for having a Life Insurance Claim Rejected are as under:

1. False Information: Concealing important information while filling the life insurance
application form can prove quite a blunder for your loved ones. Key here is to be
honest while providing this information.
2. Not Paying premiums on time: Fill the premium by due date
3. Policy document not read Correctly and general lack of knowledge about how
insurance works. Eg: A policy holder dies of death which wasn’t covered under the
policy (Eg: Driving a bike above 100 kmph)
4. Nominee not updated: Nominee name to be reviewd from time to time as per
different stages of life.
5. Death in contestability period: If the death occurs right post buying a life insurance
policy, the insurance company may find it suspicious. Insurers may find it mistrustful

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 if death happens so soon. Every life insurance company has a contestability period.
This period may range from 1 year to 2 years.

Other problems pertaining to Claims processing: KYC - the Gatekeeper against Fraud.
Referring to the modern-day fraud types, among them are the following:

 Money Laundering; Fake Accounts, Stolen Identities, False Insurance claims and
Application Frauds

Insurance Due Diligence: Undertaking due diligence, useful client’s details like names,
social security numbers, birthdays, and addresses, and others, the identity of the client is
rigorously checked, namely, if s/he is not intricated in corrupt, illegal activity, suspected
financial crimes, or money laundering, bribery, continuously monitoring his/her profile by
suspicious activities. Fulfilling this customer data collection, the client remains to be
protected as per IRDAI regulations. e-KYC is the base of todays’ modern insurance security
process and takes the KYC to the next level.
E-KYC simplify digitizes the insurance industry, offering a series of benefits such as:

 Speed, Accuracy, Cost, Adaptability, API Integration, Analytics, Auditing, Tracking,

Customer Experience and Efficiency.

The above-mentioned problems at hand lead to delay in Claims filing process & also can lead
to repudiation of claims. Thus, the requirement for an external Service which will help clients
(Nominee of a term insurance policy) file death claim for the insurance amount through help
of service platform & technology.

Top Features of an effective claims Management system appealing to customers:

 A simple submission process from any device
 All documents in customer’s pocket
 Online claims payments
 Simplicity and security
 Reminder

Core Functions of a custom Insurance software system

Challenges & Issues:

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The main two issues of the industry are related to cost savings and compliance with legal
regulations.
1. Manual processes and the paper-based documents are costly and unwieldy, slow and
prone to errors.
2. In addition, they are hard to manage and difficult to comply with risk management
guidelines and directions.

A custom piece of software can be focused on improving the entire process by:
 Eliminating paperedundancy and errors.
 Hosting and integration of transaction-based or the collaborative processes.
 Adopting compliance standards across the organization.
 Shortening workflows.

The overall benefits of a custom solution:

 Lower cost of processing the loan.

 Processing multiple loan files without a proportional increase in staffing.
 More efficient processes – eliminate duplicates, improve service performance.
 The person processing the request can access all the files as needed – this means
providing an overview of the client – both for data and for documents.
 The possibility to grow the business without the need for additional storage spaces,
which can be costly.

New Digital Value Proposition For claims with Ensure.io

Product Simplification Communication

Customer and Intermediary self-service Digital Technologies
Protection Claims
Intelligent case Management
Characteristics
Frontline and backoffice process
Claims Segmentation
Digitisation
Back office Automation Supported Claims Handling
Digital integration of claims ecosystem  

How can insurers use AI in Claims Management? (For process flow of proposed solution,
refer Annex 2)

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AI technologies make information systems more adaptive to humans and improve the
interaction between humans and computer systems. By doing this, AI gives insurers an edge
on how they manage claims—faster, better, and with fewer errors. Insurers can achieve better
claims management by using the intelligent technologies in some of the following ways:

 To enable a real-time question-and-answer service for first notice of loss;

 To pre-assess claims and for automated damage evaluation;
 To enable automated claims fraud detection using enriched data analytics;
 To predict claim volume patterns;
 To augment loss analysis

We identified several pain points in the current claims management process, which were:

 Error-prone manual data extraction;

 Inconsistent claim classification;
 The need for additional downstream validation;
 Increased time and cost for processing and resolution.

Solution Framework for Settlement as Service

Ensure.io will be a cloud first multi-API platform which will aim to resolve below key issues,
being faced by consumers in settling life insurance claims:

Problems in current Solutions being offered by Ensure.io

life insurance
ecosystem
Lack of claim process Ensure.io will always have updated claim documents from
awareness underwriters through API integration. This will help pre-fill,
review, agree and maintain required claim documents during on-
boarding stage and bring transparency to the claim process during
policy lifecycle
Incomplete paperwork This leads to delayed claim submissions and no claims. Each
and nominee not policy on Ensure.io will have both policy holder and nominee
aware of policy onboarded and maintained through out policy lifecycle to resolve
this as well as to avoid nominee running around to submit claim
during the grieving times. This will be achieved via API
integration with UIDAI so on-boarding remains a quick process
Ownership of claim Ensure.io is integrated with UIDAI, legal, police, civil registration

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 submission is with systems and medical records to complete remaining claims
grieving nominee information upon death of policy holder and ready to be submitted
upon request. All this can be achieved via single click
authorization provided by the nominee and save valuable time in
claims settlement process
Difficult to track Since we are integrated with underwriter’s and various
policy updates and authorities’ APIs, this will be the single platform to know about
exclusions any change in policy T&C, processes as well as holders’
information. This will avoid issues of inaccurate data,
misinformation and helps in tracking claim settlement status in
real time

Key Technical Components of Ensure.io Platform:

Our platform is a multi API platform which will integrate with insurance underwriters,
UIDAI, civil authorities, police and legal APIs and ensure we remain single cloud based
platform to access insurance policy information as well as future events (claims, post claim
assistance etc.).

Ensure.io will be available to both policy holders as well as other stakeholders via mobile and
web applications. Data processing, analysis and outputs will be maintained on cloud, so it
remains highly available and accessible all the time.

Compliance Check and Compatible Model

1. As per Data security norms, it is mandatory to restrict any exchange of information which
has PII data.

2. An aggregation of information will be done to share with the third party as per the data
exchange model in Digital Marketing Algorithms by Google, Facebook or likes.

3. On the other side, a premium service will include complete integration of financial services
but can be availed as per the choice of user.

4. The designed system will act like a platform for information exchange with all new age
technology and ensure data isolation at the best.

5. System is complaint to IRDA and GDPR guidelines

Considerations

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1. API integration is an essential part to ensure a successful execution of the model, hence
feasibility and Proof of Concept will be limited to certain geographies at the beginning

2. Scaling of the software would be essential but easy, considering the Service Oriented
Architecture with Microservice approach

Technical Risks

Risks Level Mitigation

Dependency on Third Party
APIs
Service Availability
Security and Data Privacy
Compliance Risk
High 1. Ensuring availability with stringent SLA
between parties
2. Appropriate error handling with user
friendly messaging services
High 1. Implementation of HADR Architecture
2. Event Driven MicroServices
High 1. GDPR Standards
2. Compliance by Design
3. Standard Encryption Methodologies
High 1. Adequate licensing is required
2. PII Data security is primary
3. Financial service fulfilment is outsourced to
primary service providers. No legal liability
post user consents to share information

Marketing Ensure.io’s value proposition

Ensure.io unique value proposition is the ‘proactive’ approach to customer service during
after sales. While buying an insurance policy, the insurer considers the claim settlement ratio,
which is upwards of 97% for top ten life insurance companies. However, a factor to also
consider is the duration it takes to settle the claim.

Typically, to initiate the process, the claimant is required to reach out to the insurer to
intimate about the death of the insured. There can be many reasons why this process itself is
not initiated for a long time - continued period of grief, lack of awareness of the process, lack
of awareness of the information regarding the insured’s policy, lack of knowledge about the
claimant and lack of knowledge about the process or who to contact to initiate the claim
itself. The delay in the intimation stage itself, delays the claim settlement process. As per

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IRDA, the claim should be processed within 30 days from the day the intimation is
received.

Ensure.io resolves the delay that takes place in initiating the intimation itself, so that the
settlement amount, which maybe a much needed financial assistance to the insured’s family
be made available to them at the earliest. While several internet based insurance marketplaces
help customers select the best policy, there is a gap that still exists when it comes to the after
sales support.

The vision of Ensure.io is to bring lightning fast financial assistance to insured’s family. The
mission of the Insurtech is to be a one-stop solution provider for all insurance services,
specializing in After Sales service by leveraging the power of technology.

Reflective in the brand colours (Blue and Yellow), these values and emotions include:

 Responsibility - A digital friend that will reach out to proactively initiate

claims
 Trust - Fastest claim settlement process in the industry
 Loyalty - Believe in the value of life
 Security - Fast access to financial assistance in times of need
 Happiness - Believe in bringing back a warm smile in my customer’s life
despite tough times
 Optimism - Assist in helping customers’ family move ahead with right
financial decisions

By approaching the right mix of marketing tactics that are palatable to the Gen Z
and Millennial generation, Ensure.io’s key marketing strategy includes:

 Brand Ambassador: Human values and emotions are best represented through a brand
face which can capture the TG’s attention while talking about a serious subject such
as death and claim settlement. Celebrity and Actor Ayushman Khurrana is an
embodiment of several of these emotions thanks to the choice of characters that he has
played in his films. He also brings the element of humour and straight faced sarcasm
that can nudge his fans to see the obvious – in this case – a solution provider that not

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 just sells the most suitable policy but also closes the loop in getting the family access
the claim without feeling helpless.
 SEO Marketing – While insurance related keywords are an obvious, a different
approach could also be to bid for keywords around death, personal distress, financial
distress as grieving family members could be looking for online resources to
overcome sadness. Thus launching the country’s first blog on ‘Learn to Heal’ can
bring people to Ensure.io’s website and one there they can be alerted through banner
messages on the process of claim settlement along with a number of outreach.
 Consumer Campaigns – Leveraging the brand ambassador several consumer
campaigns can be launched – be it to emotionally nudge potential customers to opt for
Ensure.io to make the protect their family. The campaigns can also be used with a
touch of humour to educate customers’ on how not to buy a policy.
Some of the other key activities to undertake with be educating the financial / tax
advisors about the benefits of Ensure.io platform so that they can guide the younger
generation in making the right decision. PR and Digital influencers too can play a
critical role as trust building is critical to product and the service. A huge emphasis on
social media marketing would also be essential for the brand as the TG is largely
digital native and thus they are heavily dependent on the internet and social media
platforms for search, decisioning, selection, purchase and post purchase services.

Annexures
Annexure 1: Individual death claims and ratio of settlement in volume and value terms

Individual death claims settlement Individual death claims

by % of policies settlement by % of benefit amount
 Total
 Total Total claims Total claims
Insurer claims settled repudiated Insurer claims settled repudiated

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 Future Generali 94.86% 4.49% Shriram 77.48% 15.14%
SBI Life 93.09% 3.80% Tata AIA 87.57% 11.63%
Shriram 95.12% 3.72% ICICI Prudential 89.20% 10.32%
Star Union 95.96% 3.55% Future Generali 86.24% 8.89%

India First 96.81% 2.68% Aegas Federal 83.63% 8.73%

Edelweiss Tokio 97.01% 2.59% Bajaj Allianz 91.97% 7.20%

Aegas Federal 95.07% 2.11% SBI Life 86.22% 6.41%

Aviva 98.01% 1.99% Edelweiss Tokio 87.98% 6.26%

ICICI Prudential 97.90% 1.95% PNB Met Life 93.92% 6.08%

Aditya Birla Sun
Tata AIA 98.02% 1.94% 93.15% 6.08%
Life
PNB Met Life 98.17% 1.83% Star Union 92.79% 5.91%

Sahara 97.18% 1.81% India First 91.16% 5.55%

Aditya Birla Sun
98.04% 1.79% Aviva 95.24% 4.76%
Life
Canara HSBC
97.10% 1.58% Max Life 95.42% 4.53%
OBC
Bajaj Allianz 98.48% 1.49% Reliance Nippon 95.03% 4.28%
Canara HSBC
Reliance Nippon 98.49% 1.47% 92.61% 3.91%
OBC
Pramerica Life 98.61% 1.24% HDFC 80.06% 3.09%

Kotak Mahindra 98.50% 1.14% Pramerica Life 97.01% 2.28%

Bharti Axa 99.05% 0.95% Sahara 97.47% 2.27%

Aegon 99.25% 0.75% Kotak Mahindra 95.47% 2.21%
LIC 98.62% 0.69% Exide Life 93.28% 1.91%

Max Life 99.35% 0.64% Bharti Axa 98.55% 1.45%

HDFC 98.01% 0.49% LIC 95.76% 1.45%

Exide Life 98.54% 0.22% Aegon 98.64% 1.36%

Annexure 2: Proposed Solution

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