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question regarding pre-existing disease

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19 Jul, 2021 by  harivansh agrawal

now the definition for the pre-existing disease is

It means any condition, ailment, injury or disease

a) That is/are diagnosed by a physician within 48 months prior to the effective date of the policy issued by the insurer or its reinstatement or Policy Wording

b) For which medical advice or treatment was recommended by, or received from, a physician within 48 months prior to the effective date of the policy issued by the insurer or its reinstatement


so my question is if I have not taken any advice from the physician ever for the particular disease but I know that diseases like for eg. I have acid reflux before taking the policy but I have not mentioned it in policy since it is not ever diagnosed by a physician,now when policy will be about four years old and the doctor advised me for surgery for that acid reflux , will it be considered as pre-existing diseases , if doctor ask me since when you are experiencing acid reflux and I sad since I was about 10 year old he writes it on prescription pad that patient is experiencing this symptom since he was about 10 years old
will it be consider as per-exesting if I am not dignosed 48 months prior to the first policy


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20 Jul, 2021

Hey Harivansh,


It is a very pertinent question. The qualifier is 'diagnosed by a physician'.


In the hypothetical example, you have assumed a scenario 4 years from now where you are expecting yourself to be diagnosed with exact same disease you expect yourself to have today because of the symptoms.


I always advise users to avoid self-diagnosis. To tell you an example, I met a 58 yr old woman known to me and she was in the process of buying a new policy for herself. We happened to chat. When I asked what's your PED, she said she has arthritis. I asked, since when do you have it? She said it's been about 10 yrs. I asked what's the treatment you're taking for it? She said she's been applying some ayurvedic oil on the knees. I asked who diagnosed her? She said she never consulted a doctor. Her sister has same symptoms and complaints and she was diagnosed by doctor for having arthritis. So she assumes she also has arthritis.


This is laughable. Self-diagnosis and self-medication cannot be considered as PEDs. Only the diagnosis by a qualified physician stands as PED.


Short answer to your question - Pls make the declaration in proposal form that you have these symptoms for xyz years, but you haven't consulted a doctor or taken any medication for it. This much is sufficient. Highly likely this won't be considered as PED. And any future treatment arising out of these symptoms will not be impacted by the PED waiting period, however the 2 year mandatory waiting period may apply in case your hypothesis comes true :)


Anuj Jindal

Co-founder

SureClaim

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21 Jul, 2021
harivansh agrawal
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21 Jul, 2021
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21 Jul, 2021
harivansh agrawal
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