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Undisclosed Illness in Health Policy? Your Claim Could Face Trouble!
M
Moneycontrol•24-09-2026, 16:44
Undisclosed Illness in Health Policy? Your Claim Could Face Trouble!
- •Forgetting to mention an old illness in your health insurance proposal form can lead to claim rejection, even if the problem hasn't caused issues for years.
- •The IRDAI's updated definition of a pre-existing disease (effective April 1, 2024) includes conditions diagnosed or treated within 36 months before policy commencement.
- •Insurers may investigate non-disclosure if they believe a significant medical condition was knowingly omitted, especially if it's connected to a later hospitalization.
- •A five-year moratorium period, under IRDAI rules, generally prevents claims from being contested on non-disclosure grounds after 60 continuous months of coverage, except in cases of established fraud.
- •If you realize a mistake, review your policy, and if a claim is rejected, request a written repudiation letter and gather medical records to dispute the decision.
Key Questions Answered
Under IRDAI's definition implemented from April 1, 2024, a pre-existing disease is a condition diagnosed by a doctor, or one for which medical advice or treatment was received during the 36 months before the policy commencement.
Not every forgotten illness gives an insurer an automatic right to reject a claim. Circumstances matter, including what questions were asked in the proposal form, what the policyholder knew, whether the information was material, and if the undisclosed condition connects to the claim.
Under IRDAI's framework, after 60 continuous months of coverage, a health insurance policy and its claims generally cannot be contested on the grounds of non-disclosure or misrepresentation, except in cases of established fraud.
