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Claim rejected because of a health condition happened 27 years ago

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29 Sep, 2022 by  Karthik Taduvai

Hi Everyone,

I have a health insurance policy for my mother which is 3.5 years long. She was admitted to hospital 2 weeks ago due to an emergency. During the treatment she realised she had a similar health issue 27 years ago and we disclosed it to the doctor.

We have not disclosed this health issue (happened 27 years ago) since i was not aware of it. I am a 4 year old kid when this issue happened. My mother also don't remember it since it happened very long ago.

The insurance company rejected the claim saying 'Non-disclosure of TIA' i.e., medical history not disclosed. I am genuinely not aware of this nor my mother remembers it. Now the insurer says they will cancel the policy.

What are the options for me?

Health Insurance

1 Answer

30 Sep, 2022
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Hi Karthik,

The insurance company is well within its right to refuse the claim if the treatment involved the prior condition or its linked ailments. There is no way out of this.

You could have disclosed the details at the time of policy sign, which you have mentioned was not in your knowledge then or if the medical condition was so old that it didn't affect the present line of treatment,you could have kept the information to yourself while in hospital, however i m not sure how this would have affected the treatment and well-being of your mother.

If you are not satisfied with the conduct of the insurance company other that this claim or you feel that in future also your claims might get rejected, you can port your policy to a new company and make appropriate disclosures this time around. Please note that new Insurer may add loading on the premium or might not offer the policy, Depending upon how serious the existing condition is...this decision is entirely base upon the wisdom of Underwriting team of the insurance companies.

For a detailed Discussion and help regarding your specific policy, you can also choose to seek Free 1-to-1 Consultation on the beshak Platform.

Hope this explanation helps.

Best Wishes

Rana Sahib

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30 Sep, 2022
Karthik Taduvai
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