Guo Ji Jin Rong Bao·2026-01-14 15:16Core Insights - The insurance industry in China is experiencing an upward trend in both the number of claims and the amount paid out, with claim approval rates remaining high at over 99% [1][2] - Medical insurance continues to have the highest number of claims, while critical illness insurance has the highest payout amounts, indicating a significant protection gap [1][6] Group 1: Claims Performance - In the first 11 months of 2025, the insurance industry reported a premium income of 5.76 trillion yuan, a year-on-year increase of 7.56%, and claims expenditures of 2.21 trillion yuan, up 5.95% [2] - China Life Insurance processed over 62.24 million claims in 2025, with a total payout exceeding 100.4 billion yuan, reflecting a 10% increase [2] - Ping An Life Insurance reported 4.958 million claims with a total payout of 41.51 billion yuan, averaging over 1.1 billion yuan per day [2] Group 2: Claims Efficiency - The claims processing time has significantly improved, with some companies achieving claim settlements in as little as 8 seconds [2][3] - China Life's direct payment service reached 8.17 million people, with claims amounting to over 4.3 billion yuan, showcasing the effectiveness of technology in claims processing [3] - Zhongyou Insurance reported a 370% increase in customer service interactions, with a claims processing time of 1.1 days and an online claims rate exceeding 99% [2] Group 3: Challenges in Claims - Despite improvements, there are ongoing concerns about "claims difficulty," primarily due to issues such as misreporting health conditions, misunderstandings of insurance terms, and incomplete documentation [3][4] - The disparity between consumer understanding of insurance responsibilities and the actual coverage provided by insurance companies contributes to claims disputes [3][4] Group 4: Critical Illness Insurance Gap - There is a notable gap in critical illness insurance coverage, with average treatment costs for cancer ranging from 220,000 to 800,000 yuan, while average payouts for critical illness claims are only around 100,000 yuan [6][7] - The majority of critical illness claims are concentrated in the 41-60 age group, with female claims being more than double that of males [6] - Recommendations for consumers include prioritizing critical illness insurance coverage that is 3 to 5 times their annual income, especially for family breadwinners [7]