Informing about Hypothyroidism to insurer
I have a health insurance cover of the same insurer since 2008 till date. However, even before I bought this insurance I had a hypothyroidism. because I did not know that such information has to be shared with insurer, and because the agent did not ask me anything related to health - this information remained undisclosed from the insurer.
I never had any disease related claim ever since then.
Only in March 2018 I had an accident and had to undergo a surgery near my knee. I received the claim for this. But, in my entire file of hospitalization the doctor has mentioned HYPOTHYROIDISM as my co-morbidity, several times . Yet, I did not face any problem in getting the claim.
Here are my some questions :
As the medical file was submitted to Insurer for the claim purpose, and as my Hypothyroidism has already been mentioned there in the file, and as it has been more than 3 years since then till today , and because there has been no disease related claim since then - does it mean that :
1) The insurer is implied to have been communicated about my Hypothyroidism as it is mentioned in my that particular medical file, and now I don't need to communicate them exclusively, again.
2) Does it also mean that my any claim in future would not be denied on the pretext of Hypothyroidism - because my waiting period of 3 years is over now - as it has been 3 years since I submitted my file to insurer, for the purpose of claim.
3) And would it ever have mattered, or would it ever matter in future - if I ever have any such co-morbidity - because my insurance with the insurer has been since long., and so waiting period clause should not be applicable to me. Am I thinking right Sir.
4) If, now, I convey my insurer about my Hypothyroidism and try to get it mentioned in my policy on next renewal, will the insurer charge me any loading for this. Since it has been more than 3 years since the insurer is deemed to have been conveyed about this, or is implied to have been conveyed about this, can it charge me loading after 3 years.
Please guide me - my renewal is immediately due.
Dipak R Gandhi
You violated the spirit of utmost good faith in insurance contracts by not disclosing a pre-existing medical condition (hypothyroidism) to your Insurer. Going forward, please always make full disclosures if you are buying any fresh insurance.
This worked out in your favor because you had a long running health insurance with your Insurer when you made your first claim in 2018 (10 yrs old as per your statement). The Insurer probably gave you the benefit of doubt as your indoor case papers from hospitalization may not have indicated the tenure of hypothyroidism.
As per Insurance laws, you are not required to make any additional declarations to your Insurer about hypothyroidism now as they are deemed to have been informed via your previous claim papers. However, keep your last claim papers & any mail exchanges that you've had with your Insurer at the time of claim intact for future reference. It will come handy if your Insurer raises a question ever about hypothyroidism in future.
Last part of your question. If there is any fresh co-morbidity diagnosed now, you are not required to inform your Insurer.
Hope this helps.