Rejected for a pre-existing disease or non-disclosure

Under IRDAI's 2024 health insurance master circular, the waiting period for a pre-existing disease cannot exceed 36 months, and after 60 months of continuous cover a claim cannot be contested on non-disclosure or misrepresentation except for proven fraud. Within those limits, the insurer must still show that you knew of the condition and that it was material. These rejections are among the most frequently reversed.

Step by step

  1. Count your continuous cover

    Add up the years from the first policy, including renewals and portability. At 36 months the PED waiting period is over; at 60 months the moratorium applies.

  2. Get the proposal form

    Ask the insurer for the proposal you signed. Check what was asked — and who filled it in.

  3. Date the first diagnosis

    A treating-doctor certificate on when the condition was first diagnosed. A remark like "known case for 5 years" in a discharge summary records what was said at admission; it is not a diagnosis record.

  4. Answer the ground in writing

    Grievance officer first, then Bima Bharosa, then the Insurance Ombudsman within one year — or the consumer commission within two years.

What the insurer has to prove

That the condition existed before the policy, that you knew of it, that it was asked about, and that it was material to the decision to insure. Doubt is read in the policyholder's favour.

Portability and renewals

When you port a policy, the waiting periods you have completed carry over. A policy renewed without a break counts as continuous cover.

Related guides

What is the maximum waiting period for a pre-existing disease?

36 months, under IRDAI's 2024 health insurance master circular.

What is the moratorium period in health insurance?

60 months of continuous cover. After that, a claim cannot be contested on non-disclosure or misrepresentation except for proven fraud.

Can I win a claim rejected for non-disclosure?

Often, yes — particularly where the condition was diagnosed after the policy began, the evidence is only a discharge-summary remark, or the moratorium has run.