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Clarification on preexisting diseases

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26 May, 2021 by  Dipak Jambusaria
  1. 1 Recent IRDA guidelines says that no mediclaim can be rejected on any grounds after completion of 8byrs of continuous policy. Is it so? If some one has not disclosed prevexisting disease even then this guide line will apply ? 2. Preexisting disease is defined as one for which symptoms / treatment was there in the previous 4 years. Does it mean that if some had some disease prior to 4 years but if no symptom / treatment was taken in previous 4 yrs it need not be disclosed as per existing disease?
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1 Answer

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26 May, 2021

Dipak,


Active concealment of information and/or suppression of material facts amounts to fraud. IRDAI guidelines are explicit in stating that a claim can be contested in case of fraud even after the moratorium period of 8 years.


Please read the guidelines here. Refer points no 6 & 12 in particular.


https://www.irdai.gov.in/ADMINCMS/cms/whatsNew_Layout.aspx?page=PageNo4157&flag=1


I hope this will help you answer all your questions.


Best Wishes,


Asad Akbar

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26 May, 2021
Dipak Jambusaria
Thanks. Pl clarify pt no 2 also about pre existing disease .
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26 May, 2021
Your understanding of a pre-existing disease is correct. But I always advise that one is forthcoming when it comes to declarations and discloses more than what is asked/required. This will work in your favour.
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