Claim rejected for “non-disclosure”?
Insurers often reject claims saying you hid a medical condition when you bought the policy. Whether that holds up depends on a few specific facts.
You only have to disclose what the form asked
The disclosure duty is limited to what the proposal form asks. If the form had no question that covers the condition, or you answered truthfully, a non-disclosure rejection is weak.
After 60 months, non-disclosure can’t be used
After 60 months of continuous cover, counting ported and migrated policies, the insurer cannot contest the claim for non-disclosure or misrepresentation, except for established fraud.
A rejection needs committee approval
Under IRDAI’s 2024 health insurance master circular, a repudiation, including one for non-disclosure, must be approved by a committee of the insurer: its Product Management Committee or its Claims Review Committee. You can ask the insurer to show that approval. The rejection letter must also cite the specific policy clause.
What evidence decides it
- Dated records (prescriptions, test reports, hospital notes) showing the condition before the policy started, not just a “history of” remark
- A specific proposal-form question covering the condition, answered no
- A link between the hidden condition and the illness claimed
- Whether you were past the 60-month moratorium
What to do
- Ask the insurer for a copy of your signed proposal form if you don’t have it.
- Check the dates: when was the condition first diagnosed, and when did your cover start, counting ported years?
- Write to the Grievance Redressal Officer with these facts, then go to the Ombudsman if needed.
Based on IRDAI’s Master Circulars on Health Insurance and Protection of Policyholders’ Interests (2024), the Insurance Products Regulations 2024 and the Insurance Ombudsman Rules 2017 as amended. This is general information, not legal advice.