I do not agree with Anuj and Shailesh.

The policy mentions waiting period as under:

“6. Waiting Period

The Company shall not be liable to make any payment under the policy in connection with or in respect of following expenses till the expiry of waiting period mentioned below:

6.1. First Fifteen Days Waiting Period

Expenses related to the treatment of Covid within 15 days from the policy commencement date shall be excluded.”

Definition of waiting period is as under:

“Waiting Period means a period from the inception of this Policy during which Covid is not covered.”

The wording of the policy says that treatment should be taken and expenses should not be incurred during the waiting period, it doesn’t talk about detection or manifestation of symptoms.

The policy doesn’t say that symptoms of Covid should not be manifested within the waiting period mentioned in the policy, eventhough logically that should have been the intention of the policy.

So I would think there is a solid ground for going legally against the insurer.

The interpretation of the wording shall be in favour of the party who did not draft the policy, which in this case, is the insured.

@Hari sir, looks like I can't reply to a comment of comment. Yes, I did explain the customer that he can contest on legal grounds using this wording. I've another customer with a similar story which is in the legal process since close to 2 years now.

Thank you for confirmation.

Also, in most of the other health insurance policies, I see a similar wording -
'Expenses related to the treatment of any illness within thirty (30) days from the first policy commencement date shall be
excluded except claims arising due to an accident, provided the same are covered.'
which talks only about treatment not about the 'onset of the illness'.

If we compare this with a '24 months waiting period' for treatments like cataract or knee replacement, the 'onset of illness' clause doesn't hold good, right?

Are there any such claims (onset within the 15/30 days waiting period) in the past which were rejected at first and then the legal system granted the judgment in favor of the customer.

Avinash, waiting period is like a moratorium period during which claim won’t be entertained. There is no proviso that the onset of illness should not have happened during the waiting period. That’s the case with all health insurance policies unless otherwise specified. Even in Arogya Sanjeevani Policy also it is the same.

I'd like to update you that the claim has been settled for 5 lakhs (full SI).
Thank you @Hari sir for your reinforcement and Beshak for the platform.