A parent’s claim rejected?
Often it is a son or daughter who reads the rejection letter for a parent. The same rules protect older policyholders, and there are a few extra ones worth knowing.
A separate channel for senior citizens
Insurers must have a separate channel for senior citizens’ health claims and grievances, and publish it on their website. Use it, and mention the policyholder’s age in every letter.
Renewal can’t be refused over past claims
- An insurer can’t refuse to renew a health policy because claims were made on it.
- There is no fresh underwriting at renewal unless the sum insured goes up, and then only for the increase.
The rules most often in play
- Pre-existing disease: a condition counts only if it was diagnosed or treated within 36 months before the policy started, and its waiting period is capped at 36 months.
- The 60-month moratorium: after 60 months of continuous cover, including ported years, non-disclosure can’t be used except for fraud.
- The rejection letter must cite the specific policy clause.
Helping a parent
- Collect the rejection letter, policy schedules from the first year onwards, discharge summary and bills.
- Draft the complaint to the insurer with your parent and have them sign it, or follow the insurer’s process for a representative.
- If it isn’t resolved, the Insurance Ombudsman complaint is made by the policyholder, or after their death by legal heirs or the nominee. Hearings can be held by video, so your parent may not need to travel.