Rejected for a pre-existing disease or waiting period?

What counts as a pre-existing disease

A condition is pre-existing only if it was diagnosed by a physician within 36 months before the policy started, or a physician recommended or gave treatment for it within those 36 months. A remark like “known case of” with no date is not proof on its own.

Waiting periods are capped

• The waiting period for a disclosed pre-existing disease is capped at 36 months of continuous cover.
• A specific-disease or procedure waiting period (cataract, hernia, joint replacement and so on) can be at most 36 months.
• Specific waiting periods never apply to treatment needed because of an accident.
• When you increase your sum insured, waiting periods restart only for the increased portion.

Ported and renewed cover counts

Credits for waiting periods carry over when you renew within the grace period, migrate to another product with the same insurer, or port to a new insurer. Many rejections ignore years of cover from a previous policy. Check your first policy start date.

The 60-month moratorium

After 60 months of continuous cover, including ported and migrated years, the insurer cannot contest your policy or a claim for non-disclosure or misrepresentation, except for established fraud. Older policies may still say 8 years: the 60-month regulation applies.

When the insurer is likely right

• Dated medical records show the condition was diagnosed shortly before the policy started, and it is linked to this claim.
• The treatment falls clearly within a stated waiting period, counting all continuous cover, and there was no accident.