Zheng Quan Ri Bao·2026-01-13 16:51Core Insights - The insurance industry is revealing its 2025 claims service annual reports, highlighting the effectiveness of service and the current structure of insurance products, indicating a significant gap in critical illness coverage for consumers [1] Claims Efficiency and Timeliness - China Life Insurance Company reported over 62.24 million claims in 2025, a 7% increase year-on-year, with total claims amounting to over 100.4 billion yuan, up 10% [2] - Other insurers also reported substantial claims, with Ping An Life at 4.958 million claims totaling 41.51 billion yuan, and Xinhua Insurance at 5.01 million claims totaling 14.7 billion yuan [2] Notable Claims Stories - A case from Ping An Life illustrates the proactive service approach, where a client initially claimed 5,000 yuan but ultimately received over 5.51 million yuan due to the insurer's initiative in identifying additional coverage [3] - The digital transformation in the insurance sector has significantly improved claims processing efficiency, with China Life's "Digital Guo Life" strategy facilitating 8.17 million direct claims payments totaling over 4.3 billion yuan [3] Medical Insurance Claims Analysis - Medical insurance claims are increasingly dominating the claims structure, with Ping An Life reporting that 92% of claims were for medical insurance, while critical illness claims accounted for only 5% [4] - Despite the high volume of claims, there remains a notable gap in critical illness coverage, with 80% of claims being under 100,000 yuan, indicating insufficient coverage for actual treatment costs [4] Market Dynamics and Recommendations - The rapid growth of medical insurance, due to its affordability and high leverage, is causing a diversion from the critical illness insurance market, particularly affecting budget-conscious consumers [5] - Experts suggest that consumers should utilize medical insurance for high medical expenses while relying on critical illness insurance for income loss compensation, emphasizing the complementary nature of both products [5]