Naresh was diagnosed with diabetes in mid-2019. He had a health insurance policy since 2017. In 2020, Naresh was admitted to Hospital due to an episode of Covid. In the medical report, the attending doctor remarked, “a known case of diabetes for the past two years”. The insurance company rejected the claim of Rs. 4 lakh on the grounds of the pre-existing disease (diabetes).
Naresh tried explaining to the insurance company that diabetes was diagnosed in 2019, but the insurance company was not convinced.
The family felt disheartened as they regularly paid the premium money, however, the claim was denied.
Naresh approached Insurance Samadhan with his case. After understanding the case, we understood that the documentation was not proper. He guided him with his case and helped him get his money back.
What is a Pre-Existing Disease?
Any past incident of diagnosis and treatment of disease is called pre-existing. Any incident of hospitalization or operation should be informed to the insurance company. Any incident where you have availed the health insurance benefit through personal or group insurance needs to be intimated too. You should give all information honestly and let underwriters decide whether to accept the proposal or not.
Insurance Company classifies the diseases which have happened in the last 48 months as pre-existing diseases. These diseases can be subject to exclusion as per the terms and conditions of the insurance company.
Do Health Insurance Policy Covers Pre-Existing Diseases?
A health insurance policy may cover pre-existing diseases after a waiting period. During this period, if the customer falls sick due to the pre-existing disease and was hospitalized, then the health insurance will not cover the disease. And if nothing happens during the waiting period, then the policy will cover the disease.
Note: Usually, the waiting period ranges from 1 to 4 years.
What will Happen If You Do Not Disclose a Pre-Existing Disease to Your Insurance Company?
A policyholder is required to disclose all health-related issues in the proposal form. This will help the insurance company to evaluate the risk involved. Also, it will help in determining whether to accept the risk or not. If accepted, then the company will decide the premium rate of the insurance policy.
If a policyholder conceals a disease at the time of purchasing the policy, and if the policy is approved, then at the time of claim, the company may reject it on the grounds of non-disclosure of pre-existing disease.
Therefore it is best, to be honest about your pre-existing diseases.
However, if you have already disclosed the pre-existing disease to the insurance company or you were not diagnosed with any disease before purchasing the policy, and later your claim was rejected on the grounds of non-disclosure of pre-existing disease, then communicate with your insurer.
If you are not able to fight your case, then contact Insurance Samadhan to help you.
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