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is waiting period applicable for listed specific diseases which were diagnosed after taking policy?

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15 Jun, 2021 by  Rayapu Ashok Kumar Reddy

Dear Team


My age is 63 and I am having Manipal Cigna Health insurance policy since December 2019. In May 2021 I was diagnosed with Spinal Disorder (PIVD) and the Doctors advised for laminectomy Surgery. So, I applied for cash less claim but the claim was rejected since there is a 2 year waiting period for listed specific diseases. So, I underwent surgery with my own money.


Later on I disclosed the treatment to the insurance company .They asked me to pay a loading

amount hence I paid and they issued a endorsement letter.


Again the insurance company is saying that the Spinal disorders which were treated is included as PED and 36 months waiting period will be applicable.


My concern is can the company include that health issues which occurs after the policy period as PED?


"As far as I know according to the latest IRDA standardized guide lines any health issues which were diagnosed or treated before taking the policy are called PED".



Kindly guide on this issue!

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17 Jun, 2021

Hello Mr. Reddy,


Quick question, when the insurer applied loading at the time of renewal, did they include the spinal condition as a pre-existing condition on the policy? It seems while the diagnosis of the condition happened after purchasing the policy, the insurer has taken the disease on their record as a pre-existing disease. There is no way an insurer can otherwise charge loading after the first year of the policy.


Answering your question, no an insurer cannot include a disease that is diagnosed after the policy is issued unless they have reasons to believe that the condition existed before you bought the policy.


In our opinion, you should write a detailed note to the insurance company, requesting them to remove the pre-existing disease taken on record on the policy. Please append enough documentary proof to prove that the disease was *first* diagnosed after buying the policy.


Do let us know your experience, and keep us posted on this trail.


Hope this helps.


Team Beshak

https://www.beshak.org/subscribe

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17 Jun, 2021
Rayapu Ashok Kumar Reddy
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19 Jun, 2021

Hello Mr. Reddy,


Yes, as per the endorsement you have shared it is clear that the insurer has added the health condition as a pre-existing condition.


You will have to follow this:

In our opinion, you should write a detailed note to the insurance company, requesting them to remove the pre-existing disease taken on record on the policy. Please append enough documentary proof to prove that the disease was *first* diagnosed after buying the policy.
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19 Jun, 2021

Hi Mr Reddy,


Case facts are not very clear from the description you have given. Would it be possible for you to share the following documents to my mail id anuj@sureclaim.in -

  1. your discharge summary of surgery,
  2. the doctor's consultation paper before surgery (in which your health history was mentioned)
  3. letter or email that you sent for disclosing the surgery to insurer


Case is best understood by looking at facts of the case.


Anuj

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19 Jun, 2021
Rayapu Ashok Kumar Reddy
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