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health insurance claim repudiation

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11 Oct, 2022 by  Balakrishnan C

Health insurance renewed from 2015 continuously. No claim lodged in the last 6-7 years, 1st claim lodged now. Insurer rejects citing pre existing disease clause misrepresentation. Actually in 2012 the patient had gone for a check up at the hospital for the current ailment. Is the insurer justified in rejecting the claim? Can I invoke sec.45 of the insurance act?

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Health Insurance

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This could be a valid ground for the insurer to reject a claim. It sounds like one of the cases where the existing medication conditions were not disclosed by the applicant. Please double check - but my understanding is that Section 45 applies on Life Insurance. You are referring to medical insurance which falls under 'General Insurance'.

I am very aligned to Beshak's mindset. If applicants go via experienced advisors, they will try digging into great level of details to identify required levels of disclosures. Personally for my clients, we try questioning clients through multiple angles to identify such cases so that this can get disclosed to avoid future rejections.

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