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What to do when one completely forgets to disclose a small pre-existing disease & realises it late?

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06 Apr, 2021 by  Ravi

A friend bought his health insurance policy in August 2018. While making disclosures he completely missed mentioning a pre-existing disease - a minor kidney stone condition which was treated. Now, he has already done 2 renewals of the policy and in the third year of the policy.


Being an honest mistake, he wishes to disclose it in order to avoid any future complications and claim rejections. What to do in such cases?

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3 Answer

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06 Apr, 2021

Hello Ravi


1) Your friend must inform the insurer about this missed information.

2) The insurer may cancel or update the policy depending on the age and health condition declared.

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06 Apr, 2021
Ravi
If there is a possibility of cancellation, why should he risk disclosing it since it was a minor stuff? It was an honest mistake and admitting it is resulting in cancellation of the policy - doesn't seem like a good tradeoff. I mean, prior to this policy, he never had any insurance. So how will the insurer ever find that he had this condition in the past?
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07 Apr, 2021

Hey Ravi,


Kidney stone is a simple ailment, it won't lead to policy cancellation.


Please ask your friend to write to insurance company and declare the medical condition. Insurer may ask certain proofs like consultation paper, diagnostic reports etc, just help insurer with those details.


Make sure that by the end of this process, your friend receives something called as 'Endorsement'. This endorsement is the proof that insurance company has incorporated the disclosure in the policy. Without Endorsement, your friend runs the risk of claim rejection at later date. An excuse that he sent the email or he called and inform the call center will not really help, he really needs to get the Endorsement certificate from insurer.


Hope it helps.


Anuj Jindal

Co-founder

SureClaim

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09 Apr, 2021

Hello Ravi,


I'll try and answer your question, as to how will the insurer find out.


If at any point in the future, your friend suffers from kidney stone again, the doctor will mention in his papers that there is a history of kidney stone for the patient since (insert year or no of years).


Now when your friend tries to claim for the kidney stone treatment, the insurer will find out about the history through the consultation papers. The claim therefore will be rejected, and there is a chance, and the insurer has the right as well, that the policy would be cancelled because of non disclosure of material fact.


Also, apart from specific kidney stone treatment, if in the future your friend would have to undergo some kind of major operation/treatment, there is a good chance that the treating doctor would mention all historical ailments of the patient in the consulting papers which will include kidney stone history. Although the treatment/operation at that point may not be connected in anyway to kidney stone, the claim could still be rejected because it was not declared.


So, as the other answers to your question also mention, since your friend has realised the omission, it is better to inform the insurer.


Hope this helps:)


Cheers.

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